Pubdate: Sat, 13 Jul 2019
Source: Wall Street Journal (US)
Copyright: 2019 Dow Jones & Company, Inc.
Author: Amanda Chicago Lewis


The waiting room at NiaMedic Healthcare & Research Services looked just 
like every other doctor's office at the Saddleback Medical Center in 
California's Laguna Hills: unflattering overhead lighting, landscape 
paintings and a smiling person in scrubs behind the reception desk. It 
was the ideal location to attract NiaMedic's target demographic: 
seniors. Saddleback is nestled in the rolling hills of a region 
surrounded by at least 15 retirement communities, including the over 
18,000-resident Laguna Woods Village. But the patients who come through 
NiaMedic's doors generally start with the same question: Can marijuana help?

"The short answer is yes," said Alon Blatt, NiaMedic's director of
business development. "The constant pain, the arthritis, the fatigue,
the trouble sleeping, the anxiety-we see cannabis help with all of

As legalization of cannabis has spread across the country, the stigma
and suspicions around using marijuana for therapeutic purposes have
begun to fade-even among older people. Eleven states allow anyone over
21 to purchase pot and another 22 permit medical use with a
physician's recommendation. Between 2006 and 2013, the percentage of
those over 65 reporting cannabis use in the past year rose nationally
to 3% from 0.4%, according to a study published in 2017 in the journal
Addiction, while the rates among people aged 50 to 64 rose to 9% from
2.8%. Although marijuana use is still much more common among
millennials, older folks represent a growing portion of consumers, a
trend that cannabis investors hope will continue as more baby boomers
retire. According to BDS Analytics, a market research firm for the
cannabis industry, 18% of marijuana users nationwide are baby boomers;
in states with legal, adult-use markets, 21% of boomers have consumed
cannabis in the past six months.

But in the quasi-legal, for-profit medical weed industry, where
peer-reviewed clinical studies are scarce and federal prohibition has
prevented the Food and Drug Administration from providing much
oversight, there are no clear guidelines on how many milligrams and
which mix of cannabis compounds might work best for any given ailment.
Most research involves mice instead of humans. Medical students rarely
get taught about the potential benefits of cannabis. Many doctors are
reluctant to suggest marijuana to their patients. Those who do risk
losing federal research funding or the license to study and prescribe
other controlled substances.

Filling the void is a cottage industry of cannabis-friendly doctors,
ready to give patients with a qualifying condition the go-ahead to
enter a pot store. At dispensaries, salespeople often take on the task
of advising sick people on what and how much to take. Businesses must
avoid making claims about weed's ability to cure or treat a disease,
rendering the whole process a confusing dance for the patient,
supported by little solid information and requiring trial and error.

That's where NiaMedic comes in. Their clinics aim to offer something
unusual and particularly appealing to seniors and their caregivers: an
evidence-based bridge between the scientists doing marijuana research
and the consumers buying legal marijuana. The company does not sell
its own marijuana or have a financial interest in the businesses that
do. Instead, NiaMedic offers customized cannabis treatment plans based
on the few clinical trials that have been done on cannabis as well as
the company's own internal data from over 10,000 patients, going back
nearly a decade. Founded outside Tel Aviv in 2016, NiaMedic now has
about a dozen medical staff members at three clinics worldwide-two in
Israel and one in Beverly Hills. (The Laguna Woods location's lease
expired but it's set to reopen in a nearby town.) NiaMedic expects to
open several more U.S. clinics in the next year, including on the East
Coast, and has begun to offer video consultations.

"Within five to 10 years, we're going to see cannabis in every
ambulance: for stroke, for heart attack, for all kinds of things," Mr.
Blatt said. "Right now, we're sitting on a jet engine, but we're still
on the runway going 10 miles an hour."

At the U.S. clinics, doctors see six to 10 patients a day. They try to
help people manage an array of diseases, medications and complaints
while avoiding a disorienting "high." Doctors and nurses test
patients' balance. They ask about diet. They talk about the patient's
home, and suggest getting rid of carpets and rugs, because older
people tend to drag their feet, and carpets can lead to falls. If
someone has a history of certain severe cardiac or psychiatric issues,
NiaMedic's doctors won't recommend cannabis.

NiaMedic said an internal study covering just over 100 elderly cases
shows that 93.8% of patients "reported improvement in their
condition," and more than half stopped using opioids or other

"I never wanted to try any of this stuff. I was very skeptical,'" said
Mary Perini, 58, who was referred to NiaMedic in December by a doctor
at Los Angeles's Cedars-Sinai medical center, for severe chronic pain
from two car accidents. "Since getting on NiaMedic, I've been able to
walk with my walker down the block and back, and I haven't been able
to do that for years," she said.

Dr. Benjamin Han, a geriatrician and assistant professor at the NYU
School of Medicine, said he began hearing questions from his patients
about medical marijuana about five years ago.

"The two main things are pain and sleep," Dr. Han said. "The problem
is that we really don't have much research in this area."

For decades, marijuana's illegality has made doing clinical trials on
the plant's medical benefits nearly impossible. The little research
that exists about cannabis and its compounds-such as
tetrahydrocannabinol (THC), which gets you high, or the
non-intoxicating cannabidiol (CBD)-has mostly been done in animals or
overseas. Much of the medical advice about marijuana, from dosage to
strain to delivery method, is not based on rigorous studies in humans.

