 Good morning. You are with the Vermont House Government Operations Committee. We are meeting this morning to continue our work on S-25, an act relating to miscellaneous cannabis regulation procedures. We're joined this morning by Jessalyn Dolan, who's with the Vermont Cannabis Nurse Association and Amelia Makia, a VMR patient and patient advocate. And as folks will recall, there is, at some point in the future, the medical system will move over to the Cannabis Control Board. And it is our hope to make sure that that transition is as smooth as possible. And so it's helpful to hear from some folks who've got a little experience with the medical system and perhaps can share some thoughts or concerns that they may have about how to make that a smooth transition. So let's go to Jessalyn first. Good morning and welcome. We haven't had you in our Zoom Government Operations Committee, but welcome and please share your thoughts on S-25. Thank you. Thank you so much for having me here today. All right. So, yeah, thank you very much for having me. I'm really appreciative for the opportunity to speak on behalf of medical patients and professionals in Vermont. This is Jessalyn. I'm a research nurse at the University of Vermont College of Medicine. I specialize in multi-substance use and comorbid mental health disorders. I managed Lund for a while, I've worked labor and delivery for years, and I co-founded UBM's volunteer doula program. I'm vice president of the American Nurse Association here in Vermont, and I'm starting on the SANE Nurse Advisory Board as well. I'm also a medical cannabis patient and a nurse who's had about 40 surgeries due to a childhood car accident. And it's only with the help of a bunch of titanium rods, human, cow, pigs, stem cells, holding my face together, and a row of fake teeth and lots of plastic surgery that I can talk to you right now. So between my personal and professional lives, I take anything having to do with medication and patient care very seriously. I've personally tried more meds than I can name and experienced my fair share of negative reactions and side effects. Without cannabis, I'd be on multiple pharmaceuticals with a much lower quality of life. Because I'm a research nurse, I'm a single parent of teenagers, I'm the child of an alcoholic, and spent decades working with addiction. I don't take the decision to use medical cannabis lightly by any means. My own primary care doctor had to mention cannabis half a dozen times before I would try CBD. Soon enough, I was beyond amazed how helpful cannabis really was for managing my chronic pain and migraines. But when I first set foot in a Vermont medical cannabis dispensary, they really didn't have any medical professionals or anyone I could turn to for help or guidance at all. So for several years, I've been a cultivating cannabis caregiver for another nurse in cancer remission who also felt she didn't really have anyone she could turn to. So for both of our sakes, I worked to learn as much as I could about medical cannabis. And when you're using medical cannabis, you need to be well trained because we really want it to be effective. We need to know which strains, how much to use, what form to use to get the best results. And you probably know a lot of medical professionals don't know a lot about cannabis and they can't help their patients sometimes. So I founded the Vermont cannabis nurses to help educate medical professionals and patients like myself. And I now serve on the National Board of the American Cannabis Nurses Association. Recognizing this need for cannabis education, the American Nurse Association here in Vermont and the Vermont Cannabis Nurses together recently started a virtual cannabis continuing ed curriculum for medical professionals to help close this knowledge gap that we need. But that's not going to be enough if we don't actually have medical patients and medical professionals overseeing our medical cannabis program. Just like we need utility experts on public service, right? We must have experienced educated medical cannabis professionals and patients guiding the cannabis control board. At the heart, it's really a matter of consumer protection, right? So please let's take patient well-being, education and consumer safety seriously and look at reallocating that 13th seat of the advisory board to a cannabis expert medical professional. A&A Vermont has shown the commitment and forethought to ensure we have a state full of cannabis literate medical professionals. So placing A&A Vermont or Vermont cannabis nurses as the person that can choose that 13th seat would help to ensure pace and advocacy, professional advice and that vital education for the cannabis control board. So while Vermont Cannabis Trade Association does have an interest in medical cannabis, it's a business interest more so. Their job is to advocate for the financial well-being and longevity of the dispensaries, those businesses which make their money off of those medical cannabis patients that they serve. So I feel it's not appropriate. It's a conflict of interest for them to serve as the voice of patients or experienced medical professionals. So I please suggest keeping and expanding the committee on symptom relief as a subcommittee which will give the dispensary patients that voice. But please remember though that this committee on symptom relief is not the voice of all medical cannabis patients. It's the voice of the patients who can afford to use the medical dispensary system. If medical cannabis is expensive as a patient, a nurse, I'm a single mom, I couldn't afford it if I didn't grow it. And this is true for many other patients as well. So we also need to hear from patients and caregivers who for financial reasons can't operate in the dispensary system. They don't have that privilege. In other words, the cost of medical cannabis is an issue for consumer protection and social justice and it can't be ignored. So speaking of justice, the Vermont Growers