Episode Transcript

Trevor: Kirk, we're back.

Kirk: How's it going, Trevor.

Trevor: Good.

Kirk: What did you think about the virtual pharmacy?

Trevor: And I will probably say this a couple more times after we come out and people know what I'm talking about I think I want to work for them.

Kirk: Yeah,.

Trevor: Like yeah like and I'll I'll try to keep this brief because we want to hear their story, but they are solving problems I'm seeing today. Like literally within the last month two or three times I've had doctors and I'm not pooping on the doctors. Just this is what I've seen. I've seeing doctors refer patients, like literally write down on a prescription or write down a piece of paper, you know, go to the rec store and ask for X, which is... It's not ideal. We've discussed before how that's not idea, but rather than just saying why the doctors do something different, I know I personally have then sat down with the patient, physically called one of the local stores, looked up on their website, see what they have. Usually I'm looking for like a high CBD, low THC, like 20 to one mix, and if they've got it, I'll say, you know, Mrs. X is coming down to... Get this you have it in stock you put it aside for and the bud tenders have been really good so and then you know i write up a little plan for Mrs. Smith about you know okay here's how you want to dose it here's how we're going to slowly increase it because for better or worse our i won't say our local docs aren't interested but it's not high not something they know a whole lot about and like I even had again i'm not picking on them but I had one younger doc who she was interested, which is good. I don't think she understood that she could write a prescription and have it sent directly to the patient and there's a whole bunch of things about that system which is inconvenient as all snot like the patient then has to be able to go, even when you do it properly through the medical system, the patient has to able to basically all the doc does is give you permission to go onto LP's website. And order it like you order something off of Amazon which you know for most people is fine but as as our our our fantastic entrepreneurs are about to talk about the people who are interested in medical cannabis skew older and some of them honestly are not that computer literate and ordering something online is not something they're either comfortable with, or even capable of. So... Anyway, I don't wanna steal too much of the thunder, but what they've got set up here is fantastic.

Kirk: I'm sitting here with a huge smile on my face because, Trevor, we haven't even introduced the episode yet. This must have really triggered something in you. Should we at least introduce the episode?

Trevor: Yes, Kirk. So once you talk to a couple entrepreneurs, Kirk, tell us a little bit more about them.

Kirk: Yes, I did. Once upon a time, there was a pharmacist in Ontario that went and talked to a rec store operator and said, hey, I'd like to provide you a service that you pretty much just talked about. Why don't we just jump into the episode? And you're right, they're entrepreneurs, they've found a niche and...

Trevor: They found a big problem and solved it. They are doing a good thing.

Kirk: Let's let's go into it and we'll come out and maybe I'll let you rant some more

Lisa Bigioni: My name is Lisa Bigioni and I'm the owner of Stok'd Cannabis. We have four retail stores in Ontario, three in East Toronto and one in Niagara Falls.

Kirk: And you have a pretty unique business like I was looking on your web page. Your whole business is to make it camp like. You walk into your store and it's back country, woodsy, is that sort of the motif?

Lisa Bigioni: Yeah, that's our brand. Our brand, when we were figuring out what we wanted to be, we determined we wanted to be welcoming, inviting, non-intimidating. And to us, that kind of meant Canadian and what it means to be kind of hanging around a campsite or a cottage up north in Northern Ontario or any province, in fact. So yeah, so we built our brand around a kind of chill, relaxed vibe.

Kirk: Well, that's cool. And I have spent time paddling in Northern Ontario, so I get the vibe. There you go. I get it. And Anushya, please introduce yourself.

Anushya Vijayaraghevan: Yeah, my name is Anusha. I am a pharmacist based here in Toronto, Ontario, graduated from the University of Toronto back in 2018. My business partner and I, Ajay Chahal and myself, graduated in the same class and graduated in 2018 was, you know, the same year that cannabis was becoming legalized. And we said, hey, pharmacists don't really know anything about cannabis. There's nothing in the curriculum. We're gonna have patients coming into our pharmacies asking questions, how do we handle this? So we kind of understood it from a physician's perspective in terms of how they were prescribing medical cannabis and then looked at it from our pharmacist perspective, what do we need to know, especially when it comes to drug interactions. If someone is coming into a store saying, hey, I'm on cannabis, but I'm also on these prescription medications. Are there any interactions? What do I need to be conservative? Are there any side effects? So on and so forth, is it safe for me? And so we kind of dove into the literature, understood everything that we need to know as pharmacists and started our company Apothecare. So Apothecare was founded back in 2018 and it has been growing. Initially it was an educational service to pharmacists, specifically in the whole health pharmacy banner. Uh where we were educating pharmacists um on how to be doing these types of consultations for patients um and what we found in a busy pharmacy setting is that you know there's no time um in a you know when you're having someone that's never been on cannabis before especially if they're elderly you do need at least 30 to 45 minutes to have a really like thorough conversation to to educate them. And that in a busy pharmacy setting, there's just no time. And so we said, you know what, let's just go direct to consumers in terms of our services and offer these consultations ourselves. So our target market is essentially Canadians that are walking into retail cannabis stores, so legal cannabis stores. They're asking about using cannabis for health and wellness. And those are the consumers that we are speaking to. Those walking into the retail stores. So there is the medical cannabis route. You know, a lot of patients are finding it very difficult to be going down that route, especially the elderly population. It's very convoluted for them. They get very confused. They want something simple and easy and that's why our services are there. We find that it's better for them to be speaking to a healthcare professional rather than just going into a store. You know, asking a budtender, budtender not being able to give medical advice and them being left in limbo or them, you know purchasing a product not knowing if there is a drug interaction and something harmful happening. And that's kind of where our services fit in. And we've just recently partnered with Stok'd.

