 Okay. Well, thank you. I am a board certified addiction psychiatrist from Colorado. And I've been to Vermont before to speak about the problems we have seen in Colorado from high potency THC. And I was so impressed when you became the first state to actually put a limit on potency. I felt like somebody was actually listening to the science of the health concerns. But now I have absolutely no idea why you would want to reverse this and follow Colorado with no limit on potency. And so I just I wanted to show you this graph because I think it speaks to everything that is happening. I am someone who totally supports decriminalization. And that in this graph shows that that does decrease the harms to society and individuals. The best thing is legalization with strict regulations. What we've got in Colorado right now is this opposite here of unregulated legal market where anything goes people can have everything and we had to actually a bill to try and change that which we have had some success in starting to do some more regulation. But this has done nothing to eliminate the illegal market. We have a huge illegal market. And today there was just an article in the paper about how we're seeing much more illegal marijuana being laced with methamphetamine and fentanyl, which is very concerning. Well, the slide that I have right now is actually from Dr. Deforti's work in the UK. This is a multinational study that using multi sites in Europe and Brazil looking at the effect of high potency THC on the incidence of psychotic disorder. Thank you. And how there is significant increase wherever there is availability of the high potency. There is significant increase in psychotic symptoms and psychosis psychotic disorder diagnosis. This slide just shows that the highest was in Amsterdam where they actually said that if they didn't have the high potency that would have eliminated possibly 50% of the people with psychosis. This is my experience in a program I ran for the last 20 years in Colorado and the state hospital which is an inpatient 90 day treatment program for people who have failed everything else. It is highly a touted in Colorado. Right now it's closed because the state closed it because of money issues. But I have been running it for the last 20 years and we were having really great success until we started legalizing medical recreational treatment in Colorado in 2014. I started seeing increasing problems with people not being able to participate in this highly cognitive behavioral program. And it was really totally due to their increasing use of cannabis and the effects on cognition. I was starting to see the worst psychotic symptoms I have ever seen in terms of very severe delusional symptoms. I got to the point where I was actually saying that this is worse than methamphetamine. And we were seeing this because more and more people were using cannabis. So back in 2014 only about 73% reported using cannabis up to 2019 95% were saying they were using it. We've always had people using tobacco. I made this a tobacco free program. But what's interesting is almost these people were there for either heroin or alcohol or methamphetamine problems. But we started seeing people where cannabis was their primary drug up to 14% in 2019. And so as I was saying we saw significantly increasing problems with cognition, psychotic symptoms, fixed delusions, cannabis hyperemesis syndrome, and increasing problems with violence with those people using high potency THC. So in Colorado we actually had this law passed last year House Bill 1317 where we got some control on some of the concentrates. We didn't get a potency cap similar to what you have. We still have things that are available up to 99%. But what we had to have was that there needed to be a standardized serving size. So if you look at that thing that is the handout that everybody gets when they purchase marijuana in a dispensary. There's a tiny little dot that is supposed to be the size of the dab that you use. So if you're dabbing 70% THC, that's the size of the dab that you should do. And then we have the warning which I think everybody needs to have on all of this. The one thing we were not able to get in there because the industry fought it was suicidal ideation and suicide attempts. That also needs to be on there because that is absolutely what we're seeing. But we're seeing a warning about psychotic symptoms and this can happen even in people that do not have a personal history or a family history of psychosis. And they actually have delusions that they can't control. And so we have these warnings and then it's actually a four page handout and it has the typical warnings about women that are being that are pregnant or nursing and the penalties and then resources for people can call and we were able to get on the resources for the suicide even though that wasn't a warning. And so I just wanted to make sure that you were all aware that if you do this if you reverse what you've already done which I think has been the best health thing you could do. You're actually looking at having increasing health problems and you're going down the wrong road as far as I'm concerned. You speak to your