Association, TRACE, NOFA, Rural Vermont, Vermont, Racial Justice Alliance have all really been pushing hard for this greater social equity in our cannabis program, including felons. And I absolutely support and am grateful for those efforts. And for several years I have been attending all the symptom relief committee being active as I can to help advocate for increasing that plant and that patient count for caregivers. As a cultivating patient myself and caregiver I have to tell you it's nerve wracking to be the sole supplier and support system for myself and another nurse with cancer. What if something happens to me and I can't actually grow? What if two plants die or the strain doesn't work enough? What if I get mold or my plants don't yield enough to keep either one of us going with our medicine until next harvest? What if I burn my brownies or the butter that I'm trying to make edibles for my cancer patient? We need a higher plant count. For cultivators we need a higher patient count for caregivers. The main allows 30 flowering plants for caregivers plus their own personal 12. New York caregivers get five patients and in mass they're allowed up to 24 flowering plants. So Vermont's two plant limit is extremely fear based and kind of puts an unfair burden on people who are already struggling to try to maintain their health and well being already. Well it's exciting to have a big pot of money to start this program with transferring the medical programs finances, the adult use program and earlier than anticipated would be a big loss for patients and in my opinion unfair. That money is literally patients money. It came directly from their registration fees and their purchases and should be used on our behalf whether it's lowering our registration fees or putting educated medical people in dispensaries to help consult and educate or opening access to rural patients with free delivery. You know our patients are challenged by life altering issues like cancer and Crohn's and these patients need these funds and that's where real consumer protection comes into. So a couple final suggestions I ask you if you would consider dropping the fingerprint mandate for caregivers, we know cannabis should never have been criminalized really and caregivers shouldn't bear that burden of past political mistakes and not be able to help. And additionally as a nurse I specialize in substance use disorder for a long time I asked you to include substance use disorder as a qualifying condition. Actually I'd ask you to consider allowing any condition based on the provider's discretion, as well as waving that three month relationship mandate, we need to educate our providers and then trust those providers to choose. So in summary, please continue the marijuana for symptom relief oversight committee so that the dispensary patients have a voice but honor the subset of patients with less privilege who don't use the dispensary because they can't afford it. Please designate that 13th advisory board seat for a cannabis expert medical professional such as someone from American nurse association Vermont or cannabis nurses and please don't change the timeline for the medical program to be absorbed. Please consider to expand those qualifying conditions and let's increase that plant count and the amount of people someone can care for have as a caregiver. And lastly please strike that finger print mandate if you'll consider that. So I just wanted to share some of my thoughts with you I really appreciate the time. And if you have any questions please feel free to answer and any information I can provide or any education, or any questions about being a patient as to I again I appreciate your time and here for any questions. So thank you. Thanks for being with us this morning committee members. Do you have any questions for miss Dolan representative Higley. Thank you madam chair. Thanks miss Dolan. I do have a question. You had mentioned how a lot of professionals these days whether primary care physicians or whatever don't really understand sometimes the benefits of cannabis. Just curious. I also know that a lot of times doctors that prescribe other medications. Don't really understand that in the process, the patient also prescribes themselves with cannabis. And I'm just curious to know your thoughts on that and, you know what some of the drawbacks might be and, and how how you can educate maybe, whether it's doctors or folks around around that problem because I do believe that in some cases it is quite a problem. Absolutely thank you for the question that's a great question. What we do know unfortunately is that in nursing and medical school programs right now there is no education on cannabis or the endocannabinoid system. So the people that have the education are finding it themselves. And I think you're exactly right the way you said it is they don't know whether their patients are aren't using cannabis and everyone using cannabis is not always a patient or upfront with that. So that's why I feel very strongly that and I don't mean this in a negative way when you're a care provider I don't care what your stigma or bias is pro or anti cannabis the reality is we need the education because people are using it, and they're trying to have those conversations to allow medical providers to help keep them safer, if we're not open to those conversations. And if we don't have the education for those conversations we're also not going to benefit them. So that's why, with the help of the A&A Vermont I'm very excited that they were willing and excited to start this program to offer some of this education for medical professionals because we know we don't have educated medical professionals in the dispensary system themselves. And we do have doctors or nurse practitioners or nurses talking to patients that are using it whether medicinally or their version of recreational might be medicinal if they had more education and support to use it more appropriately and use some of