Episode Transcript

Kirk: I'm Kirk Nyquist, I'm the registered nurse, we're Reefer Medness - The Podcast

Trevor:  Yep, I'm Trevor Shewfelt. I'm the pharmacist. So Gil Luxemburg, we've talked about him three times now but just and I recommend you listen to these in order. You don't have to but I'm just saying I think it'll make more sense if you do. Medical patient number seven in Israel. Done a whole lot of work on educating nurses, doctors, pharmacists, patients all over Israel. Went to places in Europe, help develop Cannabis policy. A bunch of other stuff including some very cool terpene research which we talked about last time but this time Kirk, we're talking about Gil's Wizdom system and that's wisdom with a z instead of an s. I'm going to call it a train the trainer program and also a way for you to train patients and health care professionals about how to sort of personalize cannabis treatment. Because one of the things they found was people were trying medical cannabis but dropping out after you know a couple weeks so you know he increased the dropout rate to you know 50% were dropped out after a couple of weeks to you know 50 to half were dropping out after like a year and a half. So using something like this where where everything's explained especially to the patient dramatically increased how long they the canvas for so you know they could at least find out if it was working for them or not.

Kirk:  Yeah, he calls them Wizdom Circles. And from what I can gather, the circle includes patient training and health care training. But I thought it also went in once I am recognized and before I go there, what I liked about what he says here, Gil says about how the rules were made in Israel for the patient, opposed to, you know, in Canada, we came up with a bunch of rules on cannabis that really aren't patient-centric at all. So the whole Israeli program from Gil's perspective was built with the person in mind. Our system was built on the purpose that cannabis was a substance of misuse, and we have to be protected by it. And in Canada, that belief system has filtered into the medical system in the sense that the medical systems seems to be being ignored. What I like about what Gill has done here is it seems these circles... Once I am a medical patient, these circles include my caregivers. So I guess if I, is that correct?

Trevor:  Yeah, in a perfect world, just ask them towards the end, you know, could I do this in Dauphin, Manitoba, Canada if I'm, you, know, the patient and yes, but you're in a perfect world. You know, you'd have a Wizdom pharmacist and a Wizdom nurse and a Wizdom doctor, but even if you didn't, as long as your health care team is willing to just sort of listen to the other people and the Wizdom. Then they can at least keep them informed about what sort of the protocol is going on.

Kirk:  Yeah, I think we call it cannabis coaching in Canada. In the sense that, and we've done several episodes on this, and you know what, I've just, I have just found a limitation in our webpage. I will be changing this and adding cannabis coaching, because we have a whole series of episodes on cannabis coaching and I think that's what it is, you know?

Trevor:  Why don't you do that while we're listening to Gil and we come back out the other side and talk about the Wizdom and Wizdom Circle.

Kirk:  Sure.

Trevor:  Let's go on to Wizdom and I'm going to call it, you're sort of in train the trainer mode now with Wizdom and some of the other education stuff you're doing now. Do I have that right or how do you talk about what you're doing now with your latest project.

Gil Luxemburg:  Well, it started out with a 2011 class for the nurses in Israel. And after that, I've been called onto the flag, so to speak, to give the same class in hospitals, both in Israel and abroad, and then by different LPs and then, you know, to treat, to teach their personnel how to do the follow-up with the people and whatnot, when they, when it was still legal. I mean, right now, a lot of countries ban direct connection between the supplier and brand and patient, which creates a gap, an even bigger gap. So so we had to come up with a different solution, which led me to doing it direct to consumer and opening up to everybody that wants to participate. But I'm doing cohorts of education for doctors, nurses, pharmacists, and future coaches. Everybody that's really wanting to coach the patient's through the onboarding through the first six months, medicinally through a very systemized process, but very personalized outcome. That's kind of what I'm teaching. So it starts with the pharmacology from the plant to the patient, the entire kind of circle. It takes about, I don't know, four weeks, about 16 hours of live sessions that we kind of cram it into in order to make it probably be digestible. Smaller than that, it just wouldn't be covering all the information. And you know, we just don't want to take out people's time more than necessary. But like, that's the bare minimum. And then we move on to actual coaching education, how to onboard a patient, not how to on board a disease. How to onboard a chart. No, no, no.

Trevor:  That's an important distinction.

