Since 2011, Dr. Rav Ivker has seen nearly 8,000 medical marijuana patients at his holistic medicine practice in Boulder. Over that same period, Ivker has been in steady contact with David Threlfall, owner of Denver dispensary Trill Evolutions and Boulder's Trill Alternatives, meeting regularly to exchange information gathered from MMJ patient feedback.
In September 2017, Ivker published a book called Cannabis for Chronic Pain, which detailed MMJ prescriptions for the treatment of various pain conditions. In addition to feedback from his own patients, Ivker credits Threlfall's patient data from his Trill dispensaries for aiding in his medical cannabis education. “They don’t teach this stuff in medical school,” Ivker explains.
Ivker and Threlfall met shortly after Ivker established his practice in Boulder. “It was probably that first year, 2011. I had patients who went [to Trill Alternatives], and then I went and visited myself," Ivker remembers. "And I was very impressed with the service that they were providing."
During a Westword visit to Trill Evolutions in north Denver, a customer was speaking with a budtender at the counter about CBD. Threlfall approached, asking the customer, a man in his sixties, a series of questions about why he wanted to purchase CBD products. “What are you dealing with?" Threlfall asked. "What are you taking now, anything? What are you looking to use cannabis for?”
Grabbing an armful of products and a piece of paper, Threlfall wrote as his client spoke about his bladder cancer and resulting chemotherapy treatment. After suggesting several combinations of CBD and THC products, Threlfall instructed the shopper to keep a diary and offered to put him in touch with another cancer patient who had gone through similar treatment. Trill budtenders are trained to take this meticulous approach also, but for clients seeking a full treatment plan, Threlfall will typically ask that they make an advance appointment for a “wellness consultation,” which he performs for free.
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Threlfall’s entrance into the cannabis industry was inspired in large part by his mother, whom he lost to lung cancer in 2005. Seeing her suffering, Threlfall encouraged her to try cannabis. Though she refused because the state she lived in, New Hampshire, didn't allow MMJ at the time, he retained his faith in the plant's medical potential and began learning all he could about it — and he hasn't stopped.
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Threlfall, who sees patients more frequently at his dispensary than the yearly meetings Ivker has with them, shares data he gathers from patient feedback about "specific conditions and what specific cannabis products work best for those conditions," he says. The feedback has helped Ivker learn of new products, consumption methods tailored to certain ailments, and how to relieve pain without psychoactive effects.
Ivker attributes his cannabis knowledge to a combination of feedback from his own patients and the information shared by Threlfall. “It’s a mutually beneficial relationship that we’ve had over the years. It’s quite educational, actually,” Ivker notes, adding that conversations about products such as cannabis-infused topicals and suppositories revealed even more medical products he could recommend for muscle aches or menstrual pain.
Their relationship highlights what has historically been an overlooked area in traditional training for medical professionals. Although doctors can recommend cannabis for medicinal use in states where it's legal, the majority of them learn from a combination of experience and outside research, like Ivker. The lack of training can hamper doctor-patient conversations about MMJ dosages, consumption methods and treatment schedules, leaving the daily specifics of medication to budtenders or patients themselves.
“Many budtenders are giving incorrect information about what to use, how to use it. This is a medicine. You need to know dosages, what products are best for your specific condition,” Ivker says. “The doctors and the budtenders should be better trained. I’m hoping that my book will serve in that capacity: to help train both industry workers and physicians."