In a recent conversation published in NJ Cannabis Insider, David Nathan, a Princeton-based psychiatrist and the founder of Doctors for Cannabis Regulation, spoke about the challenges and opportunities physicians serving medical marijuana patients are currently navigating amid the COVID-19 crisis. Below is an edited transcript from a Q&A conducted by Justin Zaremba, NJ Cannabis Insider’s assistant editor.
On Wednesday from noon-1 p.m., you can tune-in for a free live video chat with Nathan as well as Jahan Marcu, editor in chief of The American Journal of Endocannabinoid Medicine; Monica Taing, a New Jersey pharmacist and member of Doctors for Cannabis Regulation; and Ken Wolski, executive director of Coalition for Medical Marijuana New Jersey. The hour-long webinar COVID-19 and Medicinal Cannabis webinar is being produced by the New Jersey CannaBusiness Association, the state’s largest industry trade group. The association’s president, Scott Rudder, will moderate.
David Nathan, a Princeton-based psychiatrist and the founder of Doctors for Cannabis Regulation.
Zaremba: What are the challenges facing physicians, nurses, and pharmacists right now?
Nathan: So right now there are essentially two groups of clinical physicians out there — those who are on the frontlines of the COVID-19 crisis and everybody else. I’m in that latter category of physicians who has largely switched to telehealth in order to treat our patients. I’m a psychiatrist so my specialty lends itself to video conferencing. But even physicians in other specialties are needing to meet with patients through telehealth. The major issue there is the lack of ability to do a physical examination, and so we’re all essentially making compromises in our ability to deliver health care.
Normally telehealth or telemedicine is limited by the need to preserve all of the HIPAA statutory and regulatory requirements, but the government has actually, wisely, decided that relatively secure means of communication like Skype and Facetime will be allowed throughout the time of the COVID pandemic. That’s a really good thing, because while I use Doxy — a HIPAA compliant way of communicating with my patients — a lot of them really can’t see doing anything beyond Skype or Facetime.
Older patients especially are having a hard time navigating the technology required to do telehealth, though I haven’t yet had a patient who I wasn’t able to successfully and expeditiously connect with a video conference.
Zaremba: How about with respect to the patient-physician relationship in the time of mandatory social distancing?
Nathan: Patients and doctors alike are concerned about a degradation of the patient doctor communication that’s so vital to good diagnosis and treatment. Studies on tele-psychiatry have shown that at least for diagnostic purposes, video conferencing is as effective or has outcomes that are as good as in person evaluations. So that’s reassuring but at the same time it’s nothing like being there. So, as I’ve now applied it into practice myself, after the first couple of patients, it’s become really routine for me. The issue is that patients aren’t so used to it, and so they’re the ones that are sometimes having a little bit of a harder time adapting to the new format, but I think that’s also going successfully.
Zaremba: Should we expect to see developments for telemedicine?
Nathan: If there’s a silver lining to the crisis right now, it’s that some of the technology that we’re developing out of necessity is going to be applicable once the crisis is over. So the online (Continuing Medical Education) conferences that we’re doing now will eventually allow us to have our on-site conferences be streamed to doctors offices when they can make it to the hospital for grand rounds. So there will be positive spin-offs from the adaptations we’re making now.
We’ve been talking for years about doing online CME and it was always getting hung up because there were other fish to fry both on the I.T. side and in the CME side. So, you know, within a week we’ve gotten the whole thing up and running and tomorrow is the acid test of whether it works properly.
Zaremba: Given the respiratory impact of COVID-19, what concerns do you have with respect to patients’ consumption?
Nathan: If we’re only going by evidence in the scientific literature, we have very little to go on in terms of what we would expect about the effect of smoking or vaping on either acquiring or getting worse from a COVID infection. That said, I think that the same principles that apply to cannabis consumption generally will also apply here — that vaping is in general a safer means of consumption than smoking because it’s less caustic on the throat and lungs.
The way to dispense with the whole question of whether vaping could be a problem is to consume edibles instead, but edibles have a very different half-life and onset of action for people who are consuming cannabis that way. It’s not exactly equivalent.
Vaporization of flower is generally safer than vaporization of concentrates, given that the latter has additives that may not have an established safety profile. Overall, non-inhalation methods are likely safer among those who continue consuming cannabis during the pandemic.
Zaremba: Only three of New Jersey’s seven operational alternative treatment centers currently sell lozenges: Curaleaf in Bellmawr, Breakwater in Cranbury, and Rise in Paterson
Nathan: Right. And some people are making their own but that’s a harder thing to dose.
Zaremba: Are there any other developments patients should know about consuming cannabis in relation to COVID-19?
Nathan: I’m now part of a discussion among physician advocates and public health experts considering the possibility that the immunosuppressive effects of cannabis (though still largely theoretical) may make people more vulnerable to contracting COVID-19 and getting sicker from it. There’s also a chance that it could calm a hyperactive immune system (like steroids can), but we can’t make that assumption without much more evidence.
NJ Cannabis Insider is a weekly subscriber-based trade journal produced by NJ Advance Media, which also publishes NJ.com, The Star-Ledger and other affiliated papers.
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