 I'd like to welcome everybody to the Public Health Subcommittee meeting today on October 18th. I'm going to hand this over to Mark, Denika Scott, who can now be with us. So I'm Gina, I'm Carmen, though you've seen me on social equity all the time, and I've been a part of this meeting, just not participating. Mark. Thanks, Gina. Yes, we will, we have several sets of minutes that need to be approved, but we'll wait on that until we have another subcommittee member. And we have no public comments from this week to review. And Julie, I think we should probably save your discussion of next steps still. Sure. There are more people in the room there today. I think that would be good, yeah. Yeah. Vermont people that though we haven't received public comments, public comments can be submitted at any time to the Vermont Government Cannabis Control Board's website. And then I just want to take attendance right now. We have Ingrid, Donus, and Tenians on here. We have Mark Gorman from NAACP. Gina Cramingo from NAACP. We have Julie from the Vermont Cannabis Control Board and Nelly, and one person from the public. We have two now. Two members. Two. Great. Thank you for joining us. We're going to start with the Department of Health, the warning language that they would like to see on our last subcommittee meeting. We have agreed that the Department of Health would have oversight for public health cannabis sector. Mark. Yes. We should. I think when you take a look at what the, our work, you know, the subcommittee's warning language proposal was, when you take a look at what the Department of Health has proposed. But, you know, we can go, we can breathe through this. Probably not a bad idea to refresh everybody. So anyway, there's two things, warning language, which has to accompany advertisements and certain package labels. And then there are warning symbols, which also do the same thing, but in a more visual way. And I think studies have shown that picture language is actually much more impactful than written language like this. But here's what we say. This is a cannabis product and has not been analyzed or approved by the Food and Drug Administration. For use by individuals 21 years of age and older or registered qualifying patients only. Keep this product away from children and pets. Do not use it pregnant or breastfeeding. And it was thought that putting that in bold was important. Possession or use of this product may carry significant legal penalties in some jurisdictions and under federal law. It may not be transported outside the state of Vermont. The effects of cannabis may be delayed by two hours or more. Cannabis may be habit-forming and can impair concentration, coordination, and judgment. A person is 25 years and younger or maybe more likely to experience harm to the developing brain. Thank you, Mark. Ingrid, how do you feel about this warning language? I think that those are a lot of key elements that your subcommittee has been discussing over the last few months. Yeah, it does feel comprehensive in terms of what we've discussed. I think that this is a cannabis product. It's not been analyzed or approved by the FDA. It is new, but right, that's sort of rather new. We haven't spoken of that, but I think that's good. It is new, but I think Omar might have mentioned some of that. Yeah, and when he was speaking, I took that note. So it was interesting that this isn't now the first line of our warning language proposal. So I do like that. And I like the additional last sentence, persons 25 years and younger maybe more likely relating it to the developing brain. So I think that's good. Thank you. And I know that we can't, we're not a quorum, but if we're voting on this, would you say yes to this warning language? Yeah, I would. And just for my clarification, would this be part of the handout? Is this what goes on the packaging? You know, we've spoken up to different places where warning information would be provided. We're talking about the packaging itself. Is that correct? No, this is part of the handout. Very good. Yeah. So you call product packaging in our next slide. Got it. Thank you. Great. Thanks, Ingrid. Stan brings us to our product package. I think that paragraph is kind of dense, but it will show up on package labels and show up on probably the lower right-hand side of print advertisements. Okay, so Ingrid, this will show up on the package as well. Yeah. Are you okay with including all of that on the packaging? I am. I mean, I felt clear through this whole process that I'm not, I don't have background in advertising or how best to catch people's attention and what, you know, I agree that all this information is very important for consumers to see. And this is something that I would read if I were picking up the package of some edible product with cannabis in it. I don't, but I don't know the best way to post factual information so that people see it. But I would be very supportive of people seeing this information as effectively as possible. I think there's an effort here starting with the first sentence about the Food and Drug Administration to keep this very parallel to other products in the market so that people, you know, it's something that people expect to receive and it just abuses anybody about whether this is an approved drug or not. Very, very comprehensive. Yeah. I mean, I guess from a practical standpoint, if we're open to discussion, something like the effects of cannabis may be delayed by two hours or more is something that I would