Name: Joseph Friedman
Position: Founding Member Principal & Chief Operations Officer at PDI Medical
Interview Summary
Matt: Welcome everyone. Matt Paterini here with The Nontraditional Pharmacist, part of The Pharmacy Podcast Network, joined today actually by a fellow Pharmacy Podcast cohost, Dr. Joseph Friedman, cohost of The Medical Podcast show all, about medicinal cannabis where you’ll learn all kinds of stuff about that today. We actually have so much in common with Joseph Friedman here, not the cannabis part, I didn’t want that to come out wrong, more on the nontraditional pharmacy side of things, more on the pharmacy podcasting side of things. Actually, Joseph shares a connection with a fellow Nontraditional Pharmacist in that he has a degree from Lake Forest College. Lynn Switaj graduated with her bachelor’s from Lake Forest College, so lot in common with Joseph and we’re really excited to have you on the show today. He is the Founding Member Principal & Chief Operations Officer of Professional Dispensaries of Illinois (PDI) Medical, and this is really a topic we could have a whole series, on a full webinar on, but we’ll keep it at a high level today. Talk about the business side of things. Talk about the clinical side of things and all the controversy that goes on with it. So welcome Joseph, we appreciate you taking the time to be with us.
Joseph: Thank you Matt. I’m thrilled to be on board here and hopefully we’re going to have a pretty productive conversation and get some good information to people out there.
Matt: Absolutely looking forward to it. Excited to have you on and let’s get right to the questions. We really like to start with getting a background, getting an overview of you as a pharmacist and of where you started in the field of pharmacy, where you’ve been, and kind of how you got to where you are today.
Joseph: Well I graduated from University of Illinois College of Pharmacy several years ago. And so for the most part my career was at the beginning, working in retail, working in hospital, I was director pharmacy at one point. And then I decided to get an advanced degree in business and that opened up some doors in the corporate world and I really found a lot of job satisfaction being in the corporate world; but that job satisfaction kind of faded over time as I got subjected to some very evil bosses and some issues and then also of course getting older, and having your job blow up, you know there’s not a whole lot of opportunity out there for older pharmacists, even back in retail. The whole idea of medical cannabis was something that, “oh this could be interesting, it’s coming to Illinois.” Let’s go ahead and while I’m working part time (and that’s what I could find at the time), was a part time job in a compounding pharmacy. Let’s just see if I can get a license and then change the path of my career.
Matt: Interesting so it’s kind of from corporate to medical cannabis. You know we say ‘medical cannabis’, what exactly does that include? Because I think sometimes it has kind of maybe a negative connotation even and people don’t really understand exactly what is under the umbrella of medical cannabis. Can you expand on that a little bit?
Joseph: Well any time we hear the attorney general, Jeff Sessions, or any opponent to cannabis speak out, they talk about marijuana. And so you know the whole idea of marijuana is certainly slang. I think it was back there in the 30’s and was vilified. So I like to use the term cannabis because cannabis is more scientific, it’s more 20th century. And so your question about what is medical cannabis, well you know what it is, it’s not that stuff that comes in a baggie. It’s got a food label on it, it’s got consistency, we know exactly what the cannabinoid profile is, e know if it’s a sativa/indica hybrid and we can actually get consistency if we find something that works for a patient with a particular product, we can get that product over and over again.
Matt: Okay, so that’s what we’d like to talk about. You know, people kind of view it in one light and maybe it’s not exactly what they think it is. I’m sure it’s subject to all kinds of regulations and criteria that it must meet to be a certain pharmaceutical grade, etc. So what sort of regulations is it subject to? And you know, what’s that process like?
Joseph: Well you know, regulations are going to vary state by state. And the issue there is there’s no one state that calls all the shots and because we have we have a federal government that is adamantly against it at this point, it’s kind of a hodgepodge. So I can speak to what we’re doing in Illinois. Illinois is probably, and it was rated by Americans for Safe Access to have the number one cannabis program in the country. Now, I don’t believe we do because we only have 30,000 patients after two years, so there’s something wrong with this program. Pennsylvania is just getting started and they already have 12,000 or 14,000 patients on day one. So what’s wrong with this picture? We do have products that are high quality, no insect legs, no pesticides, no heavy metals, and so our products are very good and that in itself speaks volumes for a good program.
Matt: What about the states that are adopting medical cannabis, you mentioned Pennsylvania being a little late to the game or quick adopters. What’s the landscape look like since you’ve gotten involved in this area pharmacy?
