Broken Brain’s Dwight Hurst interviewed Utahmarijuana.org physician assistant (PA) and qualified medical provider (QMP) Tim Pickett on a recent podcast. Their conversation started out with a cursory introduction in which Tim made it clear that he was all about helping patients by educating them on Medical Cannabis and how to effectively use it.
Tim’s introduction to Medical Cannabis came by way of personal experience. His sister is a cancer patient who has used cannabis to help with pain. Tim also worked for a time in general surgery and trauma, giving him first-hand experience with patients suffering from extreme pain for whom standard pain medications don’t work. He finally came to cannabis when a friend of his began a growing operation and encouraged him to start his own Medical Cannabis clinic.
Early in the conversation, Tim and Dwight’s discussion dealt with cannabis legality in Utah. They talked about how some other states have had legal cannabis for years while in Utah, many people have been purchasing the drug out of state and bringing it back in. Tim mentioned seeing one patient who had been using cannabis for years before it became legal. She was introduced to it by her daughter after she complained that her prescribed medications weren’t helping her.
The discussion eventually turned to a lack of education among both medical providers and patients. Tim insists that there is plenty of scientific evidence supporting the efficacy of Medical Cannabis. It’s just that medical providers aren’t aware of it. And because they don’t know, they aren’t passing the knowledge on to their patients.
Tim and Dwight closed the conversation with a brief discussion about ongoing research and further education. Overall, the discussion was really focused on educating people new to the Medical Cannabis space in Utah and elsewhere.
Dwight Hurst:
Hey, y’all. Welcome back to Broken Brain. This is your host, Dwight, coming back at you again to talk about all things mental health and just basically things that are interesting enough to blow our minds and break our brains about. I am joined today by Timothy Pickett. He’s a physician’s assistant. He is also an advocate and an educator for the topic of medical marijuana and how that can be used, particularly with different kinds of disorders that have to do with psychiatric care, psychotropic medication, sort of types of uses anxiety and such. Also, to chronic pain. Do you go by Tim or Timothy?
Tim Pickett:
Tim.
Dwight Hurst:
That’s what I thought, but I’ve been wrong before about names. It’s Michael usually. I have a good friend who’s a Mike. But then I’ve known a bunch of Michaels who are like, “It’s Michael. It’s not Mike.”
Tim Pickett:
It’s Michael. Right. I knew one Thomas. But mostly, I know Toms.
Dwight Hurst:
And Tims are notoriously laid back and cool to work with. That’s what I find.
Tim Pickett:
Wow. Okay, great. Famously.
Dwight Hurst:
Famously, go by Tim.
Tim Pickett:
They famously go by Tim.
Dwight Hurst:
Timothys. It’s that guy in the Bible, but he’s not been around for a while.
Tim Pickett:
Yup.
Dwight Hurst:
I bet he went by Tim. Want to go with my majority Tim experience. Oh, this is a great start, Tim. Tell everybody a little bit about who you are and what you do. I’m very excited. I’ll let everyone know to talk about this. As you mentioned, as we were setting up, it’s been a long time since the topic has come up. And the last time I had someone on to talk about medical marijuana was way back before there were a lot … It was the same states that it always had medical marijuana for years, and years, and years. And we’re seeing it all over now. So, I’m really excited to talk about it, really excited to hear.
Tim Pickett:
Yeah, it’s an exciting topic. So, yeah, I’m Tim Pickett. I am what you would consider a medical cannabis expert. I’m a medical provider. I’m a PA, a physician assistant. I run a clinic operation that sees patients, evaluates patients and does a lot of education. We work in Utah. And that is utahmarijuana.org is the website and kind of this educational platform that we have.
Tim Pickett:
Like we were talking about, we do a podcast called Utah in the Weeds. And we really want to and I really want to personally, destigmatize cannabis as a medicine. But I want to do it in kind of our unique Utah way. Like treat it with the respect that I think it deserves. I’m not a huge fan of adult use coming to Utah. That’s kind of what I call the recreational market. Because I think that’s a stepping … We should take a stepwise approach to it.
Tim Pickett:
But yeah, that’s who I am. I have kind of gotten into this medical cannabis space in a roundabout way. And I’m excited to be here and talk about it. Because I think from a mental health perspective, there’s a lot of myths around cannabis. And I think it can be pretty helpful. But I also think it can be a little dangerous when it comes to mental health.
Dwight Hurst:
No, and that’s some of the ins and outs that I’m looking forward to talking to you about is what are those benefits and what are the risks and things. That’s one of the things I think is helpful about having an intelligent conversation really about anything. I guess the lack of nuance and intelligent conversation is something that a lot of people kind of miss nowadays.
Tim Pickett:
Yeah.
Dwight Hurst:
And wish there was more of. So, how did you get into working with that? Did you have feelings about it before you were exposed to treatment as a professional and how did you become aware of cannabis medicinal use?
Tim Pickett:
So, I graduated high school in ’96. That’s the year California passed and allowed medical marijuana clear back, now it’s been 25 years ago. So, I’ve always been supportive of this, of I’m a person of free choice. That’s my belief. So, I think adults should be able to choose what they want to do, if they can get educated about it. So, I’ve always been a prepper opponent of it.
