Lincolnshire Pharmacist Joseph Friedman talks about medical marijuana in Lake County

The new law permitting the use of medical marijuana in Illinois went into effect on Jan. 1. Since then, it’s been a hotly debated topic in Lake County.

Longtime Lincolnshire resident Joseph Friedman is pushing to have pharmacists like himself run medical marijuana dispensaries in the area. The county is currently allowed to have three dispensaries out of the 60 total for the state, but regulations are stalling most progress. Friedman has been vocal in the community about his views on the issue and an advocate for proper distribution of the drug.

Friedman recently responded to some questions via email recently on legislation and his opinions on medical marijuana coming to Lake County in a recent Q-and-A session.

Q. You’ve expressed in the past you think pharmacists should distribute medical marijuana. Why do you think pharmacists will be best to do so?

A. I am convinced that pharmacists are the ideal professionals to own, operate and be onsite at medical marijuana (MMJ) dispensaries.  

A good example of this is Connecticut. Only pharmacists are allowed to apply for medical marijuana dispensary licenses, and a pharmacist and licensed pharmacy technicians (if needed) must be onsite to dispense cannabis products. Connecticut also changed the status of cannabis from Schedule 1 (Heroin, LSD), to a Schedule 2 (Morphine, Adderal). This allows all cannabis transactions to be treated as a controlled prescription, which will be included in Connecticut’s controlled prescription monitoring system. Illinois has a similar system call PMP or Prescription Monitoring Program. On this system, all prescriptions for controlled drugs list the prescriber, the patient, the controlled drug prescription details, and the pharmacy where the prescription was filled. These transactions are updated on a regular basis. Oversight of all controlled drug prescriptions can result in actionable measures if there is concern or suspicious activity.       

Having pharmacist oversight makes perfect sense. Pharmacists already have the basic skills, training, experience and patient-focused mindset. Pharmacists already know how to protect children, create a safe and secure environment, deal with difficult suppliers, maintain quality and inventory controls, educate patients and comply with strict rules and regulations. Pharmacists understand about drug interactions, dosing frequency, side effects, potency and general health and wellness information and disease states. We know patients and understand their health-related conditions. For example, a patient with multiple sclerosis receives a recommendation from their physician to treat localized muscular cramping and spasticity with cannabis.  

At the dispensary, the patient provides knowledge about their condition and drug therapy, and asks a number of questions [about different types of cannabis, drug interaction information and other health- and drug-related concerns]. Pharmacists can understand and respond to these questions.  

Medical marijuana can cause additive depressant effects, so alcohol, benzodiazepines (valium, Ativan), antihistamines (Benadryl), and narcotics can cause varied interactions. Medical marijuana can also adversely affect patients with immunosuppression, psychiatric disturbances, and cardiac and respiratory diseases. Pharmacists know how to monitor patients.

Lastly, Pharmacists know how to interact with other healthcare professionals. This common understanding of medical terminology is beneficial for positive patient outcomes. 

Q. What are the benefits of bringing a medical marijuana dispensary to Lake County?

A. Lake County has a dense population. Three out of the 60 allowable dispensaries in Illinois have been allocated to Lake County. I’ve analyzed the top 15 physician specialties based on the 35+ medical conditions approved for MMJ. All of these specialists are represented in significant numbers in Lake County. It is believed that 2-5 percent of the patients afflicted with the qualifying conditions may benefit from cannabis.  

In addition to the health care-related benefits of treating these patients with cannabis, municipalities will receive additional tax revenue.  

The draft rules recently released by IDFPR contain a section titled “Community Benefits Plan.” This includes programs to reduce the product costs for indigent patients that qualify, substance abuse prevention plan, minority and woman ownership, and environmental plan.         

Q. Where do you think the dispensaries should be located?

A. Ideally, a dispensary should be located in a medical office building. The qualifying conditions are relatively serious and debilitating. Many patients see their doctors in these types of medical building facilities. Many of these facilities have a professional pharmacy inside for the convenience of the patient. Having this same convenience for the patients requiring MMJ makes a lot of sense. I believe this would also enhance the security of the dispensary.   

Q. You currently live in Lincolnshire. The village recently had a board meeting where they discussed a possible moratorium that would prohibit potential medical marijuana dispensaries and cultivation centers from attempting to start their business in Lincolnshire. What do you think about that?

A. When I was in the early stages of looking for locations, I spoke to a former Lincolnshire village board member. The Village of Lincolnshire is fairly conservative. I was always aware of that. I also contacted the village manager and learned, according the HB1 requirements, there would be nowhere to place a cultivation center. I also learned there were only four possible locations to zone for a dispensary. I was told three out of the four property managers within those zoned locations that the village spoke with were not in favor of allowing a dispensary on their property. I’m not surprised by Lincolnshire’s possible moratorium. Many communities are taking a wait-and-see approach.        