Gil Luxemburg:  How to onboard patient. So we sit with the patient and first treat them like humans. And only after we arrive to the understanding of what their human goals and needs are, where they are right now, we're addressing the elephant in the room, which is the sickness and what they want from that. And we run through a very. Kind of slow, fluent system, but we go through this tool that I can just talk about and very simplified, simply. The five F's of, you know, we talk about the future, we talked about the failures of the past, we'd talk about the frustrations that he's suffering right now. We're talking about the fears of what's to come and talk about the framing of how we can help him go through all of that together. Now we talk about it about his personal life. First of all about what they feel because patients feel unheard and unseen. Everybody looks at the chart. Nobody looks at them. And when you ask them what's important for them, some patients tell you, you know what, I don't care about dying. I'm not afraid of that. I don t care about losing my health. I understand that and I'm old enough. What I care about is I want to keep being there when my family comes and not being in the room, hearing them whisper behind the door. I want to be able to sit for an hour and a day and, and just do the, do some gardening. Like I know that I've lost my morning routine of swimming. My nights are ruined. I'm waking up at 3 a.m. I need help. I don't know what I need, but like that's my life and I just want to be there with my family and not to hear them talking behind my back whispering all the time. So when you reflect back to them, that basically the word that they're looking for is dignity. They want to keep their dignity throughout whatever's left and they want to enjoy those simple things that they want to enjoy so we can try and build the system and the protocols and all the treatment around keeping those important things sacred. And if we didn't talk to them we don't know about it. Now once we've seen the patient how collaborative do you think they will be with the protocol we make for them.

Trevor:  Yeah, they should be right on board.

Gil Luxemburg:  And when we work with them, we explain exactly what, what we do, but it's their choice in the end, not their family members, even though we bring on them and we call it Wizdom Circles, because we create a full circle of influence around the patient. We bring the doctor along, we bring the nurse along, we bring a pharmacist along. We bring a family member or caretaker along. And the patient at the center and us the coaches or the people I treat and teach to be coaches as facilitators of this circle as the translators they're the ones who need to translate this story of the patient to the doctor. To the pharmacist. To the nurse. To the family because everybody needs to be aligned and they cannot take the time to do all of this process of understanding it every single one of them. I mean the doctor doesn't have time the nurse maybe has time sometime when you're at the ward at night and you know sometimes you have time but it's rare as compassionate as nurses are. The pharmacist rarely gets to talk to you. And if he knows enough, he might raise red flags about some, you know, cross-medication interactions that are really wrong for you, that don't work with this way of administer cannabis. And if you want, let's call your doctor. Maybe we should change from oil to vapes or to a smoke form because we don't want to harm your liver. But if he's not informed, he just won't know to tell you that.

Trevor:  No, you're right.

Gil Luxemburg:  And if he doesn't know about your medications or about your cannabis, he might be giving you just dispersing your medicines. Okay. He's not the one, he's not, the Bud tender that you go to get your, your, your weed from, for example, even though it's medically prescribed in the US, it happens in a lot of states. If your pharmacist doesn't, no, he will not know about the CYP interactions. He will not how to raise any red flags. They'll just go under his radar. So that's why we bring the entire circle of influence around the patient as well. Therefore, Wizdom Circles. But basically, the education goes deep and long. We build the personalized protocol for the patient. We approve it with the doctor. We iterate it with a patient as we go along. We don't just stay start low and go slow. We explain what it means for each specific path of consumption. Because if you choose to vape or if you'd choose to smoke, or if you choose, to use sublingual or as they call mucosal oils, or if you used to use edibles, that's God forbid you want to use a suppository because there's very little information about it. It's broadly used, just not very broadly researched. No. All of this, each means of administration has its own risks and rewards. And we need to notify you and we need to select the right path for you. And it might be a combination and we need to write to find the right strain. And the right strain doesn't mean the best strain for you. The right strength to begin with means the most constant available strain that is also matching the profile of strain that you need.

