People: Jessica Knox of the Knox Docs

“The Knox Docs” is an Oregon-based family of physicians—Jessica Knox, MD, MBA, MPH, and her father, mother, and sister—who use medical cannabis as a tool to bring healing to their patients. The family’s collective medical experience includes anesthesia, emergency medicine, and family, integrative, and preventive medicine.

Internationally known as “the first family of cannabinoid medicine” for their work and leadership, the Knoxes are committed to incorporating ancient healing—defined as using natural substances and simple practices—to modern medicine. The family of doctor-entrepreneurs is disrupting conventional health care models, focusing on a mode of self-care—endocannabinology—the family’s trademarked term describing health practices originating from the science, study, function, dysfunction, and modulation of the endocannabinoid system (ECS).

Knox began her career in family medicine, then moved to preventive medicine before widening her practice nationwide through her work as medical director for the telehealth company Nurx, a provider of birth control and other prescriptions across 30 states. A cofounder of the Knox family-built wellness company, Doctors Knox, Inc, she began providing premier and comprehensive training services through the Pivital EDU Academy in January 2019. 

“My first clue to the importance of cannabis therapy was the patients themselves,” Knox says. “My mother, Dr. Janice, a retired anesthesiologist, was the first of the Knox Docs to venture into the cannabinoid medicine space. When she first told me that she was working in medical marijuana clinics, I thought she was off her rocker!”

Her mother related the stories of the patients she saw, people from all walks of life, who benefitted greatly from cannabis. Knox says, “Many of my mother’s patients were at various stages with serious or life-threatening conditions, and they were desperate to get better, or at least feel better. Conventional medicine had failed most of these patients, and many of them were turning to cannabis as an option of last resort.”

 Knox says many of her mother’s patients were finding relief with cannabis, whether that relief came in the form of a seemingly miraculous improvement in their condition or improved quality of life—“though we know it’s not a miracle; it’s science,” Knox adds. “These were results that, despite my best efforts, I rarely saw in my own patients in my conventional primary care clinics. These were results that make sense when you understand the physiology of the endocannabinoid system and the pharmacology of the cannabis plant.”

Handling Criticism
The Knox Docs haven’t experienced opposition to their position on medical cannabis. However, Knox acknowledges that other health care clinicians may deal with criticism and says it certainly helps that she and her family live in cannabis-friendly states and work in their own clinics, independent of larger medical systems.

“But more importantly, we have a certain approach to explaining medical cannabis,” Knox clarifies. “When we discuss or present on medical cannabis, we never actually start with cannabis. Instead, we always lead with the history and the science. The history of cannabis can be very disarming.” Knox finds that the only cannabis narrative many people are aware of is the “War on Drugs” but says there’s a much larger context.

“We educate about cannabis through ancient, recent, and modern history as medicine, food, fiber, and more,” Knox says, “which helps to disengage cannabis deniers from their limited, and limiting, perspective.” Following up with the science of the ECS—its existence and how it works—provides further validation for using cannabis as medicine. “By the time we get to talking about cannabis itself, we’ve already built a compelling case for why and how it is, in fact, medicine,” she says.

Having a sense of practicality about outcomes is beneficial, too. Knox openly discusses cannabis limitations and cautions. She says, “Being a clinical advocate for medical cannabis doesn’t mean overlooking what cannabis cannot do or ignoring the risks or the challenges of using cannabis as medicine.” Instead, Knox says, it means understanding and sharing about how to use cannabis appropriately, effectively, and safely, managing any risks that may be pertinent to a particular patient.

“I think it helps that we’re realistic about medical cannabis,” she says. “Yes, we are very enthusiastic and vocal about the benefits and promise of cannabis as medicine, but we also know it’s not a panacea.” This style of education may contribute to the wide acceptance the Knox Docs enjoy. “A science-based, pragmatic approach is hard to push back on,” Knox says.

Attributes and Applications
“There are so many exciting aspects of cannabis as medicine,” Knox says. “One is the opportunity, and the necessity, for personalized medicine. Each of us has a unique endocannabinoid ‘tone,’ so the dose and formulation of cannabis that works best for one person will almost certainly differ from what works best for another, even to address the same concern.” Knox explains that some patients will require more time and titration than others to find their optimal cannabis regimens. “However,” she says, “if they are willing to persist, the upshot is that they will ultimately find a near-perfectly tailored therapy just for them and their needs.”

The wide therapeutic window of medical cannabis, Knox says, is also exciting and facilitates the variability in dosing seen across patients. She says that it’s common to achieve meaningful benefits at low doses, or even with regular microdosing of cannabis. “This is why we start with low doses when treating most common ailments, such as chronic pain, anxiety, and insomnia,” Knox says. She has found that some patients require larger milligram doses of cannabinoids for their conditions, especially when she’s treating cancer, seizures, or neurodegenerative diseases. “To have such a broadly safe, effective, and versatile therapeutic tool is a luxury rarely enjoyed in conventional medicine,” she says.

“Another exciting aspect of cannabinoid medicine is the ever-expanding knowledge of the so-called ‘minor’ cannabinoids and their effects,” Knox adds—for example, the acid forms of the cannabinoids, which, she explains, may have as much, if not more, medical benefit than do the neutral molecules. “Early studies are showing that [cannabidiolic acid] is even more anti-inflammatory and [tetrahydrocannabinolic acid] more antiemetic than their neutral counterparts (CBD and THC, respectively) and without intoxication or other side effects.”

Practice Tips
Knox implores health care clinicians to learn everything they can about the ECS and how its dysfunction relates to illness and disease. “If you haven’t yet read them, Dr. Ethan Russo’s papers on endocannabinoid tone and deficiency are foundational must-reads,” she says. “The ECS provides the roadmap for appropriate and effective application of cannabis as medicine, so that is where your education in this field must start and where your practice must be rooted.”

Cannabis is only one tool for modulating the ECS. “Don’t stop with cannabis,” she says. “We do our patients a disservice if we believe, or allow them to believe, that cannabis is all they need to get better or feel better.” She encourages clinicians to gain knowledge about how nutrition, various botanicals, mind-body therapies, ancient healing techniques, and other cannabimimetic substances and practices influence the ECS. “Teach your patients how to use these tools, in combination with cannabis or without, to support their health and total well-being.”

Just Getting Started
“We are on a mission to make ECS physiology and cannabis pharmacology foundational components of medical and allied health education curricula,” Knox states. “Moreover, we intend to make endocannabinology an official board specialty or subspecialty.”

The Knox Docs’ education ecosystem, Pivital EDU Academy, is their first step in bringing this education and training to a wide audience of health professionals. “Through the CME-accredited Foundations of Cannabinoid Medicine and monthly Cannabis Grand Rounds, Pivital EDU provides learners with up-to-date, evidence-based education in cannabis science and clinical care that they can immediately translate into practice,” Knox says. “With more widespread knowledge of the ECS and cannabis medicine, we fully expect that cannabis will become a regular part of our daily wellness practices, as well as a first-line therapy for many common ailments and diseases.”

— Michele Deppe is a freelance writer based in upstate South Carolina.