 My name is James Pepper. I'm the chair of the Cannabis Control Board. Today is June 24th, 2021. It's currently 9.32 and I'm going to call this meeting to order. I've got a few administrative details before we move to the agenda. First, as I mentioned last week, the governor lifted the emergency order. We're going to continue to hold these virtual meetings, which, you know, we all feel increases the accessibility of the board, but now we are also going to be present in a physical space with at least one board member present for the near future. And so today, Kyle and Nellie are coming to you from the second floor conference room in the Agency of Agriculture in Montpelier. So if anyone would like to meet Kyle in person, you know, he and Nellie will be there until about 2 p.m. today. And just a huge thank you to Secretary Tevitz and his staff for their hospitality and joining us or hosting us. Sorry. In related news, the board officially has an office space. I don't think we have any furniture quite yet, but we will be located at 12 Baldwin Street in Montpelier. So thank you very much to BGS Commissioner Fitch and Marco Grady and to all of your staff for your help in standing up our board. We also have a new job posted for the board. We're seeking an administrative services manager, essentially a business manager for the board that will oversee our budgeting, our fiscal processes. It will develop our organizational structures as we grow. It will collaborate with kind of our partner agencies and just generally manage all of our administrative functions. So the job description is currently posted through the state's HR website. It's posted on LinkedIn, Facebook, jobsinvermont.com. It will be on our website shortly and we are going to be doing some print advertising and some other advertising strategies. So if you know, if you're interested or if you have anyone interested in that position, please forward it along and we encourage anyone to apply. So again, as I mentioned last week, we are going to continue to hold special meetings but on a regular schedule until we formally adopt a regular meeting schedule. We started to put pen to paper onto what that could look like and will likely adopt something as soon as our executive directors officially starts. And so with the exception of next week, when we are going to be taking a week off of public meetings, we're going to continue to meet at this rough time frame, Thursdays 9.30 to about 2 p.m. We recognize as a board that this is not ideal for everyone given the demands on people's time during the workday. But our regular meeting schedule will likely include some after-hour meetings to increase public participation. So moving to the agenda, we're continuing our work to hold meetings dedicated to the priorities that we've identified in Act 164 and Act 62. Last week we heard some very compelling testimony about how the board should be thinking about social equity and agricultural equity, economic equity, as well as we heard from some national experts that really helped orient us to what's been working in other states, what has not been very successful, and how we should be thinking about supporting equity in this industry. Today, we're going to be focused on the Vermont Medical Use Program. This is an issue of particular importance to the board who will be taking over the medical program on January 1st, 2022. I would like to acknowledge that there is a tremendous amount of anxiety about continuity of services and products for patients during this transition, as well as when the current dispensaries are allowed to enter the adult use market. I've been working with the head of the medical program and with the commissioner's office at DPS to ensure that this transition will be seamless. And I actually would like to think that this is an incredible opportunity for us to reimagine or to refresh the medical program. So, today we're going to hear from representatives from the dispensaries, including Meg Delia, who will be serving on our advisory panel. And they're going to be talking about some of the history of the medical program in Vermont, some of the current challenges that they are facing. And I'd just like to take a moment to acknowledge all the incredible work that the dispensaries have done over the past decade or so at great personal and financial risk to themselves. And I've always really been impressed with their commitment to patients, their advocacy to increase access to reduce costs. And over the last, I don't know how many years, I've consistently heard from them that their business model is not exactly profitable. And that gives me some concern as we think about the long-term viability of the medical program. On the flip side, I've consistently heard from Vermonters patients, caregivers that the dispensaries are not affordable. And that given the limited number of them and their kind of geographic locations that they're not particularly accessible. So we're going to hear from patients, patient advocates, caregivers about some of the challenges that they're facing and how we might be able to develop a more patient-centric program. Finally, we're going to hear from the chair of the marijuana for symptom relief oversight committee as well as the Vermont Medical Association appointee to that committee. This is a group that's been tasked with making recommendations to improve the quality and accessibility of the medical program. They've been given a new task for the immediate future to kind of reimagine what the board should look like and to be a conduit really for the voices of patients and caregivers. And they've been given a seat on our advisory board. So I apologize for the long introduction, but I really think that this is an important moment for the Vermont Medical Program. I've seen over the years some resistance to making wholesale changes to the program. However, with the kind of advent of adult use retail cannabis looming, this is actually the perfect time to rethink the program, think about what's working, what needs improvement, and fundamentally how we as a board should create a patient-centric system that's high quality, affordable, and accessible. So these, just repeat something that I said last week. These initial conversations are really to orient the board at a very high level to some of the priorities that are in Act 164 and once in 62. I've spoken with a number of patients and caregivers that could not join us today, but would like to make sure that their voices are heard. So our plan is to do extensive stakeholder engagement with our advisory panel, with our advisory subcommittees, and with the public. Once we have those entities in place and we have our executive director in place. But if anyone listening would like to reach out to us, we have an online portal to submit comments to the board, and we will continue to hold these public meetings. So please feel free to reach out to us in any way you can. I'd like to move now to the agenda. We're a little bit behind schedule. We have a few issues that we need to do, approval of minutes. So our draft minutes are posted on our on our website. I'd like to just ask for a motion to approve the minutes from uh 61721. I move to approve the minutes from 61721. I'll second. All in favor. Aye. Okay, and now we have also on our agenda, we have to approve our organizational structure. Nellie, if it's not too difficult, would you mind just pulling it up on the screen briefly? 20 seconds. So our organizational structure, we have, I think, where we will eventually have, when we assume the medical program, 10 employees. And this is a organizational structure that we kind of worked out that, you know, has the executive director kind of at the top of the chart answering to the board, and then kind of a pyramid of beneath that. Looks like it's coming up now. Okay. So this seems to make the most sense to me. So I would entertain a motion to approve this organizational chart. I don't know if it has necessarily a title, but um. So I will move to approve the organizational chart as presented for the cannabis control board. I'll second. All in favor. Okay. Um, so I, sorry, uh, the, um, that's it for the kind of administrative aspects of our agenda. I would like to move to the witnesses just because we're running a little bit behind schedule, but uh, Julie and Kyle, would you like to make any, uh, kind of opening remarks before we do that? No, I would like to start hearing from the witnesses, I think. Likewise. I think you covered it in your initial remarks. Mr. Chairman, so thank you. Okay. Well, do we have her? Yes, we do. Virginia, um, and Meg, thank you so much for joining us. Um, if you wouldn't mind just kind of telling folks who you are and then get into, um, the, you know, your testimony. Well, good morning. Thank you so much for, uh, inviting me and I also want to thank the board for having a day focused on the medical program, which I truly believe is a important program for many, for monitors. Um, I'm Virginia Renfrew. I'm with Satsen Renfrew Consulting. Um, I don't know, do you want Meg to introduce herself before I get going, chair or? Uh, sure. That'd be great just so everyone knows who's on the screen. Okay. Good morning. My name is Meg Delia. I have been an employee of series med, previously Champlain Valley Dispensary for almost four years now. I also serve as a representative of the Vermont Cannabis Traits Association. Thank you. So, um, just a, I'm going to kind of do an overview, the historical overview of the medical program. Um, so in 1998, Gail Sats and myself started Satsen Renfrew Consulting. And one of our first clients was the AIDS service organizations and people living with AIDS. And what I kept hearing from the coalition, people living with AIDS was that they really wanted to be able to use cannabis legally, that they found that it relieved the symptoms from the disease and also from the medication that they took. And they lived in fear of being arrested and sent to jail because of this use. So in 2000, there was a bill that was introduced in the house, the first cannabis, medical cannabis bill. And we found that we actually had support from all three parties. And this was not in any way a partisan issue. So we were successful in getting it out of the house. And then it went to the Senate. And unfortunately, we, uh, we failed in the Senate. But what we did get out of the Senate was to form a task force to look at the issue and then report back to the legislature. And on that task force, there was no legislators on the task force. It was made up of patients, caregivers, healthcare professionals and law enforcement. And there was some very lively discussions and debates that went on around that, on that task force. And the majority of the task force supported moving forward with a law that would protect patients from using cannabis. So in 2002, Senator Dick Sears introduced a bill that would allow this, allow medical marijuana. And that bill had a broad range of qualifying conditions. It allowed a patient to have up to seven plants. And it had the registry in the Department of Health. The bill passed the Senate and when it went to the house, they narrowed that bill. And they decided that only patients with HIV, MS and cancer would be part of the registry and that they could have two immature plants and one mature plant. And they also put the registry with the Department of Public Safety. Now the reason they did that was because the Department of Health came in opposing the bill and also saying that they would have nothing to do with the registry. Now both bills allowed a registry patient to buy from the illicit market and not be charged as long as they didn't have more than an ounce on them. So that bill did pass both bodies and it went to Governor Douglas and he allowed it to become law, but he didn't sign it. And at the time he made the comment, I cannot actively support a measure that allows Vermonters to be subject to prosecution under federal law, increasing the availability of a controlled substance and sends a dangerous message to our children. The law was the most restrictive one in the country and unfortunately it still is today. In 2006, there were 30 registered patients and five caregivers. In 2007, patients went to the legislature asking to have chronic pain added as a qualifying condition. And because of their testimony, the legislature supported that. And so chronic pain was added and they also increased the number of plants to seven immature into two mature. In 2009, there were 219 patients and 42 caregivers. What I kept hearing from patients was that they wanted to be able to go somewhere to actually buy their cannabis and they didn't want to be out on the streets buying it. Many of them had tried to grow it. They had failed. Some lived in housing where they were unable to grow it because they were renting. So they basically wanted to have dispensaries. And at that time, the Department of Public Safety did a survey of the patients and the majority of those patients wanted to have dispensaries. So in 2011, Senator Sears and Senator White introduced a bill that would allow four medical cannabis dispensaries. One condition to that program was that it had to be self-sufficient and not dependent on the general fund. So the bill passed and the governor signed it into law and there was a $2,500 non-refundable fee for applying for a license. And then when a license was issued, there was a $20,000 fee for the first year of operation. And then after that, it's $25,000 a year. And this program has never used any general funds to fund it. It has been funded through the dispensaries, the patients, and the caregivers. And I think, as you have heard, that program has had more money than they need to run that program. And unfortunately, a few years ago, there was about $300,000 that was taken out of that fund to put into the general fund. And that definitely caused quite an outrage. But there was really nothing that we could do about that because special funds can definitely be dipped into by the administration. So DPS put together a group to review the applications that came in for the dispensaries. And that group consisted of patients, caregivers, and law enforcement. In 2013, three dispensaries opened. In 2012, there were 648 patients. In 2014, that number had doubled. When the dispensaries opened, patients could choose to either grow their own or go to a dispensary. They could not do both. I think it's important to note that when the bill was moving through the legislature, the department of justice sent a letter to the governor stating that the federal government could come in at any time and seize the properties of the dispensaries. Vermont chose to move forward with the bill. But there were so many unknowns for those that were applying for these licenses. The IRS didn't recognize them as a nonprofit, only the state did. No banks would handle their money, so it was cash only. And certainly as a nonprofit, normally you would file for a 501C3, but because they were not recognized, they never were able to get that status. At the end of 2014, the dispensaries formed the Vermont Cannabis Trade Association. And in 2015, Zassen Renfrew started to represent them in the Vermont legislature. Since 2015, there's been some changes to the law. They have added delivery. They expanded the definition of healthcare professional to include licensed natural path physicians. They decreased the length of the bonafide healthcare professional patient relationship from six months to three months. And they removed the three month requirement for patients with terminal illness, cancer, AIDS, or currently under hospice care. In adding to the qualifying conditions, glaucoma, Crohn's disease, Parkinson's disease, and PTSD. And they also allowed an individual, I'm sorry, allowing a minor to have two caregivers. Anyone over the age of 21 can only have one. When they added the PTSD, that was a big battle. And there was a patient who came in and gave incredible testimony. He had been in the Iraq war and suffered from chronic back pain due to a wound and then also from his PTSD. And unfortunately, if you look at the law, you'll see that it's only someone who has a qualifying condition of PTSD that has to go both to a medical doctor into a mental health professional. Two forms have to be signed for those people. And so I would ask, I know that Meg is going to be talking about different things, but I think that's something that we should think about of why are we treating a mental illness differently if we're trying to talk about the overall health of an individual. They removed the requirement that a patient's application be notarized, and they allowed patients to both cultivate at home and purchase from a licensed dispensary and remove the requirement that patients have a locked container to transfer their cannabis purchases. So in 2018, Vermont legalized cannabis and allowed anyone over the age of 21 to grow two mature plants and possess one ounce. Since the law took effect, we have seen the number of patients decrease. Previously, before it was enacted, the program was growing each year. We knew that there were approximately 500 patients on the registry who only grew. That's the only reason that they were on the registry. They didn't use the dispensaries. So we knew that once this law passed that those 500 people would drop off because why would you want to pay a fee, have to go see your doctor every year? So we anticipated that. What we didn't really anticipate