Education is key in the world of cannabis. Yet, as essential as it is, it’s one of the trickiest issues patients will encounter — a lack of physicians with the cannabis expertise to offer knowledge, education and healing. But take heart, Nevada is fortunate enough to have a few working in different roles in the medical cannabis industry who are a great resource for those patients in search of guidance. They not only share an expertise of cannabis, but also an open-minded compassion for healing and understanding “first, do no harm” in the truest sense.
THE HEALER – DR. SEAN DEVLIN
by Beth Schwartz
Meet the unicorn of medical cannabis in Nevada – Dr. Sean Devlin of Reno-based Washoe Wellness. The board-certified family physician is somewhat of a rarified creature in the world of cannabis care. Not only is he supremely educated with board certifications and fellowships in Anti-Aging and Regenerative medicine, a master’s degree in Biochemistry and doctoral studies in Pharmacology, but he has been treating patients with cannabis since Nevada voters legalized it in 2000.
“Back then it was very primitive, it was like if you’re going to smoke it, vaporize it or consume it through inhaling, then you basically had to take metered doses of it via inhaling, so you would have one hit, wait five or 10 minutes, and see if you were having an effect and then take a second one,” explains Dr. Devlin. “Of course, now the world has changed and we have almost pharmaceutical-grade cannabis and, in many cases, are actually able to give milligram dose recommendations to patients for whatever is ailing them along with combinations of different cannabinoids and, ultimately, we are going to recommend a hybrid versus sativa versus indica. We can kind of sculpt a patient’s therapy around different symptoms and what they are looking for as far as either relief or treatment goes. It’s a lot better now than it was 15 or 16 years ago.”
Dr. Devlin was in the second year of his residency at University of Nevada, Reno when voters passed Question 9, amending the state constitution to sanction medical cannabis. Patients would ask him about it and he “would write recommendations because I had researched it, was familiar with it, and believed in it,” he explains. “Specifically under Nevada statutes, the law allows for licensed physicians to make a recommendation in good faith after they complete a full history and physical, and have counseled the patients about the good, the bad and the ugly associated with using cannabis.”
Both an owner and lead physician at Washoe Wellness, Dr. Devlin became “known in Northern Nevada as somebody who is not only competent, well researched and credentialed, but somebody who is open to recommending cannabis for patients with cancer because I was primarily using it to treat cancer patients as an antineoplastic and the word got out and doctors in the area would refer patients to me,” he explains. “I have seen a multitude of benefits from this one agent that I have not seen in any agent before. You have anti-nausea effects, a pro appetite effect, a bone stimulating effect, an immune modulating effect, antineoplastic effect, an antianxiety effect, an antispasmodic effect, it’s also anti-inflammatory — and for cancer patients with advanced stages of disease it’s a no-brainer. Globally they need to be on a combination of cannabinoids: CBD, THC, THC-A.”
In addition to treating patients with advanced stage cancers who have run out of options, Dr. Devlin’s other specialties are pain management and Lyme disease. “Yesterday I saw five patients and all except one had Stage 4 cancer and the last one had a severe seizure disorder,” he notes. “These folks are not dreadlocked 21-year-olds who are traveling with the Rainbow Troop. These are legitimate patients and I think the public doesn’t really understand that. They get a view of this as basically being this hippy-dippy, drum circle kind of collective and that medical marijuana is what they do, and that’s a great falsehood that’s been foisted on the public through the media.”
Doing his part to correct that falsehood, Dr. Devlin and his partners decided to bring a game-changer to the world of cannabis, creating “a very strong academic, scientifically-based program which would support a cultivation company, an extracts company, a dispensary, and eventually a clinic — and all of those things fell into line over the last two-and-a-half years,” he explains of Tahoe Regional Botanicals, Tahoe Regional Extracts, Canopy Reno, and Washoe Wellness.
Naturally, Washoe Wellness, which opened earlier this year, is the only one of its kind in Nevada — just like the state’s other unicorn in the cannabis care space.
THE RESEARCHER – DR. NICK SPIRTOS
by Lissa Townsend Rodgers
The Apothecary Shoppe is a bit different than other Las Vegas dispensaries. First, there’s the look of the place: Rather than the standard white box or spa waiting room, it looks like an old-time library or doctor’s office. But what really sets it apart is the team behind the glass cases (and what’s in them).
“A group of five of us docs said, ‘Let’s do this,’” explains Dr. Nick Spirtos, one of the doctors who created the Apothecary Shoppe. “We have three GYNs, an internist/pulmonologist, and an anesthesiologist. It’s a diverse group of doctors that’s used to taking care of patients with pain and other debilitating issues.”
In his fourth decade practicing medicine, Spirtos’ specialty is gynecologic oncology—a field whose complexity appealed to him. “The world of cancer was always going to be evolving,” he says. “There was never going to be the issue of boredom. Then there was the surgical aspect: My dad was a surgeon, I loved going to the E.R. But the oncological aspect and the challenge of moving the needle in that field—the genetics, the computer world has changed our ability to look at individual genes now. There’s always something going on.”