Tim Pickett:
And in that regard, sure, I’ve always wanted it to come to Utah, but I never thought it would. I thought we would be the 50th state probably to allow it. We’d have to be pulled, kicked, kicking, and you’d have to drag us through.
Tim Pickett:
So, I got involved or I kind of knew about it, I have a sister who has colon cancer. She lives in Washington and it was available to her for the chemotherapy. I have, one of my best friends is a recovering addict and used it to help him quit alcohol after trying over and over abstinence. And so, I have these personal relationships with people who’ve changed their life essentially with cannabis.
Tim Pickett:
But I also work in the hospital in general surgery and trauma for six years. And when you treat somebody with chronic pancreatitis who has a flare up, and they’re in the hospital, they have extreme pain, nausea, they cannot eat, and the medications that we use now are just not as effective as cannabis could be.
Tim Pickett:
And so, when it came to Utah, and a friend of mine, who is one of the growers here in Utah, everything kind of came together for me in kind of middle 2019, where there’s this opportunity to get involved to teach people and to start a business in this space. And there’s this opportunity to help people learn about it in a legitimate way. Maybe we can get it into the hospitals one day.
Tim Pickett:
But yeah, I saw my first patient I think it was January 11th, 2020. I think we saw 11, 12 patients that month. And that’s how it all started. It was like scary to write that first recommendation. It was really scary. Because here you are writing a recommendation for what you have been taught as an illegal substance. It’s still federally illegal. And you’re telling somebody, “You know what I think you should go out and do, Dwight? You should go out and use cannabis. Here you go.”
Dwight Hurst:
I think, because it’s something that unless you work in the medical field or the addiction field mental health, nobody usually says cannabis casually either. So, there’s that feeling, I’m projecting maybe but if I’m writing a prescription, it’s like, “You should use this much cannabis. There’s a medical thing and it’s researched. And I’m doing it as a professional.” But is it hard to get away from at first that feeling of like, “You should get some weed?” You know what I mean? You didn’t say it that way?
Tim Pickett:
No, I mean, exactly.
Dwight Hurst:
It’s not professional.
Tim Pickett:
Right. In the beginning, you’re talking about this and you’re asking people about their marijuana use. And it’s totally awkward. And it is really awkward for patients still. So, yeah, you see 11 patients in January, you see more in February, and then the doors come off last March when the first dispensary or pharmacy opens up. And it becomes much more comfortable for me to ask people about their cannabis use. And I don’t care.
Tim Pickett:
You want to call it weed, marijuana, ganja, grass. It doesn’t matter to me. It’s all the same thing. And I use the term “medical marijuana” in all of my website because I want people to understand what I’m talking about right from the beginning. And there’s nobody who questions when you use the word “marijuana.” There’s no question about what you mean, right?
Dwight Hurst:
Right.
Tim Pickett:
They know what you’re saying.
Dwight Hurst:
No, no, exactly.
Tim Pickett:
Right. And yeah.
Dwight Hurst:
Talking about in terms of professionality and saying in a way that is medically…
Tim Pickett:
Right, yeah.
Dwight Hurst:
It’s a very interesting thing that as you put it is very different and more different for some than others. One of the interesting things we’re going through is living in a world where we have precedent for this and other states, and those of you who maybe live somewhere where this has been legal for a long time or those of you who maybe live in a place where marijuana use is still maybe completely outlawed, it’s interesting to see the evolution of in the state of Utah right now. It’s in infancy kind of state as far as practically implementing any kind of legality around use of marijuana, even medically, right?
Tim Pickett:
Right. And your listeners come from all over. Like you say, there’s going to be people who totally have had legal weed for years and you can use it adult use, recreational, medical, some I’d like to say that people in California or people in Colorado, they live in our future because they’ve seen the evolution. They’ve seen this start. They saw the process where we’re at where we’re seeing a lack of … The patient count is growing. There’s an interest in this.
Tim Pickett:
There’s also a growing amount of pharmacies, we call them in Utah, that can provide, that can sell the product to patients. And yet, there’s still this lack of availability. There’s not enough flower. There’s not enough weed in the state for everybody who is legal who wants to buy it.
Dwight Hurst:
Interesting.
Tim Pickett:
And you still, you still have to drive sometimes. Like in St. George, Utah, you might have to drive 300 miles to the closest legal dispensary.
Dwight Hurst:
Does that come into play with having to do it within the state where you are prescribed? There’s no real federal rules because it’s federally illegal, right? So, I guess-
Tim Pickett:
I mean, the only federal rule is, yeah, you cannot go to Colorado and legally bring it back because you have to break federal law. I don’t think that’s going to change anytime soon. I think that there’s a lot of things we have to do to break down those barriers. But yeah, you have to buy your product in Utah. You have to be a medical patient in order to get into those dispensaries to make those purchases. So, there’s still a lot of barriers to use in this state, let alone other states that don’t have access yet.
Dwight Hurst:
Yeah, it’s an interesting thing when you look at the medicinal use and people don’t think about it. On the one hand, as you already said, there’s a conditioning. We have to think of the seriousness of using as an illicit drug. On the other hand, it’s sort of like sharing prescriptions. It’s highly illegal. It’s a risk, legal, a big legal risk.