Kirk: Fantastic summary. A couple things. Are you a brick and mortar store now or are you and your partner working in the cloud or are your a brick-and-mortar store?

Anushya Vijayaraghevan: So we're completely virtual. So our services are offered across Canada. So everything is virtual. So either through video consultation or phone consultation. And depending on where they are in Canada, if we have partners, for example, if we had someone from the Scarborough area and they've been referred from Stoked, we would take on those patients and do that consultation virtually. We would bring them back to store level to get them to fulfill the product sale at that specific store. We work with retailers where we're looking at their menu, understanding what they actually carry in store so that we're able to make a recommendation for a product that they can literally purchase right after the consultation. So we try to make it quite seamless for them.

Kirk: Okay, so you're not two people in lab coats sitting behind a counter with a whole bunch of meds in the back.

Anushya Vijayaraghevan: Well, Ajay and myself, we do own two whole health pharmacies in downtown Toronto, so we do operate two pharmacies. So we do that along with building Apothecare, but yeah, we're not in the pharmacy doing these consultations yet.

Kirk: Okay, so Apothecare is a virtual service.

Anushya Vijayaraghevan: Virtual service.

Kirk: Okay and I guess Lisa, so this is a mutual exclusive relationship you have with each other or can you go and get other consults from across Canada or how does it work, how does the relationship work?

Lisa Bigioni: Well, as far as I know, Apothecare is the only organization that's offering these kinds of consultations for cannabis customers. And the challenge that we have, and I think that all retailers have across Canada is that the regulations prohibit us from giving medical advice, which completely makes sense because we are certainly not medical practitioners in our stores. Our budtenders don't know anything about the medical side of cannabis. And we've been in this, there's been a gap because while we aren't able to answer the questions, there's certainly customers coming in on the daily asking us about cannabis use for sleep, for pain management, for anxiety, for appetite related to drugs that they may be on for other medical conditions. And so there's there's this gap and we struggle and our budtenders struggle with how to address those kinds of questions. We always have to say, well, we actually can't. Please go back to your doctor. Please approach a medical clinic, a medical cannabis clinic. But this partnership with Apothecare, which we're really, really excited about, gives us a definitive avenue, a phone number for our customers to call and get the answers that they need. And it alleviates any compliance concerns that we have related to the Health Canada regulations.

Kirk: This is fascinating to me. Trevor and I often talk about this. There's so many avenues and so many paths I want to take this conversation. So let's start first with the legalization of cannabis and the responsibility of pharmacists. Now in Manitoba, the College of Pharmacists have pretty much told their members to stay away from cannabis as medicine. They pretty much have said that it's not the job of the pharmacist to look at cannabis as medicine. Is it different in Ontario?

Anushya Vijayaraghevan: So in Ontario, when cannabis became legalized, the Ontario College of Pharmacists mandated all pharmacists to have like a baseline training in terms of cannabis because they knew that we were gonna be getting questions. And so they wanted us to be able to kind of give that baseline knowledge. But to be honest, that course is mostly legislative. Like they wanted us to understand what are the laws behind the Cannabis Act and a little bit on drug interactions, a little on like, what products are available, but other than that, there really wasn't anything else. Basically, the college has said that we need to do what it is that's in best interest of the patient. And so for us to give any types of counseling points, identifying drug interactions, that is our responsibility to ensure patient safety. So that would be the perspective here in Ontario.

Kirk: So is the nuance that cannabis is a medicine then or is the nuanced that cannabis will be a substance of misuse, therefore you should be knowing about it? What's the nuance?

Anushya Vijayaraghevan: I think it's kind of both, to be honest, right? Because in the pharmaceutical setting, we do have epilepsy patients that are on a prescription version of a cannabis product. So that is being dispensed. We have an Nabilone being dispenced, synthetic THC being dispense. So I think they 100% do want us to understand that medical perspective. But they also do want to understand that abuse perspective as well. Although it's not as prominent in the training that was provided, it was more so, what is the Cannabis Act? What can and can't you do? And understanding it from a medical cannabis users perspective as well, so yeah.

