- As far back as ancient times, the use of marijuana for medicinal purposes has been documented in numerous civilizations.

In colonial America farmers grew hemp plants to make clothing, paper, rope and sails.

Between 1840 and 1941, it was listed in the United States Pharmacopeia as a medicinal drug before it was criminalized and removed.

And legalizing marijuana for both medicinal as well as recreational purposes is under scrutiny and somewhat controversial.

On today's show, we'll look at the medical, legal and social ramifications of marijuana use.

Welcome to A Su Salud - Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Dr. John Interrante, our St. Luke's University Health Network expert.

Thanks for joining us today, Doctor.

- Thank you very much.

- It's a pleasure to be here.

- Doctor, let's get right into it.

I want to talk about your specialties, which includes palliative medicine.

What is that exactly?

- So palliative medicine is a field of medicine that's relatively new.

It's very focused on quality of life and symptom management for people who have serious or advanced illness.

The idea being that when you have a really bad disease, you have a whole care team full of people who are there to help you manage that disease.

But the palliative medicine team is really going to make sure that you feel well, that you have your quality of life intact while you go through your treatments.

- What specific ingredient in marijuana holds the medicinal value?

- So marijuana contains over 140 active compounds.

We're still learning so much about this every year.

What we do know is that marijuana contains both THC and CBD.

And those are the two things that at this time we think are causing the potential benefits that patients are getting from using medical marijuana.

- Break that down for me.

THC, CBD - terms I think a lot of people have heard of, but what are they?

- So our body naturally has receptors called CB receptors.

Believe it or not, we actually produce chemicals that will bind to these receptors on a daily basis.

When we dig a little bit deeper into medical marijuana and we look at those plants, there is the THC or tetrahydrocannabinol, which binds to the CB receptors.

And that is the part of the medical marijuana that we believe causes a lot of the emotional and cognitive side effects that we get.

For example, people who have anxiety, the THC may be the reason why medical marijuana helps relieve that anxiety.

For people who suffer from insomnia, the THC may be the part of this that helps those people to relax.

For people who suffer from nausea, the THC may be the substance that is helping to control that nausea.

The CBD works at a different cannabinoid receptor and it is the part of the medical marijuana that we believe causes some of the anti-inflammatory effects.

And those anti-inflammatory effects are what we think are responsible for some of the improved pain relief that people report when they use medical marijuana.

- You mentioned anxiety, insomnia, nausea, but what are some of the other conditions or illnesses that patients might seek medical marijuana to treat?

- So medical marijuana in the state of Pennsylvania is approved for a variety of different illnesses at this point.

Yes, there are the common ones like anxiety, chronic pain issues, but it also is used very effectively for certain patients who have neurologic disorders, neurospasticity disorders, seizure disorders.

There is indications for people who are suffering from essentially, unfortunately, any terminal illness to help with a number of different symptoms.

So medical marijuana has a lot of different potential uses and the state of Pennsylvania has continued to expand that list to give us more and more options as we continue to do these certifications.

- Currently, as it stands now in Pennsylvania, once a patient has been certified to receive access to legalized marijuana, what are the next steps to doing that?

- So to get a medical marijuana license in Pennsylvania, a patient obviously has to be a resident of the state, meaning you have to have a Pennsylvania ID, driver's license or state ID is fine.

You then have to find a certifying physician.

So I as a physician, I am telling the Department of Health that this is a patient who has one of these qualifying diagnoses.

Once I do that certification, the patient should receive their card.

Then they can take that card to any of the number of approved dispensaries that we have in the state.

And they will be able to confer with a pharmacist or a provider at that dispensary to get recommendations on how to specifically treat their symptoms.

- Is this something that's covered by insurance?

- Unfortunately, not at this time.

The initial card fee is not covered by insurance, and once you go to the dispensary, everything is individually priced, as far as I understand.

So really, this is something that though it has uses, unfortunately, can be a little bit financially prohibitive for some patients.

- So, Doctor, what about side effects?

Is there anything that patients should be made aware of if they do take medicinal marijuana?

- Absolutely.

So medical marijuana, much like every medication that we use, because it is active at these receptors in our body, it certainly does have a pretty substantial side effect profile.

So the common side effects that people will experience could be sedation.

