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Rena Sherbill: Welcome again to the Cannabis Investing Podcast, where we speak with C-level executives, scientists and law and sector experts to provide actionable investment insight and the context with which to understand the burgeoning cannabis industry. I’m your host, Rena Sherbill.
Hi, everybody. Welcome back to the show. Great to have you listening. Today, I’m really excited to have Dr. Jessica Knox on the show. As I say at the beginning, Dr. Jessica is, I believe, our first currently practicing physician to be on the show. And I’m really excited for you to hear her perspective about the plant.
Dr. Knox is a board-certified preventive medicine physician, who specializes in endocannabinology and cannabinoid medicine. She Co-founded Doctors Knox, Inc., American Cannabinoid Clinics, and ADVENT Academy with her parents and sister in order to build an endocannabinoidome care ecosystem that is both science-based and patient-focused and equity-driven.
Really great to have Dr. Jessica on the show to talk about the foolishness of bifurcating the medical and rec/slash adult use market, consulting on making products with purpose, and also getting into the frustration of the business of medicine.
And how Dr. Jessica, along with her family, moved to the cannabinoid system to treat patients more holistically, and the stigma and misinformation that still is deeply entrenched in the medical community unfortunately, and talking about how powerful cannabis can be, and why the mainstream medical community has been reluctant to take it on, not just because of the stigma, but also issues surrounding their preference for single molecule medicine. And the importance of incorporating whole plant cannabis medicine and the future of the industry, both the cannabis industry and the medical industry and how we can start bridging those communities closer together.
So really excited to have Dr. Jessica’s perspective. Really excited for you to listen to this conversation. Dr. Jessica will also be on the panel that I’m hosting the webinar, CannaBiz California. More information on that is on our Twitter page @canpod1. Hope you check that out and really excited for you to listen to our conversation today.
And before we begin, a brief disclaimer. Nothing on this podcast should be taken as investment advice of any sort. And in my model cannabis portfolio, I’m long Trulieve, Khiron, GrowGeneration, Curaleaf, Vireo Health and Isracann BioSciences. You can subscribe to us on Libsyn, Apple Podcasts, Spotify, Google Play and Stitcher.
Dr. Jessica Knox, great to have you on the Cannabis Investing Podcast. Thanks so much for joining us today.
Jessica Knox: Thanks for having me. Happy to be here.
RS: Awesome. Glad to have you on. So talk to us – it’s nice to have a doctor on. We don’t – I’m not – I think that you might be our first practicing doctor. I know we’ve had formerly practicing doctors on, but I think you’re our first currently practicing – presently practicing doctor. So glad to have your perspective. And I’d love to hear your journey to the medical profession and then also to the cannabis industry?
JK: Yes. happy to go back to those days of the early journey. It’s – so I think the first thing to know about me is that I come from a family of physicians. I’m one of four doctors in my family. My parents are both physicians, and my sister is a doctor as well. And actually growing up, I never wanted to be a doctor. I – I’m not even entirely sure why, but something my parents did. I saw…
RS: Maybe because your parents did?
JK: Yes. I mean, they worked really hard. They were happy. They were always there for us when we needed them to be – there are three kids in a family. I’m the youngest of the three, but we all played sports. And my parents, my mom was an anesthesiologist. My dad was an emergency physician. And somehow they made it to every single one of our basketball games.
You know what I mean? Like they were always there when they needed us to be. But for whatever reason, I never wanted to be a doctor until I got to college. And I like to say, it was really just out of a lack of creativity that I ended up going down the pre-med route, because I got to college and I got very interested in psychology and that’s what I majored in.
But as a college student thinking about, because I’m studying psychology, what am I going to do with my life? I know I want to help people, so how can I help people with psychology? Oh, I guess, I need to be a doctor. Like, literally that was my train of thought, and therefore, why I say it was lack of creativity. But that sent me on the path to become a physician.
And I decided to do a dual degree program with an MD and an MBA, because my parents really never pressured us either way to become or not to become doctors. But my mom said, “If you’re going to become a doctor, make sure that you are able to do it with some autonomy, do it in your own way, do it a little bit out of the box”, because she and my dad had really gone through the transition of medicine from really a doctor-led profession with a lot of autonomy to a profession that was very much governed by business interest, whether that was insurance companies or the billing, the department of the hospital. And they’d really – they’ve gone through the process of losing that autonomy and feeling frustrated by that. And so I did the dual degree program.
And then, once I completed medical school, then you go on to residency, which honestly, I considered not doing at all. I was already by the end of medical school very frustrated by, I mean, I guess, really, by the business of medicine, because already, as a medical student, I had experienced that I wasn’t being trained to do what I thought I was going to be doing as a doctor, which was healing people and making the world better by making people feel better. I was checking boxes and managing medication lists, and I was frustrated.
