The American medical system is nuts!

Doctors hand out opioids like candy, leading to hundreds of thousands of people getting hooked on pills with a significant percentage of them gravitating to heroin while those same doctors laugh at medical marijuana.

This is a story about my personal experiences in the medical system over the past several months. In dealing with a non-cancerous tumor, I’ve explored opioids, medical marijuana, and the legal weed marketplaces.

This is also a marketing case study, including interviews with some of the players in the Wild West world of the cannabis business in the United States.

When an entire industry is brand new it presents the organizations that want to play in that marketplace with a unique marketing challenge. Marketing in a new industry becomes even more complex when the industry is highly regulated like weed.

The non-cancerous tumor that led to my marijuana and opioid research

Last week I had an operation to remove a non-cancerous tumor from my left ankle. It was quite large — about 2.5 inches long and 3/4 of an inch in diameter. The operation took more than two hours with two surgeons working on me because the tumor was embedded in my tarsal tunnel — the place where blood vessels and nerves go from leg to foot — making it a complex extraction. The operation went well and I’m comfortable and recovering.

I now sport a five-inch long incision on my inner ankle. I’m in a kind of splint so that my ankle doesn’t flex. I’ve quickly learned how to use crutches and am able to get around just fine. Soon I’ll be upgrading to an “ankle walker boot” and hopefully within a few months I can get back to all of my normal exercise routines.

I first noticed the tumor by feel about nine months ago and soon after went to my primary care physician who diagnosed that as long as it doesn’t hurt I would be fine. I had no issues at all until October 25, 2016 when I flew to Italy for a speaking engagement and my foot went crazy during the flight. It felt like somebody was pounding hot nails into the sole of my foot.

The next few days and nights were absolutely terrible. I couldn’t sleep. I could barely walk. The flight home was particularly excruciating.

Fortunately I was able to get an appointment with my doctor for the day after I returned. He ordered X-rays and I was put on a nerve medicine that I took at night to help me sleep.

After a few weeks the terrible pain morphed to a somewhat manageable dull roar while at the same time the sole of my foot became numb. I visited various medical professionals including a physical therapist and an acupuncturist to try to figure out a non-surgical solution to my woes.

After a month of alternative therapies, I decided I couldn’t live with the pain and I missed my exercise routines so I saw a podiatrist. He ordered an MRI and quickly diagnosed my problem as being a tumor that was pushing against the nerves leading to my foot. He recommended the surgery and we booked his first available date.

Opioid pain medication scares the crap out of me

Prior to going to the pre-operation appointment with my surgeon, I discussed pain medication with my wife Yukari and my daughter Allison, who is a first year student at Boston University School of Medicine.

After reading about the problems with opioids and addiction in the excellent book Dreamland: The True Tale of America’s Opiate Epidemic, I decided that I wanted to either completely avoid the drugs or just use them for severe pain on the first day or two after my operation.

While I recognize that these opioid-based pain drugs do help some people, there’s no doubt that hundreds of thousands of people in the U.S. have become addicted to narcotic painkillers after being prescribed them.

Companies like Purdue Pharma have aggressively marketed their opioid painkillers to doctors who are frequently too quick to write the scrip. Once patients are hooked, many resort to buying more pills on the black market to feed their addiction and some move on to heroin because it provides the same high but is frequently easier to obtain and usually at a cheaper price.

Thousands of people in my home state of Massachusetts have died from an overdose in recent years. The over-prescription of pain medication is a terrible problem that destroys lives but it is often dismissed as a lack of self-control by patients.

The medical community has begun to recognize the issue. More than half of doctors across America are curtailing opioid prescriptions, and nearly one in ten have stopped prescribing the drugs, according to a new nationwide online survey. That’s the good news.

The bad news is that not all doctors have come to that understanding, a fact I learned firsthand.

At my pre-operation meeting I brought up the subject of painkillers and my surgeon said he was going to prescribe an opioid. I asked about alternatives and he said that it was my choice not to take the pills but he wanted me to have them “just in case.”

Medical Marijuana as an alternative pain medication

As of last month, weed is now legal for recreational use in Massachusetts but it won’t be legal to sell pot here until mid-2018. However, medical marijuana dispensaries have been open for business in Massachusetts for more than a year, so I wanted to explore this option with my doctor.