Dr. Spirtos’ enthusiasm for new methods of treating patients includes cannabis. “I grew up in Southern California during the ‘60s,” he laughs, “So although I never used any stuff like that, I certainly had an awareness of it.”
That awareness and openness served his patients well later: “You watch enough patients who abandon their treatment because of side effects—you start looking for other answers for them,” he says, “It was clear, anecdotally, that patients who could not have their symptoms relieved by standard available medications were responding to cannabis in a variety of forms.”
To that end, the Apothecary Shoppe is conducting a series of medical trials to study the effects of cannabis on chemotherapy patients. “It’s placebo-controlled—half the patients get a syrup with no THC or CBD. The other half will get the medicated syrup,” Spirtos explains, “After they’re treated, we compare it to their baseline, their first cycle of chemotherapy and their responses, their nausea and vomiting based on that first cycle.”
The ability to conduct these studies and others like them was a motivating factor in opening the Apothecary Shoppe. The doctors involved see the dispensary less as a way to make money than as a way to make change in patients’ lives, not only through dispensing medicine, but through researching it. Spirtos explains, “We wanted to know that if we wanted our studies done, that would be a priority. If we had to choose between using oil in a syrup for our studies versus oil in a vape pen to sell—those are some of the choices you make.”
Spirtos says the study will take a year to complete, but the timeframe also depends on how fast patients can get their medical marijuana cards—a problem many Nevada cardholders are familiar with—which are required to participate in the study.
While Spirtos appreciates the Silver State’s rigorous licensing as compared to California’s laissez-faire attitude—“the state has tried very hard to do this properly, they want it regulated, they want the quality”—he notes that such thoroughness carries problems. “Imagine you see a patient who’s vomiting their guts out, who can’t handle their chemotherapy. But you can’t get them a Nevada card for eight weeks, 10 weeks, 12 weeks. That’s three-quarters of the way through their chemotherapy.”
Even though the study is still underway, patients undergoing chemotherapy can get access to the syrup he is testing now as the Apothecary Shoppe sells it under the name Soothing Remedies medicated syrup.
Despite the delays, Dr. Spirtos is still happy to see patients who need medicine finally getting it—and other doctors increasingly willing to give it to them. “There’s a generalized acceptance that there’s a benefit,” he says. And Dr. Nick Spirtos and the Apothecary Shoppe will continue researching—and offering—those benefits for as long as patients need them.
THE EDUCATOR – DR. WILLIAM TROUTT
By Beth Schwartz
“Cannabis is not a one-size-fits-all medicine,” explains Dr. William Troutt, a licensed Naturopathic physician who specializes in cannabis-based medicine. “It’s very individualized to the patient who is using it.”
That’s why he believes dosing is one of the most important things a patient needs to understand when using cannabis. “How they start dosing is very important, especially as far as the experience they are going to get from it. We educate patients on conservative dosing or safe dosing strategies,” says Dr. Troutt, who is the Director of Medical Education for Las Vegas dispensary, The+Source.
“However,” he cautions, “we are not their treating physician so we can’t tell them what to specifically take. But, we can educate them on strategies they can use to most conservatively find the best dose that works for them.”
Another tenet Dr. Troutt espouses during the new patient orientation he teaches at The+Source each month is that cannabis’ psychoactive effect is not for everybody. “There are some people who just do not do well with it. People who have never used cannabis before typically are a lot more affected by that psychoactive effect than someone who is a regular user of it. So we educate them on THC and how they can use that as an indicator of the psychoactive potency of the medicine and understand which medicines may have more THC.”
Dr. Troutt, who also provides medical direction for five dispensaries in Arizona, has been educating patients on dosing and offering guidance on cannabis since 2010 when the Medical Marijuana Act passed in Arizona. “For the last six years, I have been exclusively working with cannabis patients and dispensaries, which allowed many of the patients and the physicians to come out of the closet.
“When I first started practicing medicine in 2004, I had many patients who were using cannabis medically but they just couldn’t talk about it then, obviously, because of the politics of it and the law. But as a naturopath who was open to that, they would share that with me and I would take that into consideration for their full treatment plan,” says Dr. Troutt, who is a member of the Society of Cannabis Clinicians.
And that is one of the major challenges with regard to patient education, according to Dr. Troutt. “I hate to say it, but that is still taking place now — patients don’t want to talk to their primary care physicians or the specialists they are seeing about their medical cannabis use because they are afraid they are either going to get kicked out of their practice or the physician is going to have biases against them. That is still the biggest problem we are facing — patients are scared to have that dialogue.”
Although patients might not feel comfortable talking to their primary care physicians, they can feel at ease speaking with Dr. Troutt in his role at The+Source. He notes that, “The+Source really does care about this being a medical program and putting patients first and absolutely provides great educational resources so the patients can get the best benefit out of this medicine.”