those harm reduction techniques. So I feel so strongly that having that education component is a huge part of this program moving forward, and I would love to help see that program crafted I know in 164 it mentions dispensary retail facilities having education every 24 months. I think we need that at least once a year we need a standard program that educated, not just any medical professional they have to have the cannabis education. We have to help with the Vermont Department of Health in unison, create an education program that we all feel comfortable with that does talk about how you can use a topical instead of smoke for harm reduction, but also does talk about cannabis use disorder and the realities of some of the fear based issues people have because we do need to educate and understand that as well. So, and actually I was very excited I got to chat with James pepper yesterday and we did talk a little bit about this and what we can do moving forward to help make sure the education is there. And that's why I'm coming to you guys and asking and saying, if this is taking over the medical program, how can we not have medical professionals educated cannabis medical professionals and medical patients, voices and weighing in on this that's my request you know one of I listed a few requests you guys of course, but one of them is definitely to put something with cannabis medical expertise on to this advisory board. It's going to help patients professionals, it's going to help break that stigma I think, and help those medical professionals that don't want to know about cannabis maybe realize how important and why we need to know, regardless of our own, you know feelings of history and understanding. Thank you very much represent you. Thank you madam chair and thank you miss Dolan. You've, you've caused me to have a look back on the composition of the committee and you're 100% right it is way in favor of business and regulatory and seriously lacking and expertise on the medical aspect of it. Thank you for doing that. If you had the opportunity to just cut and paste your suggestions into the chat, I think that might be worthwhile. But thanks for bringing this up. Thank you for listening. Committee any other questions for miss Dolan. All right, thank you so much. We always appreciate when people come with you know some some very specific sets of requests and we will do our best to to incorporate the ones that are, you know, sort of in alignment with where this bill is going so I appreciate you being here with us. So, welcome, Amelia Machia would love to hear your thoughts on as 25. Of course. Good morning everyone. My name is Amelia Macy. I'm a fourth generation Vermont or born and raised in Eden. I'm here as a patient and a patient advocate to talk to you about medical cannabis, why it needs to be taken more seriously in Vermont, why we have to include more protections for patients and caregivers in Act 164 and how bill as 25 can help achieve those reforms that we need. I didn't start to walk until I was almost to around three my elbows started to dislocate frequently. And after a particularly rough trip to the ER four, I was diagnosed with the Ehlers-Danlos syndrome. This is a connective tissue disorder that causes loose hyper flexible joints paper thin skin arthritis and a myriad of other physical issues. This was 1999, and almost nobody had heard of EDS. I was just lucky enough to find a doctor who had my parents dove head first into raising a child with chronic illness and by six, I could put my own elbow back into place, which is a painful and traumatizing for any adult to do much less a child. At seven my knees started to dislocate randomly and by this point I was in physical therapy doctors offices specialist appointments like so often that it became just like my normal. That same year I took a nasty fall down my parents stairs and landed with a six inch laceration on my shin. I had torn through skin fat and into my muscle and once the shock wore off, and I stopped begging my dad to not take me to the hospital intense pain took its place, and that is how at age seven I was given my first As the years and my illness progressed, I had multiple other trips to the hospital. I need dislocation that lasted three straight days and even larger laceration on my other shin from a horse's saddle, a wisdom tooth operation that went bad as soon as the anesthesia wore off and it was that last one where I learned the Ehlers-Danlos patients burn through traditional medications faster than those with normal connective tissue. I've woken up during surgeries reopen stitches and gone through medication withdrawals more times than I know. At 19 my geneticist who is a wonderful woman named Leah Burke agreed that I needed my medical cannabis card. I had been successfully managing my pain with cannabis for a while and she agreed that given my alternatives. It was the safest way for me to get through my day as well keeping an intense amount of pain in check. Around that same time I started getting a sharp stabbing pain in my chest that none of my doctors could explain. For almost two years I went to the ER at least a dozen times convinced I had appendicitis and infection, a tear like anything that could give me the kind of pain that doubled me over and took me out of my college classes. In 2015 an ER doctor without ordering any tests or imaging told me that what I was experiencing was lung inflammation from smoking cannabis, and he wrote me a prescription for Tylenol to hammer his point of you did this to yourself home. A month later, I was rushed into emergency surgery on New Year's Eve for a gallstone that had gotten so large it was blocking my bile duct and poisoning my liver. This gallstone was what had been causing me intense sharp pain for two years and a doctor wrote that off as lung inflammation from cannabis simply because he knew I had a medical card. During that surgery, it was discovered that I have Crohn's disease. The symptoms have