So I considered not going into residency at all, but what I ended up starting out in was actually family medicine. So I did my internship in family medicine and I chose that, because I was like of all of the specialties, this one seems to be the most broad, so maybe I’ll have the most flexibility with my business degree to do something in family medicine.
But also it starts – it’s family medicine, so it starts from birth, it goes to death. And hopefully, you’re doing more of that primary preventive care. Come to find out 80% of my time in family medicine internship was still managing chronic disease, managing diabetes or heart failure, or COPD, like still feeling like I was banging my head against the wall, and then I learned about and transitioned into preventive medicine, which is probably what I was looking for all along.
Preventive medicine is a primary care and public health specialty. So it’s really looking at programs at a community level to promote health. It’s really looking more at lifestyle. So it’s more of my speed. And so that’s what I ended up formally specializing in, and I’m board certified as a preventive medicine doctor.
But as I was coming towards the end of my residency and thinking again now, back in the spot of thinking about what’s next, I knew I didn’t want to go into a primary care clinic. I knew I didn’t want to go into a Public Health Department or the CDC, which is what a lot of public health graduates do – or sorry, preventive medicine graduates do, because those still weren’t really enough for me. You were still sort of working within a system that had a lot of red tape. It takes a long time to have impacts. So those really weren’t for me.
But by that time, both of my parents were practicing cannabis medicine. And they had been doing so for a few years. And so my mom first started working – she was the very first. So it’s always funny when people like, they don’t know about my family. They’re like, “Oh my gosh, what do your parents think about you working in cannabis?” And I’m like, “Well, like, well, my mom started it. So – but she was the first of us to get into it.” And…
RS: We learned it from watching you.
JK: Exactly. So she was the first to get into it. So she was – she is an board-certified anesthesiologist, practiced 35 years before retiring. But as – she can’t – she is not a woman to retire into a life of leisure. So she was still like looking for things to do after retiring from the OR.
And she ended up covering for another physician one day in a card clinic, kind of medical marijuana card clinic. And she went to knowing nothing, was very skeptical, was expecting to see the stereotypical stoner who just wanted her signature, so that they could go get their weed. But she didn’t see that at all. But she saw completely blew her expectations and preconceived notions out of the water.
She saw just everyday people, from babies to grandparents to professionals to law enforcement people, all these kinds of people who were seeking cannabis for relief and they were finding relief or they were seeking cannabis, because they were sort of at the end of their road. They’d been written off or had failed conventional medicine or conventional medicine had failed them, and they were desperate for a solution and we’re often finding it in cannabis.
And so she – she’ll tell the story of – she went to this clinic. People were asking her questions about how to use cannabis. Why does it work? And she couldn’t answer any of those questions, but she felt very embarrassed about, right? Because people may or may not realize, but we don’t learn anything still – even still about the endocannabinoid system or cannabis as medicine and medical school.
All we learn about in regards to cannabis is that, it’s a drug of abuse or it’s a gateway drug. That’s the only way we learned about cannabis. And so she was – she felt embarrassed that she couldn’t answer these questions. She was supposed to be an expert in physiology and pharmacology as an anesthesiologist. And she had no answer for these people of how or why to use cannabis. Why it was working for them?
So she started digging into the research. And there’s tons of research, right? One of the most common, I think, knee jerk reactions from a lot of clinicians when you ask them about cannabis is still “Oh, there’s not enough research, there’s so much.” And so she started reading everything she get her hands on, learn about the endocannabinoid system, its physiology, learned about the pharmacology of cannabis.
And, of course, she was telling the rest of us about it, right? She was telling my dad, she was telling my sister and me. At first, I was very – I was skeptical. I was like, “Mom has lost it. Like, what is she talking about, cannabis is medicine? What Kool-Aid is she drinking?” But what really – I think, what really hooked me was the patient stories.
So she and my dad would tell us about the patients they were meeting in these clinics and the sorts of just 180 turnarounds that they were having, either in their symptomology or disease process or just in their quality of life. But what they were telling me was, their patients were getting better or feeling better, which is not something that I could ever say confidently about any of my patients in my primary care clinics.
And so I was – it was like, there’s something there. I’m going to go spend my time there. So when I left residency, I started working in cannabis clinics here in the Bay Area. And from there, I just started reading more and more, learning more on my own. And really, that’s what my entire family did.
So now we all practice, what we call, endocannabinology. So that’s the function and dysfunction and modulation of the endocannabinoid system and cannabinoid medicine, which is using cannabis or other cannabimimetic tools in order to modulate the endocannabinoid system.
RS: That’s really awesome, wow. It’s a family affair. It’s interesting, just in the past couple of weeks, I’ve talked to a couple of people that work with family. I’m interested, I’m always interested, because I come from a fairly big family, and I’m always interested in what it’s like to work on that level with your family. How has just that side been with it?
