My Pineapple Express

The last time I smoked marijuana, Ronald Reagan was the president. It wasn’t my drug. Seriously. I’m not judgmental about it; I won’t lie and say I didn’t inhale. Like Obama, I did and I enjoyed it, so I get why some of my friends loved pot. But a drug that mellows and relaxes you and encourages you to sleep and eat frequently was the exact opposite of what I was looking for at 19 (or, you know, even in my mid-thirties, even though I do so appreciate a 

nap now).

But here’s the thing. Like a lot of people with HIV, I have a variety of medication-related symptoms like nausea, loss of libido, and fatigue, as well as other irritating age-related problems I’ve developed over the last decade including migraines, insomnia, myofascial pain syndrome, irritable bladder, and worst of all, a chronic unrelenting pain condition that can have me curled up in a ball sobbing on the one day I finally have off from work and want to finally hit the gym. 

I also want more energy, not less, which is why, over the years, when people have suggested I try medical marijuana, I have scoffed. Perhaps if I could have gotten a legal, medical version of cocaine — without time travelling to 1800 where it did exist — I wouldn’t have held out so long.  Still, the thing about chronic unrelenting pain is, you’ll do anything to try to stamp it out, which means in addition to common sense treatments like exercise, good nutrition, and meditation, I’ve been prescribed over 30 different pharmaceuticals including the narcotics morphine and OxyContin. I have also tried deep tissue massage, trigger point therapy, acupuncture, acupressure, body building, Chinese medicine,  myofascial release, magnet therapy, yoga, Zumba, salt soaks, forest baths, salt rooms, reflexology, Louise Hay’s self-help advice, Reiki, energy healing, color therapy, aromatherapy, BDSM, Feldenkrais, shaman counseling, traditional psychotherapy, cognitive behavioral therapy, group therapy for those with chronic pain, award-winning pain management programs at two different major hospitals, and changing my diet to be alternately vegan, macrobiotic, vegetarian, cruelty-free, paleo, and pescatarian (for the record, my current diet model is all-you-can-eat sugar, salt, fat, and gluten).   

Of this, only heavy narcotics combined with a salt soak and massage has ever lowered my pain threshold below a four (on the doctor’s infamous pain scale, which goes from zero, no pain, to 10).  Mind you, I’m thrilled with a three or four. Most days, I’m working through a six or seven. When I hit eight I have to be working from my bed; nine I’m unable to even be coherent; and 10, I’m at the ER.                     It’s happened. Plenty of times.

So, hey, dope doesn’t sound too terrible after all of this. Once you’ve tried singing in an empty bowl and imagining yourself cured (doesn’t work, don’t even bother), you’re open to new options. But pot cards (as my state’s medical marijuana card is unofficially dubbed) require a doctor’s recommendation. And many HMOs and insurance companies don’t allow their doctors to prescribe marijuana. Which means most people shunt off to what’s often a weed doctor mill, places that are set up to crank out as many pot prescriptions as possible, where it’s possible to “diagnose” and “prescribe” with few questions asked. In San Francisco, I often thought of applying for a pot card, but I was hampered by three things: a) genuinely not knowing marijuana’s efficacy in treating my symptoms, (b) not wanting to see a doctor in the hinky areas where the marijuana clinics often exist, like the street-crime-heavy Tenderloin neighborhood, and (c) not wanting to lie to my primary caregiver, lose my insurance, or void my prescription coverage. (Some HMOs actually require you to pledge in writing that you will not try marijuana and promise random drug tests that make sure you don’t screw up.) 

Google, HelloMD, and a new dispensary changed all of this for me. By now, studies on marijuana’s impact on medical conditions like HIV, multiple sclerosis, anxiety disorders, and fibromyalgia as well as medication-related nausea, insomnia, and more have generally shown surprisingly good results. Federal drug laws are still squelching a lot of research on cannabis, but some places like Israel and the United Kingdom are seeing an upswing in their own research. There, the tide has turned in voter approval of legalizing medical marijuana. People living with HIV have been using
medical cannabis since the first HIV medication, AZT, brought with it nausea, weight loss, and the inability to keep food down. One 2007 Columbia University study showed that cannabis successfully treated neuropathic pain and loss of appetite in people living with HIV.

Thus, after years of saying, “if it were easier,” “if it were proven,” or “if there was something near me,” I had studies in hand when I moved to a safe neighborhood where there’s a medical dispensary about four blocks from my home. I can walk there. I’d never have to “transport” marijuana in a car and risk getting pulled over if I so chose. And even better, it’s not filled 24/7 with twentysomething stoners whose only medical condition appears to be chronic munchies. 

Then I discovered HelloMD. The company began life as a traditional telehealth service connecting orthopedic surgeons, neurologists, and neurosurgeons with patients remotely. Though they were working with some of the nation’s top doctors, founder and CEO Mark Hadfield
says, “As we proceeded, we realized that there was a big gaping hole in the market for medical cannabis.”

His wife and co-founder Pamela now uses cannabinoid (CBD) oils to treat her own fibromyalgia and migraines, an experience that may have helped inform Hadfield of the problems with the “typical” experience. 

