Doctor Assisting Qualified Arkansans To Get Marijuana Offers His Advice And Concerns

May 13, 2019

Dr. Brian Nichol of North Little Rock offers medical marijuana consultation for people interested in seeing if they qualify for a registry ID card through the state.
Credit Michael Hibblen / KUAR News

Arkansas’s second medical marijuana dispensary opened one day earlier than expected. Green Springs Medical in Hot Springs began selling to people Sunday at about 4:15 p.m., according to KTHV-TV. It follows the opening Friday evening of Doctor’s Orders RX, which is also in Hot Springs. A steady stream of people lined up at the first dispensary through the weekend wanting to be among the first to get the drug.

Nearly 11,000 people currently have the needed registry cards from the Arkansas Department of Health. A doctor must sign a certification document that someone has a qualifying condition. Dr. Brian Nichol of North Little Rock began practicing chronic pain management and anesthesia in 1995. He soon found through drug testing of patients that many were using marijuana.

"I started asking my patients about the THC and almost all of them said they received some improvement in their symptoms. So I’ve essentially been looking the other way a little bit over the last 20 years," Nichol said. He eventually saw the benefits that certain types of marijuana had on patients with certain conditions, and began recommending its use.

"It’s really over the last 10 or 15 [years] to where I’ve really started using it as medication in my patients as their access to black market cannabis fortunately had improved and I was more able to pick strains. I noticed that when you spend some time dialing in the cannabis with their other medications as far as strain, route of administration and with [what] the individuals’ diagnosis is," Nichol said. "It helps [turn] a little bit of improvement into really marked improvements in their symptoms."

As Arkansas was working to implement the medical marijuana program, which voters approved in November 2016, Dr. Nichol began specializing in marijuana consultation. For $200, which is not covered by insurance, he talks with patients, performs an evaluation, and if the person has a qualifying condition, Nichol will sign a certification for the state health department to provide a medical marijuana registry ID card. When a patient needs to get the card renewed a year later, Nichol charges $100, since the person is already in his computer system.

Once a patient has a registry card, the person can get the drug at a dispensary, but Nichol says that’s when confusion can come in.

"It’s illegal for a doctor to actually issue a prescription. I give my patients more of a shopping list, shall we say," Nichol said. That list includes what kinds of marijuana he recommends his patients buy.

"Different strains are entirely different. Most people will think of medical cannabis as a single entity. The weakest link in the chain is going from getting your medical cannabis card that entitles you to purchase medical marijuana in the state, to actually using it appropriately. It’s the education phase in the middle that is a little bit weak," Nichol said.

He says there is a "staggering" amount of misinformation about medical marijuana, especially online. According to Nichol, a lot of it is wrong, while some is "clever marketing" for related products. If a patient doesn’t get information from their doctor, he said they are reliant on the expertise of people at dispensaries.

"The problem as I see it, is getting good advice. My experience with people in Colorado [where marijuana is legal for recreational use], the 'budtenders' as they call them – I hate that word – but they call them budtenders at the stores, there’s a lot of varied ability," Nichol said. "Some people actually are very experienced and know what they’re doing. The vast majority of them, not so much, they’re pretty much salesmen at a store."

One primary care physician with a major hospital chain in central Arkansas, who did not want to be identified, said he is limited to simply signing off that a patient has one of the qualifying medical conditions. That’s enough for the person to then get a registry card from the health department and buy the drug. The doctor said, per hospital policy, that he is not allowed to weigh in on what kind of marijuana to buy or how to use it. The only thing he encourages is that it not be smoked because of the health risks that come from smoking anything. He advises that people consume edibles.

However, Dr. Nichol says if people are not used to marijuana, he advises them to smoke or vaporize the drug because it’s faster acting and can be easier to determine the strain that best suits their conditions.

"When you administer cannabis through an inhalation route, you get almost immediate results from that. It hits the bloodstream and is working within 60 to 90 seconds, so it’s easy to kind of figure out what kind of a response you’re going to have to a particular strain you’re finding. It’s also easier to titrate the dose so that they don’t get too much," Nichol said.

Once people have gotten used to the drug, he said it can be more beneficial when orally administered because the cannabis is more potent and has a longer-lasting effect, which is ideal for treating people with long-term pain. Nichol said that can also be cheaper in the long run. He also warns that there is also a risk.

"It’s very easy to over serve yourself with orals," Nichol said. "I think orals do have a use but not for the people when they’re just coming out of the gate because they’re going to likely have a bad experience and never really want to give it a good shot again."

Nichol said most of his patients are over the age of 45 and many had traditionally been opposed to the use of marijuana for anything. But in trying to find treatments for various medical conditions, he says some have been willing to give it a shot. And with Arkansas at this stage of implementing its medical marijuana program, he believes there will be others.

"I do expect more people to be looking for the recommendations. I think a lot of people have been waiting until the dispensaries were opening," Nichol said.