Dwight Hurst:
But at the same time, people are like, “Oh, you have some pain? Well, I got something.” And many people, especially those who haven’t been interactive with the legal system, don’t think a lot about picking up some gummies in Colorado and driving back to Utah. Oftentimes, like you said, that’s a federal violation of law and there’s a big risk involved.
Dwight Hurst:
And at the same time, I’ve known people over the last few years, previous to the law changes who, let’s just say you wouldn’t ever peg them as somebody that would purchase marijuana and never have, never would anytime before, but then it’s like chemo pain or other things or replacement for opiates and things. And they will cross state lines to where it’s legal and bring it back to the state for themselves or their loved ones.
Dwight Hurst:
And so, there’s been a lot that’s happening even without it being … Well, when it’s officially legal, people can look at that from a medicinal standpoint and we can research and find, it’s happening more in the open, you can actually measure and that must be nice as a medical professional to be able to actually see what’s happening.
Tim Pickett:
Oh, completely right. And I mean, the two things to what you’re saying is, and we get a ton of patients who come in, and their only experience is getting it from somebody else, which is, of course, it’s illegal to give somebody else marijuana in general, but that’s how people get exposed to this. And that’s how people really find out that it might work.
Tim Pickett:
The 62-year-old woman who comes in and says, “I have PTSD, I’m in behavioral therapy, and I’ve been on Zoloft and Xanax and Ambien for 10 years and really not a lot of change to my condition. But I know Ambien is not that great. I don’t want to take it forever. Obviously, the benzos I don’t want to take forever. So, my daughter gave me a five-milligram gummy. I slept like a baby. And now, I’m thinking, ‘Wait, maybe there is some legitimacy to this.’ And I started talking to a couple of friends. And lo and behold, there’s a couple of friends that use cannabis.” And that’s the introduction that we hear a lot.
Tim Pickett:
To the other point about research and this honesty, we have been, I find that our patient base, totally anecdotal, I can’t quantify this, but people are not very honest with their medical providers with what they’re taking, what they’re not taking.
Tim Pickett:
And we find that in our patient population, that they’ll leave and they’ll say, “Can you just be my primary care because you’re the only person I’ve ever been honest about my real drug use, my real medication use. I’m not taking the medications that I was prescribed for this because I don’t want the side effects, but they keep prescribing it to me every three or four months. And I don’t take it, but I don’t tell them.”
Dwight Hurst:
Yeah.
Tim Pickett:
“And I’ve been using cannabis instead to help me sleep. But I don’t tell them.”
Dwight Hurst:
And you think about that, what are some of the reasons that you hear or why do you think that is that people don’t do that?
Tim Pickett:
That’s a great question. When people report it to me, it’s because they don’t feel comfortable talking about it or they have brought it up before and been shut down by their provider. The provider says, the common responses that we know are, “I don’t know anything about it, so I’m not comfortable with it. It’s illegal for me to prescribe it.” So, the legal part of it.
Tim Pickett:
And then the other one is the evidence. There’s just no evidence to support medical marijuana use for your condition. And that really is just a lack of education. All of those. They’re just a really a lack of education in the science that’s been done. There’s a lot of science out there with cannabis. There’s a ton. There’s a ton of research.
Dwight Hurst:
That’s been around a while, I think is an understatement. For those who maybe don’t know, what are some things to where we’re seeing research show efficacy and treatment? What are some things that cannabis is supplanting, replacing, assisting? What kind of conditions are people benefiting?
Tim Pickett:
Yeah, I think the main one that has been proven is chronic pain, chronic physical pain. In 2017, the government released a report where they did the research, the National Academies of Science, our own scientists, they determined that cannabis is really good for chronic pain. And it helps people reduce their opioid use and it helps people feel better. So, it’s treating the pain itself.
Tim Pickett:
There’s two things that go along with pain. There’s the pain physically and there’s the suffering that goes along with the pain. And cannabis, THC is really good at helping people with the suffering associated with their pain. It’s not going to make the pain go away. It just it has a tendency to take your mind off the pain so that you can go for that walk. And then you start to feel better.
Dwight Hurst:
That’s interesting. So, it’s interacting with sort of the same thing that I’ve seen with chronic pain as a psychotherapist is that a lot of the work therapeutically is cognitive behavioral, which has to do with reduced attention paid or distraction or thought interruption, things like that. It’s interesting.
Tim Pickett:
Yeah, there’s a huge number.
Dwight Hurst:
Yeah.
Tim Pickett:
Yeah, absolutely. There’s a huge number of chronic pain patients. When we look at the, like the veterans, the VA data, there’s a huge number of chronic pain patients that are on SSRIs, that need behavioral therapy for the depression, the anxiety, the lack of sleep associated with the pain. That negative feedback loop is causing that, is causing a bad cascade of events in the brain. And cannabis is really well suited for that type of situation where you’re treating both the issue, but you’re also treating the side effects of the issue, depression, anxiety, PTSD.
Tim Pickett:
So, that’s good for chronic pain, probably the best. But more than 80% of cannabis users will tell you they use it for anxiety. And anxiety is a little tricky because cannabis is what’s called biphasic. It’s maybe good for anxiety at low doses, but then when you overstimulate the receptors in the brain with THC, you get an anxiety response and a paranoia response.
