The Guadagnino family opened Pennsylvania’s first medical marijuana dispensary, Keystone Canna Remedies, one year ago on Stefko Boulevard in Bethlehem.
The statewide program has grown more quickly than expected — nearly 90,000 patients have ID cards allowing access to cannabis medications. So it came as no surprise when, last week, KCR announced the location of a second dispensary on Hamilton Boulevard in the Dorneyville section of South Whitehall Township. It’s set to open in May, and the Guadagninos say they’re going to try to open a third location this year, too.
The Morning Call sat down with Victor Guadagnino Jr., director of business development, and Joan Guadagnino, director of operations, to discuss the evolution and future of the state medical marijuana program. Here are some excerpts from the conversation.
One year on, how has the reality of operating a dispensary measured up to your expectations?
Victor: When we were going into this, the expectation was just to make sure patients didn’t have a negative experience with cannabis. We wanted to set up a structure in which they could experiment with different doses safely and effectively. I would say that we learned a lot in the year about personalizing consultations based on the patient and customizing treatments depending on the disease state and symptoms. … We are primarily treating symptoms of qualifying conditions rather than the condition itself.
What are the most common symptoms you’re treating?
Victor: We can boil it down to three main symptoms: musculoskeletal pain and nerve pain, anxiety and depression, and sleep issues. Cannabis works as anti-inflammatory and a mood modulator. It fits really well into the regimen for treating daily symptoms related to chronic conditions, and we are seeing a lot of patients have success in reducing pain and drug load — especially opiates.
How do you work to frame new patients’ expectations?
Joan: Especially with patients who haven’t previously used cannabis, I think the key to the first visit is about establishing a comfort level. We want to have a conversation and answer whatever questions they have. Then they go home with a product or two, try it and return with some feedback.
Victor: New patients need to have patience. We don’t know what your sensitivity is, so we’re figuring out where you are having psychoactivity (or how much gets you uncomfortably high), and where you’re having alleviation of symptoms. The trick is getting the alleviation of symptoms without impeding cognitive functions. That’s the goal. It’s going to take trial and error to get there, and that’s what we’re here for. … I always tell patients, “Your second visit is going to be a lot better than your first.”
How do patients provide feedback on dosage and forms?
Victor: Some scrapbook it, and it helps us. At first patients will come in and say, “I like what I had last time, that was good, it really helped me.” OK, let’s quantify it. If it’s a vaporizer, how many inhales did you take, and what intervals? That’s going to give me a barometer of how much of an effect the cannabis had.
There are also cannabis patient diary apps. We are hoping we can partner with the Releaf app and link our menu so people can more accurately record their medications. That’s our project in 2019: More research and quantifying of the patient experience.
Joan: That, and open two more dispensaries. … Research is what everyone is interested in, so hopefully the [state Department of Health] will work with us. We encourage all our patients to get involved [with the journaling] but you need some tools to do that.
You submitted five applications to the state Medical Marijuana Advisory Board to add qualifying conditions, and the board approved applications to add anxiety and Tourette syndrome. Why take the initiative on this?
Victor: It’s great the regulations included an opportunity to add conditions. We looked at other states’ list of qualifying conditions and for recent research backing up the benefits of cannabis treatment. For something like anxiety, like we said, it’s already one of the main symptoms we’re treating, particularly in our patients with PTSD. … I think more physicians are coming around to understanding cannabis as a first-line therapy and not just a palliative or end-of-life treatment.
Pennsylvania was the first state to approve medical marijuana treatment for opioid-use disorder. How common is it for patients to come to you with opiate-related issues?
Victor: I would say 90 percent of our chronic pain patients say, “I want to come off my opiates,” “I want to reduce my opiates” or “I never want to go on opiates.” That was the biggest thing that we didn’t expect. … I’d like to see cannabis move into that arena a little bit more — as a replacement or tapering mechanism for chronic care management. We can’t advise in the opiate tapering because of the risk of withdrawal, but we can recommend patients consult with their physicians, and it’s just really encouraging to see them come in here and realize they have another option.
Any surprises in terms of which cannabis medications and forms are popular?
Victor: CBD is a lot bigger than I think a lot of growers suspected. THC is still the main driver medicinally, but we’re finding extracts that blend both THC and CBD are tremendously popular with cannabis-naive patients — ones who have never tried cannabis before — because CBD adds a buffer to the psychoactivity of THC. And the state grower-processors are getting much better at making these types of products.
Pennsylvania’s medical marijuana market has grown much quicker than other states’, such as New York and Illinois. What needs to happen for the program to continue to progress?