Medical marijuana physicians and patients have been able to conduct appointments virtually during the COVID-19 pandemic, but that could come to an end soon. Banned under state law, medical marijuana telemedicine has been allowed temporarily under an executive order issued by Governor Jared Polis — an order that state lawmakers declined to continue once the pandemic is over.
In May, members of the House Finance Committee killed a bill that would have made MMJ telemedicine permanent. So after the governor's executive order finally ends, medical marijuana patients will have to leave the house again. Polis hasn't said when he will stop extending this particular order, but it's expected to run out before fall.
While leaving home for a doctor visit may sound trivial to most of us, Dr. Peter Pryor says that his homebound, immunocompromised and disabled patients have benefited from conducting appointments without having to go to his office. We caught up with Pryor, a medical marijuana practitioner since 2014, to learn more about the ins and outs of a virtual MMJ recommendation.
Westword: How many of your appointments have shifted to a virtual platform since the executive orders were issued last March?
Dr. Peter Pryor: 100 percent, between 3,000 and 4,000 patients a year.
How are the telemedicine visits conducted?
First-time appointments are held by video conference, if at all possible. I speak with many patients who have a land line and do not have access to video-conference platforms. After the initial visit, it is the option of the patient to video-conference. Most of my patients prefer the ease of meeting over the phone.
How have the appointments and consultations changed since going from in-person to virtual?
The United States health-care system is leaving more and more people behind. Lack of insurance and distrust of the medical community after the opioid epidemic and medications that don’t work and are addictive have pushed more people toward medical marijuana. I find it surprising how little it has changed using telemedicine as compared with in-office visits. Most of the patients I see have a chronic, debilitating disease, where the disease stays with you and doesn’t necessarily get better. A broken back at twenty years old does not usually improve over time in terms of pain. Surgeries and other invasive treatments may improve pain for a time, but the pain returns, and the procedures can be painful and expensive even if you have insurance.
In Colorado, medical marijuana can only be recommended by health-care providers for pain, HIV, cancer, seizures, glaucoma, nausea, muscle spasms, autism or PTSD. None of these conditions requires any visual cues. First-time patients are seen by me by video, and returning patient by phone or video. An example from today: A person with PTSD from combat and pain from trauma. What benefit is there to see that patient face-to-face versus a video or telephone call? I can’t visualize his pain or his mental pain. In my experience, the in-person versus telemedicine consultations are equally beneficial.
Since the pandemic and the economic crisis, many more people are coming to me to try medical marijuana to try to get rid of or avoid starting a prescribed medication such as Percocet, oxycodone, gabapentin, methocarbamol, Vicodin, benzodiazepines, sleeping meds, anxiety meds or antidepressants. Gabapentin or benzodiazepines may be the next opioid epidemic. Getting rid of telemedicine for medical marijuana patients is a barrier to treatment — a barrier to health care.
Do you think there's still a need for telemedicine when the pandemic is considered over?
I find it surprising how we are all congratulating ourselves on beating COVID. I hope that we will beat COVID, but just because we hope something doesn’t make it true. Most of my patients have told me how wonderful these appointments are, and I feel the same way. Immunocompromised patients make up more than 50 percent of my patient population. [As of April 26], Centers for Disease Control and Prevention data shows more than 9,245 breakthrough cases of COVID, meaning the patient had been fully vaccinated and still got the disease.
Mutations are happening on a daily basis. How can we not learn from our experience that these offices are little Petri dishes, where every patient who gets COVID in the future may be the source of a more contagious variant or one that could jump the vaccine? My motto during this pandemic is to plan for the worst and hope for the best. We seem to be planning for the best and not even thinking about the worst. I fear we are moving too fast to get back to a normal that may be gone forever instead of creating a new normal.
More than one of our patients is paraplegic, and if telemedicine goes away, they will again be forced to take public transportation to make this appointment every year, which seems like another barrier to treatment. Outside of the pandemic, many of our patients suffer from PTSD and have great fear of getting out of their comfort zone. Cities and offices can be a barrier to treatment for many people who find even a video conference too much to overcome.
Many patients don’t have a car and are grateful they don’t have to endure the expense and time for public transportation. My patients come from all over Colorado. It's over four hours to drive one way for many patients to get to see me. What possible benefit is there to force someone to drive four hours each way to see me for a twenty-minute appointment? I believe that humans are contributing to and causing global climate change. Having my patients and my staff get back into their cars when we have found a great alternative simply makes no sense.
Were you surprised that the legislature declined to make telemedicine permanent for medical marijuana?
Yes and no. Yes, because it seems to be such a good thing for medical marijuana, and no, because it seems like such a good thing for medical marijuana. [Telemedicine is] good for the patients, environment and health-care workers who don’t need to be “front-line.” I was not surprised, because again and again, legislators and the people who still believe marijuana is the “devil’s lettuce” will vilify medical marijuana without evidence.
I have heard no stories of anything negative about telemedicine in conjunction with medical marijuana. Taking telemedicine away from us at this point is just another barrier to treatment. The three best things that have happened to medical marijuana since its inception have been moving the application process from paper to online, finding banking that allows us to use credit cards, and telemedicine. Taking this away from us while allowing the little blue pill to be prescribed by telemedicine is just another barrier to treatment.
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