was how the illicit market really exploded in Vermont. And today you can buy anything out there. If you want to get edibles, if you want to get a vape pen, you name it, it's out there. And I really believe that there are people out there who are buying from the illicit market who are using it medically. But because we have so many hoops, people have to jump through to get into this program. It's easier for them just to get it off the streets. And I think what we have to think about is what harm is being caused to those individuals when they're buying from someone who is not making sure that that product is a safe product. I want to close with saying that I am very excited that this program is moving under the Cannabis Control Board. I think that in order for this program to remain viable, it needs support from those that are overseeing it. And so I truly welcome this move. Thank you. Thank you, Virginia. I've got some questions that are probably specific to you, but I think it makes sense for us to hear from Meg first and then ask questions to the both of you, if you don't mind. Absolutely. Yeah, that's fine. Great. Thanks. So Meg, and thank you, Meg, for your willingness to join our advisory committee. Well, the committee has a few names or a few members that have yet to be named, but we'll start kind of an orientation with the advisory committee somewhat soon. Great. Well, thank you. I look forward to it. And thank you for having me here today. As Virginia mentioned, the medical program, of course, is foundational in Vermont's cannabis industry. However, for the dispensaries providing that service to the people of Vermont has absolutely had its challenges. As states across the country have expanded their medical programs, Vermont's really has remained frozen in time with far too many barriers to access, resulting in a decreasing patient base and potentially an unsustainable program. Now that cannabis is legal in the state of Vermont and has been since 2018, it just doesn't make sense to keep having such a restrictive program. The 2018 legalization of cannabis had a significant impact on the medical program, as Virginia stated. We lost about 500 people who left the program because they no longer had to be registered to grow. We also, of course, saw the illicit market explode with product. With the restrictive nature of the program and the robust illicit market, the medical program has drastically declined. Simply put, it is easier for Vermonters to grow at home or purchase from the illicit market than it is to sign up with a Vermont marijuana registry. Moving forward, we would like to see the program grow to incorporate two to three percent of Vermont's population. But to do this, we really need to address the barriers to accessing the program. Medical patients are constantly confronted with significant barriers to access, including a lack of knowledge about the program, limited qualifying conditions as determined by the state rather than by healthcare professionals, only being allowed to shop at the patient's designated dispensary, an annual renewal process that is time-consuming and costly to the patient, a three-month waiting period after the first visit with a healthcare provider and having to wait for that healthcare provider to sign the application, and being limited to the amount of cannabis they can purchase in 30 days. And lastly, there is of course the cost of the medical cannabis. While there's little the dispensaries can do to increase access via the program, we can offer financial assistance. Series Med, for example, offers discounts to veterans and to those who qualify for the Three Squares program. Those who utilize the financial assistance make up almost 10 percent of the patients registered with Series Med. As Virginia outlined, VCTA has been fighting for years to make the program more accessible and inclusive. With the introduction of S117 by Senator Sears, we had hoped to see significant changes made to the program, but the bill was never taken up in the House. These amendments include removing the three-month treating or consulting relationship requirement so that patients are not delayed in obtaining medical cannabis, allowing healthcare providers to determine what medical diseases and conditions qualify a patient to participate in the program. Not only would this increase access, but it could potentially have a positive impact on the opioid epidemic in Vermont. Policymakers in Colorado, Illinois, and New York now allow for healthcare providers to recommend medical cannabis instead of potentially addictive and deadly opioids. We are losing people at a staggering rate to opioids in Vermont, and why not embrace the safer alternative? Also included in those amendments introduced by S117 was removing the requirement that a patient must designate a single dispensary as the one they will shop at rather than utilizing the services of any medical dispensary in the state. Increasing the possession limit to three mature plants and the purchase of three ounces per month and allowing for reciprocity. Vermont is home to many snowbirds and attracts millions of tourists a year, some of whom possess medical cards and could potentially support our program. In addition, we would also like to see removing the fingerprinting requirement for caregivers as added by S54. Increasing access via public transport by reconsidering geographic location restrictions. And of course, in order to increase social equity, we would like to see a reevaluation of background checks for employees. We do understand the importance of them, but for example, recently we had an employee of series med who was initially given a card a year later upon his renewal application was actually denied that card due to a nonviolent drug offense that had occurred years prior. Because of that, we worked with DPS as well as his lawyers while he was on first PTO and then unemployment for about six weeks while we had that removed from his record so that we could resubmit that application to DPS. Unfortunately, we see that more often than we would like and we would like to provide these employment opportunities for people, especially with nonviolent drug offenses potentially years old. We really want to see these situations evaluated on an individual basis. The people of Vermont really need the medical program. The medical dispensaries provide a variety of products that won't be offered in the adult use program with higher concentrations of THC and of course without tax. Not only are the products a necessity for those in the program, but so is the service that the medical dispensaries provide. The dispensaries ensure that patients have access to knowledgeable and compassionate staff who are available should the patient need assistance. They also ensure that patients aren't waiting in long lines or being rushed through the purchasing process. Ultimately, consumer safety is our priority. We have and continue to be supportive of lab testing. Series Med started their own lab to ensure the products are safe and have the anticipated cannabinoid profile. The lab is ISO and Emerald certified so that patients can be assured that the products are of the highest quality. We have never opposed third-party testing. It just hasn't been available. We recently have identified a local third-party lab and are working with them to understand what that process will look like as well as to expand our testing capabilities. However, we are concerned that with only one third-party lab in Vermont, there will be a bottleneck with the rollout of adult use. It is our hope that moving away from the Department of Public Safety and to the Cannabis Control Board will create positive change for the program. This industry is constantly changing and we look forward to having a regulatory body that is focused on that evolving industry and can provide the support to both medical dispensary operators and patients. Along with moving the medical program to the CCB, the medical dispensaries look forward to participating in the adult use program. Ultimately, prices of medical cannabis are high due to the regulatory burden that has been placed in the medical dispensaries. To continue serving the medical patient base and to lower prices, participating in the adult use market is the only option. Our experiences have given us a preview of what this market can be like and we want all future operators to succeed. So we hope that the challenges we have faced will help construct a successful and inclusive both medical and adult use market. Thank you. Thank you, Meg. And thank you, Virginia. I have a few questions but I'd like to defer first to Kyle and Julie. Go ahead, Julie, if you have any. I do. In thinking about the cost that patients pay each time they go to the dispensary, is there any movement in other states that have medical cannabis for like a localized insurance coverage, either like a capitated benefit or a captive benefit or something like that that patients can access? And I realize it would have to be on the state level, right, that it would not be able to be a federal or a national insurance company. I am not aware of that happening in any state. I would be curious to know if perhaps some health savings accounts would cover that, you know, if there's a facet of the insurance that could cover it, but none that I'm aware of at the moment. Okay. Yeah. And I would say that that's definitely been an issue of, you know, trying to figure out a way to have insurance cover this cost as it does for any other prescription drug that someone is getting. But as you say, it would have to be on the state level. And I think trying to add that, you know, we've talked about having legislation on that, but I think it would be a really uphill battle of trying to add that. Hi, Meg. Good to see you again. Just for my notes, would you remind me which states allow cannabis to be prescribed in lieu of an opioid? I think you mentioned like four states, but I just couldn't write fast enough. No problem. Colorado, New York, and Illinois. And I would imagine, well, I guess I shouldn't make any assumptions. So when it comes to a healthcare provider prescribing cannabis versus, you know, certain mental or physical ailments that have been identified through the legislative or statutory process, how do I guess those states, if you're aware, treat that, how much discretion would they have in generally prescribing cannabis? And what are other states doing? What's the overview of how much flexibility a healthcare provider has in other states that might not have these strictly identified physical or mental ailments through statute? If that makes sense, hopefully it does. I think so. And let me know if I don't answer your question completely. So my understanding is that at ranges, you have some states that have very specific conditions that qualify a patient for the program. And then there are other states that have implemented these kind of blanket statements that ultimately allow the healthcare provider to determine what condition they feel qualifies. Thank you, Virginia. Feel free to jump in if you have any. Yeah, I think I think that I'm trying to remember right now. I think there's a couple of states where actually lets the healthcare provider decide. But when we look at other states with their medical in the qualifying conditions, it's a very long list. And in Vermont, we have such a short list. And when you think about anxiety, how many people, especially over this last year and a half, were going to their doctors to get something to help them with their anxiety? And this would have been a perfect time for people to think about using cannabis instead of getting on to Xanax or something like that, which is so hard to get yourself off of. So having that ability, again, I think that you go to the doctor or you go to your healthcare professional and they make a decision of what's going on with you and if they're going to prescribe something to you. And again, I think it's always important to remember that healthcare professional in Vermont, they are not prescribing, they are only recommending. So they sign this form saying that this individual has this condition and that cannabis may help them. Excuse me. No, I just said thank you for that point of clarification on the prescribing versus recommending. Great. I think there's a lot of changes that need to be made. It sounds like I can totally understand how the integrity of the medical program may be thought of in a way to keep it pretty tight, I guess, but as you both alluded to, nothing's really been updated and what seems like a decade and we all know our society has moved in a certain direction. One more question and then I think unless I know Pepper has questions, talk to me about reciprocity. How are other states and other jurisdictions treating reciprocity? I'm sure just like with my last question, it's kind of a mixed bag. I believe predominantly they are allowing for reciprocity. So if you go to another state and you have a medical card, they will serve you. I know that so Maine has that and I know just hearing from patients that going up there for a few weeks and not feeling comfortable going into another state with their products from Vermont that they just go to the and of course now Maine has retail, but if you go to the Maine medical program, they look at your card and then they give you one of their cards and then again you're not paying the tax and you're getting you know a wider variety, but I do believe that most states that have medical programs are now allowing. I got more questions but I'll stop there for the second time. Thank you both. I have one more sort of in that same train of thought and Maine just happened to have been there last weekend myself. I noticed that there were you know medical stores and then you know adult use retail stores. Are medical patients able to purchase from either in Maine do you know or do they have to only go to a medical store with a medical card? I mean they can go to either but the difference is that if they go to the medical they're not paying a tax. So they're not they couldn't go to the retail store and and have a tax exempt form for example? I don't believe so but actually I'm not a hundred percent sure on that. Okay. Virginia I'd love to just tap into your kind of historical expertise on this and just hear from your perspective just what are the either the qualifying conditions or some of the restrictions around entry to the medical program that have received the most resistance in the legislature? And you don't have to name any names or name any committees but just kind of think about you know I remember acute pain always being kind of a political football in the legislature but I'm wondering what other you know you listed a number of restrictions including reciprocity with other states that kind of need to get a continuous annual approval from your physician to maintain your your patient status. I mean what are the things that have you seen that have just been kind of not the legislature's not been willing to discuss? Well I would definitely say that any condition that might be considered mental health so whether that's anxiety or anything under that we have totally hit a hit a wall on that and and really the only reason we got the PTSD is I believe is that the young young man who came in and testified he was so compelling but again they they added it but required anyone with PTSD to have two forms signed which you know is so and we have raised the issue over the years on on opiate addiction and because we have seen in other states where one of the qualifying conditions is addiction and that has hit a wall too. I think you know people might think well you're just trading one drug for another but certainly I think if someone in we have heard from patients who have had you know surgeries and they are not taking the opiates they are only using cannabis to relieve that pain when they recover and and that's to me is is really powerful to hear that. I think that you know it's just um as we've seen you know 2018 we legalized cannabis now you know the legislature has supported you know retail stores and yet we keep this program so tight and I will tell you that you know the Vermont Medical Society has not been supportive they have fought us all the way every time we bring up a bill they are in there to oppose us and it it it definitely has I'll just give you an example of a very close friend of mine who I lost last summer but as he was battling cancer asked his oncologist to you know sign the form so that he could use cannabis because he wanted to not be on all the opiates that they were giving him and the anxiety medication that they were giving him and the doctor said to him just go out on the street and buy it there's so much stuff out there and to me that is just not okay and one of the things that has really lacked in this state has been education for healthcare professionals and I reached out a few years ago to the medical society and I asked them to invite the dispensaries in to talk um I was able to get two doctors who were involved with the Vermont Patients Alliance to go to their meeting but it was basically they were given a workshop in competition with all these other workshops so very few people came to it but I really think that we need to do more education and understanding of the benefits of what cannabis can be for so many different patients across the state. Thanks for that just really quickly follow up is there any active legislation this