statement that the research was before. That's not true. We legalized recreational in 2012. The stores opened in 2014. Most of these studies that are showing the increased risk of psychosis have been done since then. The Landmark study was done in 2015 out of the UK. Then it was the one that Eric showed I think was 2018. I mean these these are and it's it's more we're seeing more and more studies showing the correlation which almost now meets causation. It does meet the Bradford Hill criteria of causation which was actually used initially with tobacco to prove that tobacco can cause cancer when the tobacco industry was fighting that. So there's a thing called Bradford Hill criteria and we can meet that now with marijuana showing causation for psychosis from marijuana. Okay well thank you very much. My name is Dr. Libby Stout. I am a board certified addiction psychiatrist from Colorado and I heard that you wanted to hear about why we did what we did in Colorado. I am representing myself and all of the patients I've seen have been harmed by high potency THC. And so as you know we did pass a bill last year. I was heavily involved in that in terms of working with others to educate legislators about the problems we are seeing with the high potency THC. And I say that the high potency is a greater than 15%. And and so this is a bill addressing the concentrates so anything you know that's higher than basically 15%. And we are average concentrates are about 69% THC. I was I respectfully disagree with Mr. Fox. In the fact that I thought you guys are doing great. Like you were the very first state to put limits on the potency which was amazing in Colorado and in California. We have no limits at all on potency and we have a huge illegal market huge. It doesn't stop the illegal market by getting your potency higher and available. And so the reason for this bill was to address those facts because this these high potency products greater than 15% are heavily advertised and marketed as medicine. These are not medicine. Medicine and the the research done to support medical marijuana has been with 10% or less. And so these are not medicine. There is no study showing that they are efficacious or safe for any medical condition. And if they're considered medicine then they should be treated like medicine. So people should be warned. They should have informed consent. And so what we do know is that there are many things that are causing these problems. The reason this bill passed overwhelmingly bipartisan support is because we had hundreds of family members testifying about their effects from high potency their families effects. And so we came up with the warnings that it should be addiction psychosis cannabis and worsening mental health problems. We lobbied very strongly to include suicide because there is a lot of research demonstrating the causation with this. But the industry fought that greatly. But I do want to point out that pretty much any psychiatric med that I prescribe has a black box warning that warns people about the potential for suicide. This is a medicine that can cause suicidal ideation. And so I strongly urge you to have severe warnings for people so that they know what they're purchasing that regular use of these products can increase the risk of addiction psychosis cannabis hyperemesis syndrome and suicidal ideation. Thank you. I'll pass on to the next one. OK. I think I brought Brad Roberts. Yes thanks. Hi my name is Brad Roberts. I'm an emergency medicine physician who practices in public Colorado and I'm also the chief medical officer for our Department of Public Health and Environment. I want to face on what I see daily in the emergency department. We see daily complications particularly from high potency THC. Those include psychosis suicidality and hyperemesis cases. We research shows that those are more common with people who use it younger ages and higher potencies. Unfortunately I'm also noticing those typically impacts are lower socioeconomic groups and a lot of these arguments for social equity are not true. Unfortunately these families become dependent on the product and are now stuck in a cycle of drug abuse psychiatric illness and are consuming significant amounts of our resources here. It overwhelms and only our emergency departments but our child protective services or police services and our homeless services here. Just to give an example of what psychosis looks like I recently had a 28 year old guy that was just at home screaming help uncontrollably. He got brought into our local psychiatric hospital where he was punching staff and couldn't be controlled was given high doses of out of hand before he was brought to me. I gave him even higher doses of out of hand until we could finally get him to dated and ultimately had to be admitted to an inpatient psychiatric service had no further prior psychiatric history. We see cases like that on a near daily basis. I also want to talk. Libby Stout mentioned but I want to also respectfully disagree with Mr. Fox. What happens is these people whose higher potency products they get dependent on it and once they're dependent on it they can no longer afford that product and