JK: It’s – overall, it’s fun and very positive. But it’s also very interesting, because you start seeing parts of your family members that you wouldn’t see if you weren’t doing business together. So like, obviously, I know my family well. But prior to us working together, I knew them in the way that you know your family that you love.
But in a business sense, you start to see what are people’s skills? What are their actual – like, their real passions? What are some of their maybe not strong points? What frustrates you about them? But also, you figure out how to navigate all of these, like strengths and weaknesses and who to go to for what? And I think, because you love each other, like it’s funny. Some of our meetings that are just a family, like can get very spirited, but you love each other.
So like, you will, like, get into that spirit and then you will clean it up and move on. So it’s funny. But it’s also interesting, because now it’s like, it’s almost like you’re never off, because at holidays, we’re talking about work. It seems, we’re talking about work. So – but what’s good is that we all love it. It’s stuff that’s really fun. We all sort of have a different angle on it. Oh, yes, it’s been…
RS: So do you have a third sibling that’s not involved with this?
JK: Yes. Well, so we have a third sibling, but he is involved, but he is not a doctor. So he is like – he has been misfit. But it’s actually very useful, because he is an attorney. He is a lawyer.
RS: Oh, a real black sheep. Yes.
JK: Yes, exactly. And so he – it’s actually very helpful when you have four doctors working in this unconventional space and doing all of these various projects to have a lawyer on the team who gets it. And so he – it’s actually funny, because actually, he was probably the first one in the cannabis industry. So he is a lawyer here in the Bay Area of California as well.
And even before my parents started working in clinics up in Oregon, he, as an attorney, was working with small businesses, small cannabis businesses here in California to help them apply for their licenses and make sure they were compliant and doing all of that, that legal stuff. So…
JK: …very useful to have him around.
RS: Well, as spirited or as heated as it may get, you guys must be doing something right that you’re all working together. So kudos for that…
JK: Thank you.
RS: …that must have no doubt, its pluses and minuses. But I bet the plus is definitely a way as evidenced by the fact that you’re all in the family business. So I’m interested, I’ve been talking to some people that focus on the medical side of cannabis, but do so in Africa, in Europe and Asia.
But in the U.S., I feel like and something that this guest was talking about was the fact that the U.S. market is so focused on the rec side, the adult use side and pushing that forward and the talk of legalization is all surrounding. I mean, obviously, there’s a bunch of states that are medically legal, but I feel like so much of the headlines are consumed by the rec side going legal, whereas…
RS: …in other parts of the world, the legal picture has really been driven by the medical side. I’m interested, like, how much pushback or reception are you getting from the medical community, like as doctors out talking to other physicians or within the medical industry less on the cannabis side?
How have you found a, I guess, the trajectory of how you’ve been received since you started until now? And kind of, I guess, where do you see that going? And how much of – this might be a long question, but bear with me. Like, how much growth do you see in terms of understanding about cannabis as a medicine?
JK: Yes. These are really important questions. So, we’ve been at this for – well, myself and my sister for five years. We both came out of residency at the same time. And then my parents going on 10 years. And it’s interesting, I think, over that time, even still when we go out to various conferences or just industry events, we’re still some of the only doctors who are around. And then there are some medical, just general medical conferences, right, not cannabis conferences, but other specialty conferences, that may sometimes have a panel on cannabis.
So it’s like, there’s starting to be some mainstream medical interest or pickup of cannabis. But it still feels very halting and it feels – it’s almost like, they’re doing it because the conversation is so loud in general that they know they need to incorporate something.
And I think – and it’s sort of always been this way, but patients are really driving a lot of the progress amongst the medical community, because whether doctors or other clinicians like it or not, patients are using cannabis or CBD. And they’re coming to their clinicians and asking about it, and often not getting the answers they want or need.
But clinicians are feeling pressure to learn about – to learn about this space. And I think, there’s, in general though, there is still a good deal of pushback on cannabis. So one of the – so Medscape is – it’s an online sort of media outlet, specifically for clinicians. And over the past year, they published quite a few pieces on cannabis. And they’re always very negative.
They’re always looking at adverse effects or they’re very sensational. And when you read them with the perspective of knowing about the endocannabinoid system and actual pharmacology of cannabis, you’re very frustrated, because you see how they are written in such a biased and just not accurate way.
But then you look at the comments who are coming – that are coming in from physicians and you can see that the misinformation and the stigma is still so deeply entrenched in the medical community. So it feels like there’s a lot of work for us to do. One of our primary jobs – one of the primary jobs my family has taken on is educating other healthcare professionals. That’s why we founded ADVENT Academy, which is our program with curriculum to train other doctors.
So there’s still a lot of pushback. But then, I think, especially in the younger generation of clinicians coming out, there’s a lot of curiosity. And so we’ll often get e-mails or DMs about people wanting to spend time with us in clinic or train with us or whatever it may be, so that they can learn what we’re doing.