want to know right away, whereas it's not been analyzed or approved by the FDA. Some people might not even know or care about that. But to actually know the practical effects of this, you know, so if we're from the mall, from the framework of biggest bang for your buck, you know, possibly should those sort of practical things be higher up in the narrative. I'm just putting that out there. I think this is great. I just, you know, we've bolded that this product should be kept away from children and pets and not to be used if pregnant or breastfeeding. I do think that the fact that it could be delayed in terms of how it affects you is a very another important factor about it. I think that's a great comment, Egrid. I would suggest you be highlighting that, making that and bold as well. The effects of cannabis may be delayed by two hours or more. And that is definitely for edibles. Right. Yeah, Gina, that's exactly what I've been thinking here, which is should that only be applied to edible packaging and advertising. I don't remember any discussion related about that. Yeah. This would be very, very difficult to put on a pre-bro. So I don't know. I don't know if we're going to be simplifying this information or I wish the Department of Health was here to really, you know, just that one question, you know, because you would need to make a box and then put the pre-bro into it. Or I think also we can just have them include in it a flyer, you know, so attached to the package just to minimize packaging and sustainability issues that come with that. Egrid, would you be happy if this just being included as a flyer and take away with the pre-bro? Sorry, if this was included as a flyer, like a handout. Yeah. Instead of just the pre-bro itself. I see. Right. Yeah, I mean, obviously if something's teeny, it's not going to be big enough to put all that writing. But I can go with it in some other way. I just don't noting that we don't, we say that it's can impair concentration of coordination and judgment, but haven't we previously spoken about impairing operation? Am I not of a vehicle? Am I not seeing that on here? Or did we? I know you have spoken about that in the past. I mean, I know it's sort of obvious, but I just... I think that's what they mean by coordination. Mm-hmm. Yeah. Yeah, I just, I mean, in fairness, you can be arrested for being under the influence of drugs when you're pulled over if you're driving in an impaired way. So I just, I don't know. I think that some people can have confusion around that. But maybe it's clear, goodness. You know, the material that came back from Department of Health has like six bullet points after following this paragraph. And one of them is about operating, driving or operating machinery. Mm-hmm. So I'm not sure if their intention was just to put that in the flyer or some additional bullet points on the, you know, on the package or on the advertisement. We'll ask David for some clarification on that. Yeah, I feel like operating machinery, a reference to that would be helpful. Okay, great. We will wait for the Department of Health to come on today and if not make those suggestions to them and come back to the subcommittee on Thursday. So we're just continuing with the product packaging that there needs to be the required warnings and then there's also inclusion of what the font sign should be. And then we have spoken about that, you know, so that people are able to read it with times the Roman, Helix or Ariel and voted, you know, keep out of reach of children. And then if a package contains multiple serving, it must be stated on the package as well in the same 10 point font. Ingrid, what do you think about that? Just give me a minute. So includes multiple serving. Yeah, I think that that's very helpful. Gina, you're on mute. Morning. Mark, would you do you want to take that? Yeah. Okay. So the morning, the morning symbols. I know a lot of people have kind of wondered about the language that we've just read and whether it's two down. And that's all debatable, although it's all good information. One thing that the studies have shown is that visual warning symbols are more impactful when combined with the language. So that's why we've spent so much time discussing this. We've debated back and forth about the color of the signs. And I think everybody agreed that they kind of liked yellow, but they were, you know, if it was not deemed to be as impactful, then we'll go with the white. So that issue was sort of left hanging like that. But everybody indicated that they were okay with the white in the subcommittee. And we'll be interested to see what the Department of Health has to say about that too. But it gives specifications for the size on a package label for the language on an edible marijuana product. And I think, you know, I'm curious to see what the Department has to say about that. Ingrid, you were involved in these discussions. Is this tracking with what you felt like we were the conclusions we were coming to? Yes, definitely. Also, I know, and so we see here that the Department of Health would like to include both the white label warning symbol and the yellow. I know that you were a very big fan of having the yellow, just that it stands out more. The reason why you're allowed to choose is just to prevent washing out from the color of the packaging. So if this was around a yellow background, you wouldn't be able to see it. So in cases like that, they would like the company to use the white label just so that people will be