year around the medical program or this biennium that's on the wall anywhere? No we were going to introduce a bill this year and you know I will say that you know Senator Sears and Senator Hoyt and other senators have been champions for this program and I have only praised for them for the work that they have done over the years of trying to improve this program. After having a discussion with Senator Sears he really felt that the bill should be introduced in the House and it was so anyhow. We have not introduced a bill we're thinking about possibly for this year and trying to kind of identify the champions that are in the House that would be willing to do this. Yeah okay good to know. Meg I just have one quick question for you we're running a little short on time and it's just through no fault of your own just we're having some issues getting up and running. Could you talk just a little bit on the on the piece about education could you talk a little bit about CVD or series how they when they when they're meeting a patient for the first time how they kind of educate the patient who might be anxious about trying cannabis and how they match up the specific product to the kind of needs of the patient how they you know a patient who may be low information about cannabis and you know trying it for the first time but they need you know RSL or a fecal oil you know some something that may they may not even know about so how do you match up the products and how do you kind of educate maybe a low low cannabis information patient. Sure so we start by having an initial consultation in that consultation we have our welcome packet which provides all of the information you know so that they patients can refer back to it but really it's just about having a conversation getting to know what that person is comfortable with our motto has always been start low go slow so you know don't jump right to something that you're unsure of start with maybe some of these smaller doses and slowly tight trade up we recommend that people also keep a journal so that they're able to track how a certain product made them feel but really it's all about understanding their comfort level what their past experiences have been with cannabis understanding what works for them in terms of whatever medical condition they have so some patients are absolutely not going to want to smoke so we have things like edibles or oils or tinctures and then just really walking them through what using that product might look like how comfortable they are with that and getting to understand what symptoms it is they're looking to address and from there our staff is really knowledgeable they can recommend a variety of products or a combination of products that they think might work best and then it's really all about just testing for the individual you know everybody is different cannabis affects everybody differently and so it's just kind of holding their hand through that process until they find something that works for them gotcha and do you have a like a training program for your the people that are doing those initial consultations yeah so when we hire someone they do go through kind of our basic training and then there is some training on the retail side about product information and then kind of a you know compassion training essentially so we want to make sure that not only is staff knowledgeable about products but they're also comfortable interacting with people who have some pretty heavy medical conditions and diseases that they're handling that's great we're running short on time i know that we all probably could you know just you know have this conversation for for hours and hours um fortunately meg will be serving on our advisory panel so we will have access to her background and her knowledge on this are there any quick questions kyle julie on that you have before we move to public comment i have just one quick one how long does that training program take meg and is there a retraining program on a regular basis sure so the initial training is done over the course of the first couple weeks of employment and anytime we have a new product or you know a change to a product staff is retrained on it um so i would say it's just a consistent constant training process versus okay it's time for your annual retraining okay thank you great well thank you so much yeah thank thank you both do you guys have any concluding thoughts for us or any information you'd like to pass on before we before we move on uh no i just want to thank you again for for having doing this and uh looking forward to the program being under the cannabis board yeah that's great thank you so much thank you okay um we're gonna move to public comment um so uh we're gonna kind of go i guess kyle i don't know if anyone's in in the build in the physical space with you no just me and nally right now okay all right we'll feel the need feel free to come on down still too okay so we're gonna do this just in two phases just to help facilitate those of who have joined through the link and are watching the video if you could raise your virtual hand if you'd like to make a public comment and then we'll move to anyone who's joined via the phone um so we'll start with anyone uh with their kind of virtual hand raised jeffrey thank you chair can everybody hear me okay yes it's good to see everybody again uh thank you for holding this meeting um so uh jeffrey pizzatello for the record uh executive director and founder from our gross association i'm here today uh in this capacity uh as a caregiver uh vmr registered caregiver i'd like to make a couple quick points um it was brought up uh from our guests previously that uh quote uh the only way uh for the dispensaries to survive is to enter the adult use market i would just like to point out that um last year uh as recently as last year um a vermont media company had reported that the parent company for a shampton valley dispensary reported 35 million dollars in total sales last year uh so i would just ask you how many businesses in vermont bring in that level of sales uh as as we think about um these concerns and moving forward i would also like to point out and this is important um framing for us um meg uh and she seems knowledgeable uh is the uh position for the advisory committee um there is no conversation uh about adding uh an additional member of the advisory committee until actually we brought it up so and we introduced this concept of uh including a patient advocacy a patient voice and a and a health care professional that understands unique challenges of patients and caregivers so we introduced that concept and instead it got redefined as a member or a designee of the vermont cannabis trade association and that's important because that is framing broadly the sentiments of countless individuals in the medical program in vermont just in the state in that we seek uh effectiveness we seek medication we seek improvement to this program only often unfortunately and we see this in other states to get co-opted by those with resources so we made an attempt to have uh an individual who could speak to our concerns uh and that got taken over unfortunately so we we think that position should not exist that should be someone who's reflective of caregivers patients and most likely a health care professional as we had initially suggested i want to leave you guys with one anecdote about uh my experience with dispensaries because i think that's what you guys are talking about i think that's important so uh the very first time my patient purchased a product from uh our designate designated dispensary which is shampton valley dispensary we purchased uh she purchased flour and some concentrates she went to go consume the concentrates and the concentrates did not combust naturally it sparked and sizzled which typically designates contaminant so we purchased a medical product with a contaminated and so it was brought up by our previous guests that the reason why uh the dmr is depleting and individuals do not purchase products from them is because of competition from the illicit market that is not true if they offered safe effective healthy products as other states do at a reasonable cost they would have consumers bottom line in main their average cost of an ounce is just over 200 the average cost in our state is over 400 they have a decentralized market that allows mayors to get in and participate and engage i would urge you guys to stay open and innovative about ways to improve this program i'll leave you with that thank you great thank you jeffrey um next on my list is bridget connery bridget if you are if you're able to please unmute yourself and if you'd like to join with video hi so i'm bridget connery and i am the director of brand experience for champlain valley dispensary something about southern wellness now known as series med and i just wanted to add something to virginia and max testimony about one of the things that has gained no traction in the legislature or the dps that we've been advocating for on the record since 2016 which is the inclusion of vermont's craft growers to be licensed to provide product for the medical market we strongly believe that they should be part of that market we've been advocating for it and it just hasn't gotten any traction so that's something that we really will continue to advocate for i also want to just speak a little bit about reciprocity and why reciprocity is important cannabis remains federally illegal and when people are using medical cannabis for symptom relief and for health reasons they face prosecution if they are going to be traveling in different states um with their product and so being able to provide medical patients legally with a product while they're in our state is something that is um really important for people so they don't have to be at risk of prosecution and that's it thank you appreciate the time yeah um next i see uh tito burn tito if you'd like to unmute yourself hi thank you for hearing me out um my name's tito burn i own burn gallery and burn living organics and i have opinions about almost pretty much every single aspect of everything we're talking about and um and i really appreciate you allowing us to be a part of it and um i enjoy being part of the process uh along each step along the way and um but today i just want to talk about my experience as a caretaker um it has broken my heart over the years to have to deny person after a medical patient after medical patient uh because i can only caretake for one person and it's just such a shame um i i feel like my product is is far superior to what's offered at the dispensaries and um and it's just a shame that i have to deny people um and these are cancer patients these are these are people who really really need it so um that's that's all for today but thanks for hearing me out thank thank you tito um and anyone else who joined via the link i don't see any other hands raised so i turn to people that are on the phone if you'd like to uh provide public comment um you know to unmute yourself just hit star six and uh you can just start talking if you could identify yourself for the record if you'd like to provide comment okay so um um julian kyle we have a break scheduled however we have um i think a number of our patients and caregivers that are on the line um currently and i'm wondering maybe if we could forego our break uh now and maybe if there's a little bit of extra time we could um just take a slightly longer lunch yes yeah i think that's a good idea okay great well first so we're moving towards um patients and caregivers you know i've i've met with a number of patients and caregivers and patient advocates um since we since i've been appointed and um i think that there are some very powerful stories that talk about um the inability to accept access or um kind of the quality or the consistency um of uh the medical program and so i'd like to first um talk to amelia meshi if if you're there amelia um to kind of help us understand your story and some of the kind of barriers that have been put in your way to accessing medical cannabis yeah um hi guys hi amelia good to see you again it's good to see everybody again yeah so i just want to i want to thank for amelia i'm wondering um if you might if you if you kill your video or stop your video um we're getting a little bit of i don't know if other people are getting that but for me okay can you hear i heard that but uh i'm not sure if it was part of a longer sentence okay you hear me now yes yeah that sounds better okay cool um there might be a bit of a lag i'm out in the middle of nowhere sorry internet reception is not great um but yeah i just wanted to thank meg and virginia for speaking and for the work that virginia has put into uh improving the medical program over the years i think that's great um i also just wanted to speak to a couple of the things that virginia and meg spoke to um the first i think jeffrey touched on it but the first thing being that people are not signing up for the medical registry because of things like um paperwork and competition from the illicit market and i can tell you that people are not signing up for the medical registry anymore and they are dropping off of it due to mainly the cost of medicine um and also to the inaccessibility geographically of the dispensaries a lot of us live i know that when i got my card i lived in eden which was at least an hour away from any of the closest dispensaries um and we live in a state with very little public transportation uh and while they do offer delivery it's still very difficult to kind of be in sync with the dispensaries in that manner as well as financial accessibility uh so i just wanted to make that point and then the other point i wanted to make was i can appreciate that the dispensaries have done everything they've done at great risk um to themselves but i would also like to point out that in the illicit market and with caregivers they have also carried the burden of a really big risk uh federally um i know that a few years ago my sister and i had a caregiver who was a legal caregiver and he had a legal grow and a legal amount of plants um and his partner called the police on him and they came and without asking if his grow was legal without giving him a chance to present his card they went in they cut the plants down and my sister was out of luck on medicine um so i i just want to point out that yes the dispensaries have had a very great risk but the illicit growers that are currently helping patients and caretakers have also carried a big risk and i just wanted that to be acknowledged i just want to go into some of the changes i think would be beneficial to the program um i'm sorry if you guys have heard these before but my position hasn't really changed much so i'm just going to go into the list uh the first thing would be to eliminate the three month requirement for a bona fide healthcare professional uh patient relationship that three month requirement is a big barrier to entry when you've got somebody who for instance is moving into the state we don't have reciprocity so they have to wait three months before they can access their medicine um that three month requirement is also a hindrance to people with chronic illnesses like me uh if i were to change my doctor and my card would were lapsed i would have to wait three months with that doctor before i could get a new card um the next point would be i'd like to see the patient possession limit increased from two mature plants to 12 mature plants with no immature plant cap um i think that our plant possession limits and our flower possession limits are criminally low for medical patients um and when you think about the sheer amount of product it takes to make effective medicine asking for 12 plants is not is not that much of a request um the next would be to allow patients and caregivers to purchase cannabis and cannabis infused products from any adult use dispensary without paying medical patient taxes which would be that 16 percent cannabis tax uh patients already don't have to pay that tax in the medical dispensaries which is great but we'd like to see the options broadened for medicine and uh if a patient could walk in any adult use dispensary show their card and just not have to pay that tax that would be a really easy way for us to increase access to medicine for patients the next would be to allow adult use dispensaries to deliver to patients um medical already has that i think that once again if we allow patients to buy from these adult use dispensaries they should be allowed to deliver medicine to patients who maybe are not able to access the physical locations a big point is we want to eliminate the fingerprint requirement for caregivers this was added in um act 164 it did not exist previously and once again it is just a barrier to entry there are a lot of people who could be very good caregivers who will not enter the program because of that fingerprint requirement we already require a copy of your id we require to know where your house is and the room in your house where you are growing and the understanding that your grow could be inspected at any time um so adding a fingerprint requirement to that is just overkill um eliminating the requirement that patients with chronic diseases reapply annually for their medical card so if you have a lifelong condition like i do um i velar standalone syndrome and i have Crohn's disease uh both are incurable um and one is degenerative so it's only going to get worse as i get