When my surgeon failed to bring up medical marijuana as an alternative pain medication when I pushed back on opioids, I asked him about it.

He laughed out loud and said, “I was wondering when someone might ask me that!” Ha Ha Ha! This doctor had never discussed medical marijuana with a patient yet he was handing out narcotics like candy!

Since I was the first to ask him about medical marijuana, I high-fived my surgeon. That was a surreal moment for sure. I explained my caution on pain drugs to him.

While my surgeon would not prescribe the weed I wanted, he basically told me to do what I need to do. That’s when I entered the murky world of marijuana marketing.

The marketing of marijuana

I started by going to the Google machine and searching on “medical marijuana Massachusetts”. I first went to the Mass.gov official website and then looked at a few other places. I quickly learned that in order to be certified for the medical marijuana program and be able to visit the dispensaries, you have to have a doctor give you the thumbs up.

Since my surgeon wouldn’t prescribe for me, my next search was for “medical marijuana doctors” which led to a mishmash of listings. I was able to see Google reviews and read the doctors’ websites. There was no site that stood out, a fact that really interested the marketer in me. It seems that some good content marketing would help these weed doctors! (More on this later.)

My research led me Canna Care Docs, which was where I decided to go. Since it is walk-in only (no appointments) I arrived, signed in, paid my $200 in cash, and waited just a moment for my evaluation.

Once the doctor heard about my pain and my other symptoms and saw my MRI printouts, she said I qualified for the medical marijuana program. I was sent to her colleague in the next office to process my paperwork to be sent to the Commonwealth of Massachusetts.

That’s when my visit got hysterical.

I noticed the paperwork guy had a photo of Jerry Garcia on his desk.

“Oh, you’re a Grateful Dead fan?” I asked. We members of “the tribe” are always on the lookout for fellow Deadheads.

He said yes so I told him I co-wrote Marketing Lessons from the Grateful Dead.

He proceeds to freak out a bit that I was sitting right there in his office. “I LOVE THAT BOOK!,” he says.

We proceeded to chat about the Dead concerts we’ve seen. It turns out he was at the Dead & Company shows at Fenway Park this summer. I was too. So was my co-author, HubSpot CEO Brian Halligan. My weed paperwork guy was also at Joe Russo’s Almost Dead at the House of Blues, a show I saw together with Brian. We laughed and chatted about our favorite band for about ten minutes until the doctor came in to tell us to stop having so much fun and that other patients were waiting.

Holy cow. What fun.

The guy who processes the paperwork for my medical marijuana doctor is a Deadhead and a fan of my book. You can’t make this stuff up!

The weed doctor had approved me for medical marijuana and my paperwork was ready. So my next step was to establish my online account with the government authorities. It was a convoluted process but I managed to navigate all the questions and pay my $50 fee. I can expect my official medical marijuana card to arrive next week.

My next consumer research involved where to purchase my (legal) supply.

So I went back to the Google machine and searched “medical marijuana dispensary.” Another crazy mishmash of listings appeared including a few search sites like Weed Maps and Leafly.

I ended up settling on a dispensary called Garden Remedies in a town near my home and I look forward to visiting them when my card arrives.

As I was searching for a dispensary, it was not easy to find what I was looking for. I was especially curious to notice that there were no Google AdWords listings for either medical marijuana doctors or dispensaries. So once again my marketer brain kicked in as I began thinking about how marketing could help these weed businesses.

So I contacted a few friends in the cannabis business to learn more.

The Cannabis Business

“Marijuana from a marketing perspective is fascinating because you can’t market in a traditional way. It’s illegal,” says Larry Schwartz, President of Cannabiz Media, the most comprehensive source for U.S. marijuana licensing information. Cannabiz Media data helps journalists, regulators, researchers, business people, and investors understand and confidently operate in the evolving U.S. marijuana marketplace.

“We quickly figured out we couldn’t use Google, Facebook, or Twitter to market our online database or print directory so we realized we had to go the old fashioned route,” Larry says. “In the marijuana business, believe it or not, print magazines are huge. I think there are about 20 magazines in this space, titles like Cannabis Business Times, Marijuana Business Magazine, and Marijuana Venture. So for us our marketing strategy quickly became trade shows, getting out our own email list, and bartering with these magazines and trade show providers. We’ve got deals with all the big guys now where we trade them our database for free ads and tradeshow booth space. This was the way everyone marketed 15 or 20 years ago!”

