Cancer and severe pain led Michiganâs list of qualifying conditions when the state legalized medical marijuana in 2008. More than a decade later, cancer and severe pain patients should have easy access to medical cannabis productsâbut thatâs not the case.
Adam, Michigan dispensary owner
In fact, those with the greatest medical needs face the biggest obstacles to obtaining high-quality medical cannabis productsâand accurate information about how to use them.
âDogs have better options [for medical marijuana] than cancer patients right now,â observes one dispensary owner. That owner, who Iâll call Adam (he requested to be anonymous due to his pending business application with the state), is both a retired veteran and a cancer survivor himself.
Technically speaking, he may be correct. Companies like Canna Companion make medicinal CBD products for dogs and cats that are easily available online. Meanwhile, Michiganâs medical patients have to hunt for doctors willing to write them a recommendation, for caregivers or dispensaries where they can find products (a one-to-three-hour drive for many residents), and for personalized information about dosages and use.
âWhen youâre a cancer patient looking to go the cannabis route, youâre treated like a second class citizen,â says Adam.
While medical patients of all ages face these same obstacles, older adults typically lack the knowledge about cannabis, connections to the industry, and digital-native research skills that younger medical patients enjoy. That makes it very difficult for seniors to access good meds and good info. Senior cancer patients, says Adam, âare apprehensive because theyâve had no chance for education about cannabis. Theyâre starting like theyâre two years old.â
Still, despite the difficulties, many pain and cancer patients older than 55 are seeking cannabis. And theyâre overcoming old fears and stereotypes theyâve been fed for their entire lives.
My own mother recently offered her personal experience as an example.
âThe more we learn, the more we realize [cannabis prohibition] was a bill of goods,â she told me. Momâaka Mecosta County resident Ruth Ann Steele, 70âhas watched her mother, sister, niece, cousin, brother-in-law, and husband die from cancer over the past 15 years. None of them had knowledge of or access to medical marijuana. Her perspective on the subject of cannabis has shifted significantly over the last few years, especially since her husband lost the battle to melonoma in 2007.
âAt the time , I would have laughed,â she told me. âWe didnât know anything, other than it was a hippie high. Medicinal qualities to cannabis? No, we didnât know anything about that. But the cannabis industry has been so demonized. We want nothing to do with it because itâs been so stereotyped. But when you watch TVâhow many of those commercials are for drugs? Itâs just astounding. We desperately need something other than big pharma.â
My motherâs friend Holly (a pseudonym) is a 62-year-old resident of Michiganâs Upper Peninsula. Cannabis is nothing she would have ever considered consumingâuntil recently.
A wife, mother of five, and grandmother with deep religious convictions, Holly is opposed to âdeliberately denying oneself of oneâs reasonââi.e., bringing about a state of intoxication.
When her leukemia diagnosis came in, Holly began researching the medical uses of cannabis. That information convinced her that it needed to be part of her treatment. This was thanks in part to her two brothers, who both use cannabis medicinally. They encouraged her to do the same.
âIâm not interested in the psychoactive effects,â Holly told me. âBut there seem to be so many benefits to using this plant. Once I was assured I wouldnât have to get high, I was on board.â
Although Hollyâs family practitioner was willing to write her a recommendation for her medical card, nobody at the clinic was able to give her any information about where to get the product, and what kind of dosage she should take.
Similarly, Hollyâs oncologist at a leading cancer research hospital noted that most of their Colorado and Michigan-based patients are using marijuanaâbut they offered no information regarding the best delivery and dosage.
âThe biggest barrier is finding someone whoâs knowledgeable about the plant, and about dosage,â says Holly. âHow many milligrams should I take? What is the right route, and the right material?â
The nearest dispensary is a two-hour drive from Hollyâs home. Although sheâs been successful in sourcing product from a caregiver locally, she has yet to be able to access cannabis in forms beyond smoking or vaping flower. Sheâs currently making her own tincturesâa three week process.
Holly is uncomfortable with smoking due to the potential psychoactive effects. So sheâs been vaporizing, and has been enjoying relief from nausea and some of the pain. But she knows sheâs not making full use of the plantâs medicinal capabilities. She knows she needs more information and a more targeted product.