older uh and so having to go in and ask my doctor for a card every single year doesn't really make sense because i'm never going to not need it um next would be to allow caregivers to care give for five patients like new york allows i know that tito just brought this up as an awesome point um and he's right we have a lot of people who could benefit from having a caregiver who maybe don't know somebody who can grow for them or maybe the person that they know who grows can't do that because they already have a patient that's registered to them um and so yeah i think if we allow caregivers to care give for five patients at a time that just increases a patient's access to medicine uh the next would be to allow each patient to have three caregivers um so if you are a patient and you have a caregiver and your caregiver gets for instance uh a mold infestation because outdoors or in vermont is on drugs or their medicine burns so that they they don't have to go an extended period without their medicine uh the next would be to allow me i think it's a great point i think that we have a lot of people that come in from out of state um and those people should be allowed to participate in our program and that's their personal choice and we've got to respect it but we also have to respect that those people are still sick and they are they're still patients so just yeah i think they don't want to be on the registry shouldn't mean that they don't see caps are really detrimental in medicine um so yeah i'm sorry amilia my glitchy again a little bit but that last point you made was about reciprocity was that sorry amilia can you hear me yeah yeah i i know like i'm out in the kind of middle of nowhere as well and i know that you know sometimes the satellites need to kind of you know be overhead or something but yeah i think i think you're coming through now okay cool sorry like i said middle of nowhere um yeah but just to speak to that last point i was making thc caps are really uh once again they're a barrier for patients who need that kind of medicine and i think we were talking last week about how when you take something like fico and then you turn it into like an edible gum you say for a cancer patient who um would prefer that you're then turning it into an edible so the thc cap on edibles uh would just absolutely prohibit that um yeah so the last thing i wanted to talk about is the um medical cannabis fund i believe it's called the medical marijuana fund um january 1st when you guys get the program that fund is set to be folded into the cannabis regulation fund and once again i'm just asking that it be separated from the cannabis regulation fund and used specifically for the medical program and the patients um and that was it i know i know you guys have heard these points before but they're i think that in the past this program has been focused on the dispensaries voices and what the dispensaries think is best for patients and less on hearing specifically from patients what they need i think that virginia brought up an awesome awesome thing when she said that you know various things about this program have been brought forth through patient testimony so it began with somebody with aids who needed to use cannabis and then again when they added ptsd it was because a patient came forward and testified and so we see these big things happening when we include patients voices and we prioritize patients voices um and i'm really appreciative that you guys seem to be following that trend well thank you amelia um thanks for coming forward thank you for your advocacy i know that we have all listened to your testimony in the past when you're in the house gov ops committee and in other places but um it's really important for us as a board for us as a board to kind of build our own record so that we can make recommendations um to the legislature around some of these issues so thank you for kind of you know coming forward once again and telling us your story um i'd like to open it if you're if you're up for it um for a few questions yeah go for it uh can i just ask a clarifying question about um the three month waiting or the relationship with a physician that has to be a vermont physician is that correct yes so it couldn't if you spent part of your year in another state and part of your year in florida you'd have to have two physicians yes you would have to have two separate medical cards okay thank you yeah and i think it doesn't it's not limited to just the physician naturopathic doctors i guess it depends on how you define a physician yeah caregiver or treating physician however willing to find that yeah um whatever your health it has to be like a licensed healthcare professional so for instance i got my card through um my geneticist which is a specialist so it doesn't have to be through your pcp i think my thought is that another deterrent is that if you have to if you spend part of the year in another state then you have to do these visits twice and have these relationships in two different states potentially yeah and i mean i guess that would be an argument for reciprocity for sure amelia i have a question thank you so much um for joining us today and i can totally uh i understand and appreciate how your um you know medical history means that you don't you shouldn't have to go every single year to get a new card or have that card kind of renewed um however you want to call it and i'm sorry that it's unfortunate that's the situation you're in but i'm wondering for for other folks that um are currently part of the program or depending on other physical or mental ailments that might be accepted into the program somewhere down the few down the line is that kind of card holder in perpetuity kind of makes sense for everybody or depending on a certain person's situation might it make sense to have that card you know um have some type of of life to it kind of like a driver's license um wondering if there's some type of middle middle ground depending on you know a patient's their ability to get better and beyond whatever they're currently facing yeah um so one point i actually didn't bring up was that we want to expand the definition of a debilitating medical condition to include any disease condition or treatment in as determined by their doctor um and when we do this uh we want that doctor to kind of the way i see it and the way that i think that it could work is if we have two different types of cards we have this chronic illness long-term card and we have a year card like we have right now and that would be up to the doctor's discretion which one they think that the patient needs um which is no different really than writing any other prescriptions you have short-term prescriptions that you need for a short period of time because you're dealing with a condition that will end at some point or you have long term long-term prescriptions i do infusions every six weeks for my Crohn's disease and i'm going to do them the rest of my life i don't have to every single you know year go back and and might have my doctor say well do you still need it because they know i'm still going to need it however if i was on you know if i was going through a bout of something like mono for instance and i was on certain drugs for mono at some point that mono is going to end but it's still a long-term illness you know what i mean yeah totally i'm just trying to get i guess come for recognizing that so many people are facing so many different physical and mental ailments i'm i'm cautious to put a blanket number whatever you want to call it on everybody's totally certain situation so thank you so much i i just i really think that it should be but like up to the doctor and the patient um yeah that's where i was getting towards versus something more outlined in statute thank you milia i'm curious uh just if you are going to purchase uh cannabis exclusively from a dispensary do you have any kind of estimation as to what your either monthly or weekly cost would be to you um um well i haven't i'll be straightforward i haven't purchased cannabis from the dispensaries since probably 2015 um but back when i was a a frequent proprietor of the dispensaries i was spending about a thousand dollars every two weeks and uh i'm just curious what was your kind of experience like when you first joined the the um when you first joined the registry and you first kind of went to the dispensaries i mean was your doctor willing to kind of you know were they accessible on this issue or did you know was there kind of some difficulty in getting them to think about cannabis as a potential medicine um so my pcp actually wouldn't write me a card so i had to go to my geneticist who was more than willing i was 19 at the time um so my my doctor was just a little weary about giving a 19 year old a medical card um which is what it is but my geneticist was very quick to sign my prescription papers um and then from there i'll say the system itself was not that difficult to navigate um i signed a few papers i sent them into dps along with my $50 and i got my card um getting into the dispensaries was pretty easy um and the product selection at the time was not bad at all i would say there were multiple strains there were multiple different kinds of edibles they were doing concentrates at that point um and really the biggest thing that took me out of it was the cost and just how much more affordable it was to grow grow my own um and accessibility i would say the dispensary was really far away and uh at a certain point i lived in massachusetts and if we had had reciprocity honestly i probably would have come back to vermont and just bought my products from the vermont dispensary and gone back home but i couldn't uh so there were a few barriers but like i know that a lot of us patients kind of rag on the dispensary and maybe we do it to an extent that's not fair given the limitations that they've faced um but cost is such a huge barrier yeah so i think that's the biggest thing yeah can it can i ask you um you know it sounds like you know uh maybe i'm wrong but it sounds like you've kind of figured out a few strains or a few products that are actually helpful for you um so how do you make sure that you have access to those plants or how did you get them initially and i don't mean you don't have to say any names or anything like that but i'm just you know it's it's curious to me that you know potentially you might need a very specific strain and that might not be kind of what your neighbor is growing or your you know that like that you can get easily access kind of a clone or a plant um i'll say that the that we have a not just like a market of talented growers who are going to come into the adult use space who have been growing at home for the last 10 15 20 years but we also have a really compassionate network of people um so we have a community of people who are trading cuts who are giving free medicine out to each other to see what works for you and what doesn't work for you um you know i i've gotten cuts from jessie lin who's going to speak later who specifically grows medicine for a nurse with cancer and the cultivars that she has target cancer symptoms nausea pain uh you know insomnia and so i would say that the the biggest thing yeah that supported me in being a home growing patient is the community um of people that are just trying to help patients at this point because they know how expensive the dispensaries are yeah uh any more questions for amelia thank you amelia thank you yeah no problem thanks for having me guys thank you so next on our list was meredith man um i've seen her kind of pop in and out of our guest list i'm wondering meredith if you're here with us now i am here okay meredith um thank you for your willingness to kind of share i'd love for you if you could just to give us a little bit of your background and then kind of talk to us about the things that you think that we could do as we refresh and reimagine our medical program thank you and thank you amelia that was excellent and i want to say i really agree with amelia reciprocity is really important mostly for uh the risks that patients take without it is unnecessary um regardless of if it's lifelong or an acute situation people are taking risks that they shouldn't have to take and it should be more accessible um thank you to virginia and meg as well it's always good to see and hear from the dispensary and get their opinion um i am a business owner i own magic man i'm also a medical patient i have been for uh four years now uh you know in vermont i've been pretty much a lifelong medical patient uh that was just when i got access uh i also was a supervisor at the dispensary and worked there for a while and i have an inside perspective of patients and patients needs um and that's why i worked at the dispensary is to get the patient care um to give the patient care that i needed that i wanted to give back um and it's very clear that uh we need much more access people need choices um um you know uh people really are only as good as their initial visit at the dispensary and the information they get and uh people need access to blood tenders that have education training there should be levels of blood tenders for recreational and as well as for the medical side uh that can give people what they need um and i don't just see that on the medical side i see it every day at magic man everybody's a patient even if they're there for their mental wellness they're still a patient of some kind and everybody has a story um they may be just grabbing a blunt to have a good time but you know there's the person right behind them has an incredible compelling story and issue um for me it just pains me every day not to be able to give people what they need it's absolutely heartbreaking as Tito said uh to have people in front of you that are in extreme pain and not be able to help them and a lot of these people are medical patients who can't afford the medicine um or they are people that don't have access to the medical program last month i printed out 20 marijuana registry forms just to give people access um they were gone in 10 minutes uh and it's not about my faith in the program it's about my belief in the access and i'm also not saying i don't have faith in the existing program but um i have my ups and downs with it um what i really do think is important is that people trust the person they're talking to it's what i see in here every day you have to have experience cannabis is anecdotal and the more people you help and the more people you communicate just helps the next person and that's the best way we can provide that is to share those experiences and each person's experience right now until we have all this federal testing is what guides um the the whole experience for a specific person um i believe you know in the three-month limit is just having to have a relationship with your doctor for three months is absolutely crazy really difficult in vermont for people people have a hard enough time finding a pcp and then they get bumps from a different insurance then they lose a job most people right now with the state of health care aren't lucky enough to have a pcp they have a relationship with and not all doctors are willing to go out on that limb a lot more are but which we're grateful for um you know from where i stand i'm just committed to providing education on cannabis education on the medicine and what people need how i can help them with strains and if i can't help them who can and i think that it's really important that we all work together on that so that's kind of where i'm coming from and you know i have a lot of insight and information and experience from working at the dispensary that i'm happy to share with you in any way i can thank you thank you meredith yeah any questions for meredith um i have some questions about uh like the medical training or the training at the dispensaries is there and i should have asked this earlier but is there training that specific to um like medical knowledge or medical professionals in the dispensary no um there there isn't uh but you know what i did you know the people in there who really care we're spending all of our time gathering that information researching it being a part of the process um i would say that depends on the individual bud tender or person in there um i was provided with training from cvd i there was a group of us i think i was told we were the first group that came in and went through cat we were given you know a good amount of just your basic clinical information what i would honestly expect from anybody who i would want bud tending for me it would be the bare basic um and i think there is a place for a bud tender with your very basic skills but there's also a place for a bud tender um who's dealing with people with chronic conditions and chronic pain or mental illness or can't whatever it is um even here at magic man you know i have deal with people on a weekly basis who are in palliative care at the end of their life that is emotionally on me sometimes because i'm like where are they are they gonna come in are they okay you know um so as a bud if you're if you care and you're a bud tender you tend to you know actually care and take on the issues and um it's also important for bud tenders to have mental health access and care for them because there's a lot of heavy heavy conversations and um you know if you take in all that energy it can be hard on that bud tender too and to be professional at what you're doing you have to learn