been there for years but when you have a rare debilitating disease you're not exactly looking to add another to the list. Within two years my Crohn's progressed to the point that I found myself in the hospital for days on end. In one particularly bad episode, the delotted that I had been giving for four days stopped being effective, and my doctor up me to fentanyl. Withdrawing from fentanyl was one of the worst things I've ever gone through. I didn't eat for a week, I was in constant pain, I couldn't sleep, and nothing helped except for cannabis. I set up straight in bed, it helped me get to the bathroom and back and eventually I was able to eat again due to cannabis. After four years of fighting with my body, my Crohn's disease was winning. I had been put on injections, pills, chemo and none of it was helping. My weight dropped dramatically, I couldn't eat and I was in constant pain and thank God for cannabis. I could seek relief with it, I could eat something, I could go to work, I could sit up straight and walk and do all these things that hurt way too much to do when I didn't have access to it. At my worst I was 83 pounds and I couldn't stand up straight long enough to make dinner and much less eat it. My husband was making almost weekly trips to the emergency room with me and I was still refusing painkillers. This whole time, for 20 years, I had been not taking opiates regularly for pain management, as many people in my situation are forced to do. They scared me. Growing up in LaMoyle County, I had seen opiate addiction victims my whole life. They were my friends' parents and grandparents and now they're my friends. Sorry. I knew that what I was dealing with was easier than a potential addiction. Sorry. Using cannabis in place of opiates has ensured that I don't become another statistic in Vermont. And that's something that touches everyone in this state. And that's why I'm asking that substance use disorder and anyone receiving an opioid prescription be added to the list of qualifications for a Vermont medical card. This is a really simple way to save people, lives, and families right now. I'm sorry. I apologize. I love being a Vermonter. I love our communities and how much we care about each other. I've lived in mass in New York and anytime I went anywhere else I would proudly tell people about Vermont and living here. It's special. I couldn't say away as a child, my grandparents value community over everything else. We volunteered for Meals on Wheels on the weekends and my grandfather was an auctioneer for charity more times than I can remember. We ran fundraisers checked in on seniors helps people with medical expenses and replaced belongings lost from fire as a community, because that's what being a Vermonter is. When my mom ran for state rep in 2000 she did it because her parents values were important and she wanted to see them reflected in the state house and that's why I'm here too. The medical patient community needs to have a voice here, especially where decisions that directly affect us are being made in 2017 the state was running into a budget problem and needed to pool resources. And in doing so they took $300,000 out of the medical marijuana fund. We consist of patient registration fees renewal fees and dispensary license fees. I stress, this is not tax money. This is patients money and dispensary licensing fees. With that money, we could have covered the cost of medical cards to low income patients paid for medicine delivery costs to senior and high need patients or transportation through the dispensary for patients in rural areas. It would have paid for education for patients and their caregivers in growing their own plants, losing that money was the state's way of saying, we need this more than you do. And they were able to do that because nobody had ever put the fund the good use it just sat there. Now we're facing losing the fund entirely. As Jesse Lynn said the remaining approximately $400,000 of patient and dispensary fees are scheduled to be transferred to the cannabis regulation fund. After March 2022, according to the statute in Act 164, a deadline that is now expedited to July 1 of this year. All of those opportunities I just listed to benefit patients with that money will be gone. This is a community of vulnerable people in pain, some dealing with terminal illness, whose insurance doesn't even cover cannabis, and the state is planning on removing a massive resource that could benefit them for the sake of adult use. I beg you to please consider pushing back the date that the medical program is absorbed into the cannabis control board, back to its original date in 2022, or at minimum, guarantee that when the program is absorbed the fund will stay separate to adult use in order to benefit patients. Before S54 passed I spoke at a rally about my concerns with the bell. One of the largest issues I saw was the proposed THC caps. Under the current legislation tax and reg dispensaries will only be allowed to sell concentrates that fall under 60% THC flower under 30% THC and edible products at five milligrams THC per serving. Under Act 164, medical dispensaries will not have to adhere to these limits. There are currently no medical professionals involved in making these decisions. Patients like myself and countless others rely on high potency concentrates like hash rosin and RSO to treat their symptoms. These are people like cancer patients taking RSO for their nausea and to help with the symptoms of their chemo. Under Act 164, our only option to legally access that medicine is through existing medical dispensaries or by donation from local growers because they can't legally sell it. These concentrates are incredibly expensive to produce from plant to final product and telling patients to pay already inflated dispensary prices for these products will only push them back to the black market, because we can't legally expect small farmers to donate thousands of dollars to product of product to patients