Cannabis in Nursing Homes. Is it Legal?

Alan Horowitz is of counsel in the Healthcare practice at Arnall Golden Gregory LLP, and a member of the Post-Acute & Long-Term Care industry team. He is an innovative healthcare lawyer handling complex regulatory issues concerning Medicare providers such as skilled nursing facilities, hospices, and home health agencies. Known for his unique and significant healthcare experience, Alan held clinical, faculty and management positions at major medical centers where he utilized his management skills as well as his background as a registered respiratory therapist and registered nurse. In 1976, Alan formed the first neonatal respiratory care team while at Hahnemann University Medical Center in Philadelphia. Above all, he is most concerned with helping clients run businesses that provide the highest level of client care possible.

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Transcript

Cannabis in Nursing Homes. Is it Legal? with Alan Horowitz, Esq

John Malanca 0:00
 Hi everybody, John Malanca, United Patient Group, Be Informed. Be Well. I hope this finds you well. Today I’m here with Alan Horowitz. He’s Attorney at Law with Arnall Golden Gregory LLP. How are you doing, Alan?

Alan Horowitz 0:13
 I’m doing just fine. Thanks, John.

John Malanca 0:15
 Thanks for joining me. I know your offices are throughout the country, East Coast, middle, the middle of the country and east coast. But you’re located in beautiful Colorado so. So kind of kind of the heart of of like California when it comes to medical cannabis. And so let’s just get right into it. I mean, you work with a lot of senior senior living facilities, nursing facilities, hospice, not only are you attorney I have 3233 years, 3032 years, 32 years, but also a registered nurse out of Pennsylvania. So you’ve kind of covered the gamut. And you can talk the talk and speak speak speak the language that nursing facilities go through on a regular basis. So let’s just start off here. Currently, how many were here in the United States? Currently, how many states are legal today for medical cannabis? Of some some sort?

Alan Horowitz 1:04
 Yeah, that’s an excellent question. So as we speak, there are 37 states that have legalized medical marijuana. There are 18 states that allow recreational marijuana in my practice, and my focus has been on the medical marijuana end of things. And that’s typically the question. The questions that I get are typically from as you referenced, nursing homes or hospices? Yeah. I’m sorry, go on.

John Malanca 1:29
 No, no nursing home and hospice. And the thing that we see on a regular basis, and I’m certain you do as well, is that the confusion is not all states are the same, not only for patients, you know, for qualified conditions, but most certainly for nursing homes. And can you can you touch touch up on that? What people are what people are running into on a regular basis?

Alan Horowitz 1:51
 Yeah, the most typical question that I received from the owners or operators of a skilled nursing facility, and by the way, there are roughly one and a half million skilled nursing facilities in the Medicare program, I’m sorry, 15,001, about 1.5 million residents in those nursing homes. And to the extent that the overwhelming majority of them if not, almost all of them are Medicare providers. When a provider with a health care provider, such as a skilled nursing facility agrees to be in a Medicare program, they agree to abide by all federal laws. Now, the problem for nursing homes are one of the problems related to medical cannabis, is that even if they’re in strict compliance with state law with those 37 states that have legalized medical marijuana, they’re violating federal law because under the federal paradigm, marijuana is still considered a schedule one substance under the controlled substance act of 1971. Which, just editorialize? I think that’s a bit ridiculous. For the folks that may or may not know, schedule one drugs are LSD, methamphetamine, heroin, and Tulum, marijuana or cannabis in with heroin and LSD. There’s no scientific basis for that

John Malanca 3:07
 with with with basically a schedule one is addiction and cause harm, but also no medical value, which unfortunately, you know, not a conspiracy theorists here maybe a little during COVID. But the United States has a patent as a CBD is a neuro protecting medical medical value. Right. And so it’s confusing. It’s confusing for a lot of patients but confusing for a lot of doctors, and and nurses and I’m searching for these facilities as well. So since you mentioned Medicare, and you specialize a lot in Medicare, and with the funding that the federal government gives to patient to facilities like this that have Medicare, cannabis being in the illegal substance, not federally legal, legal, but legal at the state level, do they need to worry about losing these grants or funds or their jobs?

