A Q&A with Nerfis Elminowski, DNP

FEATURED

A Q&A with Nerfis Elminowski, DNP about Cannabis for Veterans and Holistic Healthcare

Dr. Nerfis Elminowski is a Board-certified Doctor of Nursing Practice and Graduate of Daemen College. She possesses over 25 years of experience including aviation medicine, acute, trauma, urgent, chronic care, geriatrics, and mental health. She has also worked in oncology, chronic pain, substance abuse, and immigrant healthcare. Dr. Elminowski is a highly decorated veteran and served our country as a flight medical provider, coordinating flights for over 1000 patients during high profile, classified missions with a 100% success rate and earning six Hazardous Duty awards in 1 year.

INTRODUCTION

Dr. Nerfis Elminowski was a member of an elite Special Operations Aviation Medicine Team and obtained her flight degree from the USAF Academy, eventually earning a promotion to lieutenant commander. Throughout her service career, she earned numerous awards and commendations including the Crisis Response Service award with Bronze Star and Foreign Duty Service Award. From a young age, Dr. Elminowski knew that she wanted to work in medicine. Her passion for healing evolved from growing up with a family member who required around-the-clock care. She learned at a young age that helping others requires both preventive care and a holistic approach. While classically trained in Western medicine, Dr. Elminowski has also developed a deep appreciation for cultural anthropology and the natural sciences and incorporates both into her medical philosophy. She has studied, worked, and traveled abroad extensively. Dr. Elminowski is an authorized medical cannabis provider in NYS. She is a pioneer in integrative and alternative medicine and is a passionate advocate for the legalization of cannabis. She incorporates alternative medicine with a focus on wellness and prevention, rather than simply treating the disease. She believes holistic care is about more than integrating Western and Eastern medicine, but rather a more comprehensive and personalized way of thinking about wellness. It is about caring for the whole person, including their physical, mental, spiritual, and social needs. It’s an understanding that all of these aspects affect an individual’s overall health, and being unwell in one area may have a negative effect on other areas. For example, it works both ways; stress is a psychological response but can also cause physical symptoms such as headaches, weight gain, muscle aches, and difficulty sleeping, and being physically ill can cause you to feel anxious or depressed. Just as your spirituality and relationships can boost your mental and physical health. Geoff Brown: Tell us about how you first got involved with cannabis?

Dr. Elminowski: I’m a disabled veteran. I sustained a brain and spinal injury that changed the trajectory of my life by ending my service career. What was once a productive and exciting life turned into a life of constant pain and isolation. I suffered from migraines, neuropathy, and pain. The quality of my life decreased both physically and mentally, and I began to lose hope for the future. MY days were spent confined to a dark room and I thought she would never be able to leave my home. I was prescribed multiple medications and felt like she had no foreseeable future. One day, a very close friend of mine suggested that I try medical cannabis. Although I was skeptical, I thought, “I have nothing to lose.” I soon decided that I was going to try to stop taking the pharmaceuticals I was on. My reluctance toward painkillers stemmed from personal and professional experience. I had lost friends to opioid overdoses and had witnessed firsthand how addiction can destroy individuals and their families. There is a mounting body of research detailing the lack of benefit and potentially severe harm of long-term opioid therapy, and veterans are twice as likely to die from accidental opioid overdose compared to nonveterans. Within 2 months of starting the medical cannabis, I noticed a significant decrease in the frequency, severity, and duration of my migraines. My neuropathy, pain, mood, and sleep also improved. Within 4 months I was able to decrease and eventually stop most of my prescribed medications. My family started to notice an improvement in my mood and motivation. I started to do more around the house. I invested in a swimming pool and started to do low-impact water exercises and eventually I got stronger. My water exercises got more rigorous and soon I was swimming laps and racing my daughter in the pool. I began leaving my home, going on walks, going out to eat, and attending family events. I knew medical cannabis was working. It gave me a second opportunity in life. I thought, that if medical cannabis drastically improved the quality of my life, think of the potential it can have for my fellow veteran comrades. That’s when I knew I had to do something about it, and talking wasn’t enough. I decided to learn as much as I could about cannabis through research and studies that have been conducted all over the world. I then became certified in medical cannabis and started a medical cannabis program with a focus on veterans who suffer from debilitating service-related disabilities such as chronic pain and post-traumatic stress disorder. Many of my veteran patients continue to do very well, and as a result, have asked me to recommend medical cannabis to their family and friends who suffered from debilitating chronic conditions in hopes that it would help them in similar ways. Eventually, I opened my doors to nonveterans. This was a major turning point in her life, and I have been operating as such ever since. For many patients, it is truly a transformative medical necessity. Q: You’re very involved in the medical cannabis space, but what are your thoughts on the recreational side of Cannabis?