Q. Some marijuana advocates are concerned that if pharmacists dominate selling of the drug, the pharmaceutical industry will take over the industry and may even force out local growers and retailers. What would you say to them?

A. Cannabis is against federal law. I don’t believe the feds will change their position on that for the foreseeable future. As a result, cannabis will not be sold out of pharmacies, and not be manufactured by big pharma for a long, long while. If you believe MMJ has medicinal benefits, and a state like Illinois can regulate the growth and distribution of cannabis for a specific patient population; then placing pharmacists into dispensaries would bring the best possible patient outcomes.  

Q. Many landlords are concerned about leasing space to a marijuana retailer since it’s considered an illegal substance to the federal government. Do you think these are legitimate concerns?

A. Yes and No. The dichotomy between the federal government’s position, and the states that have legalized it is very controversial. You are either for it, or against it. There is very little in-between. Landlords are concerned about safety, security and the effect of a dispensary on the community. Assuming a landlord is willing to consider leasing space to a dispensary, the landlord is going to look VERY HARD at who is involved, and who will be running the dispensary. Most of the dealings I’ve had with landlords have been positive. Pharmacists continue to rank in the top 3 gallop opinion poll for the most respected healthcare professionals. Nurses are number one. The honesty, good reputation and high ethical standards of a pharmacist could sway a landlord to consider leasing space for a dispensary. I’ve seen it happen in Roselle.    

Q. Say you were able to open and operate a dispensary beginning tomorrow. Would you solely run the dispensary or would it fit in your job currently as a pharmacist?

A. I would run the dispensary. I feel it will be important to be hands-on. I would run the dispensary similar to how a specialty pharmacy is run. I consider cannabis a specialty drug. Because the dispensary is based on dispensing only cannabis, I could not get a DEA license needed for dispensing legend pharmaceuticals that include legally controlled drugs. However, I would stock holistic OTC remedies. This is a new industry in Illinois, and it’s against federal law! Getting into this business is not for the faint of heart!

Q. Many people are concerned about an increase in crime if the businesses are cash-only. Should Lake County residents worry about this?

A. The draft rules coming out of IDFPR contain very detailed and specific security requirements. Lake County has or will be coming out with additional recommendations for security. This applies to all unincorporated areas within Lake County. Municipalities have the option to adopt these standards or not. Since recreational marijuana became legal in Washington and Colorado, the cash business aspect of this has received a great deal of attention from our justice department. Banks are being encouraged to work with MMJ businesses, but the situation remains vague. Major banks continue to refuse to work with MMJ businesses. However, I remain optimistic about possibly working with a local bank. I am not crazy about having an all-cash business, but if that is the way this has to go for now, I will make certain a security scheme is in place that will minimize the amount of cash on site, as well as ensure the cash that is on site moves quickly through a secure system of multi-day pickups and deposits. 

I recently attended a Lake County zoning board meeting in Waukegan at the Lake County courthouse. The zoning board was having discussions and making final decisions for recommendations. One area of evidence provided to the zoning board members was a white paper report from 2009 from California. This report contained over 100 pages of instances demonstrating an increase in crime related activity when dispensaries were located in neighborhoods. What the report failed to mention was the fact that during that time, the zoning for dispensaries in California placed them primarily in bad neighborhoods! One report actually showed a decrease in crime when a regulatory scheme was in place. A significant number of dispensaries in California in 2009 were not well regulated.  

I’m actually hoping by the time the first dispensary door opens for business in Illinois in late 2014, or early 2015, the banking industry will get clear direction from the feds that would ease their concerns to do banking business with MMJ dispensaries and cultivation centers.               

Q. If you’re an advocate for marijuana use medically, how do you feel about it for recreational use?

A. This is an interesting question. I recently moderated a webcast sponsored by NASP titled, “Breaking Barriers: A New Healthcare Model for the Business of Medical Marijuana. This webcast went out to health care professionals throughout the country. The first interactive polling question was, “The States of Colorado and Washington have approved, effective January 1, 2014 recreational marijuana for anyone over the age of 21 possessing a valid ID. If yours were the deciding vote, would you vote YES or NO to recreational marijuana?” Sixty-one percent of the respondents said YES, 39 percent said NO. At this time, I am not an advocate for legal recreational use. I know it’s happening in Washington and Colorado, and it’s generating large tax dollars for those states. Other states are also considering it. Illinois may even consider it in a few years. But until a year or more has passed and the social, political, and economic effects are better understood, it’s a bit of a gamble. Many in government and around the country are very interested in seeing how this all turns out.  

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