On a recent clinical rotation, pharmacy doctoral candidate Mikayla Toussaint (pictured above, left) stood at the entrance of a retail store, ready to assist customers arriving with doctors’ recommendations for medication.
Other greeters were at the entrance too, checking ID cards and directing customers to non-medical products, including colorful bongs and t-shirts with marijuana-leaf graphics.
This was no conventional rotation at a hospital or outpatient setting.
“It’s medicine,” Toussaint said at the Verilife cannabis dispensary in Albany, “but it’s much more laidback than other rotations.”
ACPHS was likely the first pharmacy school in the state to offer rotations at medical marijuana dispensaries, beginning in 2016, the year New York gave the green light to a small group of companies to open retail locations. Toussaint and other students say the experience has benefited them in significant ways: They have learned about an emerging medicine that is not a big part of their academic training. And they have applied their pharmaceutical training fully, not merely filled orders from another medical professional.
“I could see myself potentially working at a dispensary because of this rotation, and it opened my eyes to alternative therapies that I will definitely be sharing with my future patients,” Krystin Roberts said.
Assistant Professor Dr. Megan Veselov ’10 started the rotation as a preceptor when she worked at a dispensary herself and then expanded it on her return to ACPHS as a faculty member in 2017. Dr. Veselov found it invigorating to work in a new and emerging industry where pharmacists directly counseled patients on such matters as the variation and dosage of medication.
Cannabis occupies a unique regulatory territory where state and federal laws conflict. While New York and 37 other states have legalized marijuana for medical and/or recreational use, the drug remains on the federal government’s list of illegal controlled substances. Though the federal rules are rarely enforced, licensed physicians may not prescribe marijuana but only recommend it for certain ailments through “certifications” issued to patients. And most health insurance companies will not cover the cost, making the decision to medicate with cannabis an out-of-pocket expense.
It's an issue that proponents of medical marijuana access see the need to resolve. Yet it has also put pharmacists in a desirable position: They are the go-to experts for customers not only wondering how and when to take cannabis, but also which marijuana strains they should try and what dosage they should start with.
It was the experience of working at the top of a pharmacists’ license during her rotation at a dispensary that led Dr. Alexa Valentine ’19 to pursue a full-time position in the field after she graduated. She liked several aspects of the work: It was new and offered a chance to blaze a trail. Experimenting with dosing posed less risk than some other medications, as no amount of marijuana has ever proved fatal. And she enjoyed the direct contact with patients, including those who had never considered marijuana for medical purposes.
“I can’t say how good it made me feel to directly help people,” said Dr. Valentine, now a pharmacist at Vireo Health in Johnson City, N.Y. “Giving my recommendation and having them come back and say, ‘Wow, this is so great for my pain.’”
In addition to counseling patients, students on the Verilife rotation get access to a proprietary set of data on medical marijuana’s usage – no small benefit for a drug whose illegal federal status has resulted in scant research relative to other medicines. Dr. Thomas Larson (pictured above, right), the pharmacist who runs the Albany operation and serves as preceptor to ACPHS students, shares with them Verilife’s database of de-identified information, collected from dispensaries in four states, tracking such things as medical condition treated, the ratio of ingredients in strains used (THC vs. CBD), dosage and effectiveness.
Students said the knowledge gained from using this data will benefit them and their future patients no matter what kind of pharmacy practice they enter.
“I have an interest in oncology, so it was eye-opening to see how marijuana can play a vital role in pain management and comfort care for terminally ill patients,” Avani Topiwala said.
If there is a downside to working in the medical marijuana industry now, it’s the uncertainty over how changing laws may impact pharmacists’ roles, Dr. Valentine said. Yet she sees an upside to being on the ground floor of something likely to grow exponentially.
“This is a wealth of knowledge that I’ve accumulated that not a lot of people have,” she said.