Kirk: That's interesting to me. In the sense of the process, one of the things I like to do in the summertime is my wife and I have an old van from there. It's a van with a bed in it. We go camping in it, we travel a lot and we go from small town to small town. And I visit rec shops across Western Canada. And I feel you, Lisa, that budtenders are very limited in what they can say. But you made a comment earlier about how they don't know a lot. In my experience, Budtenders tend to have more education about cannabis than many of my colleagues in the health care field.

Lisa Bigioni: Yeah, I would absolutely agree that bud tenders know a lot about cannabis itself, for sure. I mean, that's their job. And it's also their passion, for sure. And that's what we love. That's what Stok'd loves about the teams that work in our stores. But that knowledge doesn't translate to medical use. While they know a lot about Cannabis itself, they don't know a lot about drug interactions. In fact, I I would you know venture to say they know nothing about drug interactions. And so that's where there's this challenge for the budtender. Certainly we can say this gummy would help you sleep. And frankly, for the menopausal woman who may not, you know, have any other medical issues, she just can't get to sleep and stay asleep. She can likely get those answers in store without a medical consultation. She could try a gummy and it likely will not have any adverse effects. But for other customers who have other medical issues, serious medical issues or bigger medical issues. That's where we have no idea how taking any sort of cannabis from a gummy to a resin or rosin, we have idea how that will affect the drugs that they're already on or just their general wellbeing. And that's where we need an organization like Apothecare.

Kirk: Again, I completely agree with you. Like I said, when I first read the message that was pushed to me, I went, oh, this is interesting. Now, what we need to do, we haven't really clarified here is that this is a rec shop, right? You are a rec. Recreational cannabis. You are not a medicinal cannabis dispensary. Correct. So, so you've brought in healthcare people to help you and and I guess this is beyond anecdotal. This is actual factual. So what you're telling me is that you have people coming into your store looking for medical cannabis, right? Cannabis for medical purposes.

Lisa Bigioni: Yeah.

Kirk: So who reached out to who here? Who made the first thought that this relationship should start?

Anushya Vijayaraghevan: Yeah, so, I mean, Apothecare has been visiting retailers all over Ontario and we are partnering with retailers that have that, you know, like mindset in terms of, you know, being able to help Canadians that are, you know, trying to use cannabis for a health and wellness purpose. You know, they do have a great variety of products when it comes to wellness products, a good selection of oils, topicals, capsules. And so stoked definitely is that. And so when we walked into the store, which are beautiful, by the way, beautiful stores, we just found that it was a great fit. And also to kind of add to Lisa's comment on budtenders, we really do value the knowledge that budtenders have. So at Apothecare, we kind of do a very balanced approach for us. We do look at the scientific literature. Understand what is the evidence behind cannabis for various different types of conditions, but we also value the budtender's insights because a lot, when it comes to the minor cannabinoids, the research really isn't there and we're really looking to see anecdotally what are customers using and what are they finding benefits for these minor cannabinoid’s especially like CBG and CBN, CBC. So we kind of look at it from both perspectives. Whenever we do have a consultation, it's always a very balanced approach and we're very transparent in terms of products that are out there, the potential benefits that it might have, what is very evidence-based, where is the literature really not there yet? And so that is very transparent. And yeah, just to kind of circle back, we have reached out to retailers that are always health and wellness kind of focused. You know, there is a portion of their customers where they are seeing them come in for those health and illness questions, and Stok'd was definitely one of those retailers.

Kirk: I was just trying to look up Saskatchewan. I was going through a small town Saskatchawan and walked into a Tweed shop, I think it's Tokyo Smoke now. But I walked in and the manager, it's cold call, I got my dog with me, I walk in and go, you know I have a podcast, I'm looking for quotes, I want to know what's happening in your little store. And one of my most favorite quotes that we've had in seven years is a young lady who said CBG. Bubble wrap for my brain. Okay, CBG, the mother cannabinoid is bubble wrap. And it was funny because from that point forward, it seemed like every rec store I went to, CBG was the big one. This year, the big ones are now all infused reefers. Everything's infused. So, what do you find, and this is just a question off the top of my head, what are people most interested in? Are they most interested in flour? Are they more interested in topicals? From a medical perspective, again, this is very odd for me to have this conversation because we're talking to a rec store provider about medicinal cannabis. And the federal government has kind of said in soft tones that they're now questioning if we need to have a medical program. So that's another question I'd like to go down but let's talk a little bit about your store and when people come in to a rec shop, what are they going to? Are they going into the flower? Are going vape pens? What are they going to?