Trevor:  Oh, that's interesting. and then its gone in a week

Gil Luxemburg:  Exactly, we narrowed down the selection to those for the first three to six months because we want you to succeed before you start experimenting with other strains maybe. We want you know your first baseline and if it's fluctuating. If every two weeks you don't have what helped last week and now you need to chase a different dispensary that sells the same name but it's a different grower and it's not the same medicine. So we want the stable medicine, not something that's out of the fashions. We want a stable, uh, specific medicine, meaning whatever thing you choose, not just the strain, but like if you choose an edible, then we want these edibles to also have COAs that show that batch after batch are kind of stable. They're not just mix and match. Uh, same goes for the flower. Same goes for oil. And once we have this baseline, then we can start looking at the COAs and say, okay, this one out of these five matches you best. Because if I start dealing with all the strains out there, you'll just not find yourself in the beginning. And we really want the stability first. We want you to feel what you're doing. To learn your body. To learn your reactions. To learn your responses. So in Wizdom Circles, as I started, I'll go back to it. We start with the first four weeks of the education of the theory. Then we go into six weeks of deep dive into the actual start to finish, including the entire process, the entire protocol of how to build this personalized protocol for the patient. It's a full algorithm with a lot of choices that are human made. It's not something that I could even, even if I wanted to, I couldn't replicate it with AI because it depends on how you detect the emotion of the patient while you're talking to them and it's different things. And in the end, we end up with a process that we're going through with the doctor, with the patient and with the family's firsthand nurses and pharmacists as the second part of the circle. Through a duration of three to six months, and the beginning twice a week, we take notes like a text message each other for following up and making sure that they journal correctly, they send us their journaling, we kind of analyze this for them with them. Once every two weeks, we do a live session, zoom or direct meeting, or sometimes it's a phone call depends on the patient. Then slowly over time, it kind of diminishes to maybe once a week text, because it depends on how much you need to iterate. In the beginning, you need to kind of work slow, but change from once a day in the morning to twice a day and the morning and the evening and then to three times a day morning, evening and noon, just for example, and then to when do I take the two drops instead of one? Do I do it in the evening or in the morning when I add the dose? And everything's like this. And on top of all that, there's the thing that most patient don't understand. And then I kind of make sure that everybody knows to teach and to remind it. Medical cannabis is the different medicine than anything else. A part of it being reactive, which is not a bug, it's kind of a feature. It's also the only medicine that the prescription is up to. It is not constant. So it's not right. I prescribe you 60 grams of cannabis, so you need to split that to 30 days. Now smoke two grams a day starting now. That would be the wrong way that people automatically assume, because that's what we do with every other medication. I mean, look around at the streets when there's a 50 zone, everybody's driving 50. They look at it as a goal, not as a limit. So we need to teach them that maybe less is better. Not necessarily more is better, maybe if you can get it for 20 grams a month, the same benefit or better than you would at 60. Wouldn't it be better? Let's really realistically look at where you are and not to where the prescriptions say you can't get to. So all of this comes into the education program and so much more. Um, I can go for hours. I mean, I'm, I don't.

Trevor:  And and and before but before we run out of time so one more question about Wizdom then we'll just sort of wrap up so please is this available worldwide like what we're in Canada so if someone in Dauphin Manitoba Canada they were a patient and they said hey I want this kind of in individual individualized programming.

Gil Luxemburg:  Education? Yes.

Trevor:  That does that now would that mean you would have to also have... Sort of a Wizdom doctor and a Wizdom pharmacist and a Wizdom nurse locally? Or is it all?

Gil Luxemburg:  Not necessarily. A lot of times our coaches can contact your own doctors, your own pharmacists, your own nurse, your family, because these are your medical team. They don't necessarily have to come on board to do the whole education. As long as they participate in the circle, it's good enough. We want them to be informed that you're going through this protocol. So they approve of it before we started, because they're the prescribing doctor. I am not a prescribing doctor. I'm not a doctor. I'm another pharmacist. I'm, not even a nurse, even though I taught them and I teach all of them. I'm just a patient that built the system that everybody needed. And somehow it was adopted by the Israeli Ministry of Health in the beginning and then by others. But you know, as I said, I'm just a small screw in a big system that screwed up the system or call it whatever you want. I'm trying to do good and working on getting the program CME certified so that it could be for continuous medical education to doctors, pharmacists and nurses in the US and then in Europe, it will take a while. I'm working because of the you know, how the structures work will take three to three to six months, I guess before the cohort will be approved as CME. And then we'll start doing it also as maybe shorter and more prehaps like two week sessions of real 10 days of 10 hours a day education. It's a lot of homework, it's a lot of work, it a lot of studying and a lot of practicing to get to where you can really deal with patients. People misunderstand how much work goes into it. So all my graduates work online with patients worldwide. Well, gladly, like if I am not available because I'm mostly focused on the teaching and cases that get to me are getting to me by the coaches that I already taught that, you know, the very extreme cases are coming back to me, but mostly I'm redirecting to my coaches and they're gladly assisting and participating and calling the pharmacist and calling in the doctor and calling their family members and onboarding everybody. Making sure that your program is aligned to you. It's personalized to you. You know how to count your own gifts, meaning, you know, not just to remember what you already asked for, but that you and your wife can tell me after three weeks of using cannabis, that you still don't feel any relief of pain, but you that you slept throughout the entire night and that today you're just a bit less of an ass than you were yesterday.