And one of the things that we really believe in when we’re talking with our healthcare professional colleagues is we always, as we say, lead with the history and the science. We never lead with cannabis as medicine, cannabis as medicine, Cannabis as medicine, because people sort of automatically feel – they’re just put in a very defensive spot when you come at them with cannabis as medicine because of what they’ve learned for so long is a drug of abuse or a gateway drug.
So we start with the history, because the history of how cannabis went from eating widely used to prohibited and demonized and why it was prohibited and demonized to now why it’s sort of coming back with increasing legalization that really provides the context that most of us are missing or why we are where we are now, right?
Like most people assume cannabis was prohibited, because it’s dangerous. Cannabis was prohibited out of political and cultural and economic interests really at the objection of the medical and science communities who wanted to keep cannabis available for prescribing and for research, right?
So when people start to understand that cannabis was not taken away, because it’s dangerous or it makes people lazy or whatever common myths there are, they can start to think about it in a slightly different light. And then we go to the science of the endocannabinoid system. You have an endocannabinoid system, this is how it works.
And when how it works, it’s sort of a no-brainer follow-on that cannabis can be used as medicine. And only then do we really start getting into the nitty-gritty of application and really detailed pharmacology. So we’re trying to – we really try to disarm people with the history and the science, so that we can get into these – this broader conversation. And I think we’re definitely picking up speed.
There are medical schools who are starting to get interested in the curriculum we’re talking about. There is certainly a growing group of already medical professionals who are interested in learning this. So we feel like we’re making good progress and we’re happy about that.
RS: It’s interesting. Do you feel like you use your psychology background at all in terms of knowing how to disarm people and kind of – it’s interesting how much of a stigma that it has – cannabis has had for so many people? And it’s really it’s like, what you’re saying, it’s just so entrenched. It’s like, it’s simply hard to move somebody from that position. Like, would you say it’s kind of boils down to something as simple as that?
JK: Absolutely. Yes. I think that’s absolutely right. And when I’m talking to just individuals who are – they’re – they want to know how to talk to their doctor or to talk to their loved ones about using cannabis. I’ve always encouraged them to use a personal story of why you want to use cannabis or why you are using cannabis. You’re using it, because it’s helping you in some way.
And for a lot of us, like you can throw as many facts or scientific details at us as you want. It’s not going to change our mind. But what will change our mind is knowing somebody personally, who has had a hard time with a condition or with medication or with alcohol or other drugs that is now doing better, because they’re using cannabis to help them.
So the personal stories are, I think, some of the most effective tools to help start to change people’s minds. And I think that does come back to psychology and how are we attached to people? What are sort of like safety mechanisms and security mechanisms that we use to protect our cognition, right? There’s cognitive dissonance if what you’re telling me scientifically doesn’t match up with what I’ve always been told culturally. But having someone that you love or care for, share their experience can be really powerful in helping you change your mind.
RS: Yes. And I imagine, I mean, I imagine that it’s also tied up in the kind of pharmaceutical hold of the medical industry. Would you also like, just because doctors have been trained for so many years, like prescribe these pills made by this company, and what’s an endocannabinoid system like, I feel like…
JK: Yes. Well, I mean, that’s exactly right. And it’s not just the doctors, right? Really, all of us have been trained and conditioned to believe that if we don’t feel well, then we get a pill and it makes us feel better. And that’s really – that’s even within endocannabinology, cannabis is a really important tool for us. But cannabis could be used in the same way, right? I don’t feel well, so I use cannabis and that makes me better.
And we go deeper with our patients like, why don’t you feel well? There’s a root cause for this dysfunction and we focus on endocannabinoid dysfunction. So certainly, we’ll use cannabis to help manage that dysfunction. But we’re also going to look at your nutrition and your activity levels and your relationships and your work stress on and on to try to figure out, like what is the root cause for your problem, because ultimately, we would love for you to not have to be on anything at all cannabis included, unless you just want to use it to relax.
But in general, we have been trained to expect a pharmaceutical to make us feel better. And that will – that ultimately was my frustration with my medical training is that’s what I – that’s literally how I felt I was being trained, is to figure out what pill you can give to the patient to check that box and to write that code down and that’s your job.
But that doesn’t make anybody better, doesn’t make the patient better and also doesn’t fulfill my desire as a physician to be helpful and to pour into a patient, so that they can thrive. So yes, it’s a lot of conditioning that we are trying to disrupt, so to up end.
RS: Yes. Here’s to that, always a fan of that. As you see people coming through the ADVENT Academy, like are you seeing all kinds – all different kinds of people, like veterans in the industry, younger people like who are you seeing come through that, that are interested in that?
