Missouri officially legalized medical cannabis in November 2018, with the passing of Amendment 2. The state first started accepting applications from qualifying patients and caregivers for medical cannabis cards on June 28th, 2019. Since then, the state’s list of registered medical patients has quickly grown into the tens of thousands, with the approval of qualified recommending physicians, like Missouri’s own, Dr. Lisa Roark. Her clinic, Roark Family Medicine, was the first in the state to offer telehealth options, where patients could meet with her office remotely. Because of this, Lisa quickly became one of Missouri’s leading recommending physicians.
“We were the first clinic to offer telehealth in Missouri, so we became very busy, very fast. I already had a full patient panel, so I had to do a lot of scheduling adjustments, work more hours, and adjust as needed.” It was during this exciting time of growth and expansion when Lisa was officially diagnosed with multiple sclerosis, which she first shared publicly on social media in October of last year. “For my birthday, I got a diagnosis. I have multiple sclerosis. I’ll follow up at Barnes next week to discuss options to help with my vision. Sucky birthday present, but better than not knowing.”
She may have MS, but she’s not letting it stop her, and she’s grateful for the incredible support she continues to receive. Lisa is a local doctor, with local values. Raised in Exeter, MO, she graduated from Exeter High School before moving to Kansas City, MO, where she completed her medical training at the University of Missouri-Kansas City School of Medicine. Afterwards, she completed her medical residency at Cox Family Medicine Residency in Springfield, MO, where she trained in all areas of primary care, including obstetrics, pediatrics, chronic illness management, women’s health, geriatrics, and many outpatient procedures.
Don’t buy into the ‘there isn’t enough research’ crap.
Now she lives on a small farm with her husband and four children in Cassville, MO, where Lisa tells us they “Enjoy spending time outside tending to the animals, gardening, hunting, playing and making memories. We are fortunate to have a large number of family members in the Cassville area.” This is also where her practice is located, which she loves for many reasons. “I love taking care of entire families, from babies to great-grandparents. It is very fulfilling to not just know a single patient, but to also understand their home and family dynamics. Family practice allows me to know my patient as a person, not just a body. I also love that I actually have time for my family and community. I worked several years for a large health system, got paid well, but missed my kid’s parties at school. I didn’t get to take them to school or pick them up, and had absolutely no community involvement. Now my office is one block from the school. I can walk up the street and have lunch with my kids, or they can even walk to the clinic after school. I also enjoy how much time I get to spend with my patients. As a Direct Primary Care practice, I have no billing/insurance/coding and can spend significantly more time with my patients.”
Lisa was inspired to become a physician by her role as a middle child and problem solver in her family. “This led me to medicine in general. I view most medical cases as a jigsaw puzzle, and I just have to figure out how to put it back together.” This passion for helping solve medical problems for her patients lead to her becoming a recommending physician in Missouri’s new medical program. “Prior to Amendment 2 making it on the ballot in Missouri, I had a patient ask me to help treat her child’s seizure disorder with CBD. I had to admit, I had absolutely no knowledge regarding cannabis or hemp, so I agreed to do research. The more I read, the more I realized physicians have been duped. I found significant research showing the medical benefits of cannabis and many therapeutic uses for this safe, effective plant. The more I learned, the more I wanted to know. I attended several conferences, met Dr. Sue Sisley on several occasions, did medical education credits related to cannabis, and joined several physician groups who have helped educate me, so that I can help educate patients. I became a recommending physician because I believe that all people should have the right to utilize cannabis as medicine.”
“The process of choosing to do physician certifications was easy, the implementation not so much. With this being a new program in Missouri, I’ve had to spend more time educating patients than doing the actual certification. I try to educate them regarding the law, medical uses, as well as the process of getting their medical card. There have been A LOT of changes in our clinic in the last year.”
Lisa’s advice for other physicians in states who have yet to legalize, and those who now find themselves in newly legalized states is, “Get educated. Don’t accept what you’ve been taught or told to influence your opinion. Don’t buy into the ‘there isn’t enough research’ crap. There is a lot of research (much from Israel), you just have to read it.” She tells medical students interested in medical cannabis to “Talk to patients. Learn how this plant has helped people for millions of years. Learn everything you can about it, and don’t forget to ask why. Why was it taken away from patients in the 1930’s? Why was it replaced with expensive, dangerous, opiate medications? And why can’t patients pick it up in a pharmacy?”