to give people the information and not let it weigh too heavily on you so that is really really important and something i saw a lot on the inside is how heavy it weighs on people so the emotional training is as important as the cannabis education um so yeah back to specific conditions you asked about um i think uh really you shouldn't i would i never speak to anything i can't speak to so um if i need to call jesse lin i'll call jesse lin if i need to ask somebody who works at a dispensary i will if i need to call a doctor i will but or send somebody to somebody that can help them but you know for bud tenders um really one thing that i'm the most proud of is that people seek me out because they trust me because i care i'm not in it for anything else other than that and i want that to continue to be the case and i i want people to have the choices to seek out who they want and what they want um you know the dispensary could be or cvd could be the absolute best place in the world with the best flower and cheapest prices but they there should be choices for people um and you know speaking also to the afforded accessibility end of this um the prices are just you know it it's painful to watch you know the average person coming in there and dropping five hundred two thousand dollars like amelia said in cash um can't afford that and it's it's painful to watch and we're gonna have to find a way for dispensaries and you know this is all going to come down to cultivation and flower prices and you know but we have to find a way to make sure the prices um make sense so that we can provide patients with what they need absolutely tax-free um hundred percent of course um is really important uh when you go into colorado i think that was my favorite vision is you know you have your choices you have your choice in what kind of dispensary you want to go to um where you want to go you can go this way for medical this way for rec you may have different blood tenders with different training um i'd like to see a much a strong blood tender training program in the state so that people wherever they go you know that they have quality um and caring people that they can trust and ask questions to and i'll give the whole program integrity and there's no portable certification program right now there's no i'm certified as a blood tender and i can take that wherever i go to do that right now um there are some trainings like nationally that um i don't know how well they transfer in different states there i haven't seen one specifically that applies to here as well i think it you know wouldn't take too much or maybe it would but you know i think it's having our own standards of that would make the most sense um um you know one other thing that bud tender said to me in colorado was that you know he said you're never going to lose the medical patients even even on the rec side everybody's everybody's a patient and it's just important to give them that not that information and that knowledge um sort of as Amelia touched on not everybody can get into the medical program not everybody um you know some people are carrying and don't want to apply and lose their gun rights there's a million reasons why people will stay rec even if they're have a very strong medical need for it um and then i would just say also you know um you know as far as patients go just you know they're making sure they have access to what they need those those THC caps um are just going to push people to the black market or not you know if they're a medical patient they should just be able to have the right everybody should have the right to get what they want I uh I just want to acknowledge um Eric and Jesse Lynn who are our next two witnesses but uh we just thank you for joining us I just uh we're going to take a few more minutes with Meredith and then Eric will turn to you next if you're all right with that um um Kyle do you have any more questions for Meredith hi Meredith it's great to meet you Kyle Harris um I'm not I'm not sure if I have and I'm interesting and interested in the training conversation and I'd love to um you know whether it's talking with you or everybody else offline or talking in this type of setting at a later date I'm wondering if who a good organization if you have any thoughts Meredith my my head goes to VTC because they do a lot of these kind of type of technical trainings I know they've got some classes oriented towards growing um industrial hemp at least um at their Randolph campus I'm I'm wondering if you have any thoughts on if that would be should we have a conversation with them about if they're interested in doing these types of trainings or who who else or what other organizations around the state would be well positioned and have the expertise to really you know have a conversation with when it comes to that um you know I think as long as the conversation's open to you know cannabis experts as well someone like VTC could provide accessibility of the program through the state to rural areas as well um and uh you know on that note of rural areas I do you know want to say that um part of that accessibility is delivery um and part what I did do deliveries for CVD and it's really important to say that when you're making a delivery um I've never felt it was one of the things I did that I felt the most in debt to to making sure that I got from one side of the state to the other in the right time and everybody got what they needed but also as a bud tender that person on the road I think I I had some more intense conversations and interactions with patients on the road in those rural areas when I was dropping product off to them that couldn't come in so you know making sure that that you know that transfers as well into delivering to patients because those are the people sort of like Amelia said that really need that information and knowledge and because they're so disconnected they don't have it so to have someone come to you but not just come to you and drop off and be like here you go but be able to connect the dots for you and help you with your dose and take five ten minutes to talk to you is important to people yeah I mean so I guess that's what I'm hearing from you and I know Meg had kind of given us an overview of how they do an initial consultation with with folks who you know are designated their dispensary but it might be some folks obviously you know don't feel comfortable talking about their thoughts feelings conditions and that type of setting it might be if we do if a delivery you know making sure that that educational aspect is carried through to from a delivery service perspective just because folks might feel more comfortable in their own home and the other thing is that you can and I did do initial visits when I was there quite often it was one of my favorite things to do but you know each patient is different and like any situation they have a lot to tell you you have a lot to go over in a short time and it's really you know whatever you medicine they leave with that's really just the beginning of the conversation and the questions as much information as they could possibly have is going to dictate it be dictated by their experience so you know to be able to really follow through with that with people is important and it is a longer process of trust for the average person for sure and yeah yeah I don't make it in touch on that aspect of delivering everything I don't want to make any assumptions that they don't try and do outreach that way maybe if Meg has a year from her later I don't know but just just trying to follow the path please resistance on what makes the most sense from an educational perspective thank you yeah sure thank you Meredith I just have one follow-up question for you I I have to assume you know we we've been hearing a few consistent recommendations one is around the three-month kind of relationship with doctors certainly increasing the kind of patient count for caregivers increasing some of the plant counts or these are some consistent recommendations we've been hearing allowing reciprocity allowing a card holder to visit any dispensary we heard a recommendation today that I that I hadn't heard before which is the inclusion of craft growers to provide plants to the dispensaries can you just maybe give me your thoughts on that if you if you support it or if it's something that if there's a something that I'm not thinking about why that wouldn't be a good idea I can't I think that the dispensaries need the craft growers absolutely they need variety they need to be able to keep product in stock they need to have what people need when they need it and even sometimes that doesn't always happen there even with the best interests at heart so I think you you have to involve your community you have to involve the growers and it all starts with them and absolutely we need to get them involved and as soon as possible it all starts with them or with us yeah yeah well Meredith I can't thank you enough really I mean it sounds like you've been involved in every aspect of this business and you've been you know providing education and support to patients and yourself for your entire career so thank you thank you yeah and thank you for your hard work both the all of you and I look forward to helping you any way I can moving forward thank you Meredith thank you guys have a great day thank you um Eric are you uh with us yes damn can you hear me we can hear you all right good how's it going over there it's going well so all right you and I spoke um after I watched a video of you on YouTube just telling a really compelling story um about your patient that you care give me yes and I'd love to hear the story I know you know it can be painful to have to retell these stories in multiple different locations multiple different times but I think it's important for our board to hear the story and I think it's important for us to hear from you about some of the ways that we can reimagine um the medical program as we are facing kind of the advent of adult use mm-hmm yeah yeah that's no problem basically for the people who hadn't seen or heard uh I ended up being a caregiver to a very young child who has brain cancer and she was very little at the time so the state was a little bit uh the the cannabis program was a little cautious with how we went about it so they they wanted Champlain Valley dispensary to be the um dispensary of choice for us because for whatever reason they they weren't comfortable with any of the other ones at the time dealing with such a small kid so that put me I was in stow the kid is down and ran off that put me in between the two places so I took the job on as being the middleman for that and so that gave me the experience to see what the state had for the program where the shortcomings were um what we had to do to supplement what they couldn't do and it pretty much my experience substantiated pretty much everything you guys have been hearing from not being able to get enough uh inconvenience of it us having to kind of uh thwart the edges of the system to make up the for the lacking um so pretty much plant counts the amount you can get the cost of it uh the accessibility it was all a bit challenging and difficult uh there were times other people had to skirt the law and bring stuff that they got elsewhere to donate to the cost for us because it's a pretty high dose protocol when you're trying to use the cannabis to actually affect the cancer and not just provide uh appetite stimulation or stuff like that so the dispensaries were held back on how much they could even sell us a month versus how much the protocols for that kind of thing call for so those are a few of the things that we had discussed that would be addressed here and that I thought would be good for me to chime in with our experiences so her cancers took a little bit pretty much about two years it there was a recurrence and uh first it was one tumor and that started to with a very low dose protocol was working and then seven new tumors popped up in her head and that made us ramp up to the protocols that that are pretty much all over the internet substantiated with some studies that are done overseas in Israel and Spain and stuff so that second round we really ramped up pretty much everything we were doing and that's when we started to find that it was a little too expensive first of all we couldn't get enough to do the protocols that are regularly used and uh in the end of it all you know the laws were changing at the time some things have been addressed since that some things haven't so there's still the challenges that we faced some of them not so much but those are what you guys have been discussing already here and uh and I'm here to just say we experienced all that in real time what what's interesting to me about your situation and your story is that it really is at the intersection of all of the issues that we've been hearing about and it's complicated of course by the fact that your patient is under 21 in fact significantly under 21 meaning that there is no you know you hear from some people oh just you know send this person to the adult use market well that's not really an option um for your right so on that note my I mean if your patient uh didn't have access to the registry what would her alternatives be what were the kind of alternative kind of uh suggestions that the doctors were giving her other than the registry there weren't many other than following their protocols of chemo and radiation and after the first runs of chemo when seven more tumors came back they took that off of the table for the second round because of some data suggesting that that can cause more tumors in the right circumstances so they don't want to just in case that was part of that go through that again so what the doctors were pretty much doing there was a little bit of nutrition change stuff not really a lot from what we considered we pretty much went through everything you can come across as far as what would improve her chances there wasn't a lot of that out of the hospital there was a little bit but not not excessively so they they were more you know go through our chemo our radiation just let us take care of that part we did all of the the extra home stuff and making sure that any damages that happened from that could be mitigated and any extra chance we could give her would be there too what we ran into that was a bit of a challenge was her parents were separated and when the dad had her in his custody because I was the caregiver I was after the dispensary part there when we couldn't afford that or get enough from them I started being her grower now mom was primary caregiver I was the second that left him breaking the law if he was to administer medicine so I had to turn over my caregiver license to him so he wouldn't be breaking the law giving his kid medicine so that was one of our more stressful parts of that whole thing was not being able to have enough of us be a caregiver in order to legally provide her with what was what is pretty much coming out as being the protocols that are working for that stuff I think I hear you are the are the plant counts you know is has that led to some bad consequences for you we didn't have I wouldn't say bad consequences I'm I'm pretty good at growing I know a lot of people who aren't that grow much more much less than I was able to so I was able to keep up with her need but had I had a mold issue a powdery mildew issue any bugs come in there if I wasn't able to keep a turnover from the veging plants to the flowering plants any of that being out of step would have led to a shortcoming that the dispensary wouldn't have been able to make up for because they're restricted in how much they can provide to a patient per month yeah I pepper kind of beat me to the punch on my question we've we've heard um we've heard a couple folks kind of give us suggestions on raising the mature and immature plant count you know I think we've heard that from the dispensary side the the patient side and the and the caregiver side and I was going to ask what you thought you know I know there are states out west that I think the highest we've heard so far is 12 Amelia could probably correct me if I'm wrong on what she was or no two no 12 and then no immature plant cap I know that there's some states out west that have like four times that amount up near 50 plants in her just one to correct me if I'm I'm wrong there when she's going to speak with us here soon but I'm wondering and my question was going to be geared around um or centered around your your patient obviously you're up you're up self-proclaimed great great grower and that's that's awesome but for folks that might be caregiving for somebody you know under similar unfortunate circumstances what and I know it can be hard to ballpark a specific number but um I guess that's an oxymoron but when we're talking about numbers and if we're interested in raising these numbers what would be a good number given the fact that everybody's a different um stages of their ability to grow some you know like to experiment a little bit more than others until they find what really works for them so what would be if you don't mind me asking some some good numbers from your perspective I would think probably well most of the surrounding states and other not surrounding states are doing where it's six to 12 based on either household if there's two adults in the household they can do 12 flowering plants if there's one you can do six um I think because other states