Alan Horowitz 4:01
 Yeah, that’s an excellent question. Actually, could the legal ramifications go further than losing their job or grant, theoretically, healthcare provider could be terminated from the Medicare program, which then means automatically they’re terminated from Medicaid, which would essentially dry up their revenue source and will put them out of business. That said, when I’m asking this question repeatedly, I’m cautiously optimistic, and I think it’s very unlikely that you’re going to be prosecuted at the federal level, so long as your strict compliance with state law and there are two reasons for that primarily, um, there’s something known as the Rohrabacher Farr amendment, which I know that you’re familiar with, which was first introduced in Congress in 2014. It’s been reintroduced every year, including this year. It’s in the fiscal year 2022 budget. And basically, what the rollback or far Amendment did was, it was around Due to the appropriations bill, and it basically said to the Department of Justice, we’re appropriating funds for you for the next fiscal year Department of Justice, but you may not use these funds to prosecute anyone who complies with state law. And this has actually been tested in the court. There was a case a few years ago, United States v. Macintosh, when actually there were 10 cases that were consolidated. There were 10 defendants from California and the state of Washington, who were charged with felony possession of marijuana, and it was medical marijuana, and the Department of Justice brought them to was prosecuting them for violating the controlled substance act. Well, their defense was, wait a second, under the Rohrabacher far amendment. Congress has already said US Department of Justice can’t use funds to prosecute us. And here we are a federal court. The this went all the way to the Ninth Circuit Court of Appeals. And the Court of Appeals basically kicked the Department of Justice out and said, We understand and you lawyers should understand you federal lawyers should understand that when there are two competing federal statutes, such as, in this case, the controlled substance act on the one hand, and the intent of Congress, the more recent is going to trump the decision. And so the court threw the case out. So that’s one of the reasons why. I know that’s only binding on the Ninth Circuit. But I think that that reasoning, and since as we speak, that amendment is still in existence, at least through September of 2022. And has been every year since 2014. I think it’s unlikely that any provider and by provider in skilled nursing facility, or any of its employees, or any of its residents will be prosecuted again, the key is so long as they’re in compliance with state law. And I’ll just quickly as there’s another reason that I would reassure facilities cautiously, I can’t guarantee them this because you’re technically breaking the law. The other reason goes back to the Obama administration, something I know that you’re familiar with. It’s called the Cole Memo. Cole was the Deputy Attorney General in the Obama administration. And he sent a memo to all US attorneys that basically said it was a four page memo basically said, You know what, we United States Department of Justice had bigger fish to fry. We’re dealing with cyber crime, all sorts of, you know, serious crime, we’re gonna leave enforcement of marijuana up to our state partners. So there was the Cole Memo, which by the way, was rescinded by Attorney General Sessions early on in the Trump administration. And then the sessions rescission was effectively rescinded by Attorney General Barr, when he testified said, I have no intention of allowing the Department of Justice to prosecute anyone who complies with state law. So because of the Cole Memo, and then its resurgence under Attorney General Barr pardoning and the Ninth Circuit decision in Macintosh, as well as the writer to the appropriations bill, it says Department of Justice can’t use funds to prosecute anybody, I think that it would be reasonably safe. And I say that I’ll just end with this on the basis of the fact that I’m not aware of a single prosecution of any nursing home, and a nursing home employee or any nursing home resident dealing with cannabis where they’ve complied with state law.

John Malanca 8:21
 Have you run into cases where they’ve been harassed at all? I know you made the two case it didn’t sound like that there was that was a nursing home that was that that you were talking about? And so are you because I don’t hear it? I don’t hear about I don’t hear about that. And I work with a lot of hospital nurses where they just say, listen into life. We just turn our backs they go for it. I mean, I’ve had hospice nurses say we’ve even let them consume via via smoking and that that’s that’s the one thing that I always that’s a question that comes up quite a bit. May we are we allowed to have our residents use medical cannabis. And the majority of that prefer to do it but they don’t want to offend the other residents are there so smoking is not on the top of the list. Vaporization edibles topicals is what patches are what they kind of prefer that their residents do legally I guess and so you it was funny. I bet your whole practice changed when the lot Panama cannabis laws. Did you ever think that this was gonna be part of your little repertoire?