Trevor:  That's all I'm ever hoping for is that I'm a bit less of an ass today.

Gil Luxemburg:  Yeah, but let's be honest, that's what you can hear after a month and after three months you'll get better, but like really physically with your pain. But let's first count the small gifts.

Trevor:  Absolutely. And because we've gone way over time, and I appreciate all the time you've given us, what we better wrap up with, was there anything else that you wished I'd asked? Anything else you think our listeners really need to know? 

Gil Luxemburg:  well I think the listeners really need to know that the system exists and that it's not just me that's doing it. I mean, every doctor, if you want your doctor to learn it, push them. If you want your pharmacist to learn, push them. It's up to us to change the system. Every little screw can throw up a big system. You just need to start pushing. I mean... The pharmacists and doctors and nurses of the past were very kind of ashamed or distant from medical cannabis. We see the change, but while they're opening up, they're not really informed. Push them to get the education. I don't care mine or otherwise, just get them educated.

Trevor:  I think that's a great place is all to wrap up. Thank you very much for your time. Gil, 

Gil Luxemburg:  It's been amazing.

Trevor:  Um yeah so like you were saying on the way in I really liked how this the whole idea is to be patient-centric.  Gil mentioned several times in several different ways that everyone's going to experience their cannabis differently um and he wants to you to be aware and you know it's stuff that you know makes sense but i hadn't thought of ahead of time. If you're going to start someone out on cannabis, you want to make sure you start them out on something that's going to be available next week, next month, next year, so you know they can have a consistent experience. It seems very well thought out and obviously thought out from the patient point of view.

Kirk:  Yeah. And again, like I said, as we were going into the conversation in this episode, we've done Episodes episode 59 nurse on board with Susan Hagar. That company is a group of nurses that also coach patients at home during home care to how to use cannabis. We talked to Tantis Health out in the west coast and they're a licensed dispensary that also offers these types of services. The cannabis coach Teresa Bower in the Kootenay region and we talked about EduCanNation in Episode 138 and 136 respectively. So we've seen cannabis coaches before and we're trying to, EduCanNation for example is trying to build uh trying to build standards on cannabis coaching so I think this is really cool. I'm not quite sure though how it would work in in our model of care for fee-for-service if a doctor would be willing to sit in a Wizdom Circle to talk about my cannabis use. However In Canada, my medical doctor...

Trevor:  But even if even if they weren't even if you know it would kind of in my opinion it'd be kind of like if you said you know doctor whoever i've got a high-powered nutritionist and i'm going with this program they're on as long as the doctor was sort of willing to listen to what the plan is and say yeah okay i'm i'm okay with that I think that would still work fine.

Kirk:  Yeah, but expectations of what a family doctor is supposed to do. My family doctor, love him to death, good guy, chose not to be my cannabis doctor. So I had to go and find a separate cannabis doctor for my medicine. Those two people don't talk. You know, I'm not saying it's personality, I'm saying I think it's the system. Would my cannabis doctor talk to a cannabis coach about my care? I am not sure if she would. I'm not anybody's fault, but the system's not set up for them to get compensated for this in our current system. I think it's a great idea. We both are advocates of cannabis. The system is not. So I have found myself working around the system. And I think that's because we're set up by regulation, not by patient centric care. And again, I'm not I'm not putting blame here. This is just the way the system is. The system it doesn't work for us to work in consultations. You know, I think those systems that do, like Cancer Care, that have councils of professionals working together, in many cases, those physicians, I think, are employees of the system. Or our high specialists that bill a different way and can bill for those meetings. So I think there might be a difference in how their system works allowing for this kind of a council.

Trevor:  Yeah, and without, you know, going down our, you know, fee for service versus salaried physician thing, I, I

Kirk:  It's a huge thing, it's a big thing, but you know.