Lisa Bigioni: I think it depends what issue they're trying to solve. I can give an example of a long-time customer we've had who has Stage 4 cancer and is on a whole bunch of medications. She comes in and buys a lot of flower. She buys flower by the ounce and for whatever reason she's using it, whether it's pain management or appetite or what have you, she buys a out of flower. We get a lot of people coming in looking for pain solutions who are looking at topicals certainly right muscle issues back that sort of thing. Gummies are big. I'm you know I made the reference earlier and it's certainly not only menopausal women like myself who are working for sleep help but a lot people have challenges sleeping and you know getting to sleep and staying just staying asleep.  There's a lot of chatter out in the world, whether people are cannabis consumers or not, about the fact that gummies can help with sleep, right? We even see kind of false advertisements in magazines, you know, Oprah endorsing a gummy, that sort of thing. So we are seeing a lot of people coming in looking for gummies. Drinks, again, like, you know having a drink before bed to kind of relax your body and mind to get some sleep. Those are the kinds of things they're telling us about that they're looking for medical assistance with. But I think it all depends on, you know, what the issue is that they are trying to solve.

Kirk: So they come into your store and they say, you know, I'm a stage four cancer, holy crow, I wanna use cannabis. And you say, okay, well, here is a cannabis strain that might work for you for whatever reason. Do you then hand them a business card or a brochure that pushes them to Apothecare?

Lisa Bigioni: So first of all, we would not say here's a strain that would work for you. We would say, um, my goodness, that's horrible, but I'm not a medical professional. And so I can't, uh, justifiably recommend a product for you to take. I can imagine that you are also on other medications, um for your illness. And so it is our recommendation that you would phone Apothecare. Here's a pamphlet. Here's the phone number. You have a consultation with a licensed pharmacist. Who understands drug interactions and understands cannabis use medically. Have that conversation. It'll be 30 to 45 minutes. And then hopefully you'll get a recommendation out of that that you can come back to our store and ask us for some products.

Kirk: Perfect, so the patient now comes to you, and what does apothecary do? What's the process?

Anushya Vijayaraghevan: Yeah, so essentially any referral that we get from a retailer, we will have an initial consultation with them first just to ensure that we are the right medical professionals to be doing a consultation. You know, if this patient is an epilepsy patient, you know, MS patient, in this case, we're going to absolutely refer to the medical cannabis route. And those are, you know, very complex patients where definitely a physician needs to be there in assessing them. So we do that initial screening first. If we're chatting with them, we feel that this is definitely an appropriate method for them to come and see us. We're gonna do an intake with them. So we a proper, full, thorough intake, understand everything when it comes to their medical history, prescription medications, what they've tried, have they used cannabis, are they cannabis naive. Understanding the full perspective of that patient, even when it when it come to addiction as well, family history of addiction, that's very important for us to be assessing as well. And then from there, we will get them booked in for an appointment. And typically this is about 30 minutes, it's either a phone consultation or video consultation, we do everything virtually through an application known as The Jane app. So this is a practice management software that we use. So everything is HIPAA and PIPEDA compliant. So patient privacy is absolutely, you know, taken highly, very importantly. So that is all done. We will do the consultation with them from start to finish. Typically it's about 30 minutes where we dive into their intake form, understand what they're actually looking for. If they tried cannabis in the past, where have they sourced cannabis? So it's another part of harm reduction. Where have they been going to source their cannabis? A lot of these patients that we do see, they go to illegal stores and they don't know they're going into illegal stores. So that's a point of education as well. So I'm talking to them about that. And then also, the types and formats of cannabis that's available on the market. What are they comfortable with? For us, it's always again, a harm reduction approach. So we're avoiding. Smoking and vaping and we're going to alternative forms of cannabis, typically oils, capsules and topicals and even edibles as well, gummies and drinks. So those are all laid out for them so they understand methods of consumption. Once we figure out a suitable product, suitable cannabinoid profile for them. We will basically. Contact them with an entire breakdown of, you know, this is the product that you're going to be going for. I've already communicated, you, know, for example, with Stok'd, let them know that you're coming in for this product. This is how you're gonna be taking it. You know, the this is your dosing titration schedule. We're going to be following up in X number of weeks. And then, you for me, I really like to look at it holistically as well. Overlooking their vitamin supplement intakes as well. What could they be doing to optimize, you know, whether maybe it's pain, maybe it is neuropathic pain, are they taking certain supplements that might be helping with that, even more headaches and migraines, assessing vitamin B intake for them. So this is kind of like a full thorough workup and assessment for them and so they have a plan. Um, and you know, every patient that we, we do these assessments for, they're very grateful because they have no one to be having these types of conversations with, um, either they don't have a family doctor or their family doctor doesn't want to talk about cannabis. Um, And then they, they don't know what to do. And so, um they're very grateful. I have even had patients that have been using cannabis. Um, and they just haven't found the right product for them. And, uh, just kind of tweaking things and optimizing things for them so that they're able to, you know, get them maximum benefit. So, um, yeah, it really, that's kind of the process, um you know I've, I've even had patients that come from the medical side and, you know, they're elderly and they can't figure out the medical route. And they say. Okay, this is what the doctor prescribed me, but I can't figure out the medical side. Can we just do a consultation? So even doing those consultations sometimes, I catch things where it's like, you know, CBD oil for you really isn't appropriate. Your kidney function is declining. You're on a blood thinner that would interact with CBD. You would get an increased risk of bleeding. You know, you're 85 years old. This is not appropriate. Let's go for a topical formulation. You know, sometimes we even catch those things coming from the medical side. So it's a really thorough assessment from our end.