Tim Pickett:
So, you probably hear that this strain or this product gave me a lot of anxiety and so I don’t want to use cannabis and that’s an issue with education and people using too much. One of my, kind of my soapbox to keep this medical for a while is to teach people that you know when you smoke three joints a day and it causes anxiety, maybe you want to adjust.
Dwight Hurst:
Well, and that gets into the real difference. It’s funny when you say low doses because even just anecdotally, as I’ve had clients of mine tell me things over the years, those that actually benefit and say, “Oh, my anxiety meds or benzos or things I was getting hooked on. And so, I started using marijuana in one form or another.” When I hear that, those that have had long term, I’ll say, success as far as it hasn’t been problematic and it hasn’t led to any other issues, is when they’re using very small amounts.
Dwight Hurst:
It’s funny as you say that, they’ll be like, “Yeah, I just do this every other day, just this tiny bit, or whatever it is,” as you put it, which if you think about it is a lot more like how we’re supposed to engage with medicine.
Tim Pickett:
Yeah, right.
Dwight Hurst:
If it has a big crossover to large amounts or it’s recreational, and for my anxiety-ish, then you see the attendant problems of low motivation or sometimes cross addiction and things like that sometimes come up.
Tim Pickett:
Yeah. And then the last thing that I think is really cool in mental health therapy, especially with PTSD is cannabis shuts down dreams. It just is. It’s pretty well studied that reasonable doses of THC is going to depress your ability to dream.
Tim Pickett:
And so, for people with, for night terrors, trouble going to sleep, there’s a sweet spot there where you, again, keep the dose low, but it seems like this 7.5 to 10 milligrams THC is this spot where there’s not a ton of psychoactivity so you don’t get woken up. But people really report not having as much dream, I don’t know, dream activity. So, it becomes really good for the PTSD patient that can’t sleep. And I think everybody would agree that sleep is like low hanging fruit. If I can sleep better, sleep a little longer, the rest of my life gets better.
Dwight Hurst:
No, it’s one of the main things that we do talk about and I know the prescribers talk about when it comes to antidepressants, mood stabilizers, things like that, that sleep is, yeah, king. It’s very, very big. Obviously, I didn’t know that about the dream suppression. That’s really interesting, especially for those that are having nightmares.
Tim Pickett:
Yeah. It’s a nice simple, simple kind of when we’re in western medicine, we always want a simple thing, one drug one response. We treat one symptom. And that’s a place where cannabis does pretty good. You’ve got nightmares, cannabis is reasonable at suppressing those and helping people sleep without dreams.
Dwight Hurst:
I’m curious as a prescriber and a medical professional, what do you look at as kind of an ideal administration way? I think one of the things that is still a hang up for a lot of people is I’ve never had a doctor say, “Hey, here’s some medicine. You should smoke this right?” Or whatever.
Tim Pickett:
Yeah, yeah.
Dwight Hurst:
So, I don’t know. And obviously, at dispensaries, they do sell the smokable, I mean, showing my ignorance here…
Tim Pickett:
Yeah, smokable flower, right?
Dwight Hurst:
Yeah.
Tim Pickett:
I mean, right? So, in Utah, specifically, Utah has a law against flame use. So, we’re unique. There’s a handful of states with this same law, but you can use the bud, you can buy weed, raw flower, but technically you can’t smoke it.
Tim Pickett:
So, we know that the primary way people consume cannabis in the US is still smoking. But they’ve restricted that in Utah. So, what you have to do, let me see the reason they did that. The reason they did it is because when you burn weed with the flame, you inhale combusted plant material in addition to the THC. So, the combusted plant material is not helpful. It’s just harmful to the lung tissue.
Dwight Hurst:
And it’s like smoking anything, right?
Tim Pickett:
Yeah, I mean, you smoke anything, you’re going to get that smoke in your system. That’s not good. It doesn’t cause cancer that we know of. But it does cause chronic bronchitis and emphysema and COPD. And so, the other thing is, is there another alternative to get that inhaled flower like the medicine? And there absolutely is.
Tim Pickett:
You buy, it’s like a battery-powered pipe. It’s called a dry herb vaporizer. And it heats the flower up to temperatures between 320 and 450 degrees. In that range, you activate more than just the THC. You activate other cannabinoids in that range and then you’re inhaling the vapor. And that allows more of what we call the entourage effect. So, you’re getting more of an experience because you’re using it at the appropriate temperature and not causing the problems that the combustion causes.
Tim Pickett:
So, takes a little bit of getting used to. But from a delivery standpoint, you can still use flower in Utah. And I encourage my patients pretty much everywhere, I would encourage people if they’re using a flame now, try a dry herb vaporizer because while it takes a little bit to get used to it, and it is a little different, it doesn’t hit quite as hard. If you can learn to use a vaporizer, you can manipulate your cannabis use to get more out of it at different temperatures, and still, it expands the range of possibilities.
Dwight Hurst:
It’s interesting to be coming across as pro vape.
Tim Pickett:
Right, right.
Dwight Hurst:
Pro vape use coming from the medical community.
Tim Pickett:
I know, right? And really, it’s just this idea of flower being vaporized. And that’s not the oil.
Dwight Hurst:
Right, right, I see you’re saying very specifically, right?