People can have a sense of... ..extra hunger, an increase in their appetite, people can have more serious side effects like worsening anxiety, people can have more serious side effects like nausea, people can have very serious side effects like vomiting syndromes where the medical marijuana is basically responsible for some of these unfortunate symptoms that they're having.

- Now, let's talk about the use of medical marijuana.

I mean, how is it administered and what are the available forms right now?

- So in Pennsylvania, medical marijuana is actually gotten to the point where there are several different formulations available.

What initially started with pills and capsules has now become things like tinctures, oils, creams, products for vaporization.

And then, of course, pills and capsules are kind of the mainstay.

And again, every dispensary has a little bit of a different list of products that they're able to offer, that you can kind of choose from in conjunction with the pharmacist at the dispensary.

- As a doctor, what's your professional opinion?

Is there any form that's better than the other?

- What we do know is that when medical marijuana is inhaled, it does skip one of the metabolic steps in our body.

And so theoretically, it can have a little bit of a faster effect.

Because some of my patients certainly will have things like pain crises or anxiety crises, it may be beneficial to them to use the inhaled formulation.

Otherwise, any of the edible formulations certainly get the medical marijuana into your system.

It may just take a little bit longer.

- I would be remiss if I didn't ask you, I mean, how does medicinal marijuana differ from recreational marijuana or something that you can get off the streets?

- So I actually feel very strongly against the use of recreational marijuana as you can buy it off the streets.

And the reason for that, and one of the reasons why I agreed to certify patients for medical marijuana, is if you buy marijuana off the streets, you don't know what else is in there.

The medicinal marijuana in Pennsylvania is very tightly regulated.

If you buy recreational marijuana, it could be laced with any number of other dangerous substances.

And you don't know how those other dangerous substances could potentially harm you in a life-threatening fashion.

- You know, I want to end this interview, we're running out of time, but I want to ask you this - as a doctor, is there anything that you wish that the community as a whole would know about medicinal marijuana?

- Sure.

This is a very unique and interesting opportunity for symptom management.

My personal experience with my patients has been fairly positive.

I would love the community to know that this is a resource, but also that this may not be a cure all.

And so there is still certainly a lot of research to do and a lot more to find out about this.

But it is a very exciting prospect that Pennsylvania continues to move forward with medical marijuana.

- I appreciate your insight today.

Thank you so much for your time today, Doctor.

- My pleasure.

- My next guest is our very own lieutenant governor here in Pennsylvania, who's long been a proponent of legalizing marijuana.

Lieutenant Governor John Fetterman, thanks for joining us today.

- Hey, thank you so much for having me.

- Let's jump right in.

You've been on the forefront on the fight to legalize marijuana.

Why?

- Well, because... let me just first say it's not because I'm a user.

It's just something that I believe that adults in Pennsylvania should be able to access legally in a safe, pure manner that would not hamper them for the rest of their lives with a criminal record if they're caught consuming it.

And the reasons for that are numerous, whether it's the revenue, whether it's the thousands of new jobs, whether it's the freedom to have a mass expungement of people's records of all these silly convictions, using marijuana, to for cash crops for farmers to...

I mean, just the reasons are just expansive and there's something for everybody in it.

And it's not because you have to use it or not.

I don't use tobacco, for example, but I do believe that it should be legal, and tobacco's dangers and deaths are well-documented.

- I want to ask this.

I mean, for legal medical marijuana use here, the cost to patients right now is among the highest in the country.

So what would full across the board legalization mean to patients and its costs?

Would that bring costs down?

And do you think insurance companies should cover this?

- Yeah, another great question.

That was the one single main complaint that I heard from people about our medical marijuana program, is that it's too expensive.

And it's medicine.

Just the way, let's say it was insulin, we would want to make it as affordable and as accessible for people because it's a lifesaving drug that maintains your wellness.

And the governor and I both strongly support homegrown, too, for our medical patients.

So in other words, those individuals that are unable to afford, say, Flower medically would be able to grow their own with a very specific strain that would be allowed to be grown at home.

And then recreational, it will expand and drop the price, I would imagine.

But our medical program is actually very good, too, and some of the strains that are used for medical purposes are very specific.

I think ultimately to lower the price, homegrown is that option as far as I'm concerned.

But recreational would absolutely have an impact on legal too.

But I would I would rather see people maintain with the medical strain that best addresses their specific medical issue than be forced to experiment with either with black market weed right now or, say, go to New Jersey and experiment.