Kirk: It sounds to me that you're giving them a care plan, obviously. Yeah. So, I need to take a step back then. In Ontario, the scope of practice of pharmacists, do you have a limited prescribing ability?

Anushya Vijayaraghevan: So yeah, so in this case, this is a recreational product. So that's the nuance here, right? So, you know, anyone can be walking into a recreational store. I like to call it a retail store because there's a mix of different customers coming in there for both recreational and health and wellness purpose focused in terms of their use of cannabis. So I like call it retail store, but yeah. So for us, it's almost as if you're doing an OTC counseling, right? If someone's coming into a pharmacy, they're asking about, you know, Advil or Tylenol, how are you going to work up this patient? What is, you know, what are the red flags? What are the contraindications? What prescription medications are they on? It's kind of almost like an OTC, um, assessment because it's either them going into a retail store, getting product and potentially having a harmful outcome or me actually doing this assessment thoroughly to ensure that whatever product that they do get is going to be safe for them.

Kirk: Yeah, that's the thing about cannabis, you just walk that line, is it medicinal or is it recreational? Is it medicinal? So I get it, over-the-counter consultation, that makes a lot of sense to me. On your webpage you talk about the fees. Are the fees mostly covered by insurance programs, Ontario, or would it be my private insurance? How would the fees be covered?

Anushya Vijayaraghevan: Yeah, so for us, unfortunately, we don't have an OHIP billing number. Pharmacists here in Ontario don't have that. So it's not something that we can bill the government, unfortunately. So this is an expense that would be paid out of pocket for the customer. But if they do have a health spending account, we are a health care professional that is listed as one where we can issue a receipt, and they're able to claim this on their health spending account. And so that is one method for reimbursement.

Kirk: And and at the beginning you talked about your nationwide. So this is an elbows up thing Canada a Canada program, which is fantastic So do you have free trade with your profession? Can you consult in British Columbia, Newfoundland?

Anushya Vijayaraghevan: Yeah, as long as we're here, as long as we're here residing in Ontario, we can have these types of consultations virtually. Yeah.

Kirk: Well, like I said, I find this a fascinating model. I had alluded earlier how the federal government seems to be quietly questioning if we need a medical cannabis program. What do you think about that? I mean, you guys seem to have balanced something really nice here. You've taken responsibilities at the rec store for people's health care and wellness. And I wrote this down, health and wellness, so a cannabis store worried about people's health and well-ness, what is that all about?

Anushya Vijayaraghevan: You know, the Ontario cannabis store has released data as of last year that one in five consumers walking into a retail store are purchasing cannabis for health and wellness purposes, which is crazy. So 20% of customers are doing that. So that is documented that those statistics are out there. When you look at in the States, new frontier data has come out with, you know, about 33%. Of those consumers going into rec stores are wellness-focused customers or wellness seekers. So I feel like even these percentages are probably underestimated, to be honest, because a lot of these rec users are using it for wellness purposes as well. And so there is a cross between overlap between them both. So these values are probably a lot higher than what's being documented.

Kirk: My experience in the American model, though, is that they have, you walk into a store and one side is recreational cannabis, one side as medicinal cannabis. And they actually have, again, this is limited experiences in Colorado when I was there a few years ago, is if you walk in to the medicinal side and you have a script or a document from a physician, you get a price cut and all that sort of stuff. That's not in Canada, right? I mean, the disconnect in Canada is that... The medical cannabis program is federal, but the provinces manage medicine. So that's where the disconnect is. I like what you're doing. I just find it interesting. You have found a real niche that is definitely needed, because I completely agree with you. I'm astounded by how many people go to rec stores for the medicine, and I'm astounded how the medical professions, and that's all of us, have ignored it, have completely ignored it. And it's wrong. Yeah.

Anushya Vijayaraghevan: Yeah, like even our consultations, the average age of our patients that we see average age is 61. They're on three, like about 45% of them are on three or four medications. So it's crazy to think that, you know, a lot of these types of customers are still going into stores purchasing product. There might be significant interactions on and especially when it comes to cancer patients as well, like, you know, especially those that are on immunotherapy. Are they, is someone intervening where, you know, someone is counseling them on potential, you know, failure rates of immunotherapy when they're on cannabis. So yeah, I think there's just, there are a lot of issues and we're trying to solve a part of the piece.