Joseph: Well you know, we’ve seen more states go adult use/recreational and then we’ve seen our attorney general come out and rescind the Cole Memorandum which provided protections for those businesses. So what’s really happened is, there’s probably a little bit of fear now for the eight states that have adult use laws in place. The Farr-Blumenauer Amendment is still active and it was extended through March, and this is an amendment that protects the medical side of this business not the recreational side.
Matt: So adopting, evolving, ever changing, what’s the clinical role of medical cannabis in pharmacy? What settings is it typically seen in and how are people using this today?
Joseph: Well that’s a great question. The dispensary that I own and operate and run in Buffalo Grove Illinois is unique. It’s the only medical cannabis dispensary that has health care providers working in them. I’m a pharmacist, I’ve got two other pharmacists that are on board, I’ve got a nurse that comes in there on Mondays. So what would a patient expect to walk into? Well, you’re going to walk into something different if you walk into a dispensary in Michigan or Colorado or California, it’s going to be very different. Even in Illinois. But if you walk into my dispensary you’re going to see something that very much looks like a doctor’s office, where patients come in, they fill out an intake form, very similar to what they would fill out for the first time going into a doctor’s office, demographics, family history, exercise, most importantly medications that they are on. We want to take a hard look at the medications, oftentimes patients have side effects and think that’s just the way they feel, but it’s really drug interactions that they’ve been experiencing for years, taking two drugs that caused these interactions together. So we want to also check for drug interactions with cannabis. There are some serious ones, but for the most part, cannabis is not totally benign. I mean there are some dangers, we want to keep it out of the hands of kids with developing brains, it’s not a good thing. So I’m not sure, that’s sort of a long answer to your question Matt.
Matt: Yeah it is. It’s a good answer. It actually sounds more like a clinic you know, PDI Professional Dispensaries of Illinois Medical. Have you considered the term ‘clinic’ to be associated with your practice?
Joseph: Well yeah. I mean people walk in, we’ve got a waiting room. We actually do something that no other dispensary does, we do fingerprinting and passport photos, which is required for patients to submit their applications. So I have full time staff that does that. And then once they come in, we’ve got consultation rooms. We sit down, I’ve sat down for up to two hours with these patients. A lot of people come in and they’re just very nervous. They remember Woodstock, they remember the 60s or the 70s, they remember Reefer Madness. This is not what they want, they don’t want to get high. And so, what we have to do is give them good information that sets their mind at ease, go through cannabis 101, the dosing algorithms, let them know that we’re pharmacists, we’re there to help them and care for them and walk them through the process. And I think that’s what differentiates our dispensary from so many more.
Matt: Yeah it sounds like setting expectations and some education. Do you think that’s kind of the differentiator that sets you apart from other dispensaries? What’s the most challenging aspect that you run into with patients that come into to your practice?
Joseph: Well the challenging aspect is that people have to get fingerprinted. And the application process is expensive. One of the other challenges is that a lot of patients doctors aren’t behind them, they don’t want to stick their neck out, they don’t want to do the certification (which is needed in Illinois). So you know, a lot of these patients are high and dry as far I need this. But then one of the other challenges is it can take up to 120 days now, once you submit the application to get your medical cannabis card. So if you’re in pain, that’s a hell of a long period of time to wait.
Matt: Yeah what’s the general consensus in the pharmacy community? Is it being widely accepted, the practice with medical cannabis? Are you finding roadblocks or are people viewing it negatively or what’s the general thought there?
Joseph: Great question. I started giving presentations to pharmacy groups and associations about four and a half five years ago, and I always start off my presentations with an informal survey question, you know you’re all pharmacists in the audience, can I have a show of hands for those that believe we should have pharmacist involvement in this industry? And then I go on to say by the end of the presentation I hope I could change some minds. But four and a half years ago, half the hands would go up. More recently I gave a presentation, and it was one of the first presentations at a national pharmacy convention, (NCPA) National Community Pharmacists Association in Orlando. Two hundred hands went up. So there’s a groundswell of interest and at the end, there’s never enough time for Q and A. One of the first questions I got when we started the Q and A is, “you know what, I’d really like to get into this industry, but I don’t want to be taken away in handcuffs. What can you tell me about this, am I going to be safe?” And that’s an important concern because they have their pharmacy license, they don’t want to lose that to jump into something that can be very lucrative, but at the same time very dangerous.
Matt: Right. What are other career opportunities out there for pharmacists in the medical cannabis world?