When Larry first started to market his business, he tried to run Google AdWords and Facebook Ads but was quickly rejected by both companies. Twitter and Instagram also forbid marijuana advertising.

Google’s representative emailed Larry: “Thank you for calling the Google AdWords Welcome center. I looked into and tried to see if there was a way that I could help you to be able to advertise with AdWords. However I was unsuccessful in my pursuit. Google won’t allow your website to be advertised with AdWords. While your Business model is solid and company is legal it does fall into Dangerous products or services. With that being said, your ads can show organically. The Search Console will assist you Organic ad results.”

With Google, Facebook, Twitter, and Instagram out of the marketing mix, Larry shared some details with me about the marijuana search engines I discovered when I was doing my own research while looking for dispensaries and doctors. “Dispensaries are the ones who need to advertise to consumers,” Larry told me. “And each state has different laws regulating marketing. For instance in Connecticut and Massachusetts if you put a website up, the state has to approve it. It gets complicated and there are a lot of really strange laws. Now people are bypassing Google and the other traditional search engines and they’re using weed search engines like Leafly and Weed Map to find dispensaries, strains, news, all sorts of information. These are big marijuana search engines and that’s where consumers are going.”

Larry’s business is booming. Whenever companies want to enter the Cannabis business in a new state, there is a whole new set of laws to deal with. And those laws are constantly changing such as my state of Massachusetts passing recreational marijuana on Election Day 2016. Larry’s business tracks all of those new and changing laws and regulations.

“This business is currently going to go through a gold-rush mentality,” Larry says. “It’s like the Dot-Com boom starting in 1995. When California legalizes marijuana it will double the size of the entire market. And then we’re going to have a big bust. Then we’ll come back again, just like the Internet business over the past twenty years.”

As new states permit medical marijuana or legalize weed for recreational use, there are more and more people who want to grow the plant as a business. And with that an entire industry has grown to service cannabis entrepreneurs. As a marketer, I am fascinated by the business-to-business marketing strategies these companies must use.

“We are witnessing a dramatic shift within the USA; cannabis no longer must be grown surreptitiously, but can now be grown out in the open and with commercial greenhouse methods,” says Tom Springer, founder and president of NurserySource. Tom’s company has been selling RediRoot root development containers and GroPro root development fabric bags into the cannabis space since 2010. The products help growers profitability by increasing their yield as a result of healthier roots.

“2016 was the first year we marketed directly to cannabis growers,” Tom says. “The changing state laws have certainly encouraged us, but since we manufacture an agricultural product, we have needed a few years of field testing to make sure our products worked as well in developing cannabis roots as they do developing shade tree and conifer roots.”

Tom faced a number of marketing challenges. As Larry’s company Cannabiz Media tracks, each state has its own laws covering the growing of cannabis that Tom needs to keep up on. In the time he has been selling to cannabis growers, Tom has seen the market fragment from a bunch of very small growers of ten plants or fewer to large scale commercial grow facilities operating within local laws. “These two markets are very different and demand very different growing methods,” he says.

“Suppliers who service cannabis growers are quickly learning how to service full scale and open commercial enterprises who are paying hefty tax rates,” Tom says. “This is entirely different than servicing a more clandestine, black market group of growers utilizing cash for all their supplies. Cannabis farming is maturing at a rapid rate and grow equipment suppliers are watching margins shrink and sales channels constrict. The market is hyper dynamic and numerous people will be getting rich over the next few years and a ton of people will go broke. Companies wishing to stay in this market long term must utilize good business principles to survive.”

It’s not often that a market establishes from scratch and grows into a multi-billion dollar industry in a few short years. I have been a part of the Internet business since the beginnings in 1995 and have seen it go from boom to bust to boom again. Facebook now reaches an amazing 1.79 billion monthly active users (more than a quater of the worlds’ population) and the company recently reported annual profits of over a billion dollars.

The weed business is experiencing the same initial boom cycle that produced Pets.com nearly twenty years ago. Soon, there will be a few billion dollar businesses.

I’m glad my journey though the US healthcare system over the past few months led me to the cannabis industry. It will be fascinating to watch this business mature and to witness how companies innovate how they market their products and services. We will learn a great deal by watching what these entrepreneurs do to get the word out about their products and services and I hope to report regularly on what I learn.