Lisa Bigioni: Yeah, I think what's important to note too is that customers coming to a rec store won't necessarily disclose the reason they're buying the product that they're buying. In a lot of cases, we hear from customers who say, my son told me to buy this, my friend, my daughter, whatever, told me to buy that. So when you start to probe as to, you know, why are you buying that oil in the first place, you know, there may be medical reasons that come out of that. But if they just walk up to the counter, and ask for their product and the conversation isn't had, there could be some safety concerns. So the fact that we now will have Apothecare, collateral, pamphlets, whatever in our store may at a minimum tweak those customers to think, maybe I should have a conversation with the medical professional about the thing my son or daughter or friend told me to buy before I start to consume it.

Kirk: Yeah, I like what you're doing here. It's how many times I've gone out and had casual conversations. For whatever reason, cannabis always seems to come up. I don't know if it's me. I don't know. It could be me. I could be the common denominator, but I always end up talking about cannabis with somebody. And how many people are using gummies, like the funny little gummies before bed? This seems to be a t-shirt I wanna get. I take my gummy before bed. Is there anything else you'd like to talk about? I-

Anushya Vijayaraghevan: I guess I just want to add that, you know, the wellness category is growing here in Ontario, we are getting more and more wellness products coming out onto the market. And so, you know, when you think about it, it's like, how are we supporting Canadians if there are more wellness products out into the market? And so I guess just wanted to kind of bring that point up. A lot of the zero THC products coming out onto the market. And so they're there definitely is like a growing interest when it comes to wellness and cannabis. And hopefully we're able to support more Canadians.

Lisa Bigioni: Yeah, and from a rec store perspective or cannabis retail perspective, the wellness category is certainly the smallest category of sales in our stores because we are a rec story and people are coming in typically to buy flower pre-rolls and infused pre- rolls as you alluded to earlier. But I really see that growing as the stigma continues to diminish and as awareness and understanding about cannabis and its benefits starts to grow. I think we'll see more and more people asking the questions about more of a natural way to address their, you know, at least even their smaller, quote unquote, smaller health concerns. So I think this is the way of the future. The other thing I'd like to mention is a lot of customers of independence in In particular, I'll say... Have a strong relationship with their cannabis retailer. They come in, you know, once a week or even more often than that. They know their budtenders by name and vice versa. And so, as that continues to expand, I'm just thrilled that we can now offer an additional service, again, to bridge that gap between recreational use and medical use that helps everybody.

Kirk: All right, go ahead and rant.

Trevor: You want to know how I really feel.

Kirk: Before you start, I want to ask a quick couple of questions, because this is obviously... As soon as I talked to these guys, I knew that this is what was going to happen. So a couple of things, okay? Jurisdictional, is this something that Manitoba... Now don't start yet, because I know you're going to rant. So jurisdictional, can Manitoba provide this service in your thought? Now, the other thing is that what I liked about this... Was that they are definitely providing a service, but it's private health care because people have to pay for it using their private insurance, right? And that's a different issue, but recognizing the fact this is not universal health care, which is one of the problems that cannabis isn't a medicine in provincial health care. Now, go ahead, rant.

Trevor: Well, let's talk about money first because, you know, one of the things that you and I see differently, I'm not saying people shouldn't get things paid for, but in pharmacy world, unlike in nursing world, there's a lot of things people have to pay for. And that was actually one of the things I was most interested in hearing is the provinces as we've mentioned before do things differently in different professions and Manitoba is arguably the worst province in the country for being a pharmacist. There's some real good pharmacy things that are good but as a pharmacists I can't really bill for anything. Like I can do something for a patient and then have the government pay me for doing said thing. Like, these pharmacists are based in about Ontario. They can do what's called a meds check, which is literally go through someone's medication list, find problems with it, recommend solutions, and I'm gonna get it wrong, so I'm not from there, but let's say you can do that four times a year and the pharmacist can get paid for their time to sit down and go through that. Manitoba, there's no such thing, because, you know, Manitoba suck.

Kirk: Hold on, hold on, so the government, you're saying that they said they could not bill