As far as her MS goes, she was reluctant to share any updates since first making the announcement last year. “Mostly because I didn’t have anything nice to say. I was formally diagnosed with multiple sclerosis in October, 2019. Since then, I’ve been on Tecfidera (crazy expensive MS med) with the hopes of keeping my disease in remission. Unfortunately, I haven’t seen any slowing in the progression (just fantastic side effects like hives, hot flashes, and heat intolerance). I’ve had steroid shots in my eye sockets, also in my eyeball, IV steroids, by mouth steroids for Trigeminal neuralgia (crazy painful). Physical therapy for weakness in my left leg, a muscle stimulator to try to keep my muscles working. I’ve only been working part time and sleeping excessively. I’ve cut out wheat, dairy, sugar and go to yoga as much as possible. I’ve been exhausted constantly, depressed, tearful and have felt hopeless,” she bravely shared, “for accountability. I choose to no longer be miserable or fearful. I have scheduled a stem cell transplant for March in Mexico. I will go through chemo, lose my hair, and Griff will have to go with me to care for me the entire month. I am hopeful this will put this monster in remission, and I will again be a functional mother, doctor, and wife. I am thankful to have a supportive family to help care for my babies, coworkers who will take care of my patients for the month, and a husband that will hold me up when I’m ready to fall.”
In the meantime, she is including cannabis as part of her treatment plan. “I am currently using cannabis as medicine. I make a cannabis smoothie for breakfast every morning, (no THC, so no concerns about working under the influence) and then treat myself before bed. It has been immensely helpful with my pain (especially trigeminal neuralgia), muscle spasms, nausea, insomnia and anxiety. It hasn’t cured my MS but it has given me reprieve.”
In her plan to help patients by becoming a recommending physician, Lisa never imagined also becoming a patient. “I didn’t plan to get my card, due to the risk of losing my medical license, until my MS diagnosis. There isn’t really a law that physicians can’t use cannabis in Missouri. It’s really up to the state licensing board. I took a huge risk, got my card, and have been very verbal about it. I believe it takes risks, as well as people questioning the system, to make change.”
GRAM couldn’t agree more with taking risks and asking tough questions to change the system. We also believe in the power of sharing personal stories to normalize cannabis and those who consume it, and we want to give a special thank you to Dr. Lisa Roark for choosing to share her powerful story with us. From everyone at GRAM, we wish you the quickest and most healing journey.
Keeping Love + Faith Alive
After losing 36 to Covid-19
What started as a “Shelter in Place” check-in with friends Barbara and Daniel Melvin, grew into this article about a family with extreme losses to COVID-19. Barb first told me they had lost 12 family members and friends from COVID-19 in mid-April. By the end of April, the number had grown to 33. The current count is 40 family and friends lost to COVID-19 as of May 18, 2020.
Daniel and Barbara lived in Detroit before relocating to Naples, Florida, in 2001. Barbara has worked in banking for 30 years and is currently a Vice President at First Florida Integrity Bank. Dan is a multi-talented singer, radio personality, and entrepreneur. They are two of the happiest, kindest, giving, and loving people you could be lucky enough to know.
Together, they have worked to give back to their community through philanthropic endeavors, as well as volunteering on numerous nonprofit boards. They celebrate their mutual birthdays, Sept 6 & 10 by holding an annual event called “Party Hearty for Charity,” formerly known as “Party with a Purpose,” their nonprofit organization., They have raised over $90K in the past six years to help support several nonprofit organizations in SouthWest FL.
Barb says, “The coronavirus is real. I first heard about it in March, but like everyone else, we didn’t understand it, and at that time, we didn’t personally know anyone that was sick from it. Then, as time went on, we started to hear about people that we knew who were dying. My husband and I hated to wake up and look at Facebook because it seemed every time we checked someone close to us or someone we knew had died.”
Barbara tells us, some of the churches in Detroit continued to hold services, after the recommendation not to gather in large numbers. The members met to seek comfort in the face of the pandemic. Barbara believes that was crucial for most of the people she knows who were infected and died.
How could one couple know so many people who have passed from COVID-19? They are an extensive close-knit family, descendants of Tom and Etta Rhoades, born slaves. Tom and Etta’s dreams were to keep their descendants together spiritually, in harmony, and in brotherly love. They have honored their ancestors by gathering each year, for 46 years, for a three-day family reunion. Friday is meet and greet (you would need it with over 200 attending). Saturday is picnic time, complete with a softball game between the North and the South. Sunday, everyone goes to a local church, followed by a family dinner. With all those family members together, not an argument or fight ever. Until 2020, when the pandemic hit the family, and they canceled the family reunion.