are all doing that without huge repercussions negative things from that um that there's not a reason we couldn't also do that I don't think it's going to lead to a huge black market or underground market I should say um kind of thing because most people who are going to do that it's going to be for the medical reasons and not some other and other states are also doing the same Connecticut just past that New York just past that um so I think that's a safe number to go with but anything would have been good I did mention we had some family member supplements and material for us when we couldn't get it elsewhere so that in my growing time you know from going from dispensary to grower we did have help from that um so having more plants would have allowed me a less veg time so less time that I would have had to do that I had to vegetate my plants huge in order to get a good harvest out of two plants and that took months to do whereas you don't have to have that long time for vegetative growth if you don't have those restrictions great thank you can I ask a question about caregivers I think the recommendation we've heard so far is three for for a child under 18 or 21 and I'm wondering um if you think that that's enough I mean it sounds like that could be you know someone who is you know growing for the child plus two parents um but I thinking of just even my own experience raising two children without serious medical issues how many people were involved in just administering regular antibiotics could have been a grandparent could have been mom dad step is three does three cover the care for a child or could there possibly be a way that that child or person having the card means that whoever's administering the medicine because that child has their license that that's okay that we're not so much worried about who's administering it if the people who are the caregivers are okay with that person giving it then it's more based on the patient having a license so that it's okay and what kind of information do parents get if they're if they're embarking on this for their child what kind of information about medical cannabis do they typically get that's very tough because you have to pretty much chase down whatever information dispensaries are probably legally and somewhat morally held back from stating anything definitive because it's not laid out that definitively um there's studies you have to read through and find things that seem to work in those studies which are largely animal studies there's some human studies um but you have to pretty much chase that down the dispensaries very good with trying to work with what you have come to determine is going to work best for you and trying to make up whatever you need but at the same time they're kind of limited in what they can suggest you do because they're selling a product at the end of the day. Okay thank you. Well Eric kind of on this on this topic I'm wondering if somewhere down the road you know next year um or thereafter after the the the medical program actually is under the purview of the the cannabis control board with folks you know families would they find value in some type of education outreach coordinator or that being a responsibility of somebody in at the state level in the medical program to really engage with those families I understand that you know people have a lot of thoughts about state government and you know x y and z just wondering if that's something that might be of value to folks in this situation. I think it'd be extremely valuable um I have a store somewhat like Meredith has and I talked to a lot of people who come in some have done the medical program some have gone to recreational states and tried to have at it themselves and there's a lot of stories of people ending up in the emergency room thinking they're dying from overdoing it um I had an 81 year old lady who got her medical card in Vermont and got some oil and uh she ended up in the emergency room having a panic attack at two in the morning thought she was gonna die um so I a couple weeks ago talked to someone who went to Colorado got two 100 milligram cookies for him and his wife in Estes National Park and by the end of the night they were 11 000 dollars in the hole from their two ambulance rides from Estes to the emergency room um so I think education to anything dosage related type of intake what you're taking I think that to have something for that would be extremely helpful great thank you Eric I'm all kind of circling the same question um but could you maybe just describe what your early experience was like at calibrating that kind of right cannabinoid profile and that right kind of product for your patient I mean it's it's in the absence of real medical advice a real solid medical research I've kind of jokingly said I'm glad I wasn't on Facebook when it happened I hadn't really dove into that yet because there's so much misinformation out there and there's a lot of decent information but Facebook was a cauldron for all of it and we started pretty much going through uh legitimate studies that we would Google versus what people were saying in public groups like Reddit and Facebook um so that that early phase was very slow because we were going very low dose with her we had the dispensary they were good for us um so our early progress was a pretty smooth one it was uh say eight months before she had it was probably six months when the first tumor was pretty much gone which for the type of cancer she had was pretty amazing um so then when the second round of them with the seven tumors came back we had already had that ramp up that takes most people about one to three months we had six to eight months to do that so that gave us a decent time to kind of go from just cannabis and a little bit of lifestyle change to the whole very high cannabis amounts and entire lifestyle change um pretty much everything she ate was changed what she had on for aromas was changed um so it was probably a little better for us than an adult who comes out of the hospital with the diagnosis that she had and tries to go full bore at once we we were lucky enough in kind of a weird way to say that because it dragged out for a while but in retrospect we were lucky that we had that little bit of buffer where we went low dose and before going to the higher doses and I hope I don't mean to have this be a provocative question but I'm just curious was your patient um prescribed opiates at all? Yes and some of the some of the um some of what I tracked down there was the medical cannabis institute.com that did courses that give nurses continuing ed credits and it's specifically in cannabis medicine and through that they had studies where when you combine cannabis with opioids the amount you could reduce the opioid dose and still get the same relief level and it was between 60 and 95 percent depending on which opioids they were that you could reduce the amount add in cannabis and still get the same level um so that was a big help because mom would then give less and um she she didn't want to give her kind of bunch of opioids so she would either give a lot less because of that or not at all. Similar with other medicines too there's some anti seizure medicines that um it turns out with indica strains a lot of people report getting rage um there was a term for it related to the type of seizure medicine that it was so she was able to keep an eye on that and try to offset when the seizure medicine was given and when the cannabis was. It's uh it really is an incredible story and I and I mean that as in it just touches on all of the issues that we've been focused on today and so I really appreciate all of the help you've given your patient and all the help you're giving us here today. Yeah it's worth mentioning a lot of people when I get into this conversation and mention it um are wondering how she is now and she's great she's been three years without any signs in her her um her scans and stuff so uh cancer-free still it's been a five-year battle at this point but it was two years of uh dealing with the tumors and now we've been at three years of her not having cannabinoids at her um and still having some of those lifestyle changes on what she eats and stuff um but she's three years with uh clear scans and happy and just like any other kid her age that's incredible yeah that's that's that's we didn't want anything other than that and we were all pretty hell bent on doing whatever we could to keep anything else from being in the case yeah uh Kyle Julie any other questions for Eric no thank you I really appreciate you sharing this thank you thank you I appreciate the opportunity to yeah likewise no no further questions right now but I appreciate you coming and sharing your your story and your perspectives with us like thank you guys too for the work you're doing and without the program I don't know where we would have been honestly yeah well thank you um next on our list is sorry next on our list is Jesse Lynn Dolan Jesse Lynn are you with us I am hello hello can you hear me we can hear you great I don't think my camera's on but that's okay no we see you see you too oh okay great great all right well hi um so thanks for having me here today again I appreciate the opportunity to speak on behalf of both medical patients and professionals really my name is Jesse Lynn I'm an opioid research nurse at UVM I specialize in multi-substance use and mental health disorders I used to manage one they've worked labor and delivery and I co-founded UVM's labor doula program I'm also vice president of American nurse association so I have helped represent a lot of nurses statewide for Vermont and I'm on the same the sexual assault nurse examiners advisory board but I'm also a medical cannabis patient myself I'm a chronic pain patient I've had about 40 surgeries due to both childhood car accident and a genetic disorder the same genetic incurable connective disorder that Amelia has which affects my organs and joints and has also led to multiple surgeries so again I've had over 40 surgeries I have titanium rods plus human cow pigs stem cells all kinds of stuff holding my face and my fake teeth together so I can actually speak to you today so between all my personal and professional lives I take anything having to do with medication and patient care really seriously I've tried more medications than I can name experience more fair share of negative um reactions side effects I've also administered dozens and dozens of pharmaceuticals to patients and watched them go through the same without cannabis personally I would easily be on multiple pharmaceuticals um with a much lower quality of life so because I'm a research nurse I'm also a single parent of adults and teenagers I have parents in recovery from alcohol and addiction I've spent decades as a nurse working with addiction and myself personally I don't say this often but I have two and a half decades sober myself um I so I don't make the decision to use or support cannabis consumption lightly personally or professionally for many years I've been a cultivating cannabis patient and caregiver cultivating for another nurse in cancer remission I actually started out purchasing and wanting to purchase from the dispensary but I couldn't afford the medicine on my nursing salary and my medical needs I was also surprised at the poor quality of the medical dispensary I know people have discussed reasons patients aren't signing up to get their card but I really think quality is the number one issue for me beyond that um absorbent expense which made it not an option so I decided I needed to grow my own I wanted cleaner and better cannabis but I also realized that the dispensary staff weren't medical professionals so I was going to a medical facility that couldn't give me the medical knowledge that I needed to be supported so obviously I recognized there was an urgent need for cannabis education right for myself for others so I dove in I started taking as many classes as I could find on cannabis I started the vermont cannabis nurses association specifically to help educate medical professionals and patients I now serve on the board of the american cannabis nurse association and together the american nurse association vermont so the vermont nurses and um we we've acknowledged this we understand this so we've created an education program for medical professionals in vermont with the vermont cannabis nurse association a virtual cannabis ed curriculum to help bridge this big knowledge gap but that's that might not be enough right if we don't actually have medical patients and medical professionals overseeing and changing the medical program so again I appreciate you listening to us and being open to making a lot of the changes that we really need to see to improve our program um first off is the funds Amelia mentioned this before we need that to stay protected this isn't some kind of fiscal territoriality right there are real patient and programmatic needs that money can reduce annual patient fees increase the delivery so we have more rural patient access cover lab testing costs to help ensure consumer protection when we heard about the dispensaries before talking about lab testing that's just testing for thc and cbd we don't test for contaminants in this state so I don't know if my medicine that i'm buying from a dispensary has mold or mildew in it and that could make me or another patient much sicker so if we had those funds maybe we could lab test and cover that expense to ensure clean cat cannabis and then we've heard over and over education that money could create a fantastic education program which I think we all know could absolutely be done better um so a couple things I'll propose you know I propose creating a standardized mandatory statewide education program for medical and adult use staff and the medical patients right now we have five dispensaries they create their own education and it's not working I hear repeatedly from patients and other medical and cannabis industry professionals there's a serious lack of education and support amongst the dispensary staff so I know they mentioned before they have continuing ed but who do they have qualified to give them that continuing education and as the adult market opens up um we're going to start to have retail outlets all over the state but they're going to be under informed staff kind of left in the dark so this could get worse the reality um what we've heard people say before is that all consumers are patients 70 percent of Americans are on pharmaceuticals so we have to accept that a lot of people who will use adult use dispensary will be on meds so they are a patient they just might not have a med card why they're a veteran they're worried about losing their benefits they're a nurse like me and I was very nervous for years to put my name on a dispensary where my professional license could be questioned um single parents might be concerned they're putting their name in a system where they still have stigma that can be leveraged against them what about gun rights so there's a lot of good reasons people might be patients but might not be on the registry besides accessibility affordability quality of product so we really do need this education continuing education for staff because this is fast paced and this is rapidly changing the industry as a nurse I'm constantly reading and trying to keep up so I can't imagine five different medical dispensaries having five medical professionals educated enough to be doing this continuing education I would love to see harm reduction micro dosing helping efficacy to help costs learning and teaching people how to choose that best strain the dispensaries often don't have enough options of different strains or necessarily the education to help that patient um understanding medication interactions is a really big one as I said seven out of ten people are on pharmaceuticals and then having the right referrals so substance use disorder referrals and mental health support referrals and being that conduit in a way um so really every bud tender across the state medical or adult should have education I feel very very strongly about that um and we know that money that we lost in 2017 and the current cannabis control or cannabis fund could put a medical professional one day a week or more in every medical dispensary across our state and let Vermont set a national example and do it right by actually having medical professionals and education for medical patient support another quick problem that needs to be fixed no one's mentioned yet is I hear from patients and caregivers who their cards have lapsed and expired because of the systematic approach so I would love to recommend and see a better approach systematically not just maybe an email or did you sign up for the email system I've lapsed a card I've lapsed a caregiver card I just yesterday donated cannabis to a patient who her card lapsed she can't see your doctor till July it'll take a few weeks to get the paperwork so somehow that's just a little logistical thing that I think as we move forward we can do better with that um we also need to help patients financially cannabis is really expensive I'm a nurse I make a decent salary but I'm a single mom I couldn't afford that's why I started to grow for my own so we need to help support patients through that caregiving process for financial reasons outside of the retail dispensary so basically medical cannabis is an issue of social justice right so with that being said speaking