Holly, 62, Leukemia patient
How cannabis is delivered, as many budtenders and caregivers know, can have a huge impact on its results.
âCannabis is the Swiss army knife of medicine,â says Adam, the dispensary owner. âWe tell every cancer patient: Your own personal experience affects you differently than others. If you have access to the right meds, you wonât have to worry about negative side effects. The quality of the medicine is really the driving factor.â
With no budtenders or dispensaries around for 100 miles, accessing the best delivery system is difficult for Holly. And thatâs frustrating.
âThere are so many things to deal with in this type of situation,â Holly tells me. âWhen youâre sick like this, you just want somebody to say âHere, do this.ââ
Hollyâs biggest goal in using cannabis is to decrease her daily dose of morphine, which is currently at 45mg. Sheâs concerned not only about morphineâs psychoactive effects, but the long term consequences of taking opioids.
Ron Morris is a 62-year-old pain patient and retired 82nd Airborne paratrooper. âI found cannabis in spite of the doctorsâ help,â he says. âI was taking four 750mg Vicodins a day, every day, for about eight years. When I quit taking them, the pain stayed the same. The only thing they were doing was making me believe I was doing something for the pain.â
Ron, 62, chronic pain patient
Morris had also been on 500mg per day of Naproxen for 10 years, to help manage his knee and back pain from the compression injuries he incurred during his service.
âTheyâre only supposed to prescribe that for up to 30 days, but they were giving it to me for 10 years,â Morris says. He lists stomach ulcers among his other symptoms, as well as PTSD from his active duty days.
âThe first time I vaporized cannabis, the pain went away,â Morris recalls. âI didnât care anymore about the stigma, or any of thatâall I could think was that I didnât hurt anymore.â
Morris discovered cannabis from his son, who had a medical license to manage shoulder pain from his manual labor job. His son begged Morris to try his vaporizer.
âI said, âIâm high enough on this stuff,â and he said, âDad, this is totally different.â So one day I was in absolute pain, and I said OK.â Morris said he didnât notice any immediate effectsânot until he came back from the bathroom and his wife noted that he was standing straight up for the first time in years.
âIt used to be, you get up, take your meds, then turn into a zombie,â Morris recalls. âBut now, I get up and get around in the morning. You canât believe what a big world it was out there, after ten years of that.â
After a few days of his medical cannabis treatments, Morris returned a full bottle of Vicodin to the VA.
Elizabeth Ouding, 51, took refuge in cannabis after being sent on a complicated hunt to refill the pain medication her surgeon had put her on after back surgery. After the sixth such surgery (the last of which was to correct an injury incurred by the fifth surgery), her surgeons placed her on heavy pain narcotics.
Elizabeth, 51, recovering from back surgery
âThe doctor who did the surgery informed me he could no longer prescribe the narcos, I had to go to my family doctor,â Ouding recalls. âOf course, then she told me she couldnât prescribe them because she didnât do the surgery. So they tried to send me to a pain clinic.â
Meanwhile, Ouding was going through severe withdrawal from the narcotics sheâd been prescribed for previous surgeries. âFor two weeks I was lying on my couch sweating, and thinking I was going to die.â She told her husband sheâd rather experience the excruciating pain than go through withdrawal again.
She managed to get a recommendation for medical marijuana, and went to her nearby dispensary in tears. âIâm telling him no narco. That Iâm dying going through withdrawals. So he gave me a little to smoke, gave me some edibles, gave me the capsulesâthose are amazing. I take one of those 100mg CBD+THC capsules in the morning, Iâm good all day.â
Ouding says if it wasnât for cannabis, she couldnât function. âIf I donât use the cream, or smoke or eat something, I canât move. It helps with depression, tooâthat should be noted.â
When Ron Morris asked his doctor at the Veterans Administration for a medical marijuana recommendation, she turned him down and told Â him to go get his medical card elsewhereâwithout providing any referrals.
Eventually Morris found Dr. Thomas Crockerâs Michigan Holistic Health practice in Lansing. âHe was a real doctor,â Morris emphasizes. âHe knows his stuff about cannabis and the medical benefits. He gave me a real physical, and he wrote me my card.â
This has been one of the pinch points for patients in Michiganâs medical marijuana program. A patient must have a doctorâs recommendation in order to qualify for a medical card. But due to strict hospital regulations, lack of education in the medical community, and insurance liabilities, few hospital or family doctors have been willing to write marijuana recommendations for their patients.