JK: Yes. So ADVENT Academy is still relatively in its infancy. And so I would say that currently, our learners are physicians, who are really sort of anywhere in their career, you’ll either have like the new physicians who are already interested in doing things a little bit differently, or you have like the mid-career or late career physicians who are frustrated and are looking for a way to sort of pivot.
But we also have some, like non-physician clinicians as well. So we have partnerships with a naturopathy school. We’re looking to reach out to more health coaches. We ultimately want to reach anybody of whatever title and credentials, who is trying to work with people’s health.
So working in healthcare as opposed to medical care, we really want to reach all of those people. We believe everybody whether you’re an acupuncturist or a massage therapist, or a doctor, or a nurse need to understand that we have an endocannabinoid system and how it works.
RS: What do you see going forward, like where do you see in the next few years? Do you see it as a matter of the fact that cannabis is already like, let’s say, between now and three years ago, between now and five years ago, the difference and understanding of what cannabis is and what it can do and the potentials it has, is obviously greatly expanded. What do you see for the next few years and how much do you think the medical community – the main stream medical community will take on this kind of deeper understanding?
JK: It’s interesting. There are probably so many ways to answer that question. So I will try to remain coherent, because I want to follow all of these different threads. But I think that – I think the mainstream medical community in the next five years, I think, will come along quite a bit. And again, I think, that’s because there’s going to be increasing pressure from our patients, especially as legalization continues to progress.
At some point, we, clinicians, have to check our integrity and realize that we have a duty to care for our patients to be able to answer their questions. And if they’re asking us things we can’t answer, then we need to go learn about that, so that we can better care for them.
And I think with – also with increasing pressure from groups, like my family, who are constantly knocking on doors of medical schools and saying, “Hey, we have this curriculum. We think that you should include it.” Hopefully, there will be progress there as well.
I think what another factor that, frankly, frightens me, but I think will be a driving factor is, there’s a point where cannabis will be legalized or maybe only rescheduled, which is very concerning. But rescheduled to a point, where pharmaceutical companies can more broadly put out cannabis-derived prescription level medications.
And I think that certainly will push the medical community along the concern for me is that, it will push the medical community along maybe without the appropriate training in the endocannabinoid system and also concerned about the quality, not like quality as a good or bad, but literally just like what is the kind of medicine – cannabis medicine that farmer would put out? So those things are concerning to me.
RS: Stripping it of its essence and what it could be holistically used for?
JK: Right. Exactly right, which like, I feel that there is probably an appropriate place for that. If hospitals or clinics are ever to incorporate cannabis medicine, I think, I would be shocked if they incorporated whole plant cannabis medicine, because whole plant cannabis introduces some amount of variety or diversity that can be hard to manage within a clinical setting.
Frankly speaking, that is one of the reasons why, back in the early 1900s, single molecule medicine started overtaking cannabis as medicine was because Cannabis – it’s – every plant is a little bit different. And it can be hard to manage, if you don’t know about how the different parts work. But if you just give me a single molecule medicine, like aspirin, I know how to work with that. They’re standardized dosing that kind of thing.
So that’s what hospitals will look for. And so in order for them to minimize variety, they probably will go for a isolette or very – a medication with very few different variables in it.
So I think, I guess, I hope, if farmer comes with their monomolecular cannabis-derived medicines that they would stay in the hospital or clinical settings, allowing the rest of the sort of outpatient world or just consumer world to still access the whole plant cannabis medicine, which frankly, we know is safer and more effective if yada, yada, yada.
But to your earlier point about recreational market or the adult use market really taking over the medical market, that is a real phenomenon that we have seen up close and personal in a lot of our West Coast states, where the medical market – the medical markets have always come first, and so they’re sort of up and thriving and doing well and then the adult use market comes.
And, as you said, sort of the medical market is left by the wayside, all of the interest goes to the recreational market really to the detriment of patients. They lose access to some of the high-quality medication they were accessing before. And it’s just – it’s a completely different market and it gets polluted.
And it’s unfortunate, because for many reasons, one, like, the patients need a good high-quality medicine. In a lot of cases, they’ve gone back to the legacy or the illicit market, because they’re no longer able to access the quality of medicine that they were previously getting in the legal medical market once the rec comes in.
But it’s also interesting, because I don’t – my sister talks about this a lot actually. It’s hard to wrap your head around why you would bifurcate a market, right? This is one single plant that comes in countless varieties. But the suggestion that a medical market is – should be separated from a rec market means that – what means that the plant should be different for each of those markets, means that the people in each of those markets are different.
But at the end of the day, these are all people who all have endocannabinoid systems are likely medicating for something whether they identify it as that or not. And so why should we have different standards for the quality or the safety of the products that are in these two markets? And maybe in the rec market, there’s concern about limiting the amount of THC somebody can access? That’s fine, we can do that.
