When Doreen Keefe of Barre City tells people that she has a rare neurological disorder called trigeminal neuralgia, most people say they've never heard of it — until she mentions its nickname: the Suicide Disease. The chronic condition causes such intense and unrelenting pain in the face, jaw and head that many patients choose to end their lives rather than suffer through it.
"It feels like you have eight abscesses and an ice pick jabbing at your eardrum at the same time," said Keefe, 63. "And it's a 24-hour situation."
Keefe's condition was in remission for 12 years until December, when an avalanche of stressful events last year — including a life-threatening medical emergency and the deaths of her husband, brother and good friend — triggered a return of her symptoms.
But when the prescription drugs her doctor prescribed did little to ease her pain, Keefe found better relief using cannabis oil as a topical cream. Then her sister visited Forbins Reserve, an adult-use dispensary in Barre, to find out which cannabis strains and methods of delivery — smoking, vaping, edibles or creams — might work best on her sister's symptoms, without getting her high.
Since most dispensary employees, aka budtenders, aren't medical professionals, the one at Forbins Reserve suggested that Keefe call Vermont's Cannabis Nurse Hotline. The public information line allows anyone — patients, caregivers, cannabusiness employees and curious consumers — to schedule a free, 15-minute medical consultation with a registered nurse who can address their weed-related questions and concerns.
Vermont's cannabis industry doesn't use the term "recreational" to describe the adult-use market, in part because many consumers use cannabis for symptom relief as well as physical and mental wellness. But given the dearth of reliable, unbiased and evidence-based medical information available about cannabis, many consumers and health care providers are turning to the Cannabis Nurse Hotline for answers. They include a growing number of patients from Vermont's medical cannabis program, many of whom have switched from shopping at medical dispensaries to adult-use dispensaries instead.
"The Cannabis Nurse Hotline is a great resource for us when the question exceeds our certification and our knowledge base," said Brandon Marshall, owner and manager of Forbins Reserve, one of 16 adult-use dispensaries that voluntarily pay $599 a year to support the hotline. "I love it because I just want to get that customer what they're looking for."
The Cannabis Nurse Hotline was created by Jessilyn Dolan, 44, a registered nurse from Richmond who has decades of experience with cannabis and other plant medicines. Until recently, Dolan served as director of the American Cannabis Nurses Association. A certified ganjier, or cannabis sommelier, as well as a state-licensed cultivator, she's now president of the Vermont chapter of the American Nurses Association. She recently helped the national organization write the standards for a certified cannabis nursing specialty similar to those for oncology and pediatrics.
Dolan, who also teaches an eight-hour, state-mandated course for dispensary workers, launched the hotline on October 1, 2022, the same day that Vermont's adult-use market opened. Every Friday from 9 a.m. until 3 p.m., Dolan or one of her backup nurses will field queries on a range of topics, from the safety of consuming cannabis while pregnant or breastfeeding to which strains and delivery methods work best to relieve pain, inflammation, depression, anxiety or insomnia. Faced with some of those health challenges herself, Dolan found that cannabis helped.
"The No. 1 caller I'm getting right now is a senior citizen ... who is seeking symptom relief," Dolan said. She estimated that 75 percent of her callers don't want the psychoactive effects of THC but are curious about cannabis because other health remedies they've tried, such as pharmaceuticals and alternative therapies, either weren't effective or had unwanted side effects.
Because most doctors, nurses and other health care providers have no training in the medicinal properties of cannabis, Dolan said, many are reluctant to advise their patients — and may not even know where to point them for answers. Last year, when Dolan gave a presentation on the health effects of cannabis at Wake Robin, a retirement community in Shelburne, more than 40 people attended.
"The fastest-growing demographic of people who are using cannabis for the first time are people 50 years old or older. And yet, there's no good source of reliable information" about symptom relief, said James Pepper, who chairs the Vermont Cannabis Control Board. "So the Cannabis Nurse Hotline is stepping in to fill that gap ... [Dolan's] education on this subject is so deep."