able to see it. So I think that that is a really good distinction because the last thing we don't want something being camera flashed. Also with the package label, they wanted a half an inch by a half an inch and then at least 25% of the serving's height and width but not less than 0.25 by 0.25. So that people are able to see it and that would definitely help us with some smaller packaging. So I think these are really sufficient. What are your feelings? If you're asking me, I think that all looks very good. I think this was a clever way to improve the views of all the subcommittee members. Giving some choices and there were any harm in doing that. Although I say you can't monkey with the size of the label or the design. So Ingrid, I was just seeing on the warning language that it does say it is against the law to drive or operate machinery while under the influence of this product. And then they have the national poison control centers number as well. So that language will be included. Okay. Good. That's right. We did have the poison control piece as well. So just to let you know that will be included on the warning language. And so obviously they have restrictions. You cannot modify, change this in any way, recreate it. It can't be smaller than the measurements that were indicated. And the colors can't be changed, et cetera. Or having a dark background so you can't see anything at all. So I think that that's really important. Yeah. And for now, Julie, have you heard from the Department of Health at all? I have not. I have not either. So those are the last things that we really need to discuss for the subcommittee. I do apologize so much that we do not have a quorum for this section or that our expert from the Department of Health is not with us at this time. Do we have any public comments that we can take that now? Do we have public comment? Yeah, I guess so. Yes, I think we do. Okay. Great. Also, Gina, if I can just tap at the end, if I can just add a couple of things. So we do like that now before public comment? Yeah, it's nothing big. It's really important for Dr. Levine to be here. So I'm willing to meet more. I just think his input is really valuable. I'd like to have both he and Tim be able to weigh in. Whatever is needed for that. Thank you, Ingrid. I appreciate that. And yes, we will definitely be having a Thursday subcommittee meeting if the two do not appear before the end of this one. And I will be holding on the line if necessary just to make sure that there aren't any other people of the public comment. Great. I'm Jill Tatoff-Garron, and I'm representing the 2,400 members of the Vermont Medical Society, the American Academy of Pediatrics, and the Vermont Psychiatric Association. And I just wanted to say that we're concerned about the timeline. We don't really understand where you're at with the timeline because it's really hard to gauge. We can't always be at the public meetings here. We're not finding all the documents online. So I see this October 20th milestone. And I don't know where you're at necessarily. So as far as we know, you're just working on the warning labels. But one of the things that we're really worried about is the advertising component. And I don't know if you've made those decisions or not. But for us, just advertising actually encompasses much more than just print ads or even social media. It's also the distribution of the dispensaries themselves and the locations in terms of when the evidence shows that when you have a dispensary in an area near schools or near where they are, they'll actually see the signs. And those signs will then show up in social media and they'll actually, it's a branding thing that works in terms of having a perception of reduced harm. And so that's one of our major concerns is that you're looking at advertising in a very broad way. It's also the names of things, gummies, cookies, things like that. They also are attractive to youth. So again, it's really hard for me to tell where you're at in adopting the proposed recommendations. But so I just wanted to say that we would urge you to really take your time. And we don't need to rush this. We really need to get it right because it's Vermaunders Health and it's our youth that we're thinking about. Thank you. Thank you. And I can give you a timeline update after this. Great. Often it would be great. Thank you. Thank you. Jim O'Wheel, there's another subcommittee that is considering the proximity to schools and churches and so forth that will pass your views along. Great. I still have nothing from either Department of Health or from Tim, so as an update. Ingrid, do you have any more comments or questions? So just to let you know again that the driving component will be added to the warning level and warning language. We have Dr. Jean. Yeah, but unfortunately in a car, the driver is in the other end of the garage, so I'm going to get it out of here. With kind of a knowing that there was a quorum, we've reviewed the proposal of the Department of Health and I'm sure there will be questions for you or take it if there were more subcommittee members here. Do you have any permission to share the presentation? You should have that ability still. I didn't change any settings. It could just be me. Natalie, are you able to share my presentation? Yes. For some reason. One second. I had just discontinued sharing and now I won't let me re-share. No worries. Give me one second and I'll bring that up. Dr. Larine, have you been able to read the minutes from the