But why should we treat these markets as inherently separate and give them different standards to me? It doesn’t make sense. And so really, we should be treating the plant – the cannabis plant as medicinal, because it is regardless of who the end consumer might be. And then if we want to eventually separate, who can get what, based on whether they’re using it medically or just for recreation or wellness, then we can talk about, “Okay, well, who has access to what?”
RS: Right, right. Yes, it’s really interesting. I mean, it’s interesting to hear your perspective, because this is something that I talk a lot about on the podcast and also in my personal life, how frustrating it is that the plan isn’t understood more holistically, like exactly what you’re saying the bifurcation of the market.
It – we had a guest on a few months ago. He is a veteran and he lives in Canada. And he was saying for a long time Telehealth in Canada was giving them – cannabis was giving veterans for PTSD and other issues that they were having. Cannabis for, like really cheap, really good quality cannabis that was really helpful.
And then once it went legal on the rec side in Canada, that quality cheap cannabis was totally taken away. And they were given just like low-quality junk leftover from the rec side. And it’s – and I think, like, I guess, I’m interested in, like your perspective of like, there’s, I think, what we even define medicine as or what we even define treating something? What are we even treating?
Are we treating like the existential questions of life, like coping with life? Are we treating epilepsy like, does it matter more that somebody is being treated for epilepsy than depression like, or social anxiety? And I think it’s also interesting, because I feel like the understanding of the plant is such that I feel like almost, it’s like the political side of things won’t let cannabis be legalized unless first it’s done on the medical side, like the important stuff, the serious stuff, and then you stoners can get your rec side, but it’s funny how much that’s overtaken things.
How – I guess, as a physician, how do you kind of define what medicine is? And how do you talk to patients about how they’re treated? I mean, I know you said using things holistically and it’s not just about one treatment, it’s about living a holistic life and treating things holistically. But I guess, like when you are talking in these conferences or two different physicians, do you speak at all about the notion or the – what even the definition is of medicine?
JK: That’s a great question. I don’t think I’ve ever, in any of our presentations, defined medicine. I think we’ve always taken for granted that, that people know what it is. But I take your point, and I think it is important to define, because that’s sort of at the crux of the argument of whether cannabis is medicine.
And a medicine can be any – anything that we use or take to have therapeutic effect, ideally a beneficial therapeutic effect. By that definition, simply by the way that cannabis works in our bodies, it is a medicine. And actually, it’s very interesting, because now we are almost at a trifurcated market, because we have the hemp CBD market as well that is all has its own confusing mass of lack of regulation and oversight, whatever we can get into that mess if you want to.
Yes, exactly. But cannabis as medicine, and we always say, whether somebody is recreating or medicating really is just what they – what their stated intention is at that time, because regardless of how they think they’re using it, cannabis is working therapeutically in the body.
And so hopefully, people recognize that that’s what they’re doing when they’re using it, right? And some people – I think, a lot of people – well, first of all, I think, everybody can benefit from a little bit of CBD every day, children included.
RS: In terms of physical, in terms of, like mental, like…
JK: Sort of overall, so, CBD, THC as well. But obviously THC comes with its intoxicating neurogenic effects, but their anti-inflammatory, which we live very inflammatory lives. And so in general, having a daily supplemental anti-inflammatory is useful, but also just having that little bit of CBD onboard is helpful for toning the endocannabinoid system, which is constantly working to keep us in balance. But it’s also being constantly insulted by the various assaults of daily life.
So, again, I think CBD is a great just daily supplement. But even outside of that, I feel like – so we’ve set the baseline that cannabis is medicinal. I think people have a right to access it. And I think that if you have a condition, if you have a serious condition or – it, I mean, it doesn’t have to be that, I guess, even that serious. But if you feel like you have a condition where you want help and guidance for how to use cannabis, specifically to treat that, then you should be able to access a clinician who can help you manage that.
But if you’re just somebody who has like general aches and pains or like, you don’t sleep so well and you want to use cannabis to help manage that, I feel like you should be freely able to – really able to access it for your wellness needs. Yes, there’s just a significant sort of, I guess, reorientation to how we conceive of cannabis and cannabis as a medicine in order, so it’s – oh, please go on.
Oh, I was just going to say, because something you said reminded me of this. Earlier, I think another sort of hurdle that we are trying to navigate right now is the very enthusiastic expansion of the hemp CBD market that has come along with all kinds of information, right? You can find all kinds of varying quality information on the Internet about CBD.
And so it’s interesting now to try to navigate all the information that’s out there and in some cases, try to rein it in and qualify it. But yes, we’re at an interesting point now where it’s almost like we have to both try to bring people along and catch them up to where we are with science.
But also like wrangle in some other folks who have like run or like running amok all over with CBD and try to bring everybody back into like, “Okay, you guys, here’s the end of endocannabinoid system, your cannabinoids. Here’s how they work. This is what we can do with them. This is a – these are their limitations.” It’s an interesting space to be right now.
