Medical marijuana: uses and legitimacy | Local News

Brett Johnson, a physician assistant (PA) who certifies medical marijuana to patients, invited the Black Hills Pioneer into his medical cannabis clinic, High Pines Medical Marijuana Clinic, in Deadwood.

Johnson was born in McLaughlin, on the Standing Rock Reservation, and is a member of the tribe. After working on the family ranch and a variety of other jobs, he began pursuing a medical degree.

He received his bachelor’s degree in radiology technology from Presentation College in 2007, and he worked in radiology for about seven years in Spearfish. Later, Johnson went to the University of North Dakota, graduating in 2016 with a master’s degree in physician assistant studies.

After becoming a PA, Johnson worked in primary care and emergency medicine, and in July 2021, following the state’s decision to give physician assistants the ability to certify medical marijuana to patients, Johnson decided to open his first clinic, officially opening on Aug. 1, 2022.

He now has four locations – one in Deadwood, one in Mobridge, and two in Rapid City.

He said that he got into the business because, “it’s a legitimate medicine.”

“It fills the gaps that some medicines don’t reach. It’s less dangerous than other medicines, and it works,” said Johnson.

Marijuana used to be a legitimate medicine for over-the-counter purchase in America, he said.

“Cannabis was widely utilized as a patent medicine during the 19th and early 20th centuries,” reported the National Library of Medicine. “Federal restriction of cannabis use and cannabis sale first occurred in 1937 with the passage of the Marihuana Tax Act.”

Beyond America’s history with the drug, the plant’s medicinal uses have been traced back to around 400 AD, according to the National Library of Medicine; however, author Robert Deitch said it can be traced back to Chinese Emperor Fu His in 2900 BC.

Johnson discussed the various ailments that cannabis can treat.

“Your body is endowed with a whole cannabinoid system. We have receptors for cannabinoids (the main active component in cannabis),” he said. “Some cannabinoids kill cancer cells and inhibit tumor cell growth.”

According to the National Cancer Institute, clinical trials on medicinal cannabis are limited because the drug remains federally illegal; However, the American Cancer Society backs Johnson’s claims.

“More recently, scientists reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer,” the American Cancer Society reported.

It also warns cancer patients to not rely on marijuana alone for treatment and to not delay conventional medical care for cancer.

Additionally, the organization says that marijuana can help cancer patients improve food intake, reduce pain caused by nerve damage, and reduce nausea caused by chemotherapy.

Currently, South Dakota has approved six chronic and debilitating conditions that a doctor like Johnson can certify patients for, including many of the common side effects that cancer patients experience due to chemotherapy.

“(The conditions include) a chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe, debilitating pain; severe nausea; seizures; or severe and persistent muscle spasms, including those characteristics of multiple sclerosis,” said Tate Kieran, the communications director at the South Dakota Department of Health.

“It was a great starting point, because it’s all brand new in the state and people are sifting through the gray to try and figure out what is right and what is wrong,” Johnson said.

Senate Bill 1, which is currently being debated at the state legislature, would add several more conditions, including immune deficiency syndrome or human immunodeficiency virus, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Crohn’s disease, glaucoma, and post traumatic stress disorder (PTSD).

“I’m glad they included chronic pain (on the list of certifiable ailments). Who doesn’t have chronic pain? It (marijuana) is a great treatment for chronic pain that’s backed by science,” said Johnson.

According to a 2017 peer review published in the National Library of Medicine, 11.2% of adults in the United States are impacted by chronic pain, and around 4% of those adults receive long-term opioid therapy.

“This translates to around 100 million Americans. Long-term opioid therapy is associated with a number of risks, including opioid use disorder, overdose, and death,” the review said.

The Center for Disease Control and Prevention (CDC) reported 80,816 opioid overdose deaths in 2021 alone.

In comparison, Johnson claims that marijuana has little risk factor.

“If you look at the toxicity level in marijuana, there is none. There have been no reported deaths for medical marijuana. Now, look at that compared to opioids, your anxiety medicines, your steroids. It (marijuana) is a great alternative therapy.”

The claim that there have been no reported deaths for marijuana cannot be proven nor disproven, as the CDC does not have any data on it.

Similarly, a 2017 peer review in the National Library of Medicine reported that there were no good or fair-quality systematic reviews that reported on the association between cannabis use and overdose injuries and death.

While cannabis fatality reports are not kept, that does not necessarily mean that there have been no instances.

Another review in the National Library for Medicine, last updated in August 2022, reported that toxicity in un-common in non-pediatric patients. However, adults who seek medical attention for marijuana toxicity typically exhibit behavioral problems, bronchospasms from inhalation, and hyperemesis.

Toxicity can also result in cannabis-induced tachycardia and postural hypotension. Additionally, acute psychosis and short-term exacerbations of pre-existing psychotic diseases like schizophrenia reports have been made.

The greatest problem found with toxicity and cannabis can be found in accidental oral cannabis intake from children.

“The most common overdose incidents in children occur when the drug has been combined with food in an ‘edible’ form of marijuana,” reported the Children’s Hospital Colorado. “This is because marijuana ingested in this manner can have a stronger and prolonged effect, especially in children under the age of 12 years old.”

“In these instances, kids mistake ‘edible’ marijuana (like gummy bears, brownies, lollipops, etc.) for regular food and eat it unknowingly,” said the hospital’s website. “Small children are at higher risk based on their size and weight. Because edible products have very high amounts of marijuana, the symptoms are more severe on a small child. Many young children who consume marijuana edibles require hospital admission due to the severity of their symptoms.”