A: I am glad cannabis has been decriminalized in NY. Although the industry has seen considerable improvements, it continues to face many challenges in areas of legality, regulations and raising capital for those interested in expanding into the adult-use recreational industry. I believe these areas will be the key forces driving the industry as different states within the U.S. approach the use and sale of adult-use recreational cannabis differently. The Marijuana Regulation and Taxation Act (MRTA) legalized cannabis for adults 21 years of age and older. This law establishes a framework that will comprehensively regulate cannabis in NYS in a manner that will protect public health and safety while promoting social equity and economic development. However, as legalization expands, some entrepreneurs are finding gaps in the law and are selling unregulated and unlicensed cannabis, even though the Office of Cannabis Management states that it is illegal for anyone to sell unregulated cannabis in New York State and that anyone selling unregulated, unlicensed, and untaxed marijuana in NYS is breaking the law on both state and federal levels. In doing so this undermines their ability to build a legal, regulated cannabis market that will ensure products are tested and safe for consumers while providing opportunities for those from communities most impacted by the over-criminalization of cannabis prohibition. Some unlicensed entrepreneurs are even going as far as to openly advertise on social media, ads, and billboards throughout the city, thus confusing the residents and patients of medical cannabis. Despite cannabis becoming more acceptable in society, entrepreneurs will continue to face challenges in accessing traditional business services and capital as opposed to non-cannabis businesses. Due to the uncertain legal status and federal prohibition, cannabis companies do not have access to traditional insurances and traditional banking services that other non-cannabis companies have. This makes operating a legal cannabis business a challenge for business owners with the outcome being increased costs. There are supporters of the legalization of marijuana in the Senate who are proposing the Cannabis administration and Opportunity Act, which would allow adults to buy and possess marijuana without facing criminal penalties, eradicate non-violent marijuana crimes, advance medical research, and allow cannabis companies access to basic financial services, including bank accounts and loans. Q: Who do you think stands to benefit the most from cannabis legalization, (therapeutically speaking and/ or just in general)?

A: Patients who use cannabis for therapeutic purposes should benefit the most and not fear legal penalties. I believe medical cannabis has paved the way for adult-use recreational cannabis. Therapeutically speaking, for the interest of medical cannabis patients, legalizing cannabis on a federal level would be considered a great leap forward. This would open doors to advance medical research and encourage medical insurance companies to cover the cost of medical cannabis for patients who need it. The current classification of medical cannabis is also a challenge for providers. Changing the classification of cannabis may reduce the stigma some healthcare providers have and increase the understanding of the therapeutic benefits of cannabis. It has been my experience that medical cannabis has a reasonable safety profile and that patients often use it as a substitute for other, more harmful drugs, such as

opiates and nonsteroidal anti-inflammatory drugs. Due to the classification of marijuana as a schedule I drug—the the highest level of restriction—funding and conducting research about marijuana’s potential harm and benefits is extremely difficult. This needs to change and I hope it changes in my lifetime. Q: Do you think there is a clear line that can be drawn between medical and recreational use of cannabis?

