As the number of enrolled patients continues to climb, New Mexico’s medical cannabis program officials say they are restructuring to place more emphasis on community outreach and education.

The announcement comes after SFR obtained records indicating that the program's education outreach has mostly been limited to urban areas and select groups. Both patients and doctors have reported hesitancy about discussing the program to the Health Department, which could be alleviated by stronger efforts to educate medical providers about cannabis. In the absence of such outreach, private and for-profit organizations are charging steep prices for cannabis education.

The Health Department says it plans to hire additional staff who will help redesign the state's methods of educating patients about cannabis and is in the process of hiring a second medical director for the program to manage engagement with medical providers and others interested in learning more about how the medicine works.

"We want folks to know in the medical community what the program is, what it can do—and also for those who are aware of the program, if we spot issues with incomplete applications, we can try to help them out on this," program director Kenny Vigil tells SFR. "We hope to be a little more proactive."

Since January 2014, New Mexico's medical cannabis program has given at least 33 presentations for medical providers in the state, according to records obtained by SFR. Those records—which include personal calendars for health department employees, PowerPoint presentation files, field notes drafted by members of the medical cannabis program and receipts for expenses incurred by presenters—show that the vast majority of presentations took place in Santa Fe and Albuquerque.

source: New Mexico Department of Health

Dr. Maureen Small, medical director of the cannabis program, and its patient services manager, Kathryn Riter, presented to practitioner clinics and hospitals, condition-specific support groups for diseases such as ALS and Parkinson’s, and medical conferences. Vigil says that rather than offering education to providers, the state has so far only responded to requests for cannabis teach-ins.

"We will have organizations reach out to us saying they want more information about the program," Vigil tells SFR. "Basically, it's based on invitations for us to go to them."

According to some of the correspondence obtained by SFR, however, sometimes representatives of the medical cannabis program initiate contact with medical providers.

For example, in November of 2015, Small sent an email to the Family Practice Associates of Taos offering "a brief presentation on medical cannabis and an overview of the program."

"We are hearing from many patients that they are afraid to discuss medical cannabis with their doctor and we regularly are confronted with providers having misconceptions about the program," Small wrote at the time. "One of our missions here at the Department of Health is to inform the medical community about the medical legal aspects of the program and the latest scientific research on medical cannabis."

The presentation at Family Practice Associates of Taos eventually took place on March 21, 2016.

Records show that there were comparably fewer presentations in rural parts of the state. None took place at health centers on Native land, where federal funding from Indian Health Services could make medical staff more reluctant to recommend cannabis for patients. The Eight Northern Indian Pueblos Council declined to comment for this story.

Yet, field notes from a presentation to young doctors at Albuquerque's First Nations Community HealthSource in March 2015 note that the audience was "very interested and proactive in nature." Although the doctors weren't necessarily employed by the clinic where the presentation occurred, its chief executive officer, Linda Son-Stone, says providers at HealthSource are currently "not accessing the program."

Medical centers in other rural communities, including Gallup and Silver City, have coordinated presentations with the medical cannabis program through the University of New Mexico's Health Extension Rural Offices program, or HEROs. The program, which has become a model for rural health outreach in other states, is housed in UNM's Office of Community Health and funded with a federal grant.

Dr. Robert Rhyne, a professor and vice chairman for family and community medicine at the school, says the school also has contracts with the Health Department to provide training on cannabis to medical providers, noting that trainers from the school recently fanned out to give certified trainings on best practices for opioid prescription, including guidance on medical cannabis to ease pain and other symptoms.

The HEROs program does most of its own outreach, leaving rural communities relatively untouched by the cannabis program's outreach efforts. One solution, suggests community organizer Jason Barker of the Lynn and Erin Compassionate Use Act (LECUA) Patients Coalition of New Mexico, would be that producers begin to take on more educational responsibilities.

"It'd be nice to see some of the producers take on some of that aspect," he says. "They mention in licensure requirements that they [should] put forth some educational duties for patients and programs."

But he cautions that dispensary employees are often undereducated about cannabis' medical properties, pointing to a 2016 peer reviewed study by Cannabis and Cannabinoid Research that found only 20 percent of dispensary staff in the states it surveyed had received medical or scientific training.

And in the absence of free and plentiful resources for learning about cannabis, business people with little medical backing can charge hundreds of dollars for one-time "symposiums" offering a quick hit of cannabis education.

The lines are sometimes not so clear. Dr. Steven Rosenberg served as medical director of the state's medical cannabis program from 2013 until earlier this year and runs a business in Albuquerque that charges new and renewing cannabis patients for medical consultations starting at $50.

"You need to treat cannabis patients like any other medicine, and if you're going to recommend a course of therapy, even if you're not writing a prescription, you still have to know something about the substance you're recommending," Rosenberg tells SFR.

Fortunately for Rosenberg, his former tenure with the state has given his for-profit venture a higher profile.

"One of the consults I did was because [the patient] didn't get any instruction from the person who certified them, and that was what they were told to do," Rosenberg says. "Come see me."