 and welcome to Connecting Hawaii Business on Think Tech Hawaii. My name is Kathleen Lee, owner of Kathleen Lee Consulting, and I am your host for this program. Think Tech Hawaii is currently live streamed on ThinkTechHawaii.com as well as on Think Tech Hawaii's Facebook and YouTube pages. And for viewers like you who are tuning in today, you can send us questions while we're on the show. Two questions at ThinkTechHawaii.com. For today, I am excited to introduce an individual who will be furthering the conversation about legalization of cannabis. I can't even say legalization right, sorry Dr. Otto. Legalization of cannabis in Hawaii. We have Dr. Clifton Otto of Cannabis Healthcare Hawaii. He is a cannabinoid medical medicine specialist. I hope I got that right. Dr. Otto, welcome to the show. Well thanks Kathleen. I appreciate you inviting us. Absolutely, and thank you for reaching out to us as well. Again, we're always about discourse and expanding conversation regarding legalization of marijuana. But before we go into that, tell us a bit more about yourself, your professional background, as well as how you got into this space. Sure, so I am what you would call a cannabinoid medicine specialist. This is something that I went on to get additional training after medical school because we don't learn anything about medical uses of cannabis or any cannabinoid system in medical school. So I went on to do a CME training in cannabis medicine and became certified by the American Academy of Cannabinoid Medicine to further my knowledge of how to best serve patients here in Hawaii. I've been practicing cannabinoid medicine since about 2013 and originally got into this whole topic around 2010 because of a family friend who was undergoing cancer therapy and turned to cannabis to help live whose nausea and loss of appetite that was in my opinion really threatening his life and his recovery. So that was kind of my first experience. I went on to do research on my own and it was amazed at the amount of research that's been done on the medical uses of cannabis, especially back in the 70s, and then started researching the law and became a bit of an advocate and that's when I started to get involved at the legislative level. 2011 was the first year that I was able to help with a bill that got introduced by Senator Sparrow, SB 113, which was actually a cannabis research bill, which kind of reflected how naive I was at the time because I ran right up against the federal issues and the federal conflict that we're still dealing with today. So as a result of learning about the law and the position that our patients are in, that's what really motivated me to become a bit of an advocate for our patients because of their current situation. Got it. And Dr. Otto, could you tell us a bit more about cannabis healthcare, Hawaii, and the Akamai cannabis clinic? Well, yes. So as I mentioned, I've been working with the legislature since about 2011 and originally did not want to do certifications with the program because I was afraid that this might stigmatize me as a pot doctor and I wanted to be able to approach our legislatures in a way that would be respected and I soon realized that it didn't matter what I was doing. If I came to them talking about medical cannabis reform, the door was just getting slammed in my face. So after a couple of years, more and more patients started coming to me and saying, if my medical doctor will not talk to me about this, they will not certify me, cancer patients, PTSD patients, chronic pain patients. And that's what really motivated me to take that step and become a certifying provider, which is a very challenging position in Hawaii because we are required to have a doctor-patient relationship with our patients, but we are not providing treatment. I tell my patients I cannot recommend the medical use of cannabis until there's an FDA approved botanical substance available in our pharmacies. I certainly can't write prescriptions until then. But I am able under state law to have a confidential doctor-patient relationship and to provide educational information for patients. I approach this from a harm reduction point of view, trying to help patients use cannabis safely and effectively under their right to decide what happens to their body. And patients are in desperate need of education on this subject. I'm afraid that even now a lot of providers do not have the knowledge that our patients really need for on-going supervision. So that's why I opened originally a cannabis health care Hawaii to try and promote this idea that cannabis could be an integral part of sustainable health care here in Hawaii. And then also adopted the name Akamai Cannabis Clinic to also further raise awareness about patients and their needs to have a safe environment in which they can talk about medical cannabis and get suggestions for products and dosages and have on-going supervision. So that's how that all kind of evolved. Thank you, Dr. Otto. I know you had mentioned, I think through our correspondence that legalization of cannabis or marijuana is a bit more intricate than what it seems. And I think the first question that I had thought of when you brought that up was I know you are an advocate for usage of medical marijuana, but I would like to get your thoughts on legalization of recreational marijuana, which I think was where that conversation may have been going. That made you go, okay, I need to say something about this. Did I get that correctly? Sure. And through our communications, I was trying to