last few meetings? Yes, specifically. Not from the very last one. Right. Right, we realized that from the 14th. But we had meetings on September 27, September 30, October 4, where there were minutes taken and distributed. And if you and Ingrid are in a position to move for approval, that would be great. If you're not, we'll deal with that another way. And Natalie, am I able to gain control of the presentation? Maybe. You can give that a shot. I can certainly advance the slides if you just queue me up where to go. If you can go to the minutes slide, I believe it's page four. There you are. Can we approve Monday, September 27 minutes? I can make that motion. Thank you. Dr. Larine, can you start the motion? You may have gone into the garage. I think the one that says September 30, September 20, really is intended to say September 30. Yes, September 30, sorry. I can make a motion to approve that as well. Thank you. Is Dr. Larine there at all? I can second those. Okay. Dr. Larine, we couldn't hear you. Did you? That isn't the Monday, September 27 meeting. Anything at September? I heard him second that. I heard him second both of them. Okay. And Monday, October 4. I think we should wait on those if we can. I would wait on those. Okay. So for next meeting or are we able to approve those by e-mail? No. Okay. No. Okay. And Nellie, can we move on to the next slide? So for the Department of Health, we received the following information, Mark, about what should be on the running legal. Dr. Levine, are you familiar with this already? Oh, yeah. I'm going to guess, Mark, that Dr. Levine probably reviewed this before it left the Department of Health. Dr. Levine, is that right? That's correct. Yeah. So Dr. Levine, should we, are you happy with the recommendation of the warning on language from the Department of Health? And can we have, and Dr. Levine, both on acceptance of the warning language from the Department of Health? Dr. Levine? Yeah, but I would, I would certainly want my other two subcommittee members to be able to weigh in because they do come from my department. So they're more independent of the department. Yes. Great. Can you share your thoughts again about the warning language? Yes. So on the bottom, we'll also include that you should not be operating the driving. Okay. So as this was written, I thought it looked really solid. I did think that it should have the added language about operation while impaired that we have spoken about or seen in previous meetings. And then I had forgotten about the poison control phone number reference. Where would that stand, Gina? Underneath it, it will say it is against the law to drive or operate machinery when under the influence of this product. And national poison control sensor is 1-800-222-1222. It looks from, at least the paper has imprinted out on my computer, that that is a separate sense below the rest of the paragraph. It is a separate sense. And then the only comment that Ingrid did make is to both that it may take, the effects of cannabis may be delayed by two hours or more. Yeah. And perhaps, and Dr. Delavine, I know Ingrid, you said maybe not having, this is a cannabis product and has not been analyzed or approved by the food and drug administration, it might be able to go lower in the paragraph than at the beginning. Again, it's just sort of a gut reaction that while that's important, I think what's more practical is that the effects of cannabis may be delayed. And so in my simple mind of how I look at this, if that might be more effective, it's higher up or bold, as Gina mentioned. Ingrid, are you okay when having the first sentence, this is a cannabis product and has not been analyzed or approved by the FDA? Am I, are you like that further down? I think that's a good sentence. I think we definitely need to include it. I guess I would be comfortable if we just emboldened or made the effects of cannabis being delayed, have that be bolder or somewhere where it's more catchy. Because that is, I think, really important information from a practical standpoint, even more so than whether or not the FDA has weighed in on this. Yeah, Dr. Levine, are you okay with just bolding that information? Yeah, I mean, you got to start out by saying this is a cannabis product, so that's kind of stuck with that. So anyway, it's the goal of the FDA. That's, you know, that's really meant for the edibles. More than any other form. Agreed. Dr. Levine, we didn't mention that earlier today that that specifically is for edibles. Yeah, that's okay when it would be immediate effects. So, since we had you and Ingrid on the line, can we both on the morning, one way from the Department of Health should accept those? That? Dr. Levine? Ingrid? Yes or no? Yes. Thank you. And Dr. Levine? Yeah, I don't, you know, I'm only seeing it through my phone, so I'll take your word that it accurately represents all the track changes and everything else or in the original document. I can read that for you. No, no, no, if it's true, if it's the same as what I'm seeing in my phone, that's fine. Again, I just want my other committee member to be able to weigh in because I don't want it to look like the Department of Health sort of set this up as the rule without having non-department of health members be able to agree. Yeah, and this is a lot of the language that has been discussed by the subcommittee during the past few weeks. So I think this really coincides with what everybody would like with some additions from what we heard with Omar last week. And