Tim Pickett:
From another delivery … Yeah, it’s very specifically. But vaporized cartridges are reasonable as long as you’re buying them from a reputable source and they’re tested. Buying vape cartridges on the black market is just not a good idea, way worse of an idea of buying weed off the market.
Tim Pickett:
But when it comes to delivery, kind of to get back to your question on what to use, it really depends on the patient and what they want to get. If you want to sleep a little better, then using something oral, an edible, a gummy, a tincture, an oil. That’s going to last six to eight hours. So, that’s a really good thing to take at night. And if you can adjust the dose with an oil and take five or six drops, that’s perfect.
Tim Pickett:
The drawback to that is it takes a while to take effect. I mean, the edible weed, it’s going to take an hour to get really in your system. So, some people need to microdose or use more of a long-acting during the day and at night and then use for what we would call, you and I would call like breakthrough anxiety or those triggering events with pain or mental health, use some inhaled method. It’s quick onset. Within a few minutes, you’re going to feel better. And then it’s not going to last as long. Flower might last three or four hours. A vape cartridge might only last you one or two hours.
Dwight Hurst:
One of the things that I’m glad to hear you talking in terms of is you’re talking about it in terms of like, for example, if I’m prescribed anything, I have to kind of take into account when do I take it? Do I take my mood regulator? Do I take that in the morning? Do I take some at night? Well, my doctor is going to tell me when to do it. And I’m going to do that. And it orients around the efficacy of the desired medical result.
Dwight Hurst:
And do you feel like because it’s about marijuana, there’s some crossover where people sometimes are like, yeah, legalize it. There’s kind of like attitude of like fun. Where’s the fun? It’s like, well, this is really a treatment.
Tim Pickett:
Right. Well, the great thing about marijuana is that it can be both. And most use is going to be medical in my experience. Most of my patients are going to use it most of the time for their medical purposes. They’re going to get home at night. They had a rough day. Their knee hurts. They’re going to use it a little bit. Do they feel better because they get a little psychoactivity? Yeah, sure a lot of them do. And a lot of them like that.
Tim Pickett:
So, the alternative for them is take an opioid at night or take this and when you talk about the risk-benefit, they’ve decided and I would tend to agree, that the cannabis is the better option. Then you have people who are really strict about just using it for the medicine. They don’t like any of the psychoactivity so they only use it in that way.
Tim Pickett:
And you have people, the fun part is you have Saturday afternoons. You know you have the musician who knows that this strain is going to make that creative presence be more accentuated. And so, they’re using it both. They use it because they don’t like their dreams at night. But then on Saturday afternoons, they want that jam session to be really creative and so they’re able to manipulate their use to get both the fun and the medicine out of it. And that’s it’s one of the things that I love about cannabis medicine is I don’t care, I get it. You want to do both? And that’s okay.
Dwight Hurst:
Yeah. I do think that that contributes to some of the concerns. Because one of the concerns about intoxicants in general has always been … Well, let’s put it this way. There is an extreme response sometimes against something because it potentially is a pleasure-seeking behavior and pleasure-seeking behavior is sometimes demonized, and culturally demonized. And so, I wonder if that’s part of it, as people are like, “Wait a minute, I don’t want you enjoying a thing I think you shouldn’t?”
Tim Pickett:
Yeah, boy, we’ve had that history here in Utah. We try to control that. Of course, these are my opinions about cannabis use in general. So, I can see the argument, especially from my peers wanting to maintain that really strict medical use of whatever they’re recommending. I just don’t necessarily think that takes human nature into account. And I’m somebody who believes that people, once they learn that it’s okay to experiment a little bit with this in a safe way. I think it’s okay if they make that decision to seek pleasure, because we do that anyway, don’t we?
Dwight Hurst:
That’s the thing that I think of when I look at it is, and speaking of being honest, a lot of times, people will come into therapy and be pretty open. They’ll be pretty open about things. So, I can say, honestly, when it comes to any kind of prescription, people are experimenting. It’s not always for pleasure. It depends what it is, right?. It depends what it is. Not everything has a pleasurable result.
Dwight Hurst:
But when it comes to things like alcohol and opiates, and anything that has that kind of psychoactivity as you put it, the crossover.
Tim Pickett
Mm-hmm.
Dwight Hurst:
There’s, you know, we’re not really dealing with reality if we think people are not experimenting. Let me put it that way.
Tim Pickett
Right.
Dwight Hurst:
It’s something that I’ve … And we’re not dealing with reality if we think that those things are completely safe.
Dwight Hurst:
One of the things that I think is tricky is when people talk about the use of marijuana medically, the legalization, decriminalization, sometimes the concerns I hear are concerns. It’s not that they’re not concerns to say like, what about youth? What about accessibility? What about this? What about that? But I think that it ignores some of reality. And as you put it, compare it to opiates.
Dwight Hurst:
If I hear someone say, “Well, I don’t know about the medical use of marijuana,” makes me wonder how many times have I ever heard that person say, “Are we really looking hard at the way opiates are being used? Or is that something we all just kind of have accepted over time. And now, we want to go ahead and say, ‘Here’s something that’s actually in a way, potentially trying to replace and address some of the harmful effects that opiates do.'” When’s the last time we had a big old rally about blocking opiate use? Or you’re relooking opiate use?