Alan Horowitz 9:23
 Actually, about seven years ago, I kind of saw this happening. I thought that it was inevitable. It’s time has come and won states like California and Colorado, paved the way it’s hard to put the genie back in the bottle and along those lines. You know, it’s it’s my sense, and I think that a lot of people that medical marijuana in fact, recreational marijuana as well will be decriminalized. As you know, there are a cup there’s some pending legislation in both the House in the Senate the more act pardon me in the house, which is all already received, support. How far they will go in the Senate is an open question. But the Senate has a separate package of legislation that would decriminalize medical marijuana. So I think I mean, the trend is here. And if you consider the fact that we’re 37 states have already legalized medical marijuana, that means the majority of citizens, residents in the United States live in jurisdictions where it’s legal at the state level, I’m quite sure that the rest will follow suit.

John Malanca 10:32
 Yeah, it’s funny, you say the rest will follow. And you you think California and Colorado years ago, I want to say 2012, maybe I received a call from a gentleman he was a medical doctor from the Department of Health in the state of New Jersey. And he called me one day and he said, Okay, I’ve been put on this. He’s, I’m kind of the black sheep of this department. And so they put me onto this onto this, this this job, I guess, I need to talk with someone who knows California law, about medical cannabis. So well, I could share some things. He’s he goes out on the I don’t really need the law law portion. But we need to see what’s working there and what’s not working there. Can you share so I can take it back to our state and see we can improve that here in the state of New Jersey as of course. So we did that. And about a year later, he called me again, you remember I said, Of course I remember you he goes. They have me back at it again. Colorado law now is recreational, what do you see the good and the bad, the ugly with that during practice state of New Jersey. And so it’s, you know, each state is different. Each state law is different. And so is it legal here in California? It’s the same thing. I mean, there are some states that didn’t approve cannabis schemee didn’t approve cannabis qualification for cancer patients. Pennsylvania, just approved pain as a qualifying condition a couple years ago or a year ago, you know, and so it’s tough when you’re, you know, working with patients, and it’s like, Doc, I have this, I’m sorry, but that’s not a qualified condition. It’s like, what do I have to do I work with a lot of Utah patients. epilepsy was legal. Cannabis was not a I mean, cancer was not a legal qualification. And so, you know, you kind of they automatically become, you know, cannabis refugees, or you send mom and dad to another, another retirement community and or another nursing facility in a different state. So they can have access. I mean, this comes up quite a bit, you know, a patient, they’re used to having this medicine, it is medicine. And then going into a facility say, sorry, you know, Mr. Jones, you’re not allowed to bring this in here. It’s like, wait a minute, this is what’s been keeping me alive, you know. And so, and I know, for our audience, and I know you and Alan, I’ll just throw a disclaimer, you know, Alan is not giving legal or medical advice for now, if you do need legal advice. I’m certain his firm would love, love to love to speak with you with a medical advice might, you know, find that find a medical professional, that really can help you with this as well. And so there’s your disclaimer, that’s, that’s the lawyer side of me. I had to thank you.

Alan Horowitz 13:06
 I appreciate that. If I could just add a thought to what you just said about essentially, patch quilt patchwork quilt of state laws. One of the other concerns that I see are clients around the country say is that the laws are so different from state to state. So some states allow smoking, other states do not a typical examples example. So in Georgia, where our firm is, has its headquarters, when Georgia decriminalized medical marijuana and only medical marijuana a few years ago, the Georgia legislation required that it can only be in one form and one form only. And it’s called low THC oil. And that could only cannot exceed more than 20 fluid ounces of 0.5% THC in a pharmaceutical grade container. Texas allows I think, 10 times that amount of THC. So and then that creates a problem for residents, let’s say residents in a skilled nursing facility or in hospice, in one state, Colorado, where we’re California where the forms are much more there multiple forms of cannabis, and they moved to Georgia. Well, the only form that’s available in Georgia is the low THC oil. So that creates a problem of continuity of care. How does someone who’s either in hospice or in pain or has another qualifying medical condition? How did they get the form of cannabis that they’ve been using, which has provided them relief as they migrate from state to state? Again, there’s a lack of consistency. Because the feds, you know, have had hands off.

John Malanca 14:48
 You know, we did an article years ago about we worked with a lot of Texans and a lot of Georgians and Georgia, we worked a lot of families that they had to try all these and these other modalities did not work, then you could use cannabis. And we did an article was almost like you can have a driver’s license, but we don’t allow cars. Right. Right, exactly. So So we did an article, it was entitled, Atlanta the pretense state or something like that. And it got a lot of coverage and a lot of patients that you’re right, you know, I mean, I brought mom and dad to facility, they can’t use it, my child has, you know, seizures, they can’t use it. And so a lot of them were forced to move out of state to legally obtain to obtain this, you know, as the laws in the states grow. It’s confusing summer medical states versus recreational states. So in a nursing facility or or facility where a patient’s elderly are living and being taken care of, do they need to go? So California, Colorado, us, California, Colorado, recreational states, 21. And over? Do they need to when they’re in this facility? Do they need to go get a legal recommendation from their doctor like they used to, or a state issued card like that, like they they can or cannot, but being 21 over here in California, anybody can come in here, like you’re going into a bar and say, Hi, I’d like to have that.