While prescription drugs must be approved by the FDA, the federal
prohibition against pot means the cannabis industry operates in a grey
area, and is therefore harder to hold to any medical standards. Some
states have tightly regulated medical marijuana markets, but there are
also marijuana oils that claim to cure cancer and dispensary workers
known as "budtenders" who could suggest something that results in a
two-day high. NiaMedic says it is one of only a handful of
organizations and businesses that have amassed enough private data to
provide medical cannabis patients with detailed recommendations.

The company's co-founder, Inbal Sikorin, began treating patients with
marijuana about a decade ago, as the head nurse at a nursing home on
the Kibbutz Na'an near Rehovot, Israel. (She said she was inspired by
a documentary about Raphael Mechoulam, the Israel-based scientist who
discovered in 1964 that THC is the cannabinoid that causes a "high.")
Medical marijuana had been legal in Israel since 1994, though access
only began to expand significantly in 2002. After partnering with one
of Israel's licensed medical-cannabis growers, Tikun Olam, in 2010,
Ms. Sikorin began tracking her patients' outcomes, collecting
information that led to the system of protocols that her company uses

"We're not claiming to cure any diseases. We're trying to manage the
symptoms, to improve quality of life," said Mr. Blatt. "The bulk of
the work is case management."

After the initial appointment, the patient or caregiver will go to a
local dispensary to purchase products with the recommended strength
and mixture of ingredients. (NiaMedic keeps tabs on which local shops
have what products to better advise patients about what is available,
but it does not refer them to specific dispensaries.) NiaMedic's
nurses then spend about a month checking in with patients over the
phone and slowly toggling the dosage and delivery method of the
cannabis until the patient's treatment goals are achieved. Many of the
older patients are afraid of feeling stoned, so NiaMedic's
recommendations typically cover relatively low doses of THC, as well
as non-intoxicating cannabinoids like CBD, and the plant's many other
compounds, provided they are available at dispensaries. Only 6% of
their patients report feeling light-headed, or high, the company said.

Access to this kind of service, and to medical cannabis in general,
remains out of reach for most seniors. Consultations with NiaMedic
cost $350. Patients with Medicare pay only $100 out-of-pocket for the
cannabis portion of the appointment. A similar consultation with a
data-oriented medical cannabis company in California called Calla
Spring Wellness costs $200 or $300, depending on whether you speak
with a doctor or a nurse. Marijuana products themselves might cost
about $50 a month, and are not covered by insurance.

In places with wealthier aging populations, some pot firms have been
eager to market to older people. Trulieve, which has 29 medical
marijuana shops in Florida, says its average customer is over 50. The
company often holds educational events at assisted living homes and
opened a call center to connect with seniors offline.

"They want that human interaction, rather than just opening a laptop,"
says Trulieve Chief Executive Kim Rivers. To help patients better
determine what to buy and how much to take, the company encourages
them to consult with their doctors and to keep a diary of what
products they took, how they felt and how that changes. Trulieve also
created a portal where doctors who write cannabis recommendations can
browse medical journal articles about marijuana's effects.

NYU's Dr. Han remains apprehensive about the limited nature of
existing research. Seniors around the country might be experimenting
with cannabis and becoming too intoxicated, he said.

"A lot of what I do as a geriatrician is taking care of old people who
have many chronic diseases, probably take a lot of medicines, and are
really vulnerable to the adverse effects. A common thing [for older
patients trying marijuana] is they get dizzy," he said. "That makes me
worried. Could this be associated with falls?"

Other people who work with seniors expressed concern that in the
absence of accurate dosage information, cannabis businesses have a
financial incentive to recommend a patient take a higher dose than
they might actually need.

"One does not want to leave it to an individual or a dispensary to
determine how much THC or CBD a person is taking," said Daniel
Reingold, the president of Hebrew Home at Riverdale, an assisted
living facility in New York City. Mr. Reingold decided to allow
cannabis on premises after the state legalized medical marijuana use
in 2014. Now, about a dozen of his 735 residents have obtained medical
marijuana recommendations, and all have seen some benefit, he said.
But it's not ideal: "Scientific data needs to be available and
promulgated and disseminated so practitioners can know how to use the
drug to help people," he said.

Many older folks remain uncomfortable with the drug and with breaking
federal law, even if weed has been legalized in their state.

"People over 55 still have the largest percentage of what we'd call
cannabis rejecters: they don't consume, nor are they open to it," said
Jessica Lukas, vice president of consumer insights at BDS Analytics.
That "rejecter" percentage is higher among African-American and
Hispanic populations, said Sue Taylor, a retired Catholic-school
principal turned cannabis activist for the elderly. "That's who they
incarcerate first, and they don't forget it. Many of them will not
touch it still because it's federally illegal." Ms. Taylor plans to
open a senior-oriented pot shop and education center in Berkeley,
Calif., in the next few months, across from a clinic for people over

Several marijuana companies are partnering with universities and
researchers to make some of their information public. Dr. Han, for
example, has done research using patient data from a multi-state
medical marijuana company called Columbia Care.

Mr. Reingold of Hebrew Home said that as more states legalize
marijuana and evidence-based protocols like the ones developed by
NiaMedic proliferate, medical marijuana use among seniors will become
more common.

"It's no longer being viewed with the same stigma," Mr. Reingold said.
"This is going to be a very big part of the baby boomer experience."