- How substantial is the revenue that could be generated on a statewide level if Pennsylvania were to legalize marijuana, regulate it and tax it?

- Conservatively, and I want to be very clear, I'm saying conservatively, we're talking around $5 billion over a 20-year window.

And that just means that we would bring in $250 million a year in revenue over the next 20 years, which is ridiculously conservative.

It's probably going to be much more than that.

Our medical program is approaching $1 billion in sales and recreational would dwarf, dwarf medical.

So it doesn't take much math to realize that you're saying no to billions and billions of dollars of free money.

I mean, free money.

All of these funds are going now to the drug cartels and the black market because there's a thriving weed market in Pennsylvania.

It just happens to be illegal right now.

- On that note, I want to play a very brief video.

Last August, Governor Wolf expressed his thoughts on the pandemic and how the state might be able to infuse our economy and help small businesses with additional funding.

Let's take a look.

- One other place the money might come from is if the legislature does what the lieutenant governor and I asked it to do back in the summer of last year, and that is to legalize recreational marijuana, and use the income from the sale and the taxes that come from recreational marijuana to supplement these loans and carry the funding that the Cares Act doesn't.

The Cares Act, we have about $1 billion.

I think what I'm proposing here is about a billion, $90 million.

- I love that guy, love him.

And he's absolutely accurate.

And this idea that this is revenue that could help our small business community that's been so adversely affected during the pandemic, it could be invested in our infrastructure, in our schools, in anything now because it's being invested by the drug cartels to do gosh knows what.

And that's the whole point here, is that New Jersey's already legalized it.

Virginia has already legalized it.

Maryland will shortly.

New York is going to.

So we're in a place right now where even if you don't support it or use it yourself, you could acknowledge that it's coming to Pennsylvania whether they like it or not, and we could embrace the substantial benefits that it would accrue to the entire commonwealth.

And again, I want to emphasize, simply acknowledging that it's legal does not mean that you use it any more than acknowledging that alcohol is legal, that you're going to run out and go buy a bottle of Jack Daniels at lunch.

I mean, it's simply acknowledging that this is a thing that belongs in a basket of other things, like alcohol, like tobacco, like, say, gambling that you may or may not partake in, but as adults, we should be able to do that and use that revenue to foster the greater good with tax revenues.

- So I want to hear your thoughts on this.

A lot of opponents say, one of the main arguments is that it could be considered a gateway drug.

What do you say to those people?

- I'd say they're right.

It is a gateway drug.

It's a gateway drug away from pain and a gateway drug away from addiction to painkillers.

You know, it's not even disputed that many people go to get...

The irony is that, you know, OxyContin, for example, is legal, you know, and the fact that it comes from a doctor's office, and that has led countless thousands, tens of thousands of people down the road of addiction.

And the pain that drove them to that avenue can be addressed by marijuana.

And it's much more accessible.

So is it that a gateway drug to bad behaviors?

No, it's a gateway drug away from the slippery slope of addiction as well.

Let me be clear, there is not one single medical overdose death of marijuana in recorded medical history.

Furthermore, then you could say tobacco is a gateway drug.

You could say alcohol is absolutely a gateway drug.

You could say Doritos are a gateway drug because that could lead to you drinking.

And I mean, like I mean, like at this point, it's just part of that reefer madness that they're holding on to.

- Now, this is an issue that voters can't go to the polls to vote on.

It's something that has to go through the legislature, to my understanding.

So what's that process like?

How is that debate playing out right now?

- Well, we just had a major milestone last week.

We received our first Republican co-sponsor for legalizing marijuana in Pennsylvania.

And I applaud his courage in joining that because it's acknowledging the truth.

It's acknowledging the fact that it's inevitable.

And the longer we wait, the more money that we lose, the more jobs that we lose, the further behind we fall behind states that have already taken this on and made it a part of just the usual portfolio of things, no different than, you know, Gus the Groundhog and lottery tickets.

I mean, none of this stuff, you know, like once it is adopted, it would be no more jarring or disruptive than, again, a groundhog selling you lottery tickets.

I mean, the fact that it goes on, to no one's concern, the world hasn't spun off its axis with these things, it should be noted, too, that marijuana is the same thing.

Adults should be able to consume it safely, legally, and it also dramatically drops the adolescent use too Two studies came out that demonstrates that it reduces youth use by as much as 16% in states where it's already legal, because it gets that much harder for teens to acquire it through legal channels, much like alcohol.