A: Eventually, I do believe there will be a clear line that can be established between medical and recreational use of cannabis. Although both medicinal and recreational cannabis are derived from the same plant, differences do clearly exist. The main difference is the purpose of the product. Medical cannabis is used for medicinal purposes and recreational cannabis is used primarily for leisure by adults. Other differences include the way they are used, the kind of product associated with them, potency, dosing, purchase, possession quantities, taxation rates, and in some states the number of plants allowed for cultivation. I also believe that purchasing cannabis outside of a regulated dispensary for medical use should be discouraged. As a healthcare provider who recommends medical cannabis to qualified patients, it is my duty to educate them on the differences between the two. When you purchase cannabis outside a medical dispensary, it doesn’t just have THC and CBD, it has all 100-plus cannabinoids that are typical for the natural flower. On the medical side, the scientist just takes the two most active cannabinoids that they believe are medicinally potent, and that’s the THC and the CBD. When you purchase cannabis outside of a dispensary from an unlicensed and unregulated source, it does not go through any rigorous testing, and you are taking a chance that it may be contaminated. We already know the harmful effects that pesticides and molds have on the human body. Plus, you don’t know where that cannabis is being grown or produced. This can cause more harm than good. It is typically cheaper to purchase cannabis outside of a regulated dispensary, whether medical or recreational. This is because there is a cost associated with producing, testing, manufacturing, and packaging medical cannabis to ensure a safe and effective delivery process of the product to consumers. With inflation, gas prices, and food prices on the rise, some cannabis users are willing to take that risk due to cost. Q: What do you think about the VA’s stance on medical cannabis?

A: This is an extremely important topic for me, both on a professional and personal level. As a healthcare provider, I am profoundly aware of the need to look for opioid alternatives to treat a patient’s chronic pain. I do have an advantage over nonveteran providers. Being a veteran myself and an actual patient at the VA I have a lot in common with my veteran patients. Honestly, most of the time it is an instant therapeutic bond between provider and patient that we experience. Just as they feel comfortable talking to me, I feel comfortable talking to them. We share our experiences as veterans and as a patient at the VA. This helps to normalize the entire process, as veterans may find it difficult to relate to people who do not know or understand what military personnel have experienced. Having a lot in common with my fellow veterans helps to create a positive, healthy trusting relationship with them. It has been an amazing experience and I consider myself fortunate and honored to have them as my patients. Many verbalized the fact that medical cannabis has had a profoundly positive impact on their lives. While the VA cannot deny veterans benefits due to medical cannabis and VA providers are now permitted to discuss cannabis with their patients, many continue to feel hesitant to do so given that marijuana remains prohibited under federal law, and they are prohibited from issuing a recommendation of medical cannabis. This contrasts with other non-VA providers in legal states. My veteran patients often verbalize frustration about their VA provider for not wanting to engage in the topic of medical cannabis. I tell my patients in many instances it has less to do with their providers and more so with the Federal Government which needs to catch up on marijuana. We need federal and justifiable legalization of cannabis so that no one is left behind, especially those who have served and protected our country and are now paying the ultimate price of that sacrifice with service-related disabilities. I personally feel the VA provides excellent care to veterans and their families but does fall short when it comes to medical cannabis and the potential therapeutic benefits it can provide to veterans. The VA is trying to help their providers alleviate some concerns surrounding medical cannabis, though. The Oregon Health & Science University’s Center for Evidence-based Policy and Portland VA launched an initiative called Systematically Testing the Evidence on Marijuana, or STEM. The website (cannabisevidence.org) contains information about marijuana studies that have been published and additional general clinician resources for healthcare providers. The website does not take a specific side on whether cannabis should be integrated into treatment. Instead, it is designed as an independent methodological resource primarily for health care workers which emphasizes reports on studies showing potential therapeutic applications and reviews about specific cannabis-related topics, such as treatment of chronic pain and post-traumatic stress disorder. Recently, it featured a study indicating that cannabis compounds may be effective in preventing COVID vaccines. I believe this is a great initiative in the mission to institute a policy change and will help ensure military veterans’ access to cannabis. Q: Do you think that the VA’s stance on medical cannabis will change in the next 3-5 years?