Barbara shares with us information on a few of those they have lost. “My aunt, Mary Rhoades, died on April 22, 2020, she was 97 years old. She was in good health, and we were praying she made it to 100.” Several of her siblings had achieved that milestone, and she was reasonably healthy for 97 years of age so that expectation was a real one. “Aunt Mary became infected in early April; two weeks later, she was gone. She went to the hospital in Philadelphia for minor surgery, and we believe she was infected there. What hurts the most is she died alone; no family or friends could visit her.”
“Jason Hargrove was a close friend of ours. He was the bus driver who went on Facebook Live to talk about a woman coughing on his bus without covering her mouth. Two weeks later, he was diagnosed with the coronavirus, and he died shortly thereafter. His death was not in vain as the Detroit Department of Transportation made many changes to enhance the safety of their drivers. Jason was a Deacon at my church.”
Barbara continues, “Another close friend of ours was Larry Griffin. He died on April 16. He sang in my husband’s band called “In Full Effect” when they were performing in Detroit. He continued to sing in a new band called “Serieux,” who performed mostly in Detroit but also in Las Vegas. He had a beautiful voice and some great dance moves. He was so healthy until he caught the virus, and, in weeks, he was gone.”
“It spread so much faster in the churches. Many Pastors we knew caught the virus and were gone. They were older and many had health issues, when the virus attacked them they could not fight it off. These 4 Pastors were all a part of the Church of God In Christ (COGIC). Many had large congregations and were still holding services after the call for social distancing. These great men are a true loss for the COGIC community.”
“On April 23, we lost a very dear friend of mine, Lynn Raimey. I called her my sister as her father was the Pastor of my church in Detroit. Her family took me in and treated me like family when I first moved to Detroit and didn’t know anyone. She had many health issues, so when she was infected by the virus, it killed her very quickly.”
“Although we have lost many family, friends, and associates, we know God is good, and he continues to show us favor even through the midst of this storm. Even though we know of many deaths, we also know of many survivors and to that we are grateful. These people are given a second chance so their test can become their testimony. I know of an entire household, The Washington family of Detroit, who are survivors. Pastor Jamonty, his wife Tamela and their daughter Ariel Washington all recovered and are doing well.”
Barb specifically finds strength in the Beatitudes; “Jesus said in Matthew 5:4, Blessed are they that mourn, for they shall be comforted. It is during these tough times of losing loveda ones that I can refer to scripture to give me the comfort I and my family needs. The question is have you ever suffered? Please know that we all have. But I have come to know through leaning on God and his word, he meets me at my very point of need. As believers, the Bible speaks about plagues and famine and death, and its teachings prepare us for what life has to offer. Oftentimes we don’t understand the current situations, but when we look back, we realize this had to happen.”
As of May 5, 2020, there have been over 72,000 deaths in the United States, and over 257,000 deaths Worldwide. It is critical to find strength either within or in a higher power, focus on the positive, and stay connected.
It is GRAM’s honor to recognize this incredible family.
Blessed are they that mourn, for they shall be comforted.
Family & Friends Lost to Covid-19 (35 as of 5/5/20)
Mary R. – PA
Jason H. – MI
Rachelle Lynn R. – MI
Rev. O’Neil S. – MI
Gerald H. – MI
Curtis H. – MI
Larry G. – MI
Rosalind C. – MI
Rev. Gerald G. – VA
Skylar H. – MI
Rev. David F. – MI
Laneeka B. – MI
Ejuan W. – MI
Darnielita B. – MI
Bishop Phillip B. – MI
Bishop Robert S. – MI
Bishop Robert H. – MI
Tatia W. – MI
Rev. Lonie J. – MI
Carrie W. – MI
Helena J. – VA
James J. – VA
Robert J. – VA
Annette W. – NY
Helen L. – MD
Walter H. – DC
Carol T. – DE
Benjamin T. – DC
William B. – KY
Daniel R. – TX
Karen S. – NC
Denise B. – NC
Doris M. – OH
Trina D. – MI
Earl T. – VA
Nathaniel S. – MI
Lonnie L. – MI
Nathaniel S. Sr. – MI
Nathaniel S. Jr. – MI
Angel R. – IL
Americans for Safe Access + Covid
Americans for Safe Access (ASA) is a 501(c)(3) nonprofit with the mission of ensuring safe and legal access to cannabis for therapeutic use and research. The organization began in 2002 and has been helping educate people, change laws, and get more research out there about the therapeutic benefits of medical cannabis. “We also care about safety, and we want to make sure patients are using cannabis safely and legally throughout the United States,” explains Debbie Churgai, Interim Director for ASA.