- Lieutenant Governor John Fetterman, thank you so much for your time.

We appreciate your insight on this topic.

- Thank you for having me.

- Now we're going to speak with Tyrone Russell and Michael Frassetto, who bring their individual talents to the table in terms of cannabis outreach and education.

Thank you for joining us today, Tyrone and Mike.

- Thanks.

- Thanks for having us.

- Tyrone, let's start with you.

You're the president of the Cleveland School of Cannabis.

Tell us more about the school and its mission.

Yes, so the mission of the Cleveland School of Cannabis is essentially to develop the workforce for the cannabis industry, right?

So we noticed that our governments are arguing and fighting with the citizens to come up with a cannabis marketplace.

But no one is really thinking about who's going to work the, you know, the production of it all.

So we decided to start a school with a client of ours, marketing client of ours in Cleveland to prepare people to work in this industry.

Right?

So we have five programs.

We have a horticulture program where we're helping people learn how to grow.

We have a dispensary operations program.

We have a medical applications program.

We also have a program that focuses on the processing of the cannabis plant.

And then we have an executive program, which is a combination of all of the other programs combined.

You can't start a new industry and not really focus on the education of the people who are going to be working in the industry, and we understand that.

- Mike, let's pivot to you.

You work at a local cannabis dispensary, so let's start here.

What outreach duties do you have?

- Well, you know what, it's been something that I've been pushing for, for the dispensary to get involved in the community for the last three years that I've been there.

And they're finally starting to make progress in starting to reach out to the community in different ways, going to different events, having some, like Tyrone said, some educational events where we could speak and teach residents of the community about the real science behind this wonderful plant.

- Tell us a great patient success story, if you have one.

Oh, man.

We see close to 400 patients a day, we see success stories every single day for the last three years.

I would say the biggest percentage of the success stories that I see every day is people being on opiates for the last 15, 20 years, they think there's no other... there's no other recourse for them to get out of pain.

They just have to keep increasing the milligrams of opiates.

And when they get on cannabis and they get on the right products, they are able to wean themselves off of their opiates that they've been on for the last 15, 20 years all the way, sometimes within four to six months where they completely get off opiates, get healthy again, start eating well again, and start being able to move around and feel a lot happier, and no pain, or a lot less pain than they have been for the last 15, 20 years.

We see 15, 20 of those cases a day.

- Mike, we're living in a Covid world right now.

So I want to know, I mean, has the pandemic affected how people are getting their medical marijuana?

- Yeah, yeah, absolutely.

For the last year, since last March, when the pandemic hit, we moved to curbside only, so all the patients put on an online order and we run their order out to them.

So it also increased to the numbers, because it was a lot more convenient for people that way, where they just sit in their cars and just wait for us to bring it out to them.

The numbers increased since last March by more than double for the amount of patients we see a day.

- Let's talk about our black and brown communities.

You know, as the legal cannabis industry continues to rise, there's an interesting statistic that's catching the eye of a lot of marketers.

And Tyrone, I want to get your take on this.

Hispanics are more likely than any other ethnic group to consume cannabis products or support cannabis legislation.

I mean, how does that impact things?

- I mean, tremendously.

When you think about it, you know, Latinos, Hispanics, which term you prefer to use, and African-Americans have been impacted negatively by the plant more than anyone in this country.

So we're going to be, for the most part, for the legalization of it because we've realized the benefit of it for far too long.

Right?

The issue is that we aren't having the same access to participate in the industry.

So while we're for the legalization of it, if we aren't signing up to be medical patients or the market isn't adult use yet we're going to be left out.

And furthermore, if we're trying to start businesses in the industry, right, what they're asking for really begins to limit our accessibility to that industry, to be owners and leaders in it.

Right?

So we can be forward on one end and still not be reaping the full benefits on the other end.

And I think that's the important part, is that as much as we are for it, we have to be able to reap those benefits beyond just treating our ailments using the plant.

- Now, speaking of cannabis and the law, Mike, I want to pivot to you.

I understand you helped push forward an agenda for the decriminalization of marijuana in Allentown.

Tell us more about that.

- Yeah, that that movement started in 2017.

It's just something that, it just seemed like it was the right thing to do.

At that time.

there were five other cities in our state that passed decrim ordinances.

And I basically took all the best parts of those ordinances and wrote one up for Allentown and Bethlehem.