Tim Pickett:
Right.
Dwight Hurst:
I mean, they exist, but I don’t hear it as much as … It’s kind of sexier to get in the fight with marijuana on either side. And so, I’m always like, when people are complaining about it, have they been complaining about opiates the same with the same amount of energy?
Tim Pickett:
Right.
Dwight Hurst:
Yeah.
Tim Pickett:
Right. And I think to your point on the other side, too, I would say that cannabis has become this lightning rod topic that a lot of people can get behind antitraditional medicine, really this deprescribe movement that’s, I think, just barely starting to reduce the use of other prescription medications.
Tim Pickett:
But cannabis is really just a tool for that movement. It’s a tool to explore something different in medicine. Not necessarily is cannabis, in my opinion, going to solve all the world’s problems. I mean, there’s a lot of really promising things we can do with cannabinoids. But-
Dwight Hurst:
You lose a little credibility if you were saying that.
Tim Pickett:
Exactly, right. So, yeah, I think there are some really promising alternative medications that will come after cannabis.
Dwight Hurst:
Yeah.
Tim Pickett:
And so, I think cannabis has its place, but it’s not going to solve all the world’s problems. And just by legalizing it for everybody doesn’t fix all of the problems. I think even people who are advocates wish that it would.
Dwight Hurst:
Well, and I think we can see that. And people who have listened to the podcast know that my biggest bias about anything that someone comes on the show to talk about is if they talk about it and it’s like, “Oh yeah, it’s all good. It’s not bad. It’s just as amazing.” Anybody who comes … I always am happy to hear nuance and understanding and intelligence when we talk about the thing.
Tim Pickett:
Right, yeah.
Dwight Hurst:
So, when you’re talking about that and talking about it very much in terms of the medicinal use, to me that’s a really good sign for it. And that’s what I’m hearing. And well, I don’t know. For me, I’m not a doctor, but it seems like there’s a lot of risks with alcohol use recreationally, although it used to be prescribed during prohibition. That’s a whole nother program.
Tim Pickett:
Right. I’ll be interested to listen to that one.
Dwight Hurst:
That’s a whole nother thing is the way that we encounter intoxicants has always been very socially controlled and is very interesting, right?
Tim Pickett:
Right.
Dwight Hurst:
Anything that has psychoactivity associated with it. It’s like why did we decide that it has the place it has. President Obama came under fire because I think he made a comment once that pot was safer than alcohol.
Tim Pickett:
And we could talk a little bit about some of the real risks that aren’t discussed a lot with cannabis use.
Dwight Hurst:
I want to hear your opinion on that. Yeah. What are the risks?
Tim Pickett:
Yeah, I mean, so I work some shifts in the emergency department now and I still work a few days a month to keep my skills up and to try to keep my reputation amongst my peers. But we see in states with legal programs, legal pot programs, there is an increase in overdose in the ERs and there’s specifically adults plus kids, underage people using too much THC, coming in sick.
Tim Pickett:
Now, do they die? No, they don’t die. They want to die sometimes because they feel terrible and it causes high heart rate, causes people to just throw up, just throw their guts up.
Dwight Hurst:
That’s a myth, right? I mean, I’ve heard people say, “Well, you can’t OD on pot.” And it’s like you’re not going to die.
Tim Pickett:
Well, you can’t die.
Dwight Hurst:
Yeah.
Tim Pickett:
You can’t use enough THC to kill yourself. There hasn’t been any studies, evidence. They have tried to kill apes with high doses of THC, they cannot. They’ve given them 9000 milligrams of THC.
Dwight Hurst:
Oh my gosh, yeah.
Tim Pickett:
But you can’t die, but you can definitely feel terrible. And the ER visits go up in programs or in states with that effect. The other thing is there is some concern and growing research that using heavy doses of cannabis THC when you’re younger and you’re developing that endocannabinoid system, there tends to be a correlation between some psychological illnesses later in life, bipolar, schizophrenia. And we don’t know enough about that yet. But we know that’s a little risky. So, we want to keep kids away from using a lot of cannabis when they’re younger because we think that correlates to bad outcomes.
Dwight Hurst:
Kind of makes sense. I mean, the psychoactive substances like alcohol that you do want to keep away, especially from kids that are under, 21 isn’t just a made-up number completely.
Tim Pickett:
Right. It isn’t just made up. The other section of the population that we need more information about is pregnancy and breastfeeding. We don’t want to give it to breastfeeding mothers because we know it crosses the blood-brain barrier, which means it crosses that barrier to the baby and the breast milk. We know that it crosses into the fetus. And pregnancy, you get into some nuance with, well, is the medication and the vomiting and that worse than the cannabis. So, those are individual discussions to have, but-
Dwight Hurst:
They have the same discussion about antidepressants. There’s a lot of times where there’s questions about whether or not those should be taken during pregnancy. And that’s exactly the same balance. I’ve seen doctors and clients have had take, which is like, but am I going to be suicidal during my pregnancy? And what’s the risks there?
Tim Pickett:
So, it’s the same exact-
Dwight Hurst:
Yeah, it’s not without precedent.
Tim Pickett:
It’s the same exact discussion, right?