they're stuck going back to an illicit market because that's the only thing they're able to afford. It has not decreased the illicit market in fact can substantially increases that. Just to kind of end with the amount as my role the Chief Medical Officer for the Department of Public Health we look heavily at costs of health care. And I want to make it clear you will never make up the cost for the increased services needed by the tax revenue is brought in from cannabis. Thank you. Thank you. Next is Robin. Good morning committee members. Thank you for having me. My name is Robin Gribbin. I'm a Colorado mom and I'm representing myself. My kid was 15 when he started using marijuana in Colorado. I smoked weed when I was a teenager too. So I wasn't too nervous about it. And plus I was hearing that it had all kinds of health benefits. Some people can smoke weed and experience no problems their whole lives. But for not for a not insignificant percentage of people there are serious health issues like depression and psychosis. One of the many harms that my kid suffered was cannabis hyperemesis syndrome. We didn't know the name of this condition at the time. He just started vomiting uncontrollably one morning and feeling severe abdominal pain. I thought he had the flu. After about eight hours of this violent vomiting and screaming in pain I took him to the emergency department. They thought he had food poisoning. But the usual drugs that stopped vomiting would not work. So they tried howl doll. It worked. But this kept happening over and over again. The doctors would run expensive tests to rule things out. About the third incident I started googling and I found a little group on Facebook with about 300 members called recovery from CHS. I showed it to him. He said no mom weed is great for nausea. Even a nurse wondered if maybe he wasn't smoking the good stuff. Try an organic strain. She said all in all my kid went to the ER 11 times over nine months and this was billed at nearly $100,000. CHS is torture and eventually people who have it will do anything to make it stop. So it was tough for my kid to give up the lead but he finally got to the other side. It's been three years since then and that little Facebook group I mentioned it now has 17,000 members. Adults experience CHS and right now Colorado emergency departments in our state see it every single day. Ask your ER docs about it. People roll their eyes and they say the stoners are puking but it's a big problem and it costs people a lot of money. So the simple warning label we developed in Colorado could have avoided all of this because at least I would have had a heads up. Colorado created these warning labels because legislators heard from a critical mass of real people who were experiencing real harms. They are decently transparent. They give the industry some cover and they help clear up confusion for consumers. That's a win-win. It's a no-brainer and isn't that convenient? My name is Catherine Yatlian. I'm a community physician and we have been concerned about the process of regulation of cannabis in Vermont and we wanted this process to be transparent so that all of Vermonters will have access to the testimony, the expert testimony, that our legislators are receiving in the statehouse. So we wanted to have those witnesses brought to you. I will go through a little bit of the process that is happening in the statehouse. We know a lot of Vermonters are concerned. And I'll just go through some slides. The first is this is the Vermont Medical Society recommended science-based warning. The Medical Society did a lot of research and paid attention to lessons learned in Colorado and this is the label that they came up with. It was passed in November and you'll see many of the things that they talked about. The doctors, psychosis, impaired driving, addiction, suicide attempt, uncontrolled vomiting and harm to nursing or fetus or nursing babies and the psychosis of suicide attempt. Importantly, folks should know that this can occur in individuals with no previous history of psychosis or mental illness. So recently in Colorado, they passed a new law and they took lead from the testimony that you saw and also many more hours of testimony and research done by a host of physicians in the state. This is the official recommendation of the Colorado Psychiatric Society and you can see that their recommendations are nearly identical. Psychosis, mental health symptoms, problems, cannabis hyperemesis syndrome, the vomiting, unrelenting vomiting and pain, cannabis use disorder or addiction, suicide attempt and self-injurious behavior. This is the warning as they talked about that they came up with. And again, by law, this is given to folks who purchase cannabis in Colorado now. It wasn't originally, but Vermont could learn from their experience. And they did this because Colorado's youth rate of high THC concentrates went in Colorado, went from 4.3% in 2015 to over 20% in 2019. And the high potency concentrates are defined as greater than 10% THC. So this is a side-by-side comparison of what the Vermont Cannabis Control Board came up with in their warning, which is on the left-hand side compared to