There was no lump, just a dimple. But when she felt her breast, she thought it was cancer.

Christina Visco, 49, CEO of TerraVida Holistic Centers, one of Pennsylvania’s largest medical marijuana dispensaries, has long been an advocate of, and saleswoman for, treating multiple conditions with cannabis.

Now, her business and her health are intersecting, as she began chemotherapy for HER2 negative breast cancer in 2020.

Visco also ingests 1,000 milligrams daily of RSO, also known as Rick Simpson Oil, considered an extremely high dose of medical marijuana. So far, her tumors have shrunk along with the chemotherapy she has received at the direction of Penn Medicine oncologists.

Doctors say her improvement has everything to do with traditional care. But many also believe that medical marijuana can play a supportive role by lessening nausea, pain, loss of appetite, and anxiety of cancer treatment, enabling patients to stay in care longer.

“Does Chris Visco know whether her tumors shrank due to the chemo or the cannabis? She doesn’t,” said psychiatrist Lynn Bornfriend, most recently with Cancer Treatment Centers of America in Philadelphia. “But the patient’s quality of life improves dramatically. And that can further treatment along.”

Marijuana can also be costly and isn’t covered by insurance, putting it out of reach for many patients.

Visco says that so far she is coping relatively well as she manages her thriving business.

“I am forgetful and fatigued by the end of the day, but my days are more full than most,” she said recently after welcoming her new chief operating officer to her corporate headquarters in Jenkintown.

Since legalizing the drug for medical purposes in 2016, Pennsylvania now allows it for 23 conditions, from cancer to epilepsy. More than 500,000 patients and caregivers are registered under the system, according to the Pennsylvania Department of Health. Pennsylvania Gov. Tom Wolf favors legalized recreational marijuana, but it remains illegal at the federal level.

New Jersey voted in November to legalize its recreational use for adults, and experts predicted it could create a $2 billion market in the Garden State. Visco’s TerraVida is already one of the leading sellers in Pennsylvania, with each of three stores approaching $20 million in sales last year. The company aims to beat that in 2021, she said.

But Visco’s case raises questions: What is the proper role of marijuana in first-rate cancer care?

Fewer side effects, longer treatment

Cannabis helps some cancer patients complete chemotherapy and radiation — which they might not do otherwise.

And many patients are using marijuana for pain and appetite loss, said Marisa Weiss, a Main Line Health oncologist, and founder of the leading website Breastcancer.org.

Her team surveyed members of the Breastcancer.org and Healthline online communities a year ago. Of the 612 women surveyed, 42% reported using medical cannabis to ease breast cancer symptoms or treat side effects.

Respondents often reported using medical cannabis to manage more than one symptom or side effect, most commonly pain (78%), insomnia (70%), and anxiety (57%).

“Cannabis should only be used as an adjunct to traditional cancer care,” Weiss said. “Cannabis is not a cure or treatment for cancer itself, even though there are some very early preclinical data suggesting cannabinoids could have potential anti-cancer effects.”

In another recent pilot study by Frederick Goldstein, a professor of clinical pharmacology at the Philadelphia College of Osteopathic Medicine, six pain patients completed a four-week regimen in which they took rising doses of THC, increasing from 5 mg to 20 mg daily.

In this small study, the average reduction in pain scores was 45%, and most patients used fewer opiates or painkillers.

Bornfriend became a late-in-life convert to medical marijuana. She refused to recommend it until her elderly mother developed lung cancer in 2014.

“My sister said ‘Let’s use medical cannabis.’ I said ‘Absolutely not. I’m a licensed professional.’ That’s how I felt at that time.”

Her mother’s side effects of the chemotherapy included “horrendous” diarrhea, nausea, insomnia and anxiety. At the time, her mother, Roslyn Bornfriend a Center City resident, was 84.

“We tried everything. Either it didn’t work or she couldn’t tolerate it,” Bornfriend said. “Based on not eating due to the chemo, she was starving to death. And she couldn’t continue her chemo.”

At the end, Bornfriend and her sister agreed to give their mother medical marijuana to ease her pain just before dying.

“It was too late for my mother, but it was a game changer in my mind. Had she access to medical marijuana for quality of life earlier, she would have been much better,” Bornfriend said. “It was the only thing that gave her any relief.”

Moreover, Bornfriend says, marijuana is safer than opiates.

Cannabis “isn’t physically addictive, and there’s no lethal dose. You could end up high, very hungry and sedated. But it cannot kill you. It won’t impact your liver or your heart. When you awaken, there’s no hangover.”

Paying for medical marijuana

Cost can be prohibitive. Grassroots Full Spectrum RSO or FarmaceuticalRx RSO fetches roughly $55 to $60 for one gram, or 1,000 milligrams, according to retail prices. Visco estimates her daily dose of 1 gram of RSO costs $75 a day or $2,250 a month.

Because marijuana remains a Schedule 1 drug, and is illegal at the federal level, patients can’t use insurance to pay for the physician certifying them for care or for the actual medication, Bornfriend said.

“It has been tragic to see people who have enjoyed the superior efficacy and decreased side effects of medical cannabis need to go back to using addictive, potentially lethal medications because they cannot afford medical cannabis,” she said.

Some dispensaries have programs to assist patients with the cost, “but that is not the norm, so that access to medical cannabis is yet another area of inequity in our health-care system.”

Since her mother’s death, Bornfriend has written hundreds of prescriptions to patients for medical marijuana.

Types of medical marijuana

For appetite stimulation, Bornfriend recommends marijuana with a higher THC level, while marijuana with CBD compounds is more helpful for anxiety.

“THC helps optimize the absorption of the other phytocannabinoids to maximize their efficacy, so I recommend that cancer patients use at least a small amount of THC in their medication,” she said.

“CBD actually counteracts the psychoactive properties of THC, so that a patient who is uncomfortable at feeling ‘high’ might take some CBD to modulate the effects.”

“The most important thing,” she said, is to buy “cannabis products from a dispensary rather than off the street, as they risk exposure to pesticides, heavy metals, mold, and counterfeit agents with little or no medicine in them.”

Visco’s at work

Visco opened the first TerraVida Holistic location in 2018 in Sellersville and has since expanded to Abington and Malvern. She employs 168 workers.

This month, she was awarded a retailer license in West Virginia, turning TerraVida into a multi-state operator.

She is bullish on prospects for the industry, predicting that marijuana could be legal at the federal level in the next few years.

As a result, investors have renewed interest in the sector, bidding up public weed stocks, she noted.

“All of a sudden, money wants to get in. People who would never look or talk to me before are banging on doors to give me money,” she said.

Meanwhile, she’s celebrating ending her chemo treatment.

“I have to get better. I have no choice,” she said. “I have three kids and a company, and people who depend on me.”