Alan Horowitz 16:14
 Yeah, I think the short answer, and again, it’s going to depend on the specific state and the state’s laws, since there’s no federal law governing this. My understanding is that most states for recreational marijuana, one doesn’t need to possess a card, because obviously, it’s recreational. So you the prerequisite of a qualifying medical condition is not there. So, again, there’s there’s no requirement that I know, on the other hand, what I’ve seen with some many nursing facilities around the country, where somebody wanted to use recreational marijuana, and the facility said, no, they could do that. Because they could even say, no, if somebody wanted to use medical marijuana, because the physical, you could say, we can violate federal law. And actually, there are probably still, I’m my guess, is, based on my empirical interaction. The majority of nursing facilities do not allow medical marijuana at this point, I think that’s slowly starting to change as their comfort level increases.

John Malanca 17:19
 We’re seeing it out here where it’s definitely definitely increasing. Let me ask you the question. You also worked with employment law. You know, and a lot of companies, especially ones that are being getting grants and like Medicare. There, they do do drug tests. So what happens to employ a nurse, a caregiver, that’s helping a patient with their medicine, if it’s, if they’re smoking it or vaping it? And now it’s in their system here? Have you run into that? I’m sure in their cases out there like that.

Alan Horowitz 17:51
 I haven’t run into that. But that’s an excellent question. I have run into the situation. And I’m aware of cases where an employee has tested positive for cannabis and been fired. And the problem with that is that there’s no consistent approach by the states. And I’ll give you just a couple of quick examples. So in Michigan a couple of years ago, the case was Cassius, CA SS, IAS. And Cassius worked at a Walmart in Michigan, had worked there for a number of years, was pushing a cart, twisted a knee or ankle when home came in the next day and had a limp because he was limping the next day, consistent with Walmart’s policy. You had to go to the emergency room. Cassius did have a card, a medical marijuana card consistent with Michigan’s Medical Marijuana Act. It was recommended by his physician, he had a sinus problem on an inoperable brain tumor, pretty serious stuff. And it is oncologist had recommended medical marijuana which he took when he went home and never interfered with his work performance. Anyway, when the emergency room drug testing revealed the presence of cannabis, he was terminated from Walmart, he sued for wrongful termination. And that case actually was moved to federal court when it was the federal court in the Sixth Circuit. And the federal court upheld determination. Interestingly enough, and to your question, almost as some of actually a very similar fact pattern happened in Arizona with Walmart and a Walmart employee who was injured on the job went home use medical marijuana consistent with a doctor’s recommendation and the medical marijuana card that the individual had was terminated, did the same thing filed for wrongful termination. And in Arizona, almost identical fact pattern, the Court reversed the termination. Just one other example as a closer to home at least closer to the healthcare industry. A couple of years ago there was a director of activities hired for a nursing facility In Connecticut, and she disclosed on during an initial interview or secondary interview, I use medical marijuana, I have PTSD, secondary to a serious motor vehicle accident. I’m a registered union user consistent with the law in Connecticut, my doctor has recommended this will not interfere with my performance. And they withdrew the offer of employment, not singer, who was the name of that case. So Knopf singer sued for essentially wrongful termination to his terminate because she’d already they’re offered the position. And and that case settled. So whether it’s and finally, one last case, in California, there was a case Ross V, ragin wire telecommunications that went all the way to the California Supreme Court. Were in a pre employment physical similar to the case I just described with the activities director in a premium climate, physical Rost has to pause positive for cannabis, and was not allowed to, to work and, and sued and basically said, I have a disability. If I was using insulin, and you withdrew the offer of employment, that would be discrimination. I’m using medical marijuana consistent with California law, my doctors recommended it. And that went all the way to the California Supreme Court. And in a surprising decision, the California Supreme Court upheld the termination. And that case, you’re very surprised that the dissent was stinging the dissent in that case, and it’s Rossby raging wire telecommunications, the judgment descended with majority opinion basically said, in California now an employee has to choose between working having a job or getting pain relief from medical marijuana.