of social justice thank you to Vermont growers trace know for rural Vermont racial justice alliance the people who really have been pushing to make a social equity program better in Vermont for females and felons so I'm grateful to them so cost wise I can go pay a dollar to go pick up opioids I don't have to wait three months for my doctor to write me a prescription for Xanax compared to plant medicine so this is not only why I donate this is why I grow this is also why I've attended almost every symptom relief oversight committee for the last few years to try to have this voice but that committee is often the the voice of patients who can afford to use the medical dispensaries and the dispensaries appoint those patients themselves so I just want that to be noted that that I know hopefully moving forward we will see that adjusted a bit that the current makeup of that committee does not represent the patients who are unable to afford and afford and have the privilege of using the dispensary so with that being said one of my requests is to add some people to the symptom relief oversight committee right now it's a patient from every dispensary I'd ask that they continue to you appoint a nurse and a doctor but the nurse I would love to see appointed by the American Nurse Association Vermont as of right now it's governing appointed A&A Vermont starting the statewide education program does have a good pool to suggest nurses from and we are written into statute for many of our other committees and this is what we do we basically vet and see who is the best person to put forward I'd like to see a naturopath on the board naturopaths are verifiers for cards more than the Vermont medical society from my understanding and are supportively and have a different understanding of natural medicine so the dispensaries even mentioned that the Vermont medical society pushes back on them having a naturopath on the board I think would be a really good fit I'd also ask to put a cultivating patient and a caregiver on the board and I'd suggest that the Vermont cannabis equity coalition appoint that that's the that's the Vermont racial justice alliance VGA Royal Vermont and NOFA and we need someone I think from the agency of agriculture's hemp program to appoint either someone for cultivation or lab science so really to have more of a voice than just the patients that utilize the dispensary system so that's one of my big suggestions and request we need experts on the public board service that have understanding about utilities right so we need medical cannabis professionals and patients as guides on these boards with that being said for the cannabis control board advisory board itself I'd also like to see them expand to a 15th person and not just have the chair designate the symptom relief oversight committee but two positions to make sure they have both a medical professional and a patient representative so there's one you know because as I've mentioned my concern is just having that one person appointed and that they might have the financial privilege to use the dispensaries compared to other folks and that wouldn't represent my voice by any means so so a few of the hopefully legislative and bigger changes I see is really reiterating some of the great testimony we've heard today that three month relationship for a patient is silly like I said I don't need to wait three months to get a X or a per cassette the definition of a debilitating medical condition is very limiting in Vermont we have probably the most you know tightest program here I think it comes down to again education we need to trust our medical professionals to be able to say yes it makes sense for this person to utilize medical cannabis right um getting rid of having to reapply every year even my doctor thinks it's kind of silly every year oh I got to write again that you have the same degenerative debilitating condition every year increasing a patient's possession limit from two to twelve plants and I want to give an example as to here is why so one plant gives on average a grower maybe three ounces or so I need 16 ounces to make one initial treatment of what Eric mentioned before that Ricky Simpson or that FICO treatment that's just the initial treatment that's two months to get 16 ounces I have to grow six harvests so that's going to take me eight months to get two months worth of medicine so just a quick example to understand why that plant count at two is so silly and we really need to adjust that last winter I was scheduled for a long back to me for a breast tumor removal and I accidentally destroyed 16 ounces of flour making my own eight months worth of harvested medicine right before I needed it for post-surgical pain relief so even somebody like myself who has been doing it a while I did it wrong and that was a big loss and a big concern for me and if I didn't have such limited plant counts I probably wouldn't have had I guess that been such an issue mistakes happen plants die they get sick they get diseases you burn the FICO or the brownies right sometimes you grow something in that strain doesn't work for you at all the dispensaries have a limited strain selection it's taken me years to go through strain after strain and I only have so much so many plants I can have so it takes me a while to say oh it's taken me six months and now I know that plant doesn't work for me it's taken me years to find one medication that helps me for my migraines but interestingly enough it only helps on its grown outdoor and not indoor so with my minimal plant count I have to try to take that one strain and grow enough outdoor for the entire year because that's the only medication I can use for my migraines um so speaking of I guess the dispensaries if we're making an accessible market which is what we really want to do I think we have that more ethical obligation to also craft a more supportive affordable medical program that puts patients over profits right so we have to allow patients and caregivers to purchase from any red from any dispensary adult use not just any medical dispensary without paying the extra taxes or we should look at medical dispensaries being non-profit so that they can serve patients it's patients over profits um currently they can profit on both regardless of what they say we know there's a risk of them not having enough medicine for their patients because we already see them struggling to have enough quality medicine and enough options and different strains for patients so um I also encourage you to look at unlimited veg immature plant plant counts for many reasons cultivators can explain in the same light I'd like to see a larger outdoor plant count as I mentioned before if we're going to include that for adult use if they can cultivate so much indoor and more outdoor let's also afford that to medical patients as well what if I can't grow for a season or a harvest what if I have two plants die what if I um you know have to cut my plants down and I want people to be able to cut their plants down instead of try to salvage a stick or a plant that has bugs or diseases something like that so for a little regional perspective mains cultivating caregiver and new york is what we should look for new york's cultivating caregiver programs um i'm sorry mains cultivating caregiver program is much more substantial and really something we can look at for success new new york allows five patients to have to be care-gived for at the same time massachusetts you get 12 plants so our counts are so minimal and so low and extremely fear-based and basically putting burden on patients the next burden is the the fingerprints i've been a caregiver for years i've never had to get fingerprinted for that i've gotten fingerprinted for many jobs as a nurse i have to schedule it i have to pay for it i have to take time out of my schedule i have to find the right officer in the right place it's just a burden and if we're talking social equity this is the absolute opposite of pushing that social equity forward um a couple more things i'll quickly want to say caregivers i like to look at having up to five caregivers especially for pediatrics when you look at either pediatric seizures or end of life you're administering medication often you need four and a half people so that one of those caregivers is not working over 40 hours a week and i do foresee in the next five to 10 years end of life is going to be much more cannabis medication so i'd like to see us working towards this now instead of every year just having to change the you know change legislator and go back to making bills reciprocity reciprocity sorry reciprocity makes sense we've had a few people mention that lastly i think you guys have heard over and over the thc caps and removing those as i've mentioned most and many adults who use cannabis are using cannabis medicinally whether they're registered patients or consumer patients so we need to give them the options more importantly they'd like to have possibly geographically closer dispensaries more product options and maybe support small businesses rather than large-scale for-profit medical corporate cannabis so it comes down to that access that affordability and the quality so i know i've mentioned a lot pretty much everything i've reiterated probably what other people have spoken before so i appreciate your time your openness i'm asking you to help us help me help patients and medical professionals be able to make this program that much better which i know we can do it's overdue it's deserved um and i think it will entice and give reasons for consumers to become patients and make that much bigger and more substantial and better of a program so thank you again you know please feel free ask any questions that you have and i'm always um here to help and answer questions and do anything i can you know to move things forward so thank you again thank thank you jessie lin sorry i have to talk fast to get it all in no and there was a lot to cover thank you for uh being for talking quickly because we are running a little short on time but do we have questions for jessie lin um can i ask a question about employment jessie lin just since you said this a couple times about you know being a nurse and being on a on a medical registry list um i had someone mentioned to me the other day that they're in the hiring process and will be drug tested as part of their hiring process it's not for a cdl so it's not necessarily like they're going to be driving or using heavy heavy equipment and they're worried about their employment um but they're a medical cannabis user and registered patient so can you talk a little bit about what those barriers are for people and employment and medical cannabis and what made me think about that was you know what kind of guidance should be given to employers about this program um my guidance and coming from actually the american cannabis nurse association just put out a position statement on this nationwide stating that if there's somebody that is on medical cannabis and they're more speaking to nurses because we have had nurses lose their professional licenses for testing thc positive even though they've had medical cards so what we with acna recommends is not testing a medical patient for thc or knowing that they're going to test positive and that that's okay but unfortunately policy is different and here in vermont we have a different policy at every hospital at every institution so you're really at the whim of that specific job so one job might test them and they might not pass but then the concern is is that job going to report them to the nursing board so it's not only the concern of can i get that job it's will this affect my nursing license in a different way so i think it's a larger concern than just actually can i get that job it's will my license be questioned and licenses are questioned when you have a medical card i can i can tell you that personally i was very hesitant to get my card it actually took my doctor a year or two to convince me to do it because of those concerns and i called the nursing board and tried to talk to them about it we have no stance in the state of vermont specific to nurses i am working on what's called the nursing position paper to make that stance but professionally i think we are kind of in limbo and in a gray area so my suggestion to that person would be find out the institution's policy if they need to have somebody else i've made cold calls for people or they don't want to call from their number or use their name to find out what the institution's policy is to see if it is a concern because it might not be a concern at all like one thing methadone patients in the state don't know is most of the methadone clinics here don't even test you for thc because they they're not concerned about it but if you go to a private prescribing doctor they likely will test you for thc so that's a different story so you really need to know who tests for it what are the repercussions as far as will they then you know have any concerns most of the time like you said it's a concern on the job and that's what the nursing board told me is there never be a concern or question with me being a medical cannabis patient unless there became a concern reported for the work that i'm doing as a nurse then they absolutely have the right to look and see what medication and what's affecting what so i don't so i hope that kind of answered your question but moving forward i do hope to see it more if not a state stance but a national stance that if you have a medically prescribed card you absolutely can prescribe or can you know test positive just like if you were medically prescribed xanax or a barbiturate or an opioid and you can prove you have that prescription you are allowed to have that job and test positive for you know purchase that and still have your cdl as long as you have that prescription hi jesslyn thank you so much and a quick anecdote on the on the subject of julie's question my parents who live in maryland have a good friend who is part of the maryland medical program and was trying to go back to school to a community college and had scholarships lined up and at the last minute they yanked those scholarships from her because she was a medical patient and because that was disclosed i'm not sure if it's because the community college has federal funding or the scholarships themselves were a federal stream but it's inhibited her ability to go back to school because she couldn't afford it without the scholarship so the big it's a big issue and then we know there's certain states i know florida at one point was testing people that needed to use the social service system for food stamps or housing assistance they were actually testing people a couple years ago for thc and you were not allowed to get that assistance if you tested positive yeah and i know that under the previous administration at the national level that was something that was being considered um just putting that out there unfortunately um i did have a question for you jesslyn and it's something that i've heard from you a couple times um and it's the it's it's the suggestion that if somebody has a medical card and they're at some place in the state of vermont they go into an adult use recreational dispensary and be able to kind of um you know buy a product tax free or under the medical you know purview versus the adult use program and i know julie had asked virginia about um how if she had any knowledge about how main was doing that earlier and i know um meredith had kind of walked us through a little bit how colorado does it and i'm familiar with that kind of set up where you walk into a building and depending on if you're a medical patient or not you kind of get shepherded through a different part of the building right um i'm curious um if if there's any other jurisdictions around the country that allow for a medical patient to just walk into an adult use rec facility and kind of you know present their card in that way and allow them you know that kind of um you know buying power to do so with with under the medical tax free kind of concept or if that's something that that's could be unique to vermont i'm almost positive that's how oregon does it i don't know how every state does it um but i if it is something unique to vermont i think we could do it really well too i kind of see it as when you go to the regular general store and they have the liquor store you have two separate cash registers if that's what it needs to be i don't think it should necessarily be two separate rooms because i want patients to have access to any and all products and to have those options um but i i do think we can absolutely find a way to make that happen and i i hope the better we make this medical program the more we will have people people want to get their medical card and to be part of the medical system i think we've had a lot of people over the years leave the medical program because they're just not a supportive reason to do so i know i am sometimes seen as somebody that's anti the dispensaries and i'm not by any means if they were doing full panel lab testing had quality product and had the education behind them and affordable prices i would be the biggest cheerleader in helping to sign people up left or right for the dispensary system but right now i can't say that when i don't know if that that's affordable medicine i know it's not clean medicine if they're not doing their lab testing i've been growing cannabis a long time i know how growing