Trevor:  I think at the very least, I think most family physicians would at least, if they got a written report from the Wizdom people, at least they would have an idea about what was going on. I believe they would do their best to sort of, they might not have anything to contribute to what we should do with your cannabis, but at least they would know. I'm on cannabis, so if something good or bad happened to you health-wise, they would know that they could be a contributing factor.

Kirk:  Yeah, well, I mean, again, using myself as a model, because, you know, it's evidence-informed what I understand. My medical doctor is fully aware that I use cannabis for chronic pain to the point that during my last visit, there was no conversation of analgesic or anti-inflammatories on his part because he knows I don't use over-the-counter or pharmaceuticals for my pain. He never questioned anything about it which is which is his prerogative and doesn't change my care but you know once a year when I talk to my cannabis doctor we get into it and we discuss it but again you know this goes back to how cannabis and Gil discusses this. Cannabis is very individualized, right. The care planning is really up to the patient to determine. Not the practitioner. I think these I think these Wizdom Circles are there to support that, to help somebody. Like again, myself, I use one cannabis cookie in the morning and I get 12 hours of relief of chronic pain. It works for me. It works. And that's evidence informed. I can find the research to support it. But you know, I made another batch of cookies and now I only take a half of those cookies because a full amount is too much. So, every time I make the cookies, I have to relearn how much of the cookie I take, because the cannabis in the cookie has changed. Now, you know, again, I will accept the fact that I don't get my cannabis analyzed. Because it's extremely expensive. So I follow the method that we learned from Dr. Goldstrich, where I mix a bunch of cannabis flower into one recipe. So again, it's learning how to use it. And I think this is what this Wizdom Circle does for a client, for a patient.

Trevor:  Yeah, no, no. And Gil spends a bunch of time talking about that because, yeah, how in Western medicine, and he talked about a few times, we're used to, you know, you take this five milligram pill every day for X number of days. That's and people are not used to putting, frankly, putting this much effort into their own medicine or their own care. So it's a they spend a lot of time teaching people how to journal and how to understand what's going on and maybe even taking less medicine than you're sort of quote unquote allowed. So I think it is good they spend, a lot, of time with the patient sort of helping the patient help themselves individualize their care because that's not what most people want, expect or are used to.

Kirk:  No, no, our system expects things to happen fast and cannabis is learned. You know, over these series of three episodes with Gil... What really came out in my mind is again, you know Trevor, we've been doing this now for almost 10 years and there are certain themes that come up over and over and again. First of all, most of our guests stumble into cannabis and most of out guests stumble in the cannabis as medicinal users, not recreational users. This happens over and over again. So that was a theme with Gil, is that, you know, I got sick, I tried cannabis, it made me better. The other theme is that please inform your caregiver no matter how difficult it is, no you know, the fences or the barriers go up, inform your allopathic, your westernized caregivers, be it your eye doctor, your dentist, your massage therapist, your medical doctor. Let them know that you use cannabis as medicine because it could affect your care. And the other thing is that I've learned from Gil and again support Gil is if you're consuming cannabis, do it mindfully and understand it. It's not all about the big buzz, man. To get the perfect blitz doesn't mean you have to get the most infused pre-roll, you know? So this is what I got and that's where I really enjoyed this conversation. You found a fellow in Israel, a game-changer guy in Israel that is confronted by many of the same issues we are confronted here in the center of the continent.

Trevor:  Yeah, no, I love the fact we stumbled on Gil and that he had time to talk to us. And yeah, thank you, Gil, again. So I think we'll say things like I'm Trevor Shewfelt. I'm the pharmacist. This is Reefer Medness The podcast. Look for us on Reefermed.ca and all all them there podcast platforms. Who are you again?

Kirk:  I'm Kirk Nyquist. I'm the registered nurse. I am on the web page often. I just realized I need to do some updates on the webpage and includes cannabis coaching in the search engines. If you go to the bottom of our webpage, you can click on an icon that will send you to a bounty of platforms you can choose. If you are elbows up, you can use a Canadian platform. But yeah, Reefer Medness the podcast. Reefermed.ca. Tell people about us. Let people know. Give us a five-star rating in your platform.

Trevor:  Alright, sounds good. Thanks again to Gill, thanks again to everyone for listening. Those were three really cool episodes I hope you enjoyed them.