John Malanca 21:42
 It’s crazy. I had heard the Arizona Walmart case that that that did make national news. And so with this, what can you share with with it with employees? who are in these facilities that, of course don’t want to lose their job, but they want to help the patients? What can you share with our audience? Well,

Alan Horowitz 22:05
 my advice to clients has always been to be as proactive as possible. And towards that end, I recommend that the facility itself have a policy and procedure, either they’re going to allow marijuana whether or not either they’re going to allow medical and or recreational or not, either. They have a policy regarding employees where they don’t. And the reason for that is let everybody know both prospective residents, prospective employees, as well as current employees, this is our policy. I think that’s the best way to approach it. That way, there’s no surprises, just be proactive, whatever your position is, again, at this point in time, as long as it’s still a schedule one controlled substance, facilities can legally say, we’re not going to permit any resident T to use it. We’re not and if any of our employees are found to have cannabis in their blood, we can terminate them. Yeah, again, I think that being proactive, and just having a policy and procedure, disseminating, that educating your staff, and letting all I even go so far as recommending nursing facilities, post their policies and procedures on a web, there shouldn’t be any secrets. I believe in transparency, let people know. So if you’re thinking about placing a loved one in a nursing home, and your loved one is getting relief from medical marijuana, you want to know I think ahead of time, whether or not the facility is going to permit that. Likewise, if you’re a nurse, nurse aide therapist, if you’re thinking about working in a particular facility, and you are a medical marijuana user, then I think you want to know ahead of time, before you accept that position. Does this facility allow it or if I use it on my own time, and it doesn’t interfere with my performance? Will I get or could I get terminated? So being proactive, I think is the best way to go.

John Malanca 23:57
 Proactive and I think hospitals have started doing that because you’re starting to see these on the intake forms as well. It’s a new check checkbox about medical cannabis. You know, with the laws changing day to day and state to state would you recommend these facilities to to reach out to your law firm or a law firm in their local area? Just to ask I mean, it just seems like to cover their behinds.

Alan Horowitz 24:28
 Thank you for that question. I don’t want to sound self serving, I’ll just say we do a fair amount of legal representation for growers, distributors, people throughout the spectrum involved with cannabis. That and we have a national practice or firm is involved with legal issues clients in all 50 states. So the only caveat that I would advise folks about is we’re whoever you choose to legally represent you whatever law firm or Attorney, he or she or the firm should have substantial experience in the area. It’s not this is not an area for general, in my estimation for general practitioner, who maybe does some real estate closings, maybe some wills, maybe some divorces, you really want somebody, you know, whether it’s on the real estate and such as, you know, owning the crops or transactions or any other aspects along the distribution chain. You’d be best having an attorney or firm that has deep experience in that particular area. And there’s no shortage of law firms throughout the country that have that degree of expertise. Yeah,

John Malanca 25:40
 it’s funny I would say that the hours were clearly yours and so I’ll throw another plug there in the chicken shortly here before we get off. But I see that with I talked about that with the medical professionals as cannabis laws I saw are improving as you said, you know, 37 states are legalizing in some form. The education for doctors is not keeping up with the laws and so I have a lot of patients of all ages a lot of seniors actually will say Okay, John, I went to my doctor and he or she said I can use cannabis. What do I do now? I just think that’s doing a dis justice if you’re going to recommend medical cannabis to your patient, make sure he or she knows that it’s not a one size fits all and I’m starting the same thing with the same thing with with with law you know, it’s not a one size fits all speak to a someone who specializes and I’m glad you said that someone who specializes in cannabis law and I know your firm does that as well. You know, it’s can’t there’s the stigmas dropping with cannabis. I mean, when we started this, you know, my wife and I started this unit patient group back in 2010 2011. It was still hush hush no one really wanted to hear yet and like whisper will kind of lie to you work Medical Academy. Hey, we’d go to medical conferences and do have our booth we go to pharmacy conferences have our exhibit booth and people walk by I’m not looking I’m not looking in the following year. People who start talking about it. Should I go to church with my mom and her girlfriends are coming up. Okay, I’m doing this I’m sleeping better. I’m not I’m rubbing the top up. I’m not paying I’m able to walk. You know, so the stigma is dropping and then we’re seeing all these different you know, CBD so cannabis has about 140 different cannabinoids THC, which many are familiar with is a psychoactive cannabinoid is what people relate that to CBD, the non psychoactive, which you’re seeing everywhere, from gas stations, grocery stores, all over the, you know, pharmacy, CVS, Walgreens, Duane Reade wherever you’re located throughout the country. There’s so many to choose from, but the stigma is starting to drop or being lower the walls being lowered. And where do you see where do you see the future of cannabis?