let you know that there, as you mentioned, there's more depth to this than I think is really being discussed. And one thing I've been trying to promote is this authority of our state to decide how controlled substances are used within the state. That's what allowed us to create a medical cannabis program back in 2000. And the problem is that we never went back to the Department of Justice or the DEA and said, hey guys, this is a constitutional authority reserved to the state. We have exercised this authority, but the problem is it's creating a conflict with the federal regulation of marijuana, which has been impacting our patients in the past 21 years and is now impacting our dispensaries. And so that's what I think the discussion needs a little bit more of a different perspective, because I believe that we need to protect this authority of states to decide how controlled substances are used within the state before we move on to a broader authorization, such as recreational or adult use. Thanks, Dr. Otto. And you bring up a good point that I did not even think about. I know that was brought in the discussion in the last episode, whereas federal regulations definitely do affect patients. But for me, and maybe for some viewers out there as well, how would it affect patients who are currently using cannabis for medical use? Well, so right now, you know, we talk of the cannabis industry. But in my mind, an industry requires businesses that are legal and legitimate both at the state and federal level. And that just isn't the case across the entire nation. And so as was discussed in the last episode, dispensaries are considered to be continuing criminal enterprises at the federal level, which means they are not able to deduct their standard business expenses from their federal tax returns. And as was described, that can result in a federal tax burden of up to 70%. Most of the businesses will not be able to operate at a 70% tax burden. And so this cost, at least some of it, is most likely being passed on to our patients. So our patients are being made to carry this burden of this ongoing federal conflict, which means it seems the exact opposite of what should be happening to our patients. And so that's another reason why I have a little difficulty when we'll just talk about in cannabis industry, because I think that focuses attention more on the business entities and what is best for them. And not necessarily focuses on our patients and the discrimination that they are experiencing every day. I mean, I get calls almost on a weekly basis from patients who are losing their job because they're failing a drug test that's meant to test for cannabis impairment at work, but it's picking up levels of THC and they're wearing like to be there for weeks. Parents who are losing custody of their children because the judge is biased against any cannabis use. And the one that I recently came across is Native Hawaiians who are scared to death to grow their medical cannabis on Hawaiian homeland because they're being told to do so to violate their lease agreement. And you probably know how difficult it is to get Hawaiian homeland leases. So our patients, medical cannabis native Hawaiian patients who want to be able to grow their own organically grown cannabis medicine for themselves are fearful to do so. And you know, if nothing is going to make your blood boil, then that I just don't know what will. So these are the things that I'm encountering. And I feel that we need to address these issues first. And one way to do that is actually to stand up for the state's authority to decide how controlled substances are used within the state, which I believe would not only benefit patients, but would also benefit the disclosures. Dr. Otto, we are going to go on right, but when we return, we will continue this discussion. So we'll be right back. I'm Joshua Cooper and welcome to Cooper Union. We look at what's happening with human rights around the world. And we invite you to tune in every Tuesday, where we feature the voices of the people from the front lines, sharing the struggles for self determination for the importance of sustainability and solidarity with one another to make the world a better place for all of humanity. If you can't catch it live, you can also look at thinktechhawaii.com, as well as on Vimeo and many other places to catch the amazing shows where we hear from authors, activists, academics, analysts, and artists who are contributing to positive social change around the planet. Alohime Capono, thank you for joining us for justice. Welcome back to Connecting Hawaii Business on ThinkTech Hawaii. My name is Kathleen Lee and my guest for today is Dr. Clifton Otto. We are talking about the legalization of cannabis in Hawaii. And Dr. Otto at the first half of the show brought up some points, particularly from the patient perspective, when it comes to legalization. So Dr. Otto, can you expand more on that? But let me rephrase my question. I know during the break I had mentioned that it seems like you and our guest on our last show seemed to be on similar wavelengths when it comes to the idea of cannabis helping people out, especially when it comes to medical use. Where do the paths diverge when it comes to matters of opinion? Let's start with that. Well, so yeah, I would agree that ultimately we all should be in this for our patients. And perhaps part of the divergence is caused by the fact that the dispensaries by their very nature, their commercial enterprises. And so they need to think about the