Joseph: This is it. Yeah this is it. Well, consulting. I have a consulting organization called CannaRPh. And so that’s available. We have a website. But you know what, you’re not going to be a pharmacist in consulting in this industry with any credibility if you don’t have practical experience in a dispensary. So the opportunities for pharmacists in this business are probably to be on the dispensing side of the dispensary.
Matt: And what advice would you give to those pharmacists looking to get involved in that area of pharmacy? What would be some initial first steps, maybe some places to learn more. What would you recommend to them?
Joseph: Well what I do right now, because I have relationships with three colleges of pharmacy, and I have pharmacy students that come and do clinical rotations. I send them out an e-mail, and the e-mail is comprehensive, it goes through everything that they need to prepare to come in and hit the ground running on their first day. So a lot of links, a lot of good information. So I’m forgetting your question, what was it again, Matt?
Matt: That the question was, what advice would you give to people that are interested in medical cannabis, not really sure how to get started, maybe want to learn a little bit more about what it is all about, and then maybe take a couple initial steps to get on that path. What would you what would you suggest they do?
Joseph: Well if your state is currently considering it, but maybe there’s some legislation that has been introduced, definitely get involved. I wouldn’t get involved with the the Board of Pharmacy. I’d probably go to the Pharmacists Association in your state and just say, “hey look, medical cannabis is coming, I’m a pharmacist, I think we should have a mandate for pharmacists being in dispensaries.” That’s happened in Pennsylvania, New York, Connecticut, Minnesota, Arkansas. And there’s one other that I can’t think of right now.
Matt: Let’s talk a little bit about PDI Medical as a business, as a clinic. It sounds like a really unique, interesting practice setting. Walk us through how it all became a business and how the PDI Medical story started.
Joseph: Well it started when I was watching 60 Minutes and I just saw the green rush in Colorado, and I thought that it would be cool, I knew it was coming to Illinois. And so what I did, is I started reaching out to people and saying, “hey what do you think? Want to get into this industry?” I always had a plan B because Plan A’s oftentimes do not work out. Plan A was a couple of guys, the one was a pharmacist, one that owned a pharmacy. Good guys but then they got a little freaked out because of the tax consequences 280E, which we can talk about at this time. They just decided that this was never going to make money and was going to be a disaster. So, all the while I had my Plan B group queued up and within a week I had a new group with another pharmacist, two lawyers, and a boatload of money to be able to put together an application, actually three applications, and then open up a dispensary if we were successful.
Matt: What’s your role in PDI Medical. Are you the sole owner, are you working with other partners, and how does that dynamic play with the rest of your team?
Joseph: Well the rest of the team again, another pharmacist and two lawyers, the other pharmacists unfortunately (we have one partner) and you know Matt I want the audience to hear that worst ship that you could sometimes get on is a partnership. So I’ve got one partner who’s just been toxic from the get go, and the other pharmacist just got tired of that. So he’s been trying to sell. He’s he’s ready to get out. He doesn’t want to have anything to do with it. So the the one toxic partner, the lawyer, unfortunately is still involved. But they’re not involved at all as far as daily operations. The other lawyer, good guy he does all the back end, the P&L, all, the reports the legal matters, things like that. I’m there every day, I’m operations, I’m running it, I’m hiring people, I’ve got a great staff that has been with me almost since day 1 almost two years ago. So I know I’ve hired the right people and the business of medical cannabis wasn’t an easy road. There were a lot of hurdles.
Matt: Are you hiring currently?
Joseph: We are currently fully staffed, but at the same time I am always keeping my eyes open. You know the business in Illinois is one click above life support. I think I mentioned we have a governor that’s not very supportive of it. We have 30,000 patients after two years, I think we’re one governor away from having a good program. I think I might have said that already. But if I didn’t, I’m saying it with explanation points, we need to have a governor who supports the program rather than trying to kill it. And so I think that the future is to expand the program with additional conditions. We don’t even have chronic pain in Illinois as a condition. So that’s the number one reason why people use cannabis around the world.
Matt: Yeah. I mean pain management is huge. It sounds like there’s some challenges regulatory wise and governmental wise. Where is PDI Medical currently, where would you like it to be in the next 5 to 10 years, and what do you need to do to get there?
Joseph: I think the dispensary is going to do very well and survive. I’d like to take the pharmacy model and expanded into other states, Michigan, Florida, Indiana. Indiana right now has submitted legislation and I can envision having a Professional Dispensaries of Indiana, perhaps maybe two or three years from now so. So as far as where I want to be in five years, I’m doing a lot of other things having to do with putting together educational content, doing The Medical Potcast Show, the consulting group (CannaRPh) that I put together with another pharmacist and a lawyer, so you know I’m going to be keeping busy.