Alan Horowitz 27:56
 Well, I definitely think it’s going to be decriminalized. I think it stays residing as a Schedule One controlled substance are numbered. And I think that some of the states we think it should

John Malanca 28:11
 be. So again, I’m sorry to interrupt you. Do you think it should still be changed to another schedule or not scheduled at all, like some other plant medicine? Supplements?

Alan Horowitz 28:24
 You know, I’m, I’m leaning towards not scheduled at all. I’m aware of legislation. I think it’s called the 123 Act, where that was legislation would decode would declassify marijuana has schedule one and put it in schedule three? I think that, you know, I think that the appropriate way to answer that question is for there to be an unbiased commission to look into it, and see if it truly warrants being scheduled three, or four, or no schedule all and can be over the counter, much like fish oil, or so many other herbs and supplements. I just want to touch on one thing you’d mentioned. If someone is seeking legal advice, and thank you for echoing this comment, the person the attorney with the firm should have expertise. The same thing is true with physicians if you’re looking for a recommendation from your physician, so I know of a physician, Dr. Zack Palace, who is the Chief Medical Officer at the Hebrew home in Brooklyn, and I mentioned his name only because he’s appeared in The New York Times and other public medium, and Zach, and I’ve done presentations on medical marijuana. And I once asked Zach well consistent with new New York law, when you’re recommending medical marijuana for your residents in a nursing home or the docks that you supervise, you know, what are the guidelines? And Zach was elegant in a simplicity. He said, Well, there’s an old adage in medicine, start low and go slow. I will start with 10 milligrams and work my way up. So again, and a lot of physicians might not know, you know, or might not have experience in that approach. I did a presentation I’m for the Ohio Medical Directors Association. Recently, in looking at the Ohio statute, I was encouraged to see that any physician and many states do require this. Any physician that’s going to be able to recommend medical marijuana is required to have either two hours of continuing medical education credits were something similar to that, but to have some formalized training so that they’re not willy nilly saying, Okay, I’m gonna recommend three gummies a day. So I think

John Malanca 30:29
 you mentioned that that’s another topic because it’s, I think it’s, it’s, again, not truly helping the patient because a lot of the recommended physician some of these legal states now take a two hour course up to a six hour course and Okay, now you’re recommending physician and do they know the endocannabinoid system? They know drug to drug interaction? Do they know the laws do they know? You know that each cannabinoids plays plays a role and something like you said, less is more start low go slow. I’ve seen patients have success with two milligrams, you know, sent dependent me we’re all different. So, you know, I’ve seen you know, in the 12 years of being in this industry, I’ve seen a lot of good bad, the ugly, but I’ve seen I mean, I’m the first to say cannabis is not the Golden Pill, the golden ticket, I’ve seen it work. I’ve seen it not work. I’ve seen it, you know, I’ve seen it, but changed people’s lives. You know, for the better for you know, how we started my father in law was diagnosed with cancer, he was given two weeks to live, we asked about medical cannabis for appetite, stimulation, nothing else we didn’t know anything about the medical benefits. And he just passed may 2021, of old age, he was diagnosed in 2011. And so came back no evidence recurrent disease using cannabis. That put that led us on this journey of education. You know, my wife, who I called Mary Poppins didn’t drink and the smoke worked out did everything you’re supposed to do. Pass to pancreatic cancer, you know, and so to me, hitting a Grand Slam out of the park with my father in law was was, oh my god, this is incredible plant. And that was success to me saving a life others success definition is I’m off my meds. I’m sleeping better. I’m not in pain, I’m able to walk down the street, my spouse passed, and I’m in this nursing facility or living facility. And I’m able to get back into the community and be around people again, because I’m kind of it’s helped me getting out of my depression helped me getting out of my, my anxiety helped me get out in my internal body pain, which, you know, I went through with, with with the pain of losing my wife. And so, you know, so I’ve seen a lot of benefits that this plant offers. And again, it’s not for everyone. And again, I just hope that this is your body and for the facilities and the patients that are listening, you know, this is your body, your life? Don’t it’s not illegal to ask questions. So don’t don’t be afraid to ask questions. And if your doctor is not open to discussion, ask him to recommend another doctor to you. Because, you know, I, I just think it’s something that people if they’re going through something, and something else is not working, you know, don’t be afraid to try. But I truly believe that a medical professional should be involved. And when you’re dealing with law, a law specialist should be involved as well. But I know you’re down there are no golden and Gregory. So I want to give that one more plug for our listeners. And I’ll put all your information on there, as well. But you have any closing words for our audience. I really appreciate you coming on.