They are often left to their own devices to seek out a private practitioner who understands and is comfortable with cannabis. But for many in the boomer and silent generations, the legitimacy of having their own authoritative practitioner write the card seems to be particularly important. Even raising the subject with a longtime family doctor can be terrifying.
âThere is a fear when you go to your medical doctor,â my mother tells me. âBecause they sit on the right hand of God. You canât not do what they tell you, which includes the chemo regimen and everything else, even when theyâre telling you they have no cure for it.â
None of my motherâs family members were offered cannabis by any of their doctors during their battles with cancer. Medical marijuana has been legal and available in Michigan for ten yearsâbut patients like Momâs brother-in-law, who died within the last two years, were never offered the option.
âCancer patients are most discriminated against by their own doctors,â says Adam. âThereâs no education or information about cannabis. Doctors are mandated to be advocates for their patientsâso where is the advocacy? Theyâre scared of cannabis because hospitals rely on federal grant funding.â
Itâs true that most hospitals often rely on considerable grant funding, and that both hospitals and private practices also rely on income from federal Medicaid and Medicare programs. Organizations which receive federal funding are required by both the terms of these programs and by insurance policies to follow federal policiesâincluding the federal governmentâs continued prohibition and classification of cannabis as a Schedule I controlled substance, verboten in any clinical setting.
Residents of federally subsidized housing face a similar conundrumâincluding many formerly homeless veterans who have received housing through HUD, a federal agency.
âOther veterans âsee me and talk to me and want [medical cannabis] so bad,â says Ron Morris, âbut a lot of them are living at the Gold Star House, so the best thing they can do is get someone to give it to them.â
Indeed, HUDâs memos from 2011 and 2014 on the subject require property managers of assisted or public housing to deny applications for housing if the applicant is actively using medical marijuana. The memos leave it up to the owners to decide whether or not to evict a resident who has been found using medical marijuana after theyâve become a resident. Dennis Sturtevant, CEO of The Dwelling Place, which manages thousands of federally subsidized housing in Grand Rapids and across the state, says this puts owners in an untenable position âthat will eventually result in a court challenge that will result in more clarity on this issue.â
Sturtevant says he expects this situation to change in the near future, as a majority of states legalize marijuana.
In the meantime, a growing number of pioneering private practitioners are becoming friendly to marijuana, and rising to meet the huge demand for alternative pain treatment. Dr. Marla Gendelmen, an anesthesiologist with a pain practice in Norton Shores, told the South Bend Tribune earlier this year that cannabis is âa lot safer than narcotics, and in many ways itâs safer than Aleve.â She observed that âwhen you look at the long-term side effects of taking non-steroidals [like ibuprofen], turns out theyâre not benign.â
Gendelman also pointed out that marijuana âdoesnât create physical dependence like an opioid.â
Grand Rapids practitioner Dr. David Sova offers marijuana prescriptions as part of his practiceâs suite of pain management and counseling services. Heâs considering opening a dispensary in Grand Rapidsâ neighboring Cascade Township. That would give his clients easier access to medication, as Grand Rapidsâ nearest dispensary is a one-hour drive away in TK TOWN).
Although Elizabeth Ouding still faces more back surgeries, she has peace of mind about her pain management regimen. She no longer fears getting caught in the opioid cycle.
âI wish I could get this message out to people stuck on opioids, because I know why theyâre stuck,â she tells me. âWhen they start to go in that withdrawal stage, they get stuck, and they get in for more. And if it wasnât for Adam helping me, and my husband, I wouldnât have made it through.â
Morris echoes Oudingâs passion for changing the culture and erasing the stigma of cannabis for older patients. âI was living a life for about 10 years that justâŚwasnât any way to live,â he says. âThatâs why I went to the mental health peopleâbecause I was about to end it. And now Iâm totally out of the woods. I can get up and go out in the morning, and if I come home and hurt, I smoke a bit, then I donât hurt, and I can go out to dinner with my wife.â