In 2018, early 2018. both city councils of Allentown in Bethlehem did pass the decriminalization ordinance, but it was not enforced legally by the district attorney's office.

- Now we have a significant minority majority community here in the Lehigh Valley.

And Tyrone, I understand that the Cleveland school has an equity scholarship partnership.

Can you tell us more about that?

- Yes.

So part of the cannabis industry is really pushing in some aspects this idea of equity.

So a lot of the major companies are looking for ways to give back to communities that have been hurt and harmed by cannabis.

So some folks are looking at ways to give people percentages of their of their organization as they come in.

Some of that is folks just utilizing leverage and leveraging folks of color to access the cake, even though they won't get a large piece of that cake.

But the equity scholarship at CSC is a way that... A company known as Green Thumb Industries, which, they've been a tremendous partner with us for some time, they want to give back in the educational aspect.

So they are sending at least two students this year to CSC on a full ride.

And we're looking to continue building those types of partnerships, because if you can't give people access to ownership of your organization, the least folks can do is pay for people to become educated on how to enter into the industry.

And I think GTI realized that and are doing that in addition to actually doing some development, some cultural development within their organization.

So they have this full idea of how they want to include and integrate social equity in the work that they're doing.

And one way is by offering scholarships for folks to get this education.

- Now, is the school remote?

- We do have remote accessibility, right, so we do have people who are taking classes via Zoom, but we do have two campuses, one in Columbus and one in Cleveland, for people who prefer to be in person when they're meeting with us.

- Overall, what has the reception been like?

- Tremendous.

It's crazy because we go to California, where we're actually building a partnership now for some expansion, and they ask, because California has been in the game for some time, and they say, when are you going to bring the school here?

So if that doesn't tell you, like, the reception and the need for additional education, I don't know what does.

A place like California asking folks in Cleveland to come set up shop because they're seeing the hole in the education of the people who are working for them.

They're seeing the turnover and are like, we need more people who are committed to this.

And we know if someone is committing to at least six months of education, they're going to be serious.

Whereas someone who comes in off the street, for the most part, right, may not actually have that commitment to seeing these organizations grow, right?

So the reception has been tremendous.

We're employing about 70% of our students, we're highly committed to getting them employed.

So we don't just educate them and let them go.

We say, how do we get you a job and how do we build partnerships so you can go work in the industry?

And the reception from their work ethic has been tremendous.

- Well, I'll end this conversation on this note.

I'll start with you, Mike.

Both of you are in this industry and with the mixed thoughts on the topic, I want to ask you, what's something that you wish people knew about cannabis?

- Well, you know what, it's still that misconception and the taboo topic that Tyrone was bringing up from the 1930s and 40s.

I mean, this plant is, yeah, it's a wonderful plant.

It's a healing plant.

It goes over 70, 80 different conditions that it can treat.

This is something that we were all born into, a society where we cannot talk about it.

Like it's a really taboo topic to talk about.

And that's just something that we have to change.

We have to change and shift that paradigm because it's just not the facts any more.

It could really help people out and I see it every single day.

- What are your thoughts, Tyrone?

- I would echo everything that Michael said and I probably would have said that if I went first.

But I guess the thing that I would add to that is that this industry is here to stay.

Never in our lifetimes, anyone who is watching this broadcast right now, never in your lifetime, outside of the internet, have you seen an industry be born in front of your eyes.

So we need to be involved.

We need to take advantage.

We need to find our lanes and get in those lanes to be a part of these industry so that in 20, 30 years from now, folks are looking back and saying those were the pioneers.

But right now, there are so many misconceptions and there's so many lies about the industry and a lot of hurt that have been done to our communities in particular, that people are afraid to get into that industry.

And we may not ever get an opportunity like this again in our lifetime.

So what I want you to know is this is your time.

Jump in now.

- Thank you so much, Michael and Tyrone, for being with us today and sharing your insight with us.

- Thanks for having us.

- Thank you.

I want to thank our St. Luke's University Health Network expert Dr. John Interrante, Lieutenant Governor John Fetterman, and my other guests, Tyrone Russell and Michael Frassetto.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject you'd like for us to cover send me a message on social media.

Nothing's off the table.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM WLVR News, your local NPR news source.

I'm Genesis Ortega and from all of us here at Lehigh Valley Public Media, stay safe, be healthy and cheers to your health.