Moving Towards Legalization Step By Step: An Interview with Vermont PAC Dr. Paul Jerard

I stopped in today for a visit at 168 Pine Street today, excited to chat and get to know Dr. Paul Jerard, PAC, a bit better. Dr. Jerard started the Vermont Cannabinoid Clinic to help support patients interested in medicinal marijuana use.

HVT: Hi Paul, thank you so much for having me here. Tell me a little about your background.

PJ: I work ¾ time at the ER, as a physician assistant. I am from Brattleboro originally, and I went to UVM for my undergrad, and then University of New England in Maine for PA school.

HVT: What brought you into your work with cannabis?

PJ: What I see in the ER on a daily basis – the severity of the issues facing people with chronic pain and a lot of conditions for which we have sub-optimal treatment at this point. Especially the opiates, seeing that every day, people suffering.

HVT: So you weren’t really interested in cannabis as medicine before working in the ER?

PJ: Correct.  I also have had some great conversations and grew up with one of the dispensary owners along the way that has helped shaped my thinking.  We all need more knowledge as far as what actually works and hopefully we can cooperate on that in the future.

About half have PCPs who they aren’t comfortable asking or have brought it up and have been shut down by their PCP.

HVT: You were involved in the UVM cannabis as medicine curriculum development, correct?

PJ: I was involved in putting it together and have taken the course, as well. It was a good scientific basic building block to understand how cannabinoids can affect the body, what risks are, what research shows so far, and identifying the huge gaps where there needs to be more.

HVT: Tell me more about your clinic and your vision.

PJ: We are a medical clinic. We are not selling or giving anything out here – we are doing the same job that any patients can do if they have the desire or the knowledge. I am seeing patients for various medical problems, and doing necessary history and physical exams and then again seeing them over three months. I can then sign off on the paperwork to verify they have qualifying condition for VMR.

That’s about half my patients. The other half are people who have gotten their card, but have been told they can’t get good advice from those doctors, so they are looking for consultation and medical guidance on using cannabinoids. It is truly about half and half for signing people up versus consultations that we do.

HVT: What are you seeing in the clinic so far?

PJ: We have seen people for almost all of the qualifying conditions, not just pain. We are seeing people of all ages, ranging from the 30s to 80s.

HVT: That is fantastic!  How are people learning about your services?

PJ: Before we opened our doors, I sent out mailers to all the Primary Care Physicians (PCPs) in this area to let them know that we were doing this, and a potential resource for their patients. We are trying hard to work with the local community and keep them in the loop and make sure they know we are not trying to do anything with patients behind their back. We have also advertised in Seven Days and a few articles and different publications.

We have seen people for almost all of the qualifying conditions, not just pain. We are seeing people of all ages, ranging from the 30s to 80s.

HVT: What days is the clinic open?

PJ: One to two days a week right now, mostly Mondays.

HVT: What is the cost?

PJ: It is an out of pocket expense. Most people expect cash only, actually, but as it becomes more established, I foresee us accepting insurance in next year.

HVT: Are you an acting primary care physician?

PJ: No, I am more a consultant or specialist and have to have that three month relationship, but I am not a PCP. I won’t be doing any other prescriptions unless absolutely necessary.

HVT: Do you find the people you see have PCPs and docs that aren’t supportive?

PJ: About half have PCPs who they aren’t comfortable asking or have brought it up and have been shut down by their PCP.

HVT: Can I ask what you charge?

PJ:  $250 for two visits. $60 for consultation services only.

HVT: Will you be working with their PCPs?

PJ: Yes, if they have a PCP or specialist, we let them know that we are going to be faxing for records, so those doctors are going to know that people are here. We are not talking about nutrition and everything else – we are working on the qualifying condition only. I am starting to talk to people about the integrative community and also looking for people who think our patient population would overlap. They are welcome to get in touch with me to see what they can offer my patients.

HVT: So you are looking to create a supportive referral basis as well?

PJ: Were still looking to create as many ties with the medical community and looking to be seen as a resource for providers, albeit oncology or neurology or palliative care or primary docs. That’s been our mission from the get go, and we are still trying to make as many contacts as we can.

HVT: How do you feel you’ve been received in the community, locally, state wide or even at a larger level, such as big pharma in your advocacy for cannabis as medicine?

PJ: Nothing but support so far locally. I don’t think anyone beyond Burlington knows about me to have an opinion, really. I had to clear this with the hospital and had to go through state medical board certification to make sure I can do this. The folks at VMR have been nothing but supportive. They are looking forward to having someone being more communicative and responsive.

HVT: Were you concerned about coming out and being vocal in this field as a medical professional?

If it’s legal for someone to use and grow the plant and the state doesn’t want to get involved, that’s ok.

PJ: Not really. Honestly, when I decided to do it, I didn’t think about it too much. I am sure there are some out there rolling their eyes or staunch defenders of the federal prohibition and classification of cannabis locally, but if there are I haven’t heard from them. I have heard from their patients but not them. I think we are at a very different place politically then we are socially and politically ten years ago. it’s much easier now, especially in Vermont.

HVT: Do you see yourself taking a large political advocacy approach or role at all?

PJ: Not right now. We are obviously moving towards legalization step by step and I am concentrating more on the medical rather than the political or recreational. The way things are going, I also agree that I like the first step with Vermont legalization as I am opposed to a full on tax and regulate model.  I like the personal use – grow your own.

HVT: Are you then for, or in opposition to, a “legalize, tax and regulate” cannabis market?

PJ: I am for it, but I don’t feel strongly, honestly. If it’s legal for someone to use and grow the plant and the state doesn’t want to get involved, that’s ok.

HVT: So what do you see as an option for patients who can’t grow?

PJ: Right now, I am most concerned about practicing within Vermont law and focusing on the people that have qualifying conditions. I think eventually, and I know there has been discussion and talk about having bills to leave it up to providers’ discretion, leaving it up to a doc. That would be a good option. It was strongly opposed by the Vermont medical society, asking members to come out against the proposal.

HVT: So how do you like this kind of work thus far?

PJ:  I enjoy it more than I thought I was going to – more in depth than the ER. It’s been really rewarding to talk to people that are trying to deal with cancer as a family, or trying to give them hope to alleviate their chronic pain or fibromyalgia or Crohn’s disease. I really am enjoying it, and I am learning a lot from patients who have been self-medicating for a long time.

HVT: What else would you like our Heady readers to know about you?

PJ: I am not associated with any dispensaries. We see many of the same patients, but I do not work for them, nor are they involved in this clinic. We are not associated with any dispensary in particular. I do hope to connect with each dispensary so I know their product menu to help guide patients. I also am not selling any products out of the clinic.

It’s been really rewarding to talk to people that are trying to deal with cancer as a family, or trying to give them hope to alleviate their chronic pain or fibromyalgia or Crohn’s disease.

HVT: What about to other medical professionals?

PJ: I am really happy to make more connections, and let people who are knowledgeable about cannabinoids know that they have a medical ally, and someone who could potentially work with them to give evidence based medical guidance.

HVT: Well, as a nurse in the field, I am thrilled to have an ally on my side and I am sure we will be chatting much more as the days continue. Thank you so much Dr. Gerard for your time, advocacy and hugs! With the excitement and awesomeness of July 1 legalization, I think it is so important for us all not to lose sight of the medicinal value and healing of this plant. So, enjoy on July 1, without looking over your shoulder, but keep advocating with us to help make this plant a mainstream, staple, norm, in our medical arsenals, apothecaries, and homes!

PJ: Thank you!