RS: Yes, totally. A lot of wrangling is involved – edit source a lot of wrangling is involved. Yes, it’s interesting, the CBD is the market, does that – do you feel like that the whole misinformation like it being legal and just opening the floodgates for so many nefarious things to happen in that sector. And until they kind of totally figure it out, has that been helpful or hindrance like our patients coming in and being like give me this. I understand it this way. Are you having to deal with a lot of misinformation about that?
JK: Yes, yes. And I think, again, it’s sort of like a two-sided coin, because it – I think it is helpful in so far as it is prompting people to think differently about cannabis or maybe just CBD, I mean, that’s the other tricky part about it, right? It’s not clear to a lot of people what’s the difference between cannabis and hemp? And like, what’s the difference between cannabis and hemp and CBD?
So there’s still a lot of confusion there. But I think at the very least, having CBD out there so prominently is giving people a reason and cause to maybe open their minds a little bit to it. So that’s helpful. I think what is problematic, again, is just like the amount of information that’s out there and not all of it is accurate.
But I think even more concerning for me, you alluded to some of the nefarious activities that are going on around the hemp CBD market, I’m sure a lot of people will have heard of the research paper that took a bunch of CBD products off of shelves and lab tested them, and very few of them contained what they said they contain, right? Like they either had THC when they said they didn’t, or there was no CBD, or all kinds of things.
But I think what’s very concerning to me about this sort of free for all wild west hemp CBD market right now is, there is no quality control. I mean, right, I should qualify that. Unless a company is doing it on their own, right? But there’s no general widespread quality control, there are no standards to meet, these products can just go up on shelves.
And the concern for me is, people in their enthusiasm or optimism for CBD will go out and get these products, will use them and won’t have – won’t find benefit, or will have a negative experience. And we’ll use that to write off CBD and cannabis in general, when, in fact, if they had gotten a quality product, or if they’d received guidance on how to use it appropriately, they might have found a very powerful wellness tool for their use.
RS: Which is why regulations are so important, and it’s important for consumers to really find out what you’re buying in that space. Really check the certificates and the sourcing. I’m curious – I don’t know if this is a silly question. But when you’re prescribing cannabis to patients, are you specific about like, what brands they get, or which dispensaries they go to, how does that work?
JK: Yes. So the answer is no, because we have patients from all over the country and all over the world really, where we can’t start, what was that?
RS: Do it remotely?
JK: Yes, yes, yes, we do tel-healthcare.
RS: Got it.
JK: So we – yes, we do. We have a couple of brick-and-mortar spaces in the Portland area, Portland, Oregon area, which is where the other three doctors are. But we do most of our care via telemedicine. And so we have patients from all over. And so we often cannot recommend specific dispensaries or brands.
What we – the way we usually care for our patients is, they come in with a condition or multiple conditions. We try to figure out what is the endocannabinoid dysfunction that’s going on here. Sometimes, it’s pretty – it’s a pretty, I guess, simple picture for things like anxiety or insomnia. We know exactly what we will look for.
But with cancers, depending on the type of cancer, there are different sort of pathways that we’re trying to target. But ultimately, what we give our patients is sort of a, like a chemical profile or multiple chemical profiles to go out and look for, right? So how much THC, how much CBD and what ratio? What are the terpenes that we want to be in there? And we give them that to go out into the world and that’s what’s hard, right?
Now, they have to go out and try to find these profiles or close to these profiles, which in some cases, is easier than others, which is also why we are trying to educate and work with product manufacturers, so that we can help design and formulate products that will meet our clinical needs.
But yes, so we’re always orienting people to the chemical profiles of their medicine as opposed to specific brands or dispensaries. And then, of course, always educating people on like how to identify a quality product, a safe product.
RS: Do you feel like the patients that you treat when they go out and look for things… are they always in medically legal areas?
JK: They are not, and that’s what’s tricky and frustrating about this space still. A lot of patients are not in legal states. And so they find themselves in a tough spot when deciding whether or how to access this medicine. We have – we do have patients who will cross state lines to get what they need and then carry it back home, which you got to do what you got to do, but it’s scary.
And that’s really what’s hard about this is just like patient rights, right? If cannabis is medicine in some states, how is it not medicine in another state? And you’re getting into – to questions of accessibility and equity. And it’s also – was also really interesting to me, early in the pandemic, like early in the shutdowns here, there were – there was a lot of attention like on whether cannabis dispensaries would be dubbed essential, right?
Are they going to stay open? Are they – are people going to be accessing – be able to access them during the pandemic? And I think most states, I don’t know about all states, but I think most states did deem essential cannabis and essential business. So dispensaries, both medical and if you’re an adult, you state adult use dispensaries would remain open.