Alan Horowitz 33:50
 Thanks very much. And thank you for this opportunity. John. I truly appreciate it. I just want to share a study that was published in a medical journal called Health Affairs a few years ago, the researchers looked at Part D claims which are the Medicare Prescription claims. They look focused on the 17 states at the time, and this was I believe, in 2013. They looked at the 17 states that had legalized medical marijuana. They found that in those states, the Medicare Trust Fund saved in one year alone 165 or $162.5 million. They dug down deeper and because they were curious, how come those states are paying less? What they found was a precipitous drop in Oxycontin, hydrocodone, oxycodone, and to the extent and I’ve heard empirically from chief medical officers folks like Dr. Zachary palace at the Hebrew home in New York and other chief medical officers and medical directors of nursing homes, that they’ve been able to wean their patients their residents off of narcotics. and replace them with medical marijuana. And, to my knowledge, nobody’s died from an overdose of cannabis. So I’d say for. And that seems like a win win situation to me. I mean, you know, people using medical marijuana as opposed to opioids for their pain management, they’re less likely to overdose and die, less likely to become hopelessly addicted. So I think that there’s some very, and that’s just one area. That’s just a pain relief alone. Obviously, there are no less than 16 Different qualifying conditions and medical marijuana seems to alleviate. So I think that it’s at least worth looking into. It’s it’s a serious discussion that somebody who’s had who has serious condition, one of the qualifying conditions, they should have that discussion with their physician, assuming and if their physician has no experience in that area, I think it would be appropriate to ask the physician, can you recommend that someone that I can talk to who can give me advice and guidance in terms of what might be helpful?

John Malanca 36:03
 Yeah, by the

Unknown Speaker 36:05
 way, I think you’re doing a great service.

John Malanca 36:07
 I appreciate I like how you because I was I always use the win win. Example, you know, I truly, it is a win win. Let me ask you this. Before we get out of here. Will insurance ever be covered? Because this is a this is a topic I get on a regular basis from from seniors? Is Mike, does my insurance cover this? Does my will it cover this?

Alan Horowitz 36:30
 That will be up to the is an excellent question and one that is increasingly being asked. Obviously, that’s up to each individual insurer. At this point, Medicare does not pay for it, and Medicaid does not whether they will in the future, I can see that I can see that happening. So for example, if in a couple of years from now, when you and I are having this conversation, and there’s no federal prohibition, if somebody if a resident in a nursing home or a patient at home, has been weaned off of Percocet, which Medicare was paying for, and it’s being replaced with medical grade cannabis. Why wouldn’t the government pay for it? Actually, the government could theoretically even be saving money, but it would be better for the patient. So I would think that the Centers for Medicare and Medicaid Services, which federal agency that oversees Medicare, would want it have an interest in in patients not overdosing not becoming addicting and would encourage patients to use medical marijuana rather than dangerous opioids. So there’s it’s a long winded answer. It’s up to each insurer. I think the insurance, the private insurers will probably wait and see what Medicare does. And I think that there’s going to be a lot of pressure on Medicare. Certainly within a three to find your window.

John Malanca 37:43
 He made that you made the thing a comment about money. It is it is you know, the government has saved money but the pharmaceutical companies will lose a lot of money. So but anyway, Alan, I appreciate appreciate you coming on and sharing your expertise and background and story with with myself and my audience as well. And I appreciate your time and we’ll see. We’ll see again,

Alan Horowitz 38:08
 I look forward to it.

John Malanca 38:09
 Thanks for the opportunity. Everyone, John Malanca and Alan Horowitz with a we’re here with the United Patient Group. Be Informed. Be Well and wishing you a blessed day. Have a great day everyone. Bye bye. Bye bye now.