Dwight Hurst:
It’s not without precedent at all. Yeah.
Tim Pickett:
Right. And the real issue, I think it comes down to is educating our medical community, so that we can now give good advice based on some semblance of science. And it’s not all rosy. But at the same time, there’s a lot of benefit. There’s a lot of potential benefit relative to other things that you might already be taking or that you don’t want to take, especially in the mental health realm.
Tim Pickett:
It’s my understanding that in mental health conditions in the brain, there’s this hardened pathway between the emotional centers of the brain and the logic part of the brain where these pathways just get hardened and they get solidified and it’s so easy for people to say, “I suffer from this, I am this.” And cannabis has an interesting place in that where it actually softens the connection between the emotional part of the brain and the logic part. At the right dose, it modulates and softens those pathways so that if you combo that with behavioral therapy, you can reset the narrative easier than you can without.
Dwight Hurst:
Wow. It’s really interesting.
Tim Pickett:
Yeah. It’s a good spot for more research. But we need to research it in comparison to existing therapies. And that I think, while there’s a lot of research about cannabis use and about the safety and the efficacy of it, we don’t have a lot of research comparing one therapy to another with cannabis because nobody has been willing or wanted to pay for it.
Tim Pickett:
I mean, I think the dispensary is just making … I mean, we’re just selling so much weed.
Dwight Hurst:
Exactly, right.
Tim Pickett:
There’s no incentive.
Dwight Hurst:
We already have the market cornered. It’s like, yeah.
Tim Pickett:
Right.
Dwight Hurst:
It’s like I’ve told this story on here before, but when they discovered group therapy, it was because combat veterans from the World War II were having conversations in waiting rooms waiting for their appointments, and largely that’s where a lot of group therapy came from. And I always say, then they found a way to bill for it. So, anyway, so unfortunately, a lot of science can be determined by that if there’s not a financial incentive to have those studies.
Dwight Hurst:
But like you said, that’d be good to know how much are we seeing that. We know that when people take a psychotropic or psychiatric medication coupled with therapy, both tend to work better. But you’re saying there is indication that that correlates as well. But there needs to be more research there, which would be great.
Tim Pickett:
Right, yeah, on that kind of specific thing, right?
Dwight Hurst:
Sure.
Tim Pickett:
And I think that in former podcast episode, you’ve talked a little bit about psilocybin. Potentially psilocybin can actually break those and reset those pathways in the brain. Cannabis doesn’t break and reset them. But it helps people gain a better perspective, essentially, by, I don’t know, people describe it as like emphasizing the now. It enhances your ability to be in the present.
Dwight Hurst:
Like a mindfulness kind of aid is what you’re talking about. Yeah.
Tim Pickett:
Yeah. One of the really cool things about cannabis is the way it works in the brain. And it stimulates areas that are perceiving the present. And it makes it a little hard to perceive the past. It’s this short-term memory problem that we have when the mind gets a little altered, you get a little stoned and boom, that time dilates. And it’s this inhibition of being able to access the past and this memory and this perception of time, because essentially, it’s emphasizing the present.
Dwight Hurst:
I can see that working together. A lot of modern therapy emphasizes present-based thinking mindfulness is all about staying in the moment because memory and imagination interact a lot with depression and anxiety, because it’s like, thinking about what’s gone wrong, what’s going to go wrong. And a lot of times, our current moment is all right. Like right now, I’m safe. Right now, nothing bad is happening this moment. And so, tying into the moment is a big part of therapeutic intervention. So, that’s very interesting how that could work together in tandem with it.
Tim Pickett:
Yeah, I think that’s one of the promising aspects of cannabis therapy moving forward. And if we can educate more people and we can use it appropriately, then the potential is there to benefit a lot of people. But you’ve got to do two things. You got to educate them about cannabis, three things, get them access to cannabis, and then fourth, you get access to behavioral therapy, which that’s hard. That is hard in the US and everywhere.
Dwight Hurst:
Access to any of the appropriate medical needs is something that we … We talk about that on here sometimes as well. But it is obviously a big thing. It’s a big thing in our nation. It’s a big thing anywhere for various different reasons with, first, it has to do with insurance and money here in the US, availability of professionals, just all kinds of things that enter into that.
Dwight Hurst:
And it’s interesting as we talk about this, one of the things that emerges is the issues you’re talking about are not different than other medical things. And I think that’s a big takeaway for me from this conversation is, as you say, are we comparing things to things that are comparable. Are we saying, “Boy, there’s some inherent risks and problems with marijuana use.”
Dwight Hurst:
And as you’ve been listing them and talking about them, they don’t seem to be tremendously different from most other medical interventions.
Tim Pickett:
Right.
Dwight Hurst:
And so, that kind of like demystifies it, demystifies, I should say, that process a little bit to say in practical application, it’s just another tool or medication ideally, is what we’re saying.
Tim Pickett:
Yeah.
Dwight Hurst:
Are you a proponent? Or do you think recreational use should be legal under the law or you said, keep it medical for a while?
Tim Pickett:
I like the idea of keeping it medical. My priorities are … I think my peers in medicine are yet to get on board. And I think we have a role to play in the expansion of marijuana as a true medicine. And I think if you skip this step of getting us all on board, then you’ll lose the benefit of medical cannabis to a huge number of people that really could benefit.