and still survive. I should not be forced to pay the state to access my medicine in a tax and regulation system when local growers are already capable of producing what I need. I'm asking that the THC caps be struck from Act 164 so that patients like myself can get the medicine we need from anyone who can make it for us, rather than depending on the existing medical dispensaries that have frankly lost our trust. I was invited to that rally by Jeffrey from Vermont Growers Association, a group that has supported my needs and experiences as a patient throughout this process of writing as 25. My years as a patient and advocate, no group, lobbyist or politician has ever asked me what do you need from us. Jeffrey, his team and their coalition have put a humbling amount of effort in the last year to make me feel like my voice matters. And I couldn't be more grateful. In March after meetings with myself and other patients and caregivers, Jeffrey introduced the idea to add a 13th member to the advisory board. His intent was to add someone that would represent medical patients, whether that be a patient themselves or a cannabis healthcare professional. This was a monumental step forward in patients having a voice in this room. When Jeffrey and his team weren't present, that 13th member was changed to represent the Vermont Cannabis Trade Association, a group that represents corporate medical interests. This goes against the original meaning of that 13th member completely. Because of this, I'm asking that the 13th member be a patient representative from Vermont American Nurse Association, or a cannabis healthcare professional. So to conclude, I'm here to ask you for four things. One, that substance use disorder be added to the list of qualifications for a Vermont medical cannabis card, as well as anyone with an opioid prescription, as a harm reduction measure to combat the opioid crisis our state is currently facing. Two, to push back the date that the medical program is absorbed into the cannabis control board back to its original date in 2022, or at minimum guarantee that when the program is absorbed the fund will stay separate to adult use in order to benefit patients. Three, that the THC caps be struck from Act 164 so that patients like myself can get the medicine we need from anyone who can make it for us, rather than narrowing our options to five dispensaries that are largely unaffordable and inaccessible to our rural communities. And for that the 13th member of the advisory board be a patient representative from Vermont and a or a cannabis healthcare professional rather than a corporate representative from VTC or VCT. Before I answer any questions you might have. I just, I want to reiterate that when it comes to medical cannabis, my voice and the voice of other patients matters. There's a variety of vulnerable people who are relying on me to convey to you how much we need this legislation to work for us instead of against us. Patients are not a source of profit in this system, and they shouldn't be. We are physically and mentally ill tired and often don't have the energy to speak up for what we need in spaces like this. I don't think I'll use cannabis succeed in Vermont. I want profits to benefit all of our communities, and I want small farms and small businesses to make a living growing this amazing plan that saved my life. What I fear is that I'll be looked at as just another source of profit, rather than someone to be protected in this system. I hope that my experience is resonated with you. Thank you. Thank you for being with us this morning. Committee members. Any questions for Miss Misha represented more wiki. I just want to thank you. You did a great job. Despite or because of the challenges you face your, your voices is, I think is as relevant as any we've heard here and will certainly take. Take your suggestions to heart so thanks. One of the things that I think I've heard though is that from you and the prior witness is that we need people helping to make these decisions. Who are who have lived experience and or a medical professionals is that what would that be accurate. Yes. Absolutely. Um, it's easy to theorize about what will work from an outside perspective. It's even easier to put action to what we need when you have lived experience. Thank you. Yeah. Thank you. And again, it has a question. Thank you for both testifying this morning and I don't know who who best can answer this question, but I would offer either of you to try to answer. I mean, has there been any discussion in the legislature about adding substance use disorder. Situations that medical cannabis can be used for. As far as I know, within this whole process of writing us 25 is the first time it's come up. That's my understanding to in the last year or two there really hasn't been much much of a push to change the medical program at all, knowing that this is coming online and then they'll be taking over the medical program and that will bring about some changes, but in the last couple years there really hasn't been any legislative push to make any changes. So that's why we hope as the cannabis control board kind of gets settled and takes over the medical program that will be the opportune time to have voices heard and to make some of these changes. The only patient voice we've had up until now has been that symptom relief oversight committee. Again, those are patients that are appointed by the dispensary who use the dispensary and have that privilege and those financial ability is to use the dispensary, where I look at myself and Amelia as different I remember Amelia coming to me and saying, Wow, my new boyfriend grows and I can afford medicine and now she's married to someone that can help her grow her medicine instead of trying to afford 1000 or $1500 a month for her medicine. So I feel passionate that we not just need patient voices through the dispensary but we need patient voices who are those people that can't afford the dispensary because