bottom line. And those had a very difficult time. I mean, imagine all the application process they had to go through, the selection, the funds that they had to make available. And then you have to wait an entire year without even being able to open. And then you're paying your first renewal fee without even having opened your doors. On top of that, there's a regular sort of structure that I think is very difficult and constantly changing. And so this puts the dispensaries under a lot of pressure, financial pressure in addition to the federal situation. A couple of years ago, state law was changed to allow outside investors to gain interest in the dispensaries. And I suspect this is done because a lot of the original investors just kind of got over their heads. They didn't realize what was going to be required to get this up and running. And the danger of that is that we could have outside investors and operators gaining control of our dispensaries and directing the narrative as well as the commercial motivation. Meaning applying mainland sales models to Hawaii that can put unnecessary pressure on the dispensaries themselves and on the dispensary staff. Right now about 37 to 38% of patients are currently using dispensaries. That also puts a lot of pressure on the dispensaries. But there's a reason for that. And that's because patients want certain quality and certain involvement in the production of their own medicine that the dispensaries are not able to provide. And patients tell me that there is a real satisfaction that comes from being able to produce their own medicine. So I was asked by the Department of Health to be the certifying position on the original Hawaii dispensary task force. And on that task force, one of our recommendations, one of the things we talked about was creating a horizontal model for Hawaii's medical cannabis program. Meaning that you had multiple cultivators and producers who could contribute to a central distribution system. And then the idea is to make a variety of locally made high quality products available to patients at the lowest cost possible. Unfortunately, that got changed behind closed doors at the legislature. And we now have eight vertically integrated models that the dispensaries themselves have recognized is not sustainable. At the very least, they need to be able to exchange material with each other to help with production difficulties or losses of crops or demand differences in demand between the islands. So I think for the dispensaries, the idea of recreational legalization can appear to offer a solution because it allows for a lot of customer base and the ability to produce more product and increase revenue, which will get them out of this hole. But I think as we realize, the vertical model is not the correct model for Hawaii, especially in a state where we have some of the best sunlight in the world. And we should be growing this outdoors. Plants should be in the ground, maximum use of the nutrients available in the soil, and the natural UV radiation that this cannabinoid and terpene production, which is an integral part of the medicine. So I think perhaps that's where some of the divergence exists. How do we get to a place where the dispensaries are successful? I think the answer is focusing on medical use. I believe in the long run, the real potential, both for taking care of our patients and providing for a commercial benefit across the community, is to focus on medical use. And I'm talking about interest state medical use, where we could be using high quality, even FDA quality, mechanical drug products that are available only in Hawaii for sale and use in Hawaii. I should point out that the original medical cannabis bill in 2019, an introduction, one of the paragraphs said the intent is to make Hawaii an international treatment and research center for cannabis. And I believe the way to realize that is to medical use. Now, the state could certainly authorize recreation use if it wanted to. But waiting for the federal government to legalize this and put ourselves at the mercy of federal guidelines and regulations that we've already seen having negative impacts upon state hemp programs. I think that's where the divergence is. Can you expand more on those hindrances? Well, so right now we have the more act in Congress, moving through Congress, which would legalize cannabis, take it off the control substance act. But it also creates a variety of federal, new federal agencies. It creates a national cannabis tax that would ramp up to 25% over three years. And it could potentially interfere with our state's ability to decide how cannabis is produced within the state. I wish that Congress would just say, it's up to the state to do what they want with cannabis if they want to make it illegal. That's up for them. If they want to authorize adult use, fine. If they wanted to stick with medical use, that's up to the state. And as long as it stays within the state, that's none of our business. If it's going to start crossing state lines, then of course, under state commerce, the feds and the FDA would have to get involved. But I think we have a very unique opportunity in Hawaii because we are an island state. We can control our lawyers better than any other state. We could have very high quality research and products produced within the state for strictly for medical use. And we are just at the beginning of understanding what the medical potential of it is for cannabis. It is nothing like alcohol or tobacco, I can tell you that. This is a powerful