Rebecca Abraham, President & Founder of Acute on Chronic – Interview Series

Rebecca Abraham is the founder and President of Acute on Chronic. At Acute on Chronic, they believe in educated guidance to cannabis, alternative therapies, supplemental treatments, and support navigating a complex health system.

Rebecca is a registered nurse with 15 years of experience in emergency medicine, critical care, heart failure, surgical services, and case management. She is currently working on a Doctorate of Nursing Practice at Northern Illinois University, her research is focused on Cannabis science, nursing, and the integration of cannabis into traditional healthcare systems.

What initially attracted you to the legalized cannabis industry?

I have been interested in cannabis since nursing school. Cannabis was just starting to be used more mainstream both for recreation and medicinally in some states. I thought prohibition was ridiculous and read enough early research and history to know that cannabis had a good safety profile, and was made illegal for the financial gain of many politicians and lobbyists. The stigma was fueled by racist, classist, and ableist rhetoric. In the last few years, I noticed a growing gap between the cannabis industry and the healthcare industry. As I read research and had patients disclose to me in confidence that cannabis worked, I was interested in and thought that cannabis could be a game-changer in medicine and nursing care. I also saw the cannabis industry using more pseudoscience, making false claims, and grossly misinforming the public. I knew if the industry continued down that path cannabis would continue to not be taken seriously by physicians and nurses and the medical community, and risk what legalization and protections we had fought hard to build over the last 4 decades. It was also intimidating and confusing for consumers.

This is what drew me to the American Cannabis Nurse Association (ACNA). I found their courses and completed the certificate. Upon completion, I told my husband and best friend (both internal medicine physicians) about this and what I wanted to do with it (close the gap between cannabis and healthcare and help patients and the community utilize cannabis safely and effectively with knowledge.) That's when my husband said, “This is perfect for you, this is a business. You love cannabis, you love advocacy, you are a strong nurse that doctors trust and you have amazing assessment skills, you need to open this.  Doctors will refer you.” Many physicians get asked about cannabis all the time and have told me their sentiments like, “I want to support my patients but I don't want to discuss something that I haven't been educated on, is time-consuming, and that my employer hasn't enthusiastically endorsed nor provides support with.”

A cannabis nurse provides the perfect solution. Patients get help from a trusted entity, something that may work and keep them out of the hospital, and this is a win for doctors because the patient feels listened to and supported. It is also a win for hospitals because when patients use cannabis through a doctor listening to safe holistic outpatient options to decrease symptoms that are difficult to treat via traditional methods such as chronic pain, anxiety, neuropathy, etc. improves patient satisfaction and can likely contribute to decreased hospital admissions and readmissions for things such as chronic pain. My physician friend joined the business after reviewing studies with me and seeing patients that my company cared for in the hospital and seeing positive results.

You're a Certified Cannabis Nurse, could you describe what this is specifically and what rights it grants you?

The American Cannabis Nurse Association has educational programs for a certificate. Before doing this work, I spent years reading research, books, and media about cannabis. I read any study I could get my hands on in medical journals and would attend talks and conferences. The ACNA is working on developing a test and recognition from larger nursing organizations, but this process can take a while. For example, Hospice and Palliative nursing specialty existed for decades before being recognized as a specialty.

You've previously lobbied for policy and legislative changes for cannabis, could you share some detail regarding these efforts?

Prior to legalization in Illinois, I joined a bipartisan non-profit lobbying group for women and families. We would have lunch with kids and babies while telling elected officials our needs. An overwhelming number of women across the state supported legal cannabis. We lobbied for recreational cannabis for years before its passing with other groups and supported candidates based on their specific positive stands. One of the more interesting things that happened to me when advocating for cannabis was at a lunch in 2017 with a gubernatorial candidate, who said he didn't think cannabis was helpful and didn't want to legalize cannabis in Illinois. While holding my baby in my hands, I stood up and said he was uneducated about cannabis and wrong, and he needs to read up on the science. This candidate had such a poor interaction with us that it made it into local political news for being disrespectful to an engaged group of moms and women, but also for being wrong about cannabis, public education, and systemic racism.

I also worked with National Nurses United in lobbying and testifying for Safe Nurse to Patient ratios, we passed the labor committee making history as only the second state to do so, but the law still has not passed in Illinois or any state outside of California.

Currently, I also am working on organizing various stakeholders to see how we can build coalitions and push for federal legalized cannabis and better protection and support systems. For example, Illinois now has a bill that prohibits employers from firing or disciplining employees for a positive THC test. This is vital legislation that starts making cannabis TRULY legal for all, not just folks who have mostly office jobs that do not have to test. We also need an all-hands-on-deck approach throughout the cannabis industry to get cannabis descheduled and federally legalized. The industry needs to pull together and focus on this. We need full legalization, dedicated research, and we need to right all the wrongs that happened during the “War on Drugs” like expunging records and clearing people's jail sentences.

