FISHERSVILLE — Dr. Patrick Baroco is a hospice and palliative care specialist in the Shenandoah Valley. As medical director for Hospice of the Shenandoah, he says it is his passion. He loves what he does and wants more people to know his transitional care group is here to help them.
He also helps patients in severe pain. And the medications that they currently have, he says, are not ideal.
“They have safety problems,” says Baroco. “I wish I knew more about the efficacy and even the risks of medical cannabis, but we know enough to think it can be part of a medical toolkit to manage these symptoms in my patients.”
The good thing about cannabis, he says, is we have more safety data.
“From a pain standpoint, it’s pretty well established that the risk of opioids are real. They’re significant and they’re real. They carry a risk of addiction. They carry a risk of respiratory suppression, even when taken as prescribed.”
In his specialty, many of his patients in severe pain need high doses of opioids.
“So there’s real risk there,” Baroco says.
“If we have something available that may lessen the doses of opioids required, that’s a huge win.”
“If we have something available that may lessen the doses of opioids required, that’s a huge win.”
The other concern Baroco has is the reality that people are using marijuana illegally.
Or, when people see a product with the letters CBD, they think medical marijuana. No two products could potentially be more unrelated, and unregulated. Anything sitting on a shelf right now in a Virginia store isn’t medical marijuana. There’s only five places a patient can receive medical marijuana in Virginia, and these pharmaceutical processors/dispensaries aren’t open yet.
None of it is regulated, he says. So there’s a lot of confusion and potential danger, and Baroco is looking forward to those dispensaries opening.
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“Being able to have conversations about it in a somewhat more regulated manner will hopefully be helpful,” he says.
Another huge caveat, says Baroco, is the lack of studies done in the U.S.
“For obvious reasons, you can’t get funding for any studies and not a lot of private industries are stepping up,” says Baroco. “But we do have some data for our patients, especially pain and anxiety.”
More: Roadblocks limit Virginia patient access to marijuana
The National Institutes of Health conducts studies in the United States. And the NIH conducts studies in Israel. Jenn Michelle Pedini, executive director of Virginia NORML, says the studies conducted in Israel on medical cannabis are just as clinically accurate.
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On PubMed, there are over 30,000 studies that reference cannabis.
“Of those studies, over 200 meet the criteria for an FDA-approved clinical trial,” says Pedini. “That’s a lot. Is there an absence of U.S. conducted FDA-approved studies? Yes, but that does not equate to, there’s not enough research.”
Has Baroco received calls from patients since he registered with the Virginia Board of Pharmacy for the state’s medical cannabis program?
Yes, he chuckles. Just not his patients, though.
“We’ve gotten more than a few calls from a people. We’ve certainly gotten more than a few calls from people asking for a certification of medical need. This is for purposes of taking care of my patients.”
Patients need to register with the board of pharmacy, too, and none of Baroco’s patients have registered yet. He says it’ll be interesting to see how it plays out. For many of his patients, they don’t want to use cannabis in any form; the stigma, he says.
“Then, there are patients who do use it. From other sources,” he says. “And they’re worried about appearing on a registry.”
“Then, there are patients who do use it. From other sources,” he says. “And they’re worried about appearing on a registry.”
But for many of his patients, it’s the newness of it.
“There are a lot of people that don’t know what it means, what it is, and how it works and don’t want to be the first people to sign on the dotted line.”
“It’s pretty easy to certify this for patients to take it home, but it’s still a schedule 1 substance. It’s still a federal crime to possess or distribute. I think the actual risk of that is very low,” says Baroco.
He also says his hospital administration is trying to find ways to be supportive of its availability and use within the state rules without also risking any issues on the federal level. This seems to be a balancing act for most hospitals in Virginia.
“It’s not a prescription,” clarifies Baroco. “It’s simply a certification. You certify the presence of a disease and then the dispensary takes it from there.”
In reality, as a physician, he is recommending a form of treatment he thinks will be helpful to his patient. But, given the federal law, it can’t be done using his prescription pad.
More: How hard is it to get a medical marijuana card in Virginia?
“We all work under a DEA license. We’re not prescribing illegal substances; rather we are certifying they have conditions.”
Again, Baroco wants people to understand that the medications on the market for pain and anxiety, simply, he says, are not safe. He thinks the safety profile of cannabis is good.
“Benzodiazepines are not safe, and they’re not safe with opioids. It seems cannabis is a part of that solution,” says Baroco. “It’s going to be very hard to do while it’s still a schedule 1 controlled substance. A schedule 1 is classified as a potential for high abuse, and that’s not nearly the case with medical cannabis.”
“A schedule 1 is classified as a potential for high abuse, and that’s not nearly the case with medical cannabis.”
Like most physicians, he thinks it’s important to the overall effort to move forward with this given what physicians are prescribing their patients instead.
“It’s not like what we are using instead is perfectly effective or perfectly safe. It’s far from both. People remembering that is what we hope, and to make it more accessible to patients, and to have better studies.”
Read: Virginia medical cannabis to expand to full therapeutic-strength products
More: Bill to ensure access for medical cannabis patients set to become law
Dr. Rob Horowitz, chief of palliative care at Strong Memorial Hospital, would consider medical marijuana as a first-line treatment.
Read emerging clinical applications for research on the efficacy of medical marijuana.
What should we know about how health care works or doesn’t work in this community? Let health reporter Monique Calello know at mcalello@newsleader.com. Follow her on Twitter and Instagram @moniquecalello.
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