that's a huge social equity issue that we have right there. Sorry to cut you off representative. I would agree with Jesse Lynn. I know that in addition to needing to have the education and resources to grow a lot of people just can't grow because they rent property rather than own it. Which is why we're also asking that the caregiver patient allowance be up from one patient per caregiver to five patients per caregiver to give more of an opportunity for people who just can't grow for themselves or don't have that resource to grow for themselves and ability to have medicine grown for them. And that's why I mentioned that to plant limit as well. You know I've tried for years to grow and there's definitely times you have two plans to die and then you're beat for a couple months and that really talk about putting a financial hurt on someone when you put months into your electric bill and a couple of plans and then they just don't work for you so I do think there's a lot of different ways we could support the medical program much better and having that that finance behind us instead of that folding into the cannabis control board will be helpful. So we really hope as this program moves forward we have new administration we have new voices that our voices can be louder and we can help. You know like Amelia said it's theorizing what is helpful is different than actually talking to people that have been part of this program for years and I want to reiterate I don't take this lightly. I'm an opioid use disorder nurse that has withdrawn babies from opioids for months and years at a time in my profession. So I have seen the throws of the absolute worst substance use disorder and I don't say that lightly by saying I do think cannabis can help when appropriate but that's why we need the educated professionals because it's also not a light decision to say sure you have substance use disorder let's get you a cannabis card it's not appropriate for everybody but we need to have the educated professionals we trust to allow them to make the decisions and have that support network for our patients because as you know you hand somebody a card that doesn't mean they don't have any education or support or the money to buy their medicine so whatever we can do to create a better medical program as we're creating a statewide fun adult use you know regulated market where people can profit let's not forget the patients come first. Representative and did you have any other questions for these fine people. I said thank you. Representative Anthony. Thank you very much madam chair and thank you both for appearing before us. I want to go back to the request that the THC limit be raised or abandoned. Could you give me a little background. What do you suppose was the purpose and what potentially are any social or negative effects for having either abandoned or raising that limit as you suggest. Thank you. That's a really good question. And I would argue given my experiences in this system that the THC limits were introduced as a way to ensure that the only people that could benefit from these high potency concentrates were corporate medical dispensaries within the state. Because we did not get rid of them completely. There are still medical dispensaries that are allowed to sell these products. But they're just the dispensaries that are already existing in there just the ones that are labeled as medical dispensaries. So if if that means that we make it so that only medical patients can buy these products that's one thing I suppose but they should be allowed to be sold wherever somebody can make them. When I like to remind people that not all medical cannabis users have a medical card. I'm a nurse. It took my doctor convincing me to put my name into a system that the nursing board could look up and see that I'm using a federally controlled substance that they can question my nursing license. And I have had my nursing license questioned because of my support of cannabis by the nursing board. So I'm a strong advocate for you guys to understand that people are using medicinally. But they might not want to go to the medical dispensary and have their name listed in a system somewhere because of the fear of stigma or their job or child custody concerns. There's a lot of different reasons. I can't tell you all of them that people don't want to be a patient. But that doesn't mean they're not using medicinally or somebody recreationally goes to a dispensary and realizes how much this medicine helps them and they can get off their opioids or their five other medications. But they might need that higher concentrate or something different. So just I ask you to please remember that not all patients and medicinal users are actually in the medical system some for a very good appropriate reason. Yeah I agree with Jesse when I know many people who have severe if not worse conditions than I do who just simply don't want to be a part of the program due to having their name on a registry or due to a moral objection to paying the state to access their medicine. Or gun rights. That's another one I've heard from a lot of remonters here too once you have a medical card it changes you are comfortable you know or your legal ability to have gun rights. And the one thing I want to mention is not everybody understands how much concentrate you actually need at times. A quick understanding you need a pound of cannabis a pound that's a lot that's thousands and thousands of dollars and it takes me probably 24 hours of physical labor to take that pound and turn it into that RSO medicine Amelia is talking about which for a day of medicine at the dispensary cost $60 for a cancer patient. So that's a lot of money that's a lot of cannabis that's a lot of medicine. I like to make that for myself and my patient because I can do it much more affordably than the dispensary. So realizing why we use concentrates is for those severe and chronic issues because as you can think of any kind of medication