“Usually people go down to the clinic where they really have sort of the bottom end of the doctors providing recommendations, and the experience is often quite sketchy,” he says. “They are often in bad parts of town and it’s a very cursory discussion with the doctor; barely what we would consider a medical consultation at all. As a result, we think that a much larger pool of people that are looking for access to legitimate medical uses of cannabis are turned off by that experience and therefore don’t bother to get their cards. So we realize that by putting a high-quality service that was convenient and could be accessed from home, over your phone, or your computer in the market, you’d be able to access these moms, dads, elderly people, professionals, military vets, the people that are really looking to get therapeutic benefit, but are not looking to have that experience of going … to downtown L.A. and sitting in line in the clinic.”

Meaning I was HelloMD’s ideal client. So I tried it out myself, and I’m thrilled I did. Here’s how it works: you can log on to HelloMD on your computer or smart phone, fill out a membership form, pay fees, and wait for a live video service that connects you to an actual doctor, who looks, sounds, and talks like an actual doctor, not a tie-dye throwback from the ‘60s (not that there’s anything wrong with that). You will fill out a detailed medical file with medical history, conditions, any medications you take, and such. Your doctor will ask a lot of questions, basically hosting your exam online, and if s/he sees fit, will write you a medical marijuana recommendation. If approved, you can take that recommendation, print it, and go to the dispensary that day. Or if you want to be sure like I did, a physical sealed copy of that recommendation and your actual medical marijuana card (it looks like a library card with your picture) will arrive via mail in a week or less. 

Wait times are short and consultations are usually about 10 minutes, depending on how many questions you ask. The service is available seven days a week. The entire process can happen on your smartphone in 20 minutes. No wonder the company’s revenue growth is at 35 percent.

My doctor spent time giving me advice that was both knowlegable and clinical enough to appease me. I should always tell the dispensary about my childhood penicillin allergy, she said, since some cannabis flower strains have a mold quotient. She also encouraged me to try CBD oils, what Hadfield’s wife takes, which have no THC, psychotropics so you get pain relief without getting high.

Way past my 35^th birthday, I’m apparently more like the other HelloMD users than not, having now met a Afgahnistan vet treating PTSD, a soccer mom with lupus, and a gay real estate agent who managed to return to work after medical marijuana made it so he could stomach the side effects of his HIV meds. (In fact, a 2005 study in JAIDS: Journal of Acquired Immune Deficiency Syndromes showed that medical marijuana users were three times as likely to adhere to their antiretroviral medications.)

“When we started the business, we knew that some people coming through would be recreationally-oriented, but we didn’t know what percentage,” admits Hadfield. “And we’ve been very surprised to find the types of people that come through on a daily basis. I mean, we hear heartwarming stories every day about people who are are recovering from surgeries or have missing limbs. They are quadriplegics. They have any number of complaints — often pain is one of the most common ones — and they’re just really thrilled to be able to get a card legitimately.”

The live stream doctor’s appointment came with a lot of assurances as well, reviewing the HIPAA privacy rule (nobody needs to know I have a pot card unless I tell them, as my doctor won’t disclose information), prescription, and dosage information. It’s no longer as simple as smoking a joint.

Of course, with my letter and card in hand, I took my first trip to the dispensary, which is like a little pharmacy for pot with really strict security parameters. Being the fogey that I am, I was so nervous, I wanted to bring my friend in for moral support, but because he didn’t have a card, he wasn’t allowed inside.

What I found was an array of sativa and indica strains, CBD and hemp oils, tinctures, edibles, vape cartridges, wax, pre-rolled joints, and so much more. In fact, here’s where I went back to HelloMD on my smartphone repeatedly. You see, when I last smoked “weed,” there was only one strain of marijuana I was interested in: free. If someone’s boyfriend brought it to a party, I smoked a bit. I never sought it out. And while I smoked out of some unusual things (an apple, a Coke can, a milk jug turned bong), it was always something teenagers had repurposed, rather than fancy and ornate pipes you’d find in a head shop.

When I landed at my current dispensary for the first time, I had looked up their ratings and reviews on HelloMD as well as Leafly and Weedmaps, which are both like Yelp for pot businesses. I read HelloMD’s information on which strains were best for which types of pain, what studies were done on my condition, and what experts offered as caution. I took a list on my phone into the dispensary, apologized for being the weed version of a 42-year-old virgin, and asked what I’m sure were very pedantic questions like, “What is a vape pen?” and “How does one take hemp oils?”  And sometimes, too embarrassed, I went home and hit up Google or Urban Dictionary instead. One such incident led me to realize that there are dozens of different quantitative definitions for what size a “bowl” of marijuana is. 

Either way, I did as my doctor suggested and started very small, experimented with different products, and waited until I knew more about the impact of cannabis on my body as an adult with medical conditions before I stepped up my intake. I took home ordinary prescription bottles, each with 1 gram of pot inside, something for morning, lunch, and nighttime.  I’ve tried a vape pen that I puff on once every hour, tincture droplets that I put under my tongue twice a day, and gummy bears laced with a bit of THC that supplants the usual CBD when I’m on the road and need some pain relief in places where smoking isn’t cool (like the doctors office). 

In my new cannabis-using treatment regime, I’ve never been what you’d imagine as high. Sleepy and hungry, yeah. But not stoned, giddy, spacey, or just plain out of it. I did get something I haven’t had in years, as well: some unexpectedly sweet pain relief. That’s something that may not have happened if not for HelloMD, and I’ll be forever grateful.