According to the National Library for Medicine, children who ingest oral doses of five to 300 milligrams of THC can have more severe symptoms including hypotension, panic, anxiety, myoclonic jerking/hyperkinesis, delirium, respiratory depression, and ataxia.

“Packaging in a kid friendly manner sends the wrong message,” said Johnson.

In his opinion, manufacturers and parents are responsible for keeping children safe by making child-safe packaging and storing the medicine out of reach of children.

Johnson also claimed that marijuana is not addictive.

“You can’t become addicted to it,” he said. “The research studies show that there are no habit-forming properties to it. Without it you don’t suffer withdrawals. It’s good therapy.”

However, this claim isn’t cut and dry.

The National Institute on Drug Abuse reports that there can be mild withdrawal symptoms after discontinuing use of cannabis.

“People who use marijuana frequently (and quit) often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort that peak within the first week after quitting and last up to 2 weeks,” the institute reported.

Similarly, the CDC says that people who use cannabis have a 10% likelihood of becoming addicted, and this risk of developing a use disorder increases if the person started using cannabis in their youth or adolescence.

A use disorder describes the misuse of a substance, with addiction being the most severe degree of a use disorder.

“About 4 million Americans meet the diagnostic criteria for a marijuana use disorder, meaning that due to their marijuana use they suffer from difficulties with health or the ability to meet responsibilities,” reported a 2018 study by the Yale School of Medicine.

In comparison, over 14 million American adults suffered from alcohol use disorder in 2018, and 414,000 children between the ages 12 and 17 had an alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism.

Moreover, the CDC reports that 1 in 3 adults are excessive drinkers, and 10.2% of excessive drinkers are dependent on alcohol.

For prescription pain medications, the American Medical Association estimates that 3% to 19% of people who take them develop an addiction.

For teens that use marijuana, the risk of developing a use disorder isn’t the only negative effect. Others can include difficulty thinking and problem-solving, problems with memory and learning, reduced coordination, difficulty maintaining attention, and problems with school and social life, according to the CDC.

“The teen brain is actively developing and continues to develop until around age 25. Marijuana use during adolescence and young adulthood may harm the developing brain,” the CDC reported.

Getting a medical marijuana card

In South Dakota, the parents of children with certifiable medical conditions can become a medical marijuana caregiver and administer the drug to their child. The parents must first undergo a background check and be free of felonies.

This treatment is most common for children with seizure disorders; however Johnson himself has not seen any pediatric patients.

In South Dakota, cardholders can be as young as 18 years old, and Johnson said an 18-year-old is the youngest person he has certified.

“50-, 60-, and 70-year-olds are the most common patients. My patients are predominantly middle-aged women,” said Johnson. “I see patients for chronic pain, but I also see a lot of cancer patients, MS patients, and some seizure patients.”

“The vast majority have been long-time users. They do it because it works,” he added. “Some people have been looking forward to this (the legalization of medical marijuana) for 40 or 50 years. People have been self-treating with it for decades.”

Regardless of whether his patient has used marijuana before, Johnson always gives a thorough exam.

“I ask them questions and do a consultation about their medical history. I can do a physical exam and look for scars and things, and I check their charts,” he said.

Medical records are the best tool used to sniff out suspicious patients who might not need the medication.

“There are a few (patients) that I have turned away. I need to see records and documentation before we proceed,” he explained.

“I have a very low percentage of denials,” said Johnson. “If they have a condition that warrants it, then of course I will certify them.”

Johnson said that one group he would not certify is pregnant women. A bill is at legislature that would prohibit pregnant women from receiving certification.

“Science hasn’t backed it yet,” he said. “I am not here to cause harm. I am here to help. I wouldn’t prescribe opioids or anything like (to pregnant women) that either.”

After he has agreed to certify a patient, Johnson does the rest of the paperwork with his patient in the doctor’s office.

“I certify you (the patient) with the department of health, and your card will show up in your mailbox. Some people aren’t computer savvy, some have flip phones, so I do it all for them before they leave the door,” Johnson said.

Kieren said the department of health reviews that paperwork within 15 days, and a medical marijuana card is mailed to the cardholder’s home.

At that point, the patient is able to go to a dispensary to get their medicine.

Johnson and his patients also explore different treatment options together, which include tinctures, edibles, smokeable flower and THC vapes, and even topicals, which do not give patients the high.

“Tinctures are a little faster (at delivering the medicine’s effects) opposed to digestion (with edibles). Smoking is the fastest way to get effects. Topicals just get rubbed in and work pretty quick,” Johnson said.

“I tell patients to find a dispensary they like so that they know what they have to offer and can keep the treatment the same. We want consistency,” he said.

He explained that his clinic is just like any other clinic. He wants his patients to be able to come back or call and ask questions if they feel like their treatment plan isn’t working.

“People need to be able to call their provider with questions,” he said. “Some of these people have never used it (marijuana) before, and I want them to come back and chat about all of this.”

For those patients who have not used cannabis before, Johnson said that he often suggests half of an edible (about 5 mg of THC) before they go to bed. However, some of his more experienced patients already know what works best for their condition.

“Some have been smoking every day for 50 years, they know what they like to use and how much,” he said.

The third part of this series, which explores the implications of medical marijuana on law enforcement, will be in Wednesday’s Black Hills Pioneer.

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