Matt: Absolutely. Sounds like you have your hands full, a lot of different projects, a lot of great projects going on, how do you prioritize everything that you’re doing? Obviously, first and foremost is the business at hand, PDI Medical. How do all your other projects that tie into that?
Joseph: First and foremost is the business at hand. And as far as prioritizing, I mean there’s there’s certain aspects of my life that are out of balance right now. I mean, I’ve got to work on my marriage a little bit more. My kids are grown ups so that’s okay. But as far as prioritizing, right now I’ve got a great crew and I’m starting to step away a little bit to work on some of these other initiatives. And I want to be able to, in fact I’m leaving for Pennsylvania on Thursday, there’s a dispensary, the first dispensary to open up in Pennsylvania, that’s one I consulted for, they got a license. I’m going to help them in their first week of being open. They’re going to be inundated and they asked me to come and help them out for five days to see patients and to get them up and running.
Matt: That’s great. Taking your expertise spreading the word helping other people get up and running to a level where they need to be to practice it in an effective way. You mentioned before some of the business challenges with with the medical cannabis world and specifically tax issues. Could you expand on some of the tax consequences or implications around medical cannabis?
Joseph: Sure. The IRS has has a rule it’s called 280E, 280E was basically to catch the bad guys, you know the Al Capone’s of the day because they were avoiding paying any federal taxes on all their illegal businesses. So 280E was penalizing ,those people. So you 70 years later 280 Eis still looming on a business that is a schedule one. And right now we cannot take any regular business expense deductions. The only deduction that we can take is on our cost of goods sold. And so we can’t take phones,,, and insurance and lights and everything else. So we’re going to be paying a lot of federal taxes and it is ridiculous.
Matt: Yeah it sounds like that’s one of the more challenging things you know. Boy it sounds like there’s so many different aspects to this and like I said we could we could go on for a whole series, and The Medical Potcast Show does exactly that, I’m sure it does a fantastic job. You know it’s so important to balance professional life with personal life and you kind of touched on it a little bit how running your own business has affected you personally. How does medical cannabis, your personal business, affect your personal life?
Joseph: Well I think I mentioned that. I mean I definitely have an imbalance and I’ve got to get that balance back. I think I’m starting to finally do that. I think once I work out these these partnership issues and I can actually bring on a partner who’s involved to help me out rather than what I’ve got now will make a big difference.
Matt: Yes it’s always a work in progress. I think everyone can certainly relate to that. We like to ask all of our guests in the nontraditional world, because you have an interesting perspective. What is your take on the pharmacy field in general? Where do you see it heading in the future? Where do you see it today?
Joseph: Well unfortunately, and I’ve had these discussions with pharmacists that want to come work for me. It’s become kind of a factory job. I mean a lot of the big box retailers,, it’s numbers it’s filling prescriptions and I think we know there’s a lot of issues with that. You know I think pharmacy today is a little bit more challenging, although there are some pharmacy positions. When I was in compounding pharmacy I thought that was one of the better retail positions to be in. Certainly one of my partners in the consulting group was an E.R. pharmacist, I thought that was very interesting, he was happy with that. But his passion was in medical cannabis so he wasn’t happy. I think pharmacy has some challenges. Just you know about a year ago in the Chicago Tribune an article came out. I opened up the paper and it was the front page and it was just how pharmacists were making mistakes filling prescriptions. So there was a couple of professors from the University of Washington. The name is escaping me right now, John Horn and I believe another PharmD, and they came up with four or five different combinations of two drugs, that when taken together, pose a great danger to the patient. And what they did is they gave these prescriptions to several reporters who walked into Walgreens, CVS, Osco, independent pharmacies, etc. and 52% of the time those prescriptions were filled. The worst performers were the independent pharmacists, missing that drug interaction 70% of the time. Walgreens did the best, only missing it a third of the time. We have a challenge.
Matt: Isn’t that unbelievable? The field is certainly in an era of change and constant evolution. And it’s really going to be interesting to see how everything shakes out and how everything changes over the next several years. But we certainly appreciate all the help and everything that you’re contributing to the field of pharmacy Joseph, and thanks for tuning into this episode of The Nontraditional Pharmacist. Be sure to tune into The Medical Potcast Show with Dr. Joseph Friedman. Please leave a comment below this post and connect with Dr. Friedman on The Pharmacy Network. Thanks again. And we will talk with everyone next time. Thanks, Joseph.
Joseph: Thank you, Matt.