You have a background in ICU nursing, how has this helped you as a certified cannabis nurse and as a cannabis entrepreneur? 

Having a critical care nursing background helps a ton as an entrepreneur. Labor conditions in hospitals are brutal (and need to change), we don't go to the bathroom for hours, we skip meals, and we are used to making decisions in high stakes and a high-stress environment. Being an entrepreneur is also stressful and demanding, but the stakes aren't life and death, and while entrepreneur life is filled with ups and downs, I can now handle the long hours and high-stress days better than someone without this training. If I have a bad day or a rare unhappy client, I know that while still unpleasant, no one dies or can become permanently injured. With cannabis nursing, my ICU background is a huge benefit. In the ICU, nurses decide what doses of life support the patient should get by continuously assessing and reassessing the patient. No two patients are the same, even when they have the same problem on the same life support, and this is true with cannabis. Cannabis nurses educated and help patients learn how to titrate, but cannabis nursing requires good assessment skills, a strong understanding of pathophysiology, experience with pain and other symptoms, and empathy.

The nursing process also works well with cannabis care. The nursing process and nursing care plan are used in training nursing students and solving problems and symptoms unique to nursing care. This process also seems to work well in helping cannabis patients with cannabis care, more than if a cannabis user does not use the nursing process.

Could you share the genesis story of your company Acute on Chronic?

I have always been interested in cannabis since nursing school. For years, I supported patients prior to legalization giving them advice on how to find safe cannabis in legal states. As cliche as it sounds, I became a nurse to help people, but I am more fulfilled helping people in a way that provides a deeper impact. That's what is great about this work, I help the individual, but I am also helping cannabis be taken more seriously and our work encourages larger studies. I had done work in advocacy, policy, and critical care and wanted to do public health advocacy. I found the certificate via the ACNA, and it was my husband and best friend (both physicians) that encouraged me to start this business because they said they wanted to provide resources for patients interested in cannabis but had no trusted resources. Being a nurse and a former ICU nurse, physicians, nurses, and healthcare workers know that I am going to collaborate and provide high-level safety interventions, education, and guidance.

How do you help someone determine if cannabis is the health solution for them? 

While cannabis can help with dozens of symptoms and disease processes, there are some things it worsens, and it can interact with many medications. We have screening tools to see if someone is appropriate or not and we do a complete assessment.  We also check drug interactions and collaborate with the client's doctor as needed and if the patient allows.

Many of our patients come to us through their doctor who recommends cannabis. Many people come to us if they are afraid to speak to their doctor, but cannabis is a safe supplement so, excluding medications or a past medical history that is contraindicated, cannabis is a pretty safe supplement to try for many symptoms and disease processes. We do need more research.

Why is cannabis a great alternative solution for chronic pain? 

It's a great anti-inflammatory similar to the effects of NSAIDS (Like Motrin, Naproxen) NSAIDS prevent pain by decreasing inflammation. What's a little better about cannabis as opposed to an over-the-counter supplement for pain is at this point it has a good safety profile with few side effects. Cannabis also likely alters pain sensory and how our brain interprets pain signaling. Cannabis can also work synergistically with opioids and other medications, allowing patients on opioids to use less (and decrease side effects). Cannabis also alters our brain chemistry and decreases stress response and helps regulate cortisol.

Absorption of cannabis differs on how it is consumed; how would you recommend that someone who is experiencing chronic pain consumes their cannabis? 

It depends on the person, their pain, and what is going on. Some products I like that many folks don't know exist are patches, lotions, fast-acting dissolvable tablets, and vaginal suppositories and lubricant. I also love beverages that are great for patients who can't swallow but still want edibles or want to consume slower edibles. For very chronically or acutely ill folks, the beverages are easy to place through a g-tube or an NG tube (gastric and naso-grastic tube).

Creams are best for a new and tentative user, they work well, are not absorbed in the bloodstream and cannot be overused. They also cause no mind-altering effects.

Is there anything else that you would like to share about Acute on Chronic? 

Cannabis nurses are a resource that the industry can use to help educate the public and help folks have a good cannabis experience. We are also a vital resource for the medical nursing, healthcare, and wellness community. With so many hospitals not allowing providers to discuss medical cannabis, patients have few trusted sources. We strive to be the expert trusted sources of academic institutions. We are providing grand rounds for physicians, educational training for residents and fellows, doing lunch and learns all over the country, and we are one of the few companies in cannabis being recommended by physicians and nurses are many of the top academic medical centers in the country. We are also writing case studies on our client's success and positive outcomes with cannabis and nursing guidance. This hopefully helps encourage other researchers and healthcare workers to move forward with more research, and those in control of funding to provide grants for this work.

In the future, we are also hoping to build more public/private partnerships to help improve healthcare for everyone that includes alternative care based on scientific research and advocacy.

Thank you for the great interview and for all of the work that you have done to help move this industry forward, readers who wish to learn more should visit Acute on Chronic.