A: I do believe the VA’s position will change eventually. I hope it happens in my lifetime. Participation in a state marijuana program no longer affects eligibility for VA care and services. VA providers are now able to discuss cannabis use with veteran patients and adjust care and treatment plans as needed. This is clearly a sign that the VA is moving in the right direction. However, in my opinion, the VA needs to move faster on this and advocate for change at the federal level. We offer a significant discount for veterans because current laws prevent many veterans from being able to access medical cannabis due to cost. Some veterans can afford to pay out of pocket, but many others rely solely on the VA for their healthcare. Therefore, many veterans are unable to even pursue treatment with medical cannabis. It breaks my heart to see this happening. Until Federal cannabis policy reform occurs, veterans will be stuck in this legal gray area. I have heard many stories repeatedly from veterans, that they have used cannabis medicinally to cope with physical and psychological injuries sustained during their service to our country. This is not new information. Cannabis has been used to treat a variety of illnesses for centuries all over the world. Many veterans use it medicinally as a safer and more effective alternative to treat their chronic pain and PTSD. I believe the VA has a responsibility to research it. Many veterans, including myself, are tired of hearing that “more research is needed on the effects of medical marijuana on veterans with service-connected disabilities.” Veterans deserve better than that for their service to our country. We as veterans, instead, want to hear that the VA is now conducting studies on the relationship between cannabis and chronic conditions in service-disabled veterans. That’s what we want and need to hear! I support legalization which seeks to do this. Q: What sets Adult Health DNP apart from the crowd?

A: What makes us unique is that we are a true specialty of medical cannabis. Medical cannabis is all we do! We provide quality care to all our patients. During their free consultation, the person will be told if they qualify and if they don’t, for whatever reason, we let them know right away, not after they pay! As a provider of cannabis, it is my responsibility to keep my patients informed about all aspects of cannabis. Laws surrounding cannabis are constantly changing across the United States and can be quite a challenge to keep track of. We’re also small and independent which gives us some advantages. One reason that I enjoy working in a small practice is because of the quality of the work being done. Providers working in a smaller, close-knit, clinical setting have more autonomy over their jobs including how much time they can spend with their patients. This has repeatedly proven to increase patient satisfaction. Providers typically have more time to develop quality relationships with patients in a more consistent setting, thus, providing greater continuity of care. We also can cut through all the bureaucracy that bigger businesses often go through which, in turn, allows us to spend more quality time with our patients and better focus our attention where it is needed most. We spend at least 1.5 to 2 hours or more if necessary with each patient at their initial visit, something that many larger businesses are unable to do. We help patients and caregivers obtain their medical marijuana cards as well. This time is spent talking about their health concerns, preventive care, cannabis education, and laws surrounding cannabis. All of my patients are educated on how the plant functions inside the body as it relates to the endocannabinoid system. It has been my experience that when patients know about how cannabis works, they achieve better outcomes and are more likely to adhere to their treatment. TO SUMMARIZE:

• We have a robust veteran population that we serve. • Veterans receive a significant discount in our office. • We offer telehealth visits to all patients throughout

NYS.

• We offer in-home visits for those patients who are

homebound.

• We focus on and serve our surrounding WNY

community.

• We offer free consultations, and qualifying patients

can start their cannabis same-day.

Q: Is there anything else you want our readers to know?

A: While disabled veterans and female minority business owners are listed as social equity applicants for adult-use retail licenses, both of these categories were excluded from the rollout of conditional licenses for certain “justice-involved” individuals. I believe this to be a mistake and I urge NYS and the OCM to include disabled veterans in the rollout of adult-use cannabis sales in NYS.