you might gain a tolerance and need a little bit higher of a dose. So we need to allow for that higher dosing for the people that are using it and but have all those safety measures in we know they're 21 we hopefully will get a state program set up to educate the dispensary bug tenders and retail sales people so they can help keep people safe with the right information. So I think instead of being fearful of the THC caps we instead of being fearful we need to push education if everyone has the education and information and the posters hanging up and the phone numbers to call. That's going to give us the consumer protection more than putting these limiting mandates in place in my opinion. Representative Hooper has a question. Maybe it's an apology. I don't know. We spent a lot of time on this last year and I don't know that we ever really broach the idea of cost and you throwing out the thousand to $1,500 a month number was a pretty stark awakening if it is that normal and I mean we talk about affordable health care if this is a cost that somebody needs to engage in effective treatment. That's that's a big issue. Yeah, and like I said earlier our insurance doesn't cover medical cannabis and it won't until medical cannabis is federally legalized. Maybe not even then there's a big surprise. Yeah, you know and Jesse Lin puts out you know $1,000 to $1,500 but that's just for one type of medicine if you're a cancer patient and you're relying on this RSO and edibles and you know other ways to get you through the day then you're looking at $2,000, $3,000, $4,000 a month just in cannabis alone then that's not counting whatever other drugs are on like your chemo and various things. So yeah it is an apology. That's why I often mention that the people who go to the dispensary those those are privileged people those are the people that have the money to do that. I became a medical patient I went to the dispensary once and realized okay I cannot afford that on my single mom nursing salary so what do I need to do. So I put everything I could into researching learning how to grow started to grow for another nurse but again I'm two nurses I only get four plans and I haven't been growing since I was two years old I do things wrong you know I had a whole plate of seeds. I recently so there goes a couple hundred bucks worth of seeds that are going to become nothing so it, it's an expensive endeavor and if we can help make it more affordable that is quality affordable health care otherwise you are exactly right it is not affordable health care. Thank you. Thank you. Rep Higley. Thank you Madam Chair. I have a question yesterday we heard from a couple of folks regarding a synthetic THC product produced from hemp or CBD oils and and I'm my understanding is it's you know they call it a synthetic process product. Any, any concerns about that or does it not matter as long as it's, you know, has the THC content whatever it is delta nine I guess is what they're calling it. Any, any issues with that is that perfectly acceptable as well to medical patients. I would say that the the craze that we're seeing in Vermont right now delta eight came up from prohibition. It came from THC products not being retail legal, if that makes sense. The only reason people are trying to get delta eight THC is because they can't get normal THC products right now legally. The synthetic cannabis will always concern me simply because I don't have the education to understand what goes into making it. And if I did maybe it wouldn't concern me as much but I will say that need. And that trend of delta eight THC came from prohibition and regular THC not being legal. I would, there is talk that the reason delta eight came about was because there was too much CBD isolate leftover and people didn't know what to do with it. And from that chemical medical standpoint, it is synthetic, it is a very harsh chemical process to bring it into the THC eight so that's why I'm not a fan of it. And we don't have the education or experience right now to know how to thoroughly test the eight inside and out to make sure that it is safe. So we, in my opinion we don't have enough research to know that it's safe. I agree with Amelia we're trying to use it instead of THC to give people that high feeling they want instead of CBD giving that to them which it doesn't. I'm not a big proponent of it because we just don't know if it's safe it hasn't been around long enough. And I don't like that chemicalization process that comes with it. My biggest thing and I'll tell you guys this is lab testing. If we don't have the proper lab testing to know that it's clean it is not medicine it is not safe and I know that is written into 164 there's only a one or two liner in there. I'm really hopeful that that will be expanded at least to a minimum to follow the Vermont hemp standards. I did help the agency of ag a little bit when they were creating some of those rules and regulations to have that lab testing based around that consumer safety. So right now I don't think we have the lab testing to ensure that delta eight is safe in my opinion. I know a lot of people are frustrated because it's a financial thing for them but from the medical perspective I was actually grateful that Vermont took that step and made that new and appreciate that and I'll go right back to as long as you know this program and our hemp program and our medical program needs to up the anti on lab testing that's the one thing we can do to really ensure consumer safety more than anything out there is to know it doesn't have the scary nasty stuff in it. I'd rather know it doesn't have mycotoxins and metals than know the exact dose of THC because as a nurse I'm going to recommend someone start a really really low dose that they don't even feel until they slowly creep it up that safety. If I'm telling them take this dose but it has heavy metals and pesticides in it that's not consumer safety and we just don't know so thank you for asking that