GRAM sat down with Churgai to discuss how they are handling COVID-19 for patients throughout the U.S. She tells us, “When it first started, patients were really concerned about there being a lack of access to their medicine. So, one of the first things we did was host a stakeholders call. We contacted a bunch of people: patients, industry professionals, medical professionals, legal professionals, and within two hours, 15-20 people were on the phone strategizing. From that phone call, we then created a letter that we sent to Governors, medical cannabis commissions, and health departments urging them to keep medical cannabis businesses as essential, not just the dispensary but also cultivation and manufacturers so that there was no stop in production or supply chain.”
“It also meant, we needed to make sure patients were receiving safe products, that employees were also being kept safe. Then we started thinking about delivery for states that did not have that yet, and the states that did not yet offer telehealth – we wanted to encourage the changing of regulations at least temporarily to help accommodate the patients. As well as things like tax relief and adding additional caregivers, it wasn’t just about keeping businesses open, it was about making sure that patients were being protected and that products and employees were safe.”
In Colorado, we have seen dispensaries adapt to this crisis by adding hand sanitizer at checkout counters, wearing gloves and masks and only allowing one person in the purchasing area at a time. 33 states now have some sort of medical cannabis program.
According to news around the U.S., cannabis is now considered essential. But it wasn’t that way at first. According to Churgai, “Some states seemed to hold back on making any temporary changes in regulations. Within two weeks though, all the other states began implementing the suggestions we recommended.”
We needed to make sure patients were receiving safe products, that employees were also being kept safe.
“California has reached out more than any other state, I believe that is due to the fact that every single county there is different, from its tax structure to its implementation of the laws. Massachusetts was high with the questions as well because of them deciding to close down their recreational dispensaries for adult use. Now there is an influx of new patients. Now there are new concerns.”
Each state has a different set of rules and regulations surrounding their medical cannabis programs. “We wanted businesses to all have the same information so we offered a live training on health and safety during COVID-19, that can now be purchased as part of our Patient Focused Certification.1 In the training we provide information such as how to properly put on and take off gloves, how to properly touch things, how to properly sanitize surfaces, and more to make sure that businesses are being as safe as possible during this time.”
“When we realized that we helped assist in making these services essential, we wanted to learn how they actually worked for patients throughout the U.S. We wanted to understand, what do they still need during this time? Are their needs being met as patients? Would they like to see services like telehealth and delivery continue after COVID-19? We realize that we really need to streamline our advocacy efforts at this time, and we felt the survey would be a great way to learn what we can do for patients out there,” Churgai explains.
Help ASA discover what patients need around the United States.
Take the survey here: https://www.safeaccessnow.org/covid-19_survey
COVID-19 Patient Experience Survey asks questions like:
• How do you obtain cannabis?
• Do you feel you are at risk for covid and why?
• Rate your state’s response to the covid crisis.
• How should your state be assisting you more?
Patients are at greater risk for a variety of reasons so ASA is working to ensure that the needs of patients are taken into account. So, in addition to creating this survey, Americans for Safe Access has also created a page on their website dedicated to resources for patients seeking information surrounding COVID-19.2
Churgai says, “Cannabis is real medicine. I have been in this industry for so long, and I am a realist, and I know things will not change overnight. But I do feel the pandemic has highlighted the need for this medicine to be seen as real medicine. At ASA, patients are our priority, we are unbiased, we are not paid to play, and patients will always be our top priority.” You can learn all about Americans for Safe Access by visiting their website: https://www.safeaccessnow.org/
Trends in Endocrinology + Metabolism
The quest for a healthy
Endo-Cannabinoid System (ECS)
Emphasis on immunoregulation
The ECS is a disperse system, extending throughout the body; it is in constant interplay with all other organ systems promoting homeostasis in almost every aspect. Despite that, the ECS is still neglected and not included in the curricula of medical schools. For this reason a few introductory notes are in order (Battista et al, 2012). The ECS is the regulator of cognition, mood, nociception, energy metabolism, oxidation, inflammatory processes and a disease modifier as well (Tantimonaco et al, 2014).