the Medical Society's warning, which is on the right-hand side. That warning is the result of following the law in Vermont as it was passed. So it went through the CCB process, the CCB heard from physicians like Libby Stout, heard from physicians from the Medical Society, and they came up with this recommendation. It then went to LCAR, which is legislative oversight, and they agreed with the recommendation. So what's concerning about this is the law in Vermont was specifically passed in order for the commercialization of marijuana to be done safely. This process resulted in a warning, the warning label that you see there, which is inaccurate by omission. This label that followed all the rules that they were supposed to follow in Vermont to come up with an inaccurate warning label is inaccurate by omission. What do we mean by that? This warning label does not have psychosis, uncontrolled vomiting, suicide attempt, or addiction per se. On this, they list maybe habit-forming. Well, walking your dog might be habit-forming. Or brushing your teeth is habit-forming. Those are good things. So habit-forming, the words habit-forming, does not connote the damage to someone's life or those around them that addiction does, the loss of control, the harm, quite frankly. So it's inaccurate by omission. In addition, right now in Vermont, the testimony that you heard was solicited because they're thinking about getting rid of the 30% and 60% caps that are now currently present on Vermont cannabis. So as you heard from Dr. Stout and the other Dr. Roberts, the consensus from physicians is that that would be a very bad idea. But it doesn't, and so some folks in the legislature agree and others don't agree. But unfortunately in the Senate committee, they only heard testimony from 10 minutes, as you heard from the witnesses from Colorado. And they heard almost twice as much from industry. And so one leading senator in that committee said, I don't understand concentrates. And then the committee only took 10 minutes of testimony from the experts and 10 minutes on the health warnings. But nevertheless, the committee acted on the concentrates amendment, following the advice of industry advocates, removing the 60% cap on THC concentrates from Vermont law after taking, like we said, almost a third as much time, twice a third as much time listening to industry trade groups than doctors or the Vermont Medical Society representatives. Now what's interesting about that is that during the last week or so when this has been happening, there's been a lot of talk about that among people, the public. And a nearly 100 Vermonters called in to the statehouse wanting to have the caps, wanting to have accurate labels. So clearly the public wants accurate labels. So we were one of the first in the country to have GMO labeling. Vermonters want to know what's in their product, what's possible harm so they can be informed decision makers. And we're seeing that through their calling in to the statehouse, writing their representatives and what now. There is currently a bill in California that looks to address similar cannabis advertising health warnings and purchase limits and potency. Hopefully that bill will succeed and help in California. Legislating the marketing production and regulation of cannabis appears to be a challenge in the United States. However, cannabis control boards are composed generally or at least in Vermont of human resource professionals, lawyers and other non-medical doctors. In other words, two lawyers and one human resource professional actually. Faced with the headwinds of powerful interest groups, it appears that these folks are challenged to evaluate the health impacts that the label that they produce may have on Vermonters or the concentrations to appreciate the harm of the different concentrations. So the Vermont Medical Society is recommending 15% THC limit. Vermont law creates a limit of 60% THC for concentrates. Colorado has no limit and has had quite a lot of difficulty from that. However, in Quebec, just north of us, they have a 30% cap and that has resulted in lower use of high THC products in Quebec. So we're hoping that our THC caps will remain in place. Hopefully one day we'll be able to get them lower to the level of Quebec or 15% hopefully. But certainly it should be like one of the witnesses said, a no-brainer that we should have accurate warning labels. Right now, we have a new term which is coined in 2013, the corporate determinants of ill health. It's a new term and it's defined as strategies and approaches used by the private sector to promote products and choices that are detrimental to health. So unfortunately, this may be an instance where we're seeing that tug-of-war in between what's good for industry to sell more products because the high potency is more addictive or what's better for individual Vermonters and consumers, so consumer protection. So at this point today, it remains an open question if these corporate determinants of health will prevail or if science-based cannabis regulation is indeed possible in Vermont or in the United States. Thank you very much for your interest and we hope you'll tune in again next time.