Dolan begins each consultation with a standard disclaimer: As a registered nurse, she complies with the federal privacy law known as the Health Insurance Portability and Accountability Act, or HIPAA, which means that all calls are confidential and anonymous. Aside from gathering basic details about the nature of the query and what meds, if any, the person takes, Dolan doesn't gather or share personal identifying information.
Dolan also tells callers that the advice she provides is the same as what she'd tell a family member or close friend. That said, she always advises callers to defer to the recommendations of their own health care professionals and inform them of any changes they make to their medications.
A common concern among callers is how cannabis can interact with specific prescription drugs, especially for patients who take multiple pills for complex medical conditions. Dolan recently spoke to a man about a chronic gastrointestinal ailment that affects how his body absorbs nutrients. Edibles don't work on this patient, Dolan explained, and smoking doesn't adequately relieve his chronic pain. So she recommended that he try either a nanotech product, which the body absorbs through the stomach rather than the intestine, or a sublingual product, which gets absorbed through the mouth.
"Understandably, a budtender should not be making a definitive recommendation to this patient," Dolan said.
Still, budtenders should be familiar with certain medical conditions, she added. One caller reached out last year with concerns about cannabinoid hyperemesis syndrome, a rare condition that afflicts chronic, heavy cannabis users and causes severe bouts of vomiting. The 22-year-old, who uses distillates daily, visited five different dispensaries seeking answers.
"Each dispensary looked at him like he had three heads and said, 'What are you talking about? People don't vomit from cannabis,'" Dolan recalled.
The individual visited a sixth dispensary, where the budtender explained what the condition was, then recommended he call the hotline. Dolan said the caller felt much better getting his information from a medical professional.
Dolan explained to him what the syndrome is and how rare it is and suggested avoiding high-potency distillates, which are just THC and don't contain the other cannabinoids in the plant. In fact, she generally recommends the "full-plant medicine" rather than THC-only products, especially for symptom relief.
Dolan estimated that about half the hotline users are or were enrolled in Vermont's medical cannabis program. She's heard that many have opted not to renew their state registry cards even though it means they lose access to the high-potency strains available only at medical dispensaries and must pay the 14 percent state cannabis tax and 6 percent sales tax levied on retail customers. Products for medical patients are tax-free.
Such anecdotal evidence is consistent with statewide data. According to the Cannabis Control Board, enrollment in the medical program has plummeted from a high of 5,600 patients in 2018 to 2,896 this month. Based on the most recent annual survey of medical patients, Pepper said, the decline in enrollment is driven by several factors, including the convenience and proximity of shopping at adult-use outlets versus medical dispensaries, the wider range of products available in retail stores, and the fact that patients want to avoid the expense and hassle of reenrollment in the state program.
As a consequence, adult-use dispensaries are increasingly serving medical patients — and some retailers are addressing that demand by bringing the cannabis nurse right into their own stores. Pepper expects lawmakers to revamp the medical cannabis program this legislative session. One change he recommended is merging the medical and adult-use markets, as other states have done.
Down to the Roots, an adult-use dispensary in Chester that opened in September, is a financial supporter of the Cannabis Nurse Hotline. It's also the first dispensary that's paying to bring Dolan in for monthly, in-person visits with customers. The store's owners even built a consultation room where the cannabis nurse can meet people in private.
"The vast majority of our customers, at some point, are using cannabis for health and wellness," said Andi Goldman, CEO and co-owner of Down to the Roots. "It's not about [Dolan] making product recommendations or anything like that. It's about educating the public and answering health questions that only a health professional with knowledge of the plant can answer with conviction."
Though Dolan is paid for staffing the hotline, her wage isn't on par with what a registered nurse typically earns in Vermont. Currently, the hotline receives no state funding and is supported entirely by the adult-use market. Dolan will offer callers an hourlong consultation — on a sliding scale from $75 to $125 — but often provides the service for free to cancer patients and others who are terminally ill or live with severe chronic conditions.
That was the case for Keefe, the Barre City woman who called the hotline last month. Though the phone call lasted about half an hour, Dolan didn't charge for the extra time.
"Right now I don't have any pain at all," added Keefe, who's gone off all her prescription meds since switching to cannabis. "I really feel that Jessilyn was just wonderful and very, very helpful."