Ingrid did comment that, you know, she was in agreement with the FDA comment that Omar raised which you have included in the morning language. The morning language right now. I think it still remains to be seeing what their intention was with the two hour delay statement and whether that should be clarified. Well, that is quite a bold remark because it can take up to two hours to build effects if you have an edible. Yeah, I know. And that's really the only circumstance under which there would be that kind of delay that I'm aware of, but it's just kind of hanging out there. Well, it's included in it as an overall warning and may not be appropriate for a lot of cannabis products. I think because they're not going, they just want one set of morning language and not have it differ from each package that that's why it's included and probably just be the vast included all then start subdividing between, okay, if this is a smokable product versus an edible product. And Dr. Levine, is that your thoughts on that? It is, but I understand remarks coming from Levine. One could say the effects of ingested, I guess you can suppose, does the word ingested generally mean always something you would eat as opposed to breathe in or take it in another form? You could just say the effects of edible cannabis. Yeah, true. Are you happy with making that revision, Dr. Levine? I just think so. Okay, Ingrid, what are your thoughts? I think I'm following, yeah, I'm fine with that. Okay, so let's re-vote on this with the morning language. We will make in bold that the effects of cannabis may be delayed by two hours or more, but also changing that sentence to say the effects of edible cannabis may be delayed by two hours or more. And have that in bold. So both yes or no, Ingrid? Yes. Thank you. And Dr. Levine? Yes. Wonderful. Can we just go on to the next slide, Nellie, please? Thank you. And the product of packaging should have the required warnings and it should be capitalized in at least 10 points times the Roman elix or aerial. Keep out of reach of children and if a cannabis product includes multiple servants, that should also be in the same 10-point bond and voted. Ingrid, can you please follow on that? Yes. And Dr. Levine? Yes. Thank you. Thank you so much, Nellie. And that these are the acceptable warning signs that need to be included on a package. So it will either have the white wash or the yellow, depending on the package background because we want to be sure that there is no climate harsh. The packaging and labeling needs to be 0.5 inches by 0.5 and then the edible products have at least 25% of the servings height and width but not less than 0.25 by 0.25. And the required colors are the yellow and the black with the red rim around it or white in the center with red around it and black lettering and that it cannot be recreated, modified at all. It shouldn't be stretched or distorted. You cannot use less than the measurements indicated and you cannot change the colors or include it on a dark packaging. Ingrid, please vote. Yes. Thank you. And Dr. Levine? Yes. Thank you. So we have finished that portion out and I know that Julie had some messaging and Julie just one of the questions is that we still have two minutes that would need to be approved but as of right now we have concluded all the material work for the subcommittee. So how, what are our next steps forward? Is there one other discussion item about the oversight for edibles production? Yes. Whether we would accept the recommendation that edibles would be overseen by the Department of Health, Vermont Department of Health. Is that what you're talking about, Julie? Yes. Yeah. That is a decision that needs to be addressed as well. Ingrid, what are your thoughts about that? Are you okay with that oversight? Yeah. Okay. Dr. Levine? Dr. Levine, are you there? Julie, maybe you can give us the set forward while we wait for Dr. Levine to get out. Sure. And we need to perhaps we'll have to do one that may be a shorter meeting on Thursday to address this and then approve the other two sets of meeting minutes. But so my statement was just that as a reminder that this is not sort of the last step in the process, it's the first. So the recommendations that are coming from the subcommittee will now go to the CCB and we'll be going back to our rules. So we'll come back to some advisory, full advisory committee meetings when we have substantive information to share. I don't think we've scheduled those dates yet, but I know that is part of our plan. And then once we do draft our rules, there's additional public comment time within the rulemaking process. So in terms of making sure that we're getting some input from those who are not in this department's public health and getting input from the greater members of the public, there's still lots of opportunity for that. Thank you, Jerry. Dr. Levine, are you on the line? Dr. Levine? Well, we will have a call on Thursday to discuss the oversight, a manufacture of edibles to the Department of Health and to approve the minutes to previous minutes and today's minutes. Are you okay with that, Ingrid? It'll be shortened if we should schedule about a half an hour. That's good for that. Okay, great. And then you don't have to move to adjourn right now. You can just call adjournment. Okay. Are there any public comments with some of the public comments before we leave? Other public comments? All right, good. And that's it. Okay. We need to adjourn. Thank you. See you on Thursday. Thanks, everybody.