In the interest of remembering that there’s a culture and community in progress as the dopes on Beacon Hill bicker about the future of marijuana in Mass, I regularly designate a slice of my calendar for witnessing the industry with my own bulging eyes. Sometimes I suffer through tedious medical lectures about cannabis at area hospitals, while in other cases I spend time with those who are still working in the black market, or dealing with the repercussions of their prior endeavors in related professions.
Of the innumerable leaders and Commonwealth trendsetters I have encountered, Karen Munkacy M.D. stands out by any measure. The medical muscle behind Garden Remedies, which opened last November in Newton, she is a sincere believer with a trove of knowledge that she shares via various vessels—from colloquiums and interviews like this one, to the growing network of informed customer service reps at her facility. A breast cancer survivor who discovered the power of pot through personal trials, Munkacy is one of many doctors in this space whose passion forged their course.
Since that passion seemingly extends to the products that her team at Garden Remedies develops at its state-of-the-art laboratory and grow hangar in Fitchburg, we took a royal tour and, despite spending most of the time snapping panoramic pictures and salivating, somehow managed to throw a whole bunch of questions at Munkacy and Garden Remedies Communications Coordinator Tom Haley …
DB: Some dispensaries don’t even return our calls, but you proactively invited us to poke around every corner. This seems like a pretty welcoming place despite having to wear a hood with a full body suit and covers on my shoes.
KM: We have a very strong focus on education. A lot of people have been buying their medicine in Ziploc bags on the street, and there are a lot of different ways to adjust this. For instance, if you ingest [cannabis], it lasts about twice as long than if you inhale it. There are a lot of better ways for people than to just inhale. If you inhale it, it will last maybe three to four hours; if you ingest it, it can last all night. So when we have patients who have severe chronic pain or something like that, who are constantly suffering, it’s ingestion that will get them a good night sleep. Ingestion doesn’t work for people who are vomiting though, so what we would teach them is to inhale something for the immediate relief, and then maybe to ingest something for lasting relief.
How does the outreach work? Is there a formal process of some sort?
KM: I teach the people at the dispensary, and they teach the patients. You can only go in if you are already a patient, but once you get into the dispensary, all of our patient care advocates are trained to help the patients and to answer all of their questions.
When the patient comes in, the first thing that we ask is, Why are you here? What do you need help with? Do you have nausea and vomiting? Do you have severe chronic pain? Whatever their problem is, we’re there to help them. Everybody’s different, so we’ll say that based on experience, this medicine is likely to go with this. We’ll recommend that they try it. One of the ways that we help people and help them very quickly is that if it doesn’t work, we encourage them to come back in a few days. And then we work with them and have them try something else.
Now that there is a growing body of work, how do you continuously communicate new developments with patients?
KM: We have handouts that we give to them when they come in, and we have our web site. Some people don’t have computers, so we have a phone number you can call during office hours. We answer questions; people put reviews on Leafly, and I’ll respond to them if there are any questions or concerns.
TH: We’re also looking at the demographics of who we see each day, and [some studies have shown] that the typical cannabis consumer is around 37 [years old]. We’re seeing 45- 50-plus clientele in our dispensary. It’s a little bit older, and I think it’s in part because of the location in Newton. But we’re seeing what kind of symptoms [those patients] are coming for, and we’re forming some of the education around the specific needs of those patients. We want everybody to know as much as possible, but when we’re seeing a specific subset of the population coming in, we’re going to focus on that as well.
What would be an ailment that you see a lot of in that older demographic?
KM: A lot of people are taking heavy doses of narcotics. But narcotics are dangerous, so a lot of people would like to stop if they can. They also don’t want to suffer with severe pain, so they’ll come to us and we can help them.
Are you seeing a more diverse range of doctors? Or is it still mostly the few usual physicians who are brave enough to recommend cannabis?
KM: There [are slightly more than 100] doctors who have gone through the [state program to prescribe medical marijuana]. You have to do two hours of continuing medical education, then you have to apply with the [Department of Public Health] to become a recommending physician. Most physicians doing this have educated themselves well beyond two hours, and the people who are comfortable doing this have typically spent a lot of time learning about this medication and how patients can benefit.
How do you tend to communicate with like-minded doctors?
KM: I speak with them in person, I speak with them over the phone. Sometimes we email each other. They’re not allowed to recommend a specific dispensary though, and there can’t be a business relationship between dispensaries and doctors, and to me that makes sense.
How about you? Do you prescribe?
KM: I can’t. According to regulations I can either be a physician who runs a dispensary, or a physician who recommends, but I can’t do both.
What have been some major shockers since you’ve been open? Some things you’ve learned along the way that you didn’t expect at all?
KM: For me the first shock was what a great medicine medical marijuana is. I was never taught that in my training. The second is I find it shocking that it’s still not legally available for all patients who can benefit from it, because it’s so much safer than so many prescription medications. That’s very shocking to me that that’s still the case.
What are some changes you would like to see at the state level?
KM: We’re regulated by the Department of Public Health. Their primary goal is to protect the health of the people of the Commonwealth. So they are very thorough in how they vet and choose the people who [sell and administer] this medicine. I think that’s appropriate, because in other states they have had problems that we haven’t had. There have been a lot of pesticides that shouldn’t be used that have been used in other states. In Massachusetts, you have to grow organically, so everything we use here is organic. We don’t use pesticides and we don’t need to use pesticides because of our level of biosecurity.
Can you explain how biosecurity works around here, and why I’m wearing a blue jumpsuit?
KM: When our employees come in here, they have to take a shower, shampoo our hair, change into the clothes that are provided and washed here, change into the shoes and socks that we provide. And then they go through an air shower, so if there’s anything left it’s taken off. It’s a very biosecure area. We have a system that cleans the air; if there happen to be any mold spores, it filters them out and kills them. We don’t have to do that, it’s not in the regulations, but we looked into it and realized that it would help us produce the best medicine, so we paid the $70,000-plus that it costs to do that. We also use a reverse-osmosis system. When we tested the Fitchburg water, it’s actually very safe, but drinking water can vary in quality, and testing it you don’t get the results for a few days. It’s something you don’t have to do per the regulations, but it gives us a consistent quality of water. We never have to worry about having anything in the water that can get into the plants that can then get into the patients.
What kind of reputation are you shooting for? What products could you see someone coming to Garden Remedies for even if they live closer to another dispensary?
KM: We feel that we have the best vape pens in the state. We have more than $400,000 in lab equipment to get where we are now. We have a PhD chemist, we have a master of science in plant extraction technology, and then they have an assistant scientist, and between the three of them they figured out how to extract the active ingredients without using butane so there’s no residual carcinogens. You can’t get out all of the residual carcinogens in a butane extraction; it’s only parts per billion of carcinogens left, but I can’t say to people, Don’t worry about it, it’s only a very small amount.
We want to make everything the safest we possibly can, the best we possibly can for accurate dosing.