Tim Pickett:
So, to me, it really is this stepwise approach I think that we need to get the medical community on board first. Once the medical community is all on board and we’re all experts in cannabis, and everybody is able to use it, write prescriptions and recommendations for it and understand it as another tool, then I think you can move to the adult use in a much more like the population safer and you could really change the world.
Tim Pickett:
Do I have high hopes that that will occur? Yeah. I don’t know. I think the industry is so powerful and it will become so much more powerful that I think we might get rec use before, I would say we’re ready.
Dwight Hurst:
Yeah, it makes a lot of sense. I mean, once again, the money behind it. And when there is money to be made and it’s with something that is psychoactive or interacts with our own compulsions. And I will say when it tickles around the issues of addiction, and I know that’s a dicey word to use with marijuana. But look at the way that food has been marketed. Look at the way cigarettes were marketed.
Tim Pickett:
Oh, yeah, absolutely.
Dwight Hurst:
So, yeah, that’s an interesting point as you bring that up. And I think we are not good in society with a balanced approach to how we implement things. It’s kind of swings all or nothing is what you’re saying.
Tim Pickett:
Yeah.
Dwight Hurst:
And now, it’s interesting to see. There’s a lot of passion that you have. And I imagine that being in a situation to where you can now use that to benefit patients as a tool, there’s got to be a lot of emotion attached to that for you. Because you’re very passionate about patient care.
Tim Pickett:
Yeah. I mean, I love to help people change their view on medicine. I like to give people that permission to experiment with their own health a little bit. And so, to me, that’s where the emotion comes from is just, it’s that lightbulb moment where you give somebody permission to think outside of the typical prescription. And you can say, you know what, you can try this or this or this, it’s okay. It’s okay.
Tim Pickett:
And if you get not enough and you don’t feel enough, then the next time you can take a little more. And if you feel a little too much, you can turn on Ferris Bueller and eat chips all afternoon, and that’s okay. It’s okay. And they can take that next step.
Tim Pickett:
So, my emotion comes from that, helping people understand that they can take control of their own health. We have been asking patients to take control of their own health for generations. And now that we have cannabis, a lot of the medical community will say, “Well, we didn’t want it to be that way. We wanted you to eat right and exercise and not take medications, but we didn’t want you to smoke weed in order to get there.” And we don’t get that choice.
Tim Pickett:
As the medical community, we get to say, “No, we are asking you to and we are trying to help you to take care of yourself.” And cannabis is a great way to have those discussions with people and get that light bulb to turn on. And it’s not going to work for everybody. But it’s exciting to be a part of.
Dwight Hurst:
That’s great. To have your passion here as we’re talking about it and your experience here and to hear that, I think it’s important for people to understand kind of where that’s coming from. And I appreciate you being able, I should say, just I appreciate being willing to make the time to be able to do that. Those who are listening now don’t know that I screwed up when I recorded.
Dwight Hurst:
When I recorded on my calendar that we were going to meet, I thought it was today and it was yesterday. And you were kind enough. So, essentially, from your perspective, I just didn’t show up yesterday.
Tim Pickett:
It still is fine.
Dwight Hurst:
And so, I was grateful, extra grateful that you were able to, willing to do that today. One of the things I ask all guests at the end is if they have a charity that they’d like to take a moment to highlight, it doesn’t have to be connected with what we’re talking about, but certainly can. Are there any charities that you particularly feel attached to you that you’d like people to be aware of?
Tim Pickett:
Great question. So, we donate some money every year at the end of the year based on what my staff decides. And you know what, we donated the money to elementary schools. So, as far as I’m concerned, donate to your PTA and your local public school. I think they need it, especially in Utah, they need it. And I have a connection to the school system in my life. And so, yeah, that’s where we put our extra money.
Dwight Hurst:
Yeah, I love that. Go down to your elementary school and see what they need.
Tim Pickett:
Yeah, see what they need, because they need time and money.
Dwight Hurst:
That’s the thing too, is that’s a great outlet for when money is a hard time, too, they need people, too. There’s no people there. It’s just what they have. And that’s a great one. That’s a great one to highlight. Tell everybody again where they can find you, about your podcasting and just where they can learn more about this topic.
Tim Pickett:
Yeah, I mean, the best place to connect with me and to learn about what’s going on in Utah is utahmarijuana.org. That’s the website and organization that I run. You can listen to our podcast, Utah in the Weeds is basically cannabis culture in Utah. We talk to the Department of Health and patients and just a good place to learn about cannabis in Utah specifically. And that’s available on all the podcast apps, Utah in the Weeds.
Tim Pickett:
But utahmarijuana.org, it’s a good resource. There’s a lot of Frequently Asked Questions there, a lot of information about how to become a patient or can I become a patient. Of course, there’s links there to get ahold of us and schedule. But that’s where I would go, for sure.
Dwight Hurst:
Tim, thank you so much.
Tim Pickett:
Thanks, Dwight. I’m really excited to have this opportunity to talk about this with you and kind of expand the knowledge.
Speaker 3:
Thank you for listening to the Core Temp Arts Podcast Network. To listen to more Core Temp Arts shows, visit coretemparts.com.