medicine and I believe we need to respect it as such. So with you being in this space, what are the biggest challenges that you run into when it comes to educating people or delivering your message? Well, I think the biggest challenges I'm kind of pretty much all on my own in the middle. On the one side are people who think that cannabis is evil. And on the other side, folks who think that recreational legalization is the only answer. And I believe it by focusing on our patients and correcting the current difficulties they're having and ensure that dispensaries are open and patients have access. But the discrimination that they are facing is just unacceptable. And I have been trying to educate on this topic however I can. And I think quite obviously from the last session, our legislature got it. For the first time in the existence of our medical cannabis program, we had unanimous approval of a resolution in both chambers that asks the Department of Health to file a federal exemption with the DEA to exempt the state authorized use of cannabis in Hawaii from controlled substance regulation. So it would remove this conflict with the ongoing federal regulation of cannabis as a federal and controlled substance. Now, some people say that was just a resolution. It's not binding. But this was a significant event and I really have to take my hat off to all of our state lawmakers because this is the first time they came together and said, this situation is unacceptable. Maybe we realize at this point that our governor is not in a position to stand up for our state's authority to decide how cannabis is used within the state. But we realize that this is something that is not helping our patients or our medical cannabis program. And we would like the Department of Health to do something about it. So that's how I have been working to try and educate and try and move this issue forward because I think all of us have a responsibility to help our patients. They are not in a position to help themselves. They need our help. Thanks, Dr. Otto. And so again, your perspective is absolutely valued and I appreciate you like shedding the light on that. Do you see a path somewhere down the line, whether it's like 10 or 15 or 20 years from now for both medical and recreational cannabis to be legalized? And if so, what would that look like? Well, so yeah, I think the feeling that a lot of us are getting is that recreational legalization is coming. And I hope that it's something that is not forced upon us. I hope it is something that we can decide as a state is the right thing for Hawaii. And in the meantime, making sure that our patients in our medical pet program are protected. That's why it's so important to get on this now before there's any significant federal action. Because some states, when they legalize recreational use, they just kind of fold their medical program into the recreational program. And products that are meant for adult use are not necessarily good enough for a patient. You know, it's kind of the difference between homebrewed alcohol and medical grade ethanol. They might require different standards and different testing for contaminants. But that being said, cannabis is an agricultural product. And we have patients who have been using this for decades in Hawaii, patients who are masterful at cultivating their own cannabis and producing products that it doesn't seem to be harming anybody. So we have to be careful about finding a balance between protecting our patients and over-regulating the production of cannabis and recognizing its use as an agricultural medical product. I hope that we can move in that direction to expand its production in an organic fashion, in a natural fashion that can produce the highest quality cannabis in Hawaii, which would definitely benefit our patients and would certainly benefit a adult use market if that's something that our state wants to pursue at some point. Dr. Otto, is there anything else that you would like to add in our last few minutes of our very educational talk today? Well, I would just like to encourage people who feel that something needs to be changed in this area, encourage our patients. First of all, thank the state lawmakers for adopting this resolution, HCR 132 last session, and encouraging them to take further action. I believe our state lawmakers want to do the right thing, but they're hesitant to stick their necks out if patients are not willing to fight for what they believe in. Well, I would encourage people to take action and politely and persistently pursue this with their state lawmakers. Wonderful. And if we can pull up the website for cannabis health care Hawaii, Dr. Clifton Otto, how may people get a hold of you if they want to learn more, or if they just want to talk to you to continue this conversation? Yeah, they could just go to my website. I have all my contact information there. I answer all my phone calls directly so you don't have to worry about getting stuck with a receptionist and maybe not getting called back for a couple of days. Please contact me. I'm happy to continue the discussion. Wonderful. Thank you again so much for joining us today, and I really appreciate you reaching out again. I love the discourse, especially when it comes to this, since I feel like it should be talked about R. So, Dr. Otto, thank you for coming today. We also want to thank Jay Fidel and the entire staff at Think Tech Hawaii for making programs like this possible. Eric helped us out today, so thank you, Eric. And until next time, aloha.