The ECS consists of receptors, ligands to these receptors and enzymes that synthesize and degrade these ligands. The number of known endocannabinoid receptors is still growing to more that 55; the two most outstanding receptors are CB1R, mainly distributed throughout the nervous system and responsible for the psychoactivity of cannabis, and CB2R, mainly distributed on immune cells, even those “disguised” as specialized cells within other organs. Other receptors include TRPVx, GPR55, PPaRs etc; all these receptors form dimers between them as well as heterodimers with other types of receptors, like opioid, dopamine, serotonin, adenosine, catecholamine receptors and many others, thereby promoting a universal regulatory interplay throughout the body. The ligands to these receptors are the endocannabinoids (ECs): lipids of the eicosanoid family, derivatives of arachidonic acid (AA); the latter abounds in cell membranes; five of these are well characterized to date, but two are well studied: Anandamide (AEA) and 2-Arachidonoyl-Glycerole (2AG). ECs in the nervous system act in negative feedback loops, more or less like neurotransmitters, but, unlike them, they are synthesized and degraded on demand, and not stored in micro-vesicles. Several formerly unrelated morbid conditions are now recognized as ECS deficiencies, including, among many, migraine, autism, fibromyalgia, irritable bowel syndrome, etc (Russo, 2016).
The endocannabinoid system is involved in immunoregulation through the CB2 receptor and through receptor independent biochemical pathways. The mechanisms of immunoregulation by ECs include modulation of immune response in different cell types, effect on cytokine network and induction of immunoapoptosis; in brief, ECs down-regulate the innate and adaptive immune response in most, but not all, instances. Manipulation of endocannabinoids in vivo may constitute a novel treatment modality against inflammatory disorders.
It is obvious that the health of the ECS is of great importance in many ways, including the facing of a viral infection like COVID-19. A healthy ECS depends on many factors, most importantly from proper nutrition (McPartland et al, 2014).
Dietary ω3 fatty acids seem to act as homeostatic regulators of the ECS, acting in opposite directions if consumed by obese or non-obese individuals. Little change in EC levels are seen in individuals with normal weight, not fed a high ω6 diet.
Dietary ω6 fatty acids are also essential, but should be in a balance to ω3s; suggested balance is ω3:ω6=1:1 to 1:3 for proper ECS signaling and prevention of peroxidation in general. Arachidonic acid is an essential component of the ω6 fatty acids.
Probiotics and prebiotics play a significant part in ECS health, but, for a bizarre reason, they are generally not mentioned: They up-regulate CB2Rs residing on immune cells of the gut; they also modulate CB1Rs, depending on conditions, for instance, they down-regulate CB1Rs in obese individuals and help them gain less or no fat.
Some flavonoids, like kaempferol, genistein, epigallocatechine gallate, and curcumin enhance the ECS; same happens with some anthocyanidins, like cyanidin and delphinidin, although with a different mechanism.
Phthalates, pesticides, additives to pesticides like piperonyl butoxide act as ECS disruptors, meaning that consuming organic food may be a sound protective measure, along with intake of detoxifiers, in case of health problems consistent with ECS deficiency not otherwise explained.
Chronic stress impairs the ECS by decreasing levels of AEA and 2AG, and possibly through changes in CB1R expression too. Stress management may reverse the effects of chronic stress on ECS signaling. Anecdotal reports and common experience suggest that techniques such as meditation, yoga, deep breathing exercises and practicing of sex as well, exhibit mild cannabimimetic effects, thereby balancing the system.
Exercise is also an ECS regulator: Long-term exercise leads to sustained elevations of ECs, and predictable CB1R down-regulation.
Chronic alcohol consumption and binge drinking likely desensitize or down-regulate CB1R and impair EC signaling. Alcohol is not compatible with a healthy ECS.
Nicotine is an ECS deregulator: It induces EC production in some areas of the brain, while decreasing them in others. It should be avoided too.
Caffeine, acutely administered, potentiates CB1R-mediated effects through antagonizing adenosine at the A1 receptor (AA1R). At the undisturbed state, AA1Rs tonically inhibit CB1R activity; Caffeine antagonism on AA1Rs sets CB1Rs free of inhibition, thereby enhancing ECS function, for example by letting 2AG activate CB1Rs. During chronic administration of caffeine, the effects are blurred by individual differences in adaptation. In general, CB1Rs are down-regulated.
Chocolate: Cocoa contains sm-all amounts of at least three N-acyl-ethanolamines with cannabimimetic activity, expressed either directly by activating cannabinoid receptors, or indirectly, by increasing AEA levels (di Tomaso et al, 1996).
Battista et al, 2012: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303140/
Tantimonacco et al, 2014: https://pubmed.ncbi.nlm.nih.gov/24526057/
(Russo, 2016): https://pubmed.ncbi.nlm.nih.gov/28861491/
(McPartland et al, 2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951193/
(di Tomaso et al, 1996): https://pubmed.ncbi.nlm.nih.gov/8751435/
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