Plant a seed
Recommending cannabis for a pet, and even talking about it with clients, is tricky. When the subject is handled properly, veterinary cannabis can add to a practice’s bottom line.
My dog loves popcorn, but not just any popcorn. He loves the simple, homemade stuff — just oil, corn and salt — that I make in my grandfather’s old popcorn pot. Since Jack, my 12-year-old miniature schnauzer, was a puppy, he’d come running as soon as he heard the kernels begin to pop, jumping up on his hind legs to catch the pieces I’d toss his way. Over the past couple of years, though, Jack has responded more slowly to the popping kernels. I sometimes noticed a slight limp as he hurried to the kitchen. He stopped jumping for pieces, opting to wait for them to hit the floor.
Jack, it turned out, has arthritis. He’s been on joint supplements for several years, but the disease has taken its toll. Hoping to help relieve his pain, I reached out to Casara Andre, DVM, cVMA, the owner of Veterinary Cannabis, an education and consulting company near Denver.
“Every person I consult on cannabis just wants guidance,” said Dr. Andre, who will host the second annual Cannabis in Veterinary Medicine Symposium in October. “The pet owners who contact me just want to help their pet, and their vet isn’t able to talk to them about it.”
Stephen Cital, RVT, RLAT, SRA, VTS-LAM, who speaks nationally about cannabis, said veterinarians have an ethical and moral obligation to learn about cannabis even if they don’t agree with its use in animals.
“Clients are going to ask about it,” Cital said. “When a veterinarian shuts down the conversation because he or she doesn’t really know about it, that opens the pet up to being harmed inadvertently by the owner, who might give a product on their own that’s not well researched or has other ingredients that might be dangerous.”
Marijuana vs. Cannabis
Marijuana is classified as a Schedule 1 substance under the U.S. Controlled Substances Act. But is marijuana the same as cannabis? What about hemp? The terms are often misunderstood.
“Under the Controlled Substances Act, marijuana refers to certain portions of the Cannabis sativa L. plant, including the flowers, the leaves and the viable seeds,” said Garrett Graff, an attorney with Hoban Law Group in Denver.
Other parts of the cannabis plant, like the stalks, stems, nonviable seeds and fibers, are exempt from the legal definition of marijuana. Pursuant to the Agricultural Act of 2014, also known as the Farm Bill, Congress defined hemp as all parts of the Cannabis sativa L. plant below 0.3 percent THC (tetrahydrocannabinol) by dry weight.
While Graff recommends that veterinarians ask their respective boards of licensure for guidance on cannabis, Cital says many boards have gone too far.
“The California Veterinary Medical Board has overreached with its mandate that veterinarians cannot discuss marijuana hemp products or CBD [cannabidiol],” Cital said. “They mentioned CBD specifically when we know that, at the federal level, CBD derived from hemp is legal.”
State licenses aren’t the only thing practitioners could risk if they discuss cannabis with clients.
“Many practitioners also hold DEA [Drug Enforcement Administration] licensure, which could be implicated given marijuana is federally illegal,” Graff said.
When it comes to veterinary nurses, “It depends on the state that you’re in and what you’re talking about,” Cital said.
“If you’re talking to owners about marijuana-derived cannabinoids, that is opening you up for reprimand from the veterinary medical board in your state,” he said. “If you’re discussing CBD sourced from industrial hemp or hemp products, that, legally — even at the federal level — does not open you up to anything.”
Cital’s medical record notes are purposely vague when he consults on cannabis.
“I write something to the effect of, ‘Discussed endocannabinoid support,’” he said. “I think that’s a great way to protect the practitioner from legal recourse.”
Are You In or Out?
Clients are going to provide cannabis to their pets whether veterinarians like it or not, Cital said.
“We have to do what keeps the clients happy, and clients are interested in this product,” he said.
Even though clients might be interested in cannabis, the veterinary profession walks a fine legal line. Dr. Andre does not recommend that any veterinarian or veterinary clinic be the direct source of a cannabis product, regardless of its status as hemp or marijuana.
Marijuana products (greater than 0.3 percent THC) can be purchased through a dispensary in states that legalized recreational marijuana. Hemp products (less than 0.3 percent THC) might be available from online and brick-and-mortar retailers, depending on local laws.