Trevor: Well, this is why I was into this. That's why I'm throwing meds check out. So in a pharmacy, let's ignore the cannabis stuff for a second, but in a pharmacy in Ontario and some other provinces, pharmacists can get paid for doing basically a medication review for a patient. Manitoba you can't, because Manitoba sucks. Anyway, so that was my first thing is are these pharmacists getting paid for doing a quote-unquote medication review as part of a meds check. And no, it doesn't sound like they're doing that. Could they, couldn't they? I don't know. I'm assuming they looked at it and it wouldn't qualify for some reason. Again, not an Ontario pharmacist. So I don't know all the ins and outs. So I was very interested in the, as the greedy pharmacist, how they were going to get paid because they are putting out a goodly chunk of time, half an hour to an hour-ish consult with the patient. You know. You can only do that for free so many times that you're running a charity, not a business. So I thought that was fascinating. I'm not saying best case scenario, it'd be wonderful if the government would let them bill for it or let us bill for, but it makes sense to me as a pharmacist that they were charging the patient and in a perfect world, the patient has some sort of insurance plan where they were allowed to then claim that back from their insurance, but. I thought that was really interesting. I wondered how they do that because if I was going to do something like that in Manitoba, I would absolutely have to charge the patient directly because there's no other way for me to get paid for my time. So I was really interested by that. But let's go back to the, could I do this in Manitoba? I could absolutely do it within the province of Manitoba, but honestly, when we talk about telemedicine or telenursing or teledoctoring, the only time I've looked into it is when it's like a nurse, a nurse practitioner, a physician, you know, can they see someone in another province and still build their own healthcare system? And the answer is sometimes yes, sometimes no. Since a pharmacist can't really bill. It's never come up and, you know, nor has in, you know let's put on a different hat. I've got some extra training in asthma, COPD and smoking cessation. Could I, do I have the skills to teach somebody in Newfoundland how to like use their inhaler and create an asthma action plan and report some stuff back to their doctor? Sure, I have to skills to do that. If my butt is sitting in Manitoba, and I'm virtually talking to them in Newfoundland, am I breaking some kind of rules? I don't have the foggiest. Did I kind of sort of answer that question?

Kirk: I think so, because I guess how I look at it, because nursing's in the same boat, right? Nurses, even nurse practitioners, prescribers in Manitoba cannot bill directly to the province. We are seen as employees. But I am also, I mean, I'm the secretary of the Canadian Association of Self-Employed Regulated Nurses. So there are private practice businesses that nurses have. I have a business as a nurse. I don't work for another employer, I work for myself. So I bill, as a nurse, for my skills. Now, there is a process of doing that following the college, but I can't bill the college. Like, I can build, sorry, I can bill the province directly. But as a nursing, I could contract my services, right? So my question is, they are pharmacists in a virtual pharmacy. So the pharmacy is the business, they're employees. So the Pharmacy is submitting an invoice to the insurance agency and as a patient, I then click on a box, I get $65.

Trevor: Well, I'm not trying to put words in their mouth. I think that the virtual pharmacy is billing the patient. Here, Kirk is a bill for 120 bucks. And then if you, Kirk, the patient wants to take that $120, I've been making up numbers, but again, take that invoice and submit it to your insurance company, you can. I don't think they are directly submitting anything to an insurance company. Before we get too lost in the weeds on billing, because fascinating for me as the pharmacist, maybe not so much to the non-pharmacist out there, I thought you hit on a really good point that I want you to talk about a little bit more because it kind of turns a little on our head, stuff we have been talking about. So people are now going to rec stores to get medical campus. They just are, we have lamented about. Wish there was a better way and who how could get but they are they just are and you've also noted that maybe the federal government wants it to go that way doesn't want there to be a medical system we don't have direct proof of that but you know their actions seem to be saying that that's not at least not something they're not interested in what do you think about this as a has another way, like, you know... Patients are showing up at rec stores to get medical advice anyway, this is a way for them to might not be perfect, but this is at least a way to them have a chance to get some medical advice.

Kirk: You nailed it in your opening rant about here are some entrepreneurs that found a niche. So I'm going to answer the question this way in the sense that there is a need for this. I lament to the fact that the health care system says that cannabis is a substance of misuse. Oh, but if you decide to use this medicine, just go get it from your rec store like you by Tylenol as an over-counter med. I, after seven years of studying cannabis the way you and I have been, I find that resentful. I physically get a sense of regret and also embarrassment and disgust that my health profession has chosen to view cannabis this way. The hypocrisy of using pharmaceuticals off label is horrific and is probably the number one reason why I keep saying if you're prepared to use a drug off label, why are you not prepared to even consider cannabis as medicine? So to answer your question is I think it's ludicrous that people go to a rec shop. However, it's happening. It's the way of the world. So let's pivot. And what we discovered here, and this story was pushed to me, right, and I sort of pitched it to you, you couldn't find an opening that worked, so I did the interview, but I knew it was yours.

Trevor: And I think you did a great job, and yeah, I think I would have asked way too many stupid, not, you know, pharmacy minutiae questions. I think this was good that I got to hear it afterwards.

Kirk: Well, but they, but I mean, we've done a few stories in the last little while, cannabis coaches, non-regulated, I'm coining the phrase, they're a non- regulated health provider, right? They're sort of like athletic therapists, you know, non- regulated sports therapists. I mean we have a niche, people need to be educated. Our colleges, I shouldn't say the colleges, You know, I can't blame my profession for this. I have to blame the individuals for this. Individual health professionals are not paying attention to cannabis and that's wrong. So therefore entrepreneurs are going to pick it up. So here is a couple of health professionals, pharmacists. They created a virtual pharmacy and they are going around to other rec. stores like Stok'd.

