This post was originally published on this site.
Medical cannabis became Dr. Lynn Parodneck’s professional focus in 2016, not long after seeing how the plant helped treat her husband’s Parkinson’s Disease symptoms.
But in 2022, Parodneck, a Bedford-based doctor who previously ran a private obstetrics and gynecology practice in Manhattan, noticed some of her cannabis patients dropping off when it was time to recertify with her. A few told her they received a mailer from Leafwell offering recertification telehealth appointments for $99.
“Once a month they blast these things – “renew cheap and easy” – which is pretty disgusting,” Parodneck said.
Cannabis telemedicine company Leafwell, in partnership with medical cannabis company Curaleaf – and possibly other medical operators in New York – have been emailing medical cannabis patients who have subscribed to mailing lists with offers of lower-cost telehealth certifications, both companies acknowledged to NY Cannabis Insider. Both companies said they only send these mailers to patients who actively opt in to their list.
However, the partnership between the two companies appears to violate medical cannabis regulations.
According to rules for medical cannabis businesses, “No marketing or advertising of medical cannabis products shall:… cooperate, directly or indirectly, in any advertising if such advertising has the purpose or effect of steering or influencing patient or caregiver choice with regard to the selection of a practitioner.”
When NY Cannabis Insider asked the Office of Cannabis Management if the mailers advertising discounted certifications violate regulations, a spokesperson didn’t say whether this specific activity breaks the rules.
“Any registered organization found to have violated medical regulations will be subject to applicable penalties,” OCM spokesperson Aaron Ghitelman said in an email response. “As with all reports of potential misconduct, the Office of Cannabis Management reviews any and all allegations and if warranted, conducts an investigation and makes a determination based on Cannabis Law and regulations.”
Parodneck and others also say that the certification method is detrimental to patients, in addition to diminishing their medical practices.
Leafwell’s telehealth model incentivizes quick consultations with patients who may not get all the information they need about issues like prescription drug interactions or which marijuana products are better for different situations and ailments.
Meanwhile, a patient advocate says that while telehealth poaching can harm some patients, it can be a lifeline for others.
“I think there’s plenty of us who are able to self-manage and can educate ourselves enough, but there’s definitely some patients who do need a little bit more of an active hand in their care,” said Tim Mitchell, a medical cannabis patient and advocate. “It’s those more vulnerable patients who would be the ones to suffer.”
New York State’s medical cannabis program requires patients to get certified by a registered medical practitioner who may prescribe marijuana for various qualifying conditions. Patients must recertify at least once per year to remain on the medical program.
Parodneck approaches her medical cannabis practice in a community-focused manner, she said. Rather than simply writing prescriptions for weed, she also refers them to groups that can help them cope with health conditions. Under her guidance, some of her female patients living with multiple sclerosis formed a group which regularly meets for lunch, and whose members make themselves available to others for support when their symptoms are acute.
“People have these diseases … and they don’t know who to talk to,” Parodneck said.
She spends at least an hour on each initial patient consultation, because it’s important to understand all the issues a patient is dealing with, and whether there are non-cannabis therapies that can supplement their weed prescription, Parodneck said. She gives individualized recommendations for products based on factors like lifestyle and other prescriptions.
That, she said, is a major reason for why she became concerned when she heard about the Leafwell/Curaleaf emails. Emails Parodneck provided to NY Cannabis Insider show that when she reached out to Curaleaf, an employee speaking on behalf of CEO Matt Darin told her the Leafwell promotion was a standard practice, legal in every state in which they operate.
When Parodneck reached out to Leafwell, CEO Emily Fisher offered her a job. Fisher sent Parodneck an independent contractor agreement, so that she could start doing patient certifications for Leafwell. Parodneck declined.
“She said you can do like 25-30 certifications per day … for between $25 and $45 per head,” Parodneck said. “I spend an hour with each patient in consult, my renewals are half an hour – my practice is not a paper mill.”
In an email response to questions from NY Cannabis Insider, Leafwell said they conduct consultations with a patient-centric approach. The company partnered with Curaleaf in an effort to “enhance the affordability and accessibility of medical cannabis treatments.”
Leafwell said that while some patients may require a brief session to renew their certifications, “others may benefit from a full 20-minute appointment to discuss their specific treatment, ask additional questions, and discuss health outcomes.” Patients may schedule post-consultation services, and have the option to reconnect with specific practitioners, Leafwell said.
The company added that Leafwell’s partnership with Curaleaf and discounted consultation promotion “adheres strictly to state laws and regulations regarding medical cannabis certifications and advertising.”
Curaleaf echoed that the practice is legal, and pointed out that sending information about Leafwell to patients who have signed up for their email list does nothing to force patients to leave their current healthcare provider.
“As with any affiliate marketing offering, patients always have the option to stay with their current provider or to seek Leafwell’s network of doctors and telehealth services,” Curaleaf said.
But a 20-minute session is below the level of service many patients need, said Dr. Ken Weinberg, Chief Medical Officer of Cannabis Doctors of New York, who practices in Manhattan. It’s important to spend at least 45 minutes for an initial consultation, and around 30 minutes for renewals, in order to make sure the doctor understands all the issues affecting the patient, Weinberg said.
Weinberg said he has elderly patients for whom certain strains and delivery methods (i.e. vaping versus smoking versus edibles, etc.), can cause adverse reactions like heart palpitations and dizziness, which could cause a life-threatening fall.
“I would not feel comfortable having just a 10- to 15-minute conversation, especially with an initial patient. It’s really doing them a great disservice,” Weinberg said. “It’s a very serious medicine, and you need time to interact with a patient.”
Mitchell, the medical cannabis advocate, agrees that brief consultations aren’t enough for many patients, and they can be less than ideal even for patients who are well versed in cannabis. Mitchell has received his certifications through a telemedicine provider for years, and about half of the calls lasted less than a minute, he said.
“It wasn’t like they came on the line and asked me how I felt about my medical cannabis use,” Mitchell said. “There was no effort to try and see what my comfort level was or if I needed some kind of help.”
That became a problem when Mitchell began using a high-CBD product without realizing that CBD reduces the efficacy of an antidepressant he was taking at the time. He eventually realized and discontinued using the product.
On the other hand, telemedicine options can help people become certified patients when their primary care physicians act as barriers to cannabis, Mitchell said. He certifies via telemedicine, because his primary care physician has declined to certify him, despite the fact that, he said, cannabis helped him reduce his intake of pharmaceuticals by about 2,000 pills per year.
The closest Mitchell’s doctor came to certifying him for medical cannabis was a referral to an expensive clinic, which requires patients to recertify every three to six months – charging for each appointment.
“That was kind of a big disincentive to me, because I’m not willing to pay more when I’m pretty much able to self-manage.”
Mitchell added that many patients who are elderly, new to cannabis or who take prescription medications likely need more attention than telehealth options generally provide.
Although Curaleaf and Leafwell say their email promotion is designed to offer affordable medical cannabis certification options, Parodneck and Weinberg see it as a cynical exercise that offers patients a lower standard of care than their current doctors provide.
“I’m playing by the rules, and then they’re taking my patients away,” Parodneck said. “What they’re doing is unethical.”