And so for me, I was like, “Okay, well, if cannabis is essential, meaning, that we need to keep it open during the pandemic, like what does it mean, then that not everybody can equally access it? Like, what does that say about what we think of as a right to access medicine or a right to access as an essential service?”
And that sort of goes further into, like, if we go back to the CBD – the hemp CBD industry, which, in a lot of ways, is almost becoming a luxury wellness space or a space of privilege, right? Because there is still a lot of BIPOC folks who can’t easily access that industry, even just the CBD products that they’re priced out of them. Or even when cannabis becomes legal in a state, BIPOC folks are still disproportionately policed regarding. So anyway, that just brought – it brings up.
JK: …this brings up just a lot of questions about equity and accessibility and rights when we start talking about differential access to cannabis and hemp goods.
RS: Absolutely, absolutely. There’s so many rights that need to be wronged, like in the present time, not just the historic wrongs that still need to be righted. I mean, even in Israel, like the CBD market is super expensive. And I know people that have found relief from it, but can’t afford to, like continue to take it every day. It’s just like – it’s just like you said, it’s like a luxury item almost. Yes, it’s craziness.
And even like, I was just seeing a headline today that Washington DC, since it’s been legalized, the arrests – or the citations are predominantly given to people of color, like it’s craziness. Like it’s, we take one step forward, two steps back, it’s – there’s so much for lack of a better word… the only word I’m coming up with right now is policing ourselves and policing the industry.
But it needs to be done, like in a positive real way, there’s just, even the ability to like grow a plant for yourself for medical treatment at home, like, “My God, it’s like you’re asking to establish your own land.” It’s hard fought.
JK: Yes, it is. It really is. My – so my sister, Dr. Rachel, she does a lot of awesome stuff. She is doing a lot of important work. But she is the Chair of the Oregon Cannabis Commission, and she is a very active in drafting legislation around cannabis and like health equity related to cannabis for States to hopefully review and adopt or even local levels.
But yes, what she has found and what I think all of us are experiencing is that a lot of times cannabis-related legislation has been written and put into place without any, I shouldn’t say without any, that might not be fair. But it seems with little scientific or medically-based information, accurate information considered.
And so, it’s like they put an arbitrary limit on the number of plants you can have, or they put an arbitrary limit on the amount of THC that is going to be available without having considered that their actual, like, there’s actual science that we can base some of these decisions in…
RS: Did you say science?
JK: So we do a lot of work also to try to inform and educate our lawmakers. So that hopefully, we end up with laws and rules and regulations that actually makes sense and help people as opposed to hindering us in our attempts to take care of ourselves.
RS: Yes, absolutely. I mean, it’s like you said at the beginning, when cannabis was deemed something illegal, it was for political reasons to the – they were completely in disagreement with the medical community and just like it is now. I think it’s – the medical science, it doesn’t seem to be what’s driving things. It’s very much something else, political profit, perhaps. Yes, wait, so are you in touch with different brands? Did you say that?
JK: Yes, yes, we are. There are a few brands, mostly in the Pacific Northwest, but some around the country who we – we’ve met with or we’ve met through various industry events and we find that our values align, or they hear us talk about, we call it, products with purpose, but here’s talk about that. And they’re like, “Oh, we want our products to have purpose, right, which, by that, we just mean that they are informed by science and driven by data and make sense.
We see so many products that are just – it’s like all of the trendy things thrown in at once. And like that’s put on the market as like newest amazing product. And it’s like, “Well, wait, but what are you trying to help with? And like, those things aren’t going to work?” Like we call products with purpose things that are made with purpose. And so we have their various folks that we work with to help them make formulations that makes sense.
RS: Cool. Very cool. Well, Dr. Jessica, we’re going to be speaking in – next month at the webinar for people to understand how to, not just survive, but thrive in this cannabis industry. So I look forward to that. Anything that you want to leave listeners with before we go?
JK: Just that you can follow our work at our website, it’s doctorsknox.com, all spelled out, D-O-C-T-O-R-S-K-N-O-X.com. And you can follow us on Instagram @theknoxdocs. I’m @jessdocknox and my sister is @racheldocknox. So people want to keep up with what we’re doing in the various events we’re showing at that, those are good places to check that.
RS: Awesome, awesome. Thank you so much for coming on Dr. Jessica. You’ve brought us a wealth of information from a physician, a medical side. It’s been really fascinating, and I look forward to talking to you soon.
JK: Thank you so much.
RS: Thanks so much for listening to the Cannabis Investing Podcast. Subscriber follow us on Seeking Alpha, Libsyn, Apple Podcasts, Spotify, Google Play or Stitcher, and we’d really appreciate it. If you could leave us a review on Apple Podcast, it helps other investors find our show. If you have feedback or questions, we’d love to hear from you at [email protected] That’s [email protected] Thanks so much for listening. See you next time.