“Many of the companies that understand the legal risk faced by veterinarians offer affiliate programs where the clinic can get a financial [inducement] when their clients purchase products,” Dr. Andre said. “This is a much safer way to handle the merging of cannabis and the veterinary industry right now. The DEA licenses of veterinarians should not be jeopardized just to add another product to the shelf.”
But, when handled properly, veterinary cannabis can add to a veterinary practice’s bottom line.
“This can create a really nice revenue stream for veterinary practices,” Cital said. “There’s no reason that we can’t be part of this successful, multibillion-dollar industry.”
Cannabis has the potential to increase revenue and improve patient care, Dr. Andre added.
“People want that guidance, and they are willing to pay for it.”
I paid for veterinary cannabis, and after nearly six months of daily doses, Jack’s arthritis pain has diminished noticeably. Now when I make popcorn, he runs to me like a puppy, ready to jump for every piece I toss his way.
Sarah Rumple is an award-winning veterinary writer and editor living in Denver.
The path to cannabis
Embracing cannabis as a treatment option in a veterinary practice can:
- Boost revenue.
- Improve the client relationship.
- Increase job satisfaction.
How? Picture this:
You are managing the care of an epileptic dog. The patient hasn’t responded to traditional medications, and the client is frustrated watching her dog’s health decline.
After doing research, the client comes to you with a question: Do you think cannabis might help? You tell her that because of the legal status of marijuana and the possible implications for your veterinary license, you aren’t comfortable discussing cannabis with her, but you have a certified cannabis counselor on your team. You tell her she can schedule a consultation with the counselor.
When the client returns for the consultation, the cannabis counselor has reviewed the dog’s medical records. The counselor recommends an appropriate product, dosage, frequency and administration method, along with baseline blood work. The counselor also explains how to obtain the product. The client leaves feeling as if she has been listened to and taken care of.
When the client purchases the recommended product, she uses the practice code provided by the counselor, and a portion of the sales price is credited to the practice because an affiliate program has been set up with a distributor.
Four weeks later, the client returns for a follow-up exam and blood work to ensure no unintended consequences of the cannabis treatment and to confirm that the dog is on a therapeutic dose. You, the veterinarian, ask how the dog is doing and she reports that the seizures have significantly lessened in frequency and severity. She can’t wait to discuss the changes with your cannabis counselor.
When you review the blood work, you see no adverse side effects of the cannabis treatment. Your cannabis counselor calls the client to discuss the results and to recommend continuing the dosage and frequency. The counselor feels empowered and valued, a sign of improved job satisfaction.
Consultant Casara Andre, DVM, cVMA, has launched a program designed to teach veterinary nurses how to discuss cannabis with pet owners. Nurses who pass the course become certified cannabis counselors.
“It’s geared toward technicians just because the legalities with this topic are so sticky that technicians seem to be a good option to be on the forefront for patient advocacy and discussing this without concern, because we don’t hold a DEA license,” said program instructor Stephen Cital, RVT, RLAT, SRA, VTS-LAM.
More information is available at www.veterinarycannabis.org.
Does cannabis work?
Should cannabis be prescribed for the control of pain or seizures in animal patients? What about for the treatment of inflammation or anxiety?
“There is evidence that strongly suggests that animals may experience the same benefits that humans experience from the use of medical cannabis,” the Denver consultancy Veterinary Cannabis states on its website.
The Colorado State University School of Veterinary Medicine and Biomedical Sciences is conducting two studies of cannabis use in companion animals. The pharmacokinetic studies of a hemp product (cannabidiol, or CBD), have concluded, and Stephen Cital, RVT, RLAT, SRA, VTS-LAM, said they “suggest a wide safety margin in dosing and minimal side effects for one product from one manufacturer.”
The next phase of the studies involves testing the efficacy of the same CBD product on client-owned dogs suffering from epilepsy or osteoarthritis. Results of the double-blind studies are expected later this year.
Cital is a consultant with ElleVet Sciences, a veterinary cannabis manufacturer that has reported favorable safety and efficacy results in studies conducted through the Cornell University College of Veterinary Medicine. Three studies involving cats and other species for different clinical uses are ongoing.
“CannPal Animal Therapeutics has also announced a successful pharmacokinetic and safety study for a product containing CBD and THC,” Cital said.
“We have studies in 17 different species of animals so far, with all showing receptor use of cannabinoids.”