and again I appreciate that Vermont made that that rule and I think as we move forward the cannabis control board can know and see the more research that we have available and make decisions in the future as well. Thank you. Representative Bihowski. Thank you. So I expressed some concern with the synthetic process yesterday I mean we've seen what happened when we made synthetic poppy extracts and how poorly that's gone speaking of the opioid crisis and so it's helpful for me to hear the medical standpoint. I'm wondering if you can point me in the direction of any research that does exist about about this synthetic THC products and any potential side effects that don't exist in naturally occurring THC or any of the other concerns. As I said I expressed some concern around this yesterday as well. I will dig up and see how much I can find. I was trying to look a little bit yesterday and unfortunately there isn't much research yet. A lot of the places writing about Delta 8 are the places producing it and the cannabis industry that wants to put information out there. So we just haven't had any of that kind of nonpartisan research that we want to see so I will keep digging in and if I can find anything I will absolutely send that to you. What we do know is we do have solid research showing that synthetic THC that we've made you know and put out there is prescriptions and FDA approved does have more negative side effects typically then whole plant cannabis flower medicine so we have already seen that with synthetic THC. Not every medical professional is going to agree with me. Some medical professionals don't mind that chemical isomerization and isolation process but I'm somebody that believes in plant medicine and using this as natural as we can. That doesn't make sense to me but I would not say every medical professional would agree but I do think every medical professional would probably agree there's not enough research and information out there to make a definitive decision either way. Thank you so much. So I do hear you saying though that that in the places we have used we have used medicinal synthetic THC that there are in fact increased negative side effects. Can you and maybe you can't but can you let me know at all what those are. Yeah typically you know they they will prescribe marinal pills is a very common one that is prescribed to cancer patients that's a synthetic isolate of just THC with that patients often report that psych that psychoactive high that is too much that is very uncomfortable. Some patients actually get more nauseous from it because it's just too heavy hitting the idea when you think of the chemistry behind it and when you learn that you realize how important it is for the plant to work together. So there's a reason there's a little bit of CBD in all our THC plants. It helps our body use it more effectively and not feel as intoxicated. You know that that toxic word. So by taking something and isolating it we're bringing it to that pharmaceutical level which then changes everything about gentle plant medicine compared to pharmaceuticals and that's why you know I remind people this is plant medicine we're going to start with a low dose. And that's the empowering safe way to treat patients rather than you only have a 10 milligram and a 20 milligram option instead of going from 10 to 11 to 12 and gently allowing your body to do that. So that wham bam here's a heavy dose of THC while you're on chemo can sometimes be much unfortunately much more detrimental than helpful for many and I know a lot of patients who have said I've tried marinal and it doesn't work. But then when I tried full you know full flower full spectrum we call it cannabis. It really did help and not give me all those negative symptoms that I want or that I don't want. I'm sorry. Absolutely thank you so much my last follow up is are there do you know of any long term side effects from the synthetic THC's. You know I don't I've never seen research on that because I don't honestly know many people that are on synthetic THC for a very long time most people don't tolerate it and oftentimes this is prescribed for the most part you know during a cancer unfortunate stint which we hope doesn't last for you know 10 years so. Thank you so much. Thank you representative Higley. Thank you. Mr. I'm a little confused because I'm and I kind of mentioned this yesterday I guess but you know you're talking delta eight this individual yesterday was talking delta nine so I don't understand the difference I guess. So delta nine is THC delta nine is completely THC delta eight was created in a lab. It's through hemp so they took hemp turned it into CBD and then with more chemicals turned it into delta eight delta nine is just what the cannabis flower is the minute you heat it up it turns to THC. It's more natural it's when you take the plant and you bake it in your butter or you put a flame to it that becomes THC, but to get delta eight through hemp and CBD. It's a lot of chemicals to get it to turn into that. Okay, that makes sense. Yeah, no that helps a lot. Thank you. Thank you both for being with us this morning. That was a very helpful and enlightening conversation and I do appreciate you coming in and helping us understand how how cannabis is used for symptom relief and how it has impacted both of your lives. Committee members any other questions for these two witnesses. All right. We are on break now until 1030 when we'll come back with some committee discussion on on S 25 and, and this will be an opportunity for us to to discuss some of the, some of the testimony that we've heard and and sort of check in and ground with what we think we might want to make for changes to the language as past the Senate so welcome you to review the language while we're on a 30 minute break and and come back with some thoughts and suggestions and and we'll go through the bill at 1030. Thank you. Thank you for having us and feel free anytime any questions I love to help.