Trevor: I was going to say, let's circle back to Stok'd because Lisa and her team, they've developed a very cool store. My notes say four Ontario stores, three Toronto, one Niagara Falls, I'm getting that right. I like the outdoor feel. That all sounds good, which is all great as a rec store. Basically I'm selling to people who want to get high, which fine. Just like frankly, a liquor store sells to people who want to get drunk. So that's perfectly fine.

Kirk: But we want responsible drinking, sorry.

Trevor: Responsible drinking and responsible smoking and all that good stuff. Yeah, but full credit to Lisa and her team to say, but you know at least 20% I think it was actually Anusha who said that you know, the Ontario cannabis store Stats was about one in five or about 20% of people basically admit to going into their rec store looking for medicinal stuff and everyone assumes it's higher but, that's at least a number that has been measured. So Lisa and her team have obviously noticed that and said, hey, we know a lot about cannabis. We don't know a a lot about people's medical conditions and we don't a lot about the medicines they're on. How can we do it better? And kudos to them for recognizing that and then recognizing that Apothecare would be a great partner.

Kirk: And like it's going back, exactly, they recognize a niche, there is a niche. The niche is created because health professionals are generally ignoring it. And also, I guess, you know, we know you say you know doctors that are pushing people to the rec store. I've also heard doctors say that, just go get your pot from the rec store, and I've written about this in our Blog Page, how I think that's negligent. But yeah, it's niche and, and, uh... It's one of the reasons why I like doing this podcast is we find interesting people There's there's a whole lot of stuff that is that I don't know if we have the time to discuss that's in there but I love the fact that it's nationwide is elbows up it's Canadian business and They're doing something that they that you recognize people need right so I mean and I want to congratulate you because I know this for sure. I mean I walk I walk in the rec stores all the time just you know, asking questions of what's going on in the rec market, and there is one particular store in town that knows you very well, and they do call you the pharmacist, the pot pharmacist in Dauphin, so I love the fact that you take the time, and again, I know you're not getting paid for it, but you take time to call ahead and say, you know... And I don't think you're breaching any confidentiality here, you know? No, no. So no, it's, so you're, I love the fact you're doing that. So I guess congratulations to you for taking the extra time.

Trevor: Yeah, no, but again, I'm not tooting my own horn, but I can only take my time away from doing pharmacy stuff. So many things to do. My boss won't be very happy if I spend all my time doing stuff that isn't earning money for the store. That's just the way of the world.

Kirk: But what did we learn today? There might be a way

Trevor: That's what it's going to circle back to. Full credit to the Apothecare guys that said, okay we can we can do this but we'll you know sorry customers and we would don't have me wrong pharmacists would be the pleased-as-punch if this will be something that could eventually be charged to provincial health care things but for the moment it isn't and frankly again sorry cannabis users. This is usually how things get covered is, you know, enough people pay out of their pocket and then they complain to politicians and then eventually gets covered. That's just kind of the way things go. It doesn't usually get covered first. So the fact that they have a business where the customer gets charged, the pharmacist gets compensated for their time so they can, you don't have time to do this. Again, there's. As even our two entrepreneurs pointed out, there's lots of holes in this. You know, people, if they don't tell their budtender that they are using this medicinally, if don't ask the questions, if the look at the pamphlet, but to go, Oh, that's too much money. You know there's still lots of places for people who are using their rec store cannabis medicinally to fall through the cracks, but at least gives them a chance to connect with a healthcare professional. It gives them a chance there's there's now at least an off ramp in the rec store and I think that's great.

Kirk: Yeah, I do too. I thought it was a really cool story. It was pushed to me and I thank them for that story. So, I'm Kirk Nyquist, I am the registered nurse.

Trevor: I'm Trevor Shewfelt, apparently today I'm the excited pharmacist.

Kirk: No, shit. And we're at reefermed.ca and all of the socials, most of the Socials. LinkedIn is, we're very, very good on LinkedIn and Instagram is where I spend most of our time. And our webpage, I really encourage people to go to our webpage. It's an informative page, lots there.

Trevor: There is and yeah Kirk was before we got on air just talking about all the things he's done literally today to Get everything all spruced up and easier to find find us During that there searching. So yes, we've been it's not like the web page is static and just staying there

Kirk: working on our SEOs, you know, learning from our past guests. So that's what we're trying to do. Optimizing our webpage. So, so, Oh, and also guys, please. We've said this before. It's sort of a whine, my whine. Meta doesn't like cannabis. So the only way we get heard is by the people that are already following us. And the only we can grow on Meta is that if you share our posts, so please share our post. The other thing is that Like us on your podcast platform that you're listening to. Share us and let's let everyone know about Reefer Medness - The Podcast.

Trevor: Give us five stars. We're not going to ask for one, two, three, four stars. Give us a five star review.

Kirk: Five stars.

Trevor: I think they should. I think this was a good one. I think this one deserves five stars again. I obviously horrendously biased, but I think this one was really good.

Kirk: Talk to you later.

Trevor: Alright, have a good day everybody.