large scale um if you don't test your medicine you know not every time but you'll get problems here and there if you're not checking it so i would love to see us really grow this program and make patients be excited to sign up and be proud of the vermont program great thank you one more question and i think it makes sense for you based off of your your profession and i'm wondering let's say there is an opportunity in the future to open this medical program up to other physical and mental ailments and i'm thinking about recovery from opioid addiction and whether it's somebody that's leaving a rehab rehabilitation facility um and you know is looking for something to help them with that or somebody who's currently incarcerated for something and has an addiction while they're in a correctional facility and in lieu of using you know recovery drugs like suboxone or whatever the case may be they might be able to um use a medical cannabis i'm wondering if you have any thoughts on that and if you'd be willing to entertain me oh i've got a lot of thoughts but i'll try to make it quick because this is definitely my wheelhouse and probably one of the reasons i am such a supporter of cannabis medicine because i hate to say and be graphic but i have done CPR on people and my patients that are overdosing you know pregnant people that are overdosing i i'm the person that administered methadone to babies for years to withdraw them so this is such a passionate topic for me um one thing i would like to see in vermont is that anyone who gets an opioid prescription automatically gets a medical card that's how pennsylvania does it so we really can as eric mentioned you can use less opioids when you're using cannabis so this comes all comes back to the education we need people to have the education what we know is you use less opioids when you're using cannabis in conjunction but we also know for not for every person with substance use disorder is cannabis right so that's why we need the education it's when within the substance use world we always talk about what's better for you abstinence suboxone or methadone and that you have to know the information to make the right choice same thing cannabis is not going to be the right thing for every person in recovery but for many people in recovery you can get off your opioids you can help your withdrawal symptoms you can you can be on suboxone or methadone and maybe now you don't need to take ambien too you can use cannabis in the evening at night or you can reduce your suboxone dose i've helped people use cannabis to slowly wean off methadone or suboxone or percocets to not have such bad withdrawal symptoms so i think in every way absolutely cannabis should always be an option alongside every opioid with the right medical support to know if that is the patient and i'd say seven eight maybe even nine out of ten times i think cannabis in conjunction with with opioids is the right decision but i have had those patients who will look at me and say i can't touch anything the minute i feel a little bit i'm gonna go right back to heroin or i'm gonna jump you know right into my world so that's why it's it takes that skill and education and also i want every bud tender even at the adult use dispensaries to have this info because i guarantee you we are going to have people go into adult use and say oh yeah i'm taking percocets for my knee and i want to try this weed and this and that dab and you know and just having that knowledge to say hey here's a phone number you could call there's some states doing hotlines there's a nurse hotline in colorado that is getting raging reviews because a patient or a staff at a dispensary can pick up the phone and say hey a couple questions can can you help me or a text line we again we have the unique opportunity to provide education like no other state has done because we have a small state and because we have a new market and because we have the cannabis control fund money sitting there to say yay here let's start a program and educate people so with vermont being one of i know we're not the highest now but at one point we were the highest opioid opioid epidemic overdose in the country i think we it is unethical for us to say no we are not going to make cannabis another option basically so yes please please anything we can do to substitute or support opioid use disorder opioid prescriptions even alcohol use disorder you know other addictions as well absolutely and if you guys ever want to sit down i'll chat with you for hours specific i have all the research i've presented on this yes yes please i i have some education for for everyone for detail and for medical dispensaries i'm also wondering how much endocannabinoid education is in a nursing license or do physicians get or do naturopaths get just in general in a medical education unfortunately none you have to seek out the education yourself that's why we started this vermont um nursing program because the national nurse statute state that every nurse needs to know about cannabis but it's not in anybody's nursing curriculum so you have to seek it out for yourself so yes it is it is we'll get there eventually are there like a approved CLE type um courses for nurses or physicians to use that will you know count towards your CLE count depending on your your license absolutely absolutely and the one we're doing with the vermont nurses gives you a couple hours i work with another program i think it gives you 12 CEUs which is a much larger comprehensive program there's several programs throughout the country some are UVM has ones um UVMs is i'd say pretty expensive compared to a lot of other programs if you're looking at financial feasibility i've taken UVMs i've taken pretty much most every program out there vetted it um so yeah there's a few programs there's not a per se national standard or certification as in a lot of other certifications you can kind of start it in your bedroom or the garage right and call it a certification so there you know institute has won several different colleges are now putting things out there's cannabis coaching certificates so you could choose one and go with it or i really like Meredith's suggestion of i i think it would take a little bit of of work for sure but i think vermont could create their own program and do it really well but as i mentioned before my concern would be that one um does the medical dispensaries have the medical professionals to be doing this training or the continuing ed and also in some ways i think this medical training should come from someone in some place that is not attached to making financial gains so the dispensary themselves maybe shouldn't be the ones educating their staff at a statewide level because of that financial gain possibility great thank you i know i got more questions but we're running behind schedule so i'll turn it i'm done asking questions right now uh mr chairman i'm sure julie has a lot more too but i recognize it's 12.08 yeah thank you jesse jesse lane i mean you've been an incredible resource for the board already um and we uh and prior to the board's formation as well so but but thank you for your for your advocacy thank you for your help um understanding these issues thank you for the kind of um work you've been doing on the intersectionality with opiates but uh and i'm sure we'll be working with you in the future um i i would like to turn to public comment um you know our quorum rules will require at least uh at least two of us to be here i know we haven't had a break yet so julie or kyle if either of you want to step out for lunch um that's great i can um conduct the public comment um but i do see a few hands raised so i'd like to do it um for those with their hands raised i'd like to just really limit your public comments to two minutes each and um we'll start with the people that have uh joined via the link um that have their hands raised the first one that i see is eric read eric if you could unmute yourself um if you have a comment um great okay am i on we see you we hear you here okay uh to what meredith said to what eric said to what jesslyn said um because of federal legalization i think your bud tender should minimum know the endokinabic system um i too i will not do uh i won't do your medical registration anymore um just for all the reasons that they mentioned um i couldn't afford it and you were talking minimum five thousand bucks a year uh i took five grand and i um i now have my own ethanol processing lab and what they're saying about it takes this much flour right there's a half a pound of flour to make a few tubes of fico and it just really it we need we need a higher plant count um for sure we absolutely have to have a higher plant count um i think you guys are crazy if you don't get jesslyn on somehow involved to put her in charge of some kind of curriculum to educate and have her um or somebody like her have her the one um to educate people i've learned more about the endokinabinoid system from her and i went to a lime specialist uh here in vermont and i took the hygienics test i took the western blot test and i score i hit more markers than anybody she had ever seen i was well over 200 pounds um because of cannabis i've lost close to 75 pounds uh every day i do 100 push up push ups chin up sit ups um for three years now i go to mental health counseling um because of cannabis my life has and and i've lost covid forget covid i've lost my dad i've lost relationships i've lost so much and because of cannabis and him and thc um i can get up every day and i can be the most positive i've ever been i get up at four or five in the morning um and i again i so here it is i have light i have fire in me because of a plant and the way that we are um regulating it the way that we don't because the federal regulars because of the federal legalization i watch what goes on in israel and i watch what goes on in canada there's so much research that's the key to that federal legalization and once that's open then you can answer a lot of those questions because doctors can't prescribe it they can't and they don't know and with the cultivars we we need research we need scientific data we need to know which ones um you know put uh send prostate cells into uh apoptosis versus uh the colon cells so the bud tenders i think we should just get them educated on the endokinabic system learn about 2ag learn about andondomide eric thank thank you thank you for the the public comment i really appreciate i think that's been a consistent theme that we've heard over and over and over again today so so thank you for kind of you got it reinforcing that for us absolutely thank you for your time thank you thank you thank you eric i totally agree that federal legalization will open a lot of research doors to a lot of the institutions that you know the federal government has a partnership with appreciate it thank you so much um next on my list is tito tito if you could just unmute yourself and provide public comment and please if you can keep it to two minutes i'll let you know when that when that marker is okay for sure i'll be quick so ever since i started down the road uh for advocacy of tax and regulate i've really uh enjoyed trying to work with other business owners and and people along the way and so i feel compelled to talk about the vermont cannabis trades association that virginia brought up that was started by shampton valley dispensary um i went to these meetings and it started off great it kind of felt like oh we're gonna get everybody involved and um and then the the the meetings kind of fizzled out and then um since i'm a patient i as you know i have to designate a dispensary as my personal dispensary so i get their emails and i was surprised to see the vermont cannabis trades association still being touted in their emails as if it's uh something that's inclusive and it just it feels extremely disingenuous to me i reached out to them um through email multiple times nobody's ever answered me back and um so i just i felt compelled to talk about that because um i think we need to keep we need to keep things genuine as we move forward thank you thank you uh does anyone else who joined via the link uh the um want to provide uh public comment and if you do please just raise your kind of virtual hand all right does anyone who's on the phone um want to provide public comment and again to unmute yourself you hit star six okay um well we're going to take a break um we're going to be back at one o'clock in about 45 minutes um we're going to be hearing from the chair of the marijuana for symptom relief oversight committee as well as the uh physician appointed member of that committee who's in surgery right now and hopefully will be able to join us um but uh nely if you could maybe just uh for the next 45 minutes throw up our away message and uh you could pause the recording as well and we'll all be back at one o'clock okay uh this is uh james pepper chair of the cannabis control board we're resuming our meeting it's one o'clock um we have uh two witnesses on the agenda i believe i saw both of them here um dr joe uh and uh jim are you are you on the are you on the line could you turn your cameras on yeah i'm here oh great i'm here as well well let me give just a quick if you don't mind let me just give a quick orientation um as to why i asked you all to to join us today so essentially um you know we are uh the cannabis board is is taking over the medical program on january 1st 2022 and um you know i think that the medical program we've heard from a few witnesses today feels like in some ways that it's been frozen in time since its inception with a few minor kind of adjustments over the years but um really it seems to be kind of based in a coal memo mentality which is i think it was an important um you know it was important at the time it's still important to this day about doj enforcement but i do think that now um that we're moving into a world of adult use cannabis in vermont i think it really makes a lot of sense for us as a board to reconsider some of the restrictions that exist in this program and really try and make sure that uh we're achieving a patient-centric medical program here in vermont and i think that what's interesting is that the um the legislature i think recognized the need to have a um a group like the marijuana uh for symptom release oversight committee to help advise them on um you know changes to the system that needed to be made over time and i think that your reports which i have read um are incredibly instructive and uh incredibly helpful in trying to achieve that patient-centric focus um but uh you know for one reason or another there's competing priorities in the legislature i'm not sure that you've gotten the attention you deserve but i think again this is a time and they've directed you all to really rethink the membership of the marijuana for oversight um committee us you know solidify the relationship between your committee and the cannabis board and think about how you can provide some good information to us um to really help you be the conduit for patient voices in uh through the cannabis board and we can be kind of a megaphone for for you all and the recommendations that you're making to us so i'd like you guys to talk about whatever you would like to talk about um but i think that some of the things that uh we've discussed offline are um how to be more patient-centric how to really focus on quality affordability and accessibility of the program and um talking about your kind of 2019 report which i think um you know really focused on those issues and really anything else that you'd like to like the board to know um keeping in mind that we do have a report back to the legislature on november first of this year with some recommendations specifically around how to reconstitute and how to restructure um the marijuana for symptom relief oversight uh committee so that i'll turn it over to you joe or jim if you want to start thank you very much uh chairman pepper um and i want to write from the start uh thank you all for your support so far and this morning's testimony was was really uh uh enlightening it's certainly the the type of uh testimony and information we've been receiving uh for these many years and putting in our reports um but it's clear that the cannabis control board is interested uh and incredibly supportive of the medical program here in vermont and uh that's makes it uh exciting time now because as as we've seen the the medical program has been a little bit of the wild west so i'm going to just quickly introduce myself and my colleague and then talk a little bit about uh the marijuana for symptom relief oversight committee i'm jim romanoff i've been the chair of the symptom relief for oversight committee for this year i've been on the committee for six years i believe i'm a registered patient uh was initially appointed by champlain valley dispensary and uh the besides that i've never spoken to them uh about being on the committee again and uh i also want to introduce my colleague dr joe mcshary joe do you want to joe as the prior chair give a brief introduction of yourself well sure i uh was a chair from the inception uh but i have other responsibilities and i really was looking forward to someone else being here now which is why jim is um basically uh i come from a background of physics at 1965 from harvard i went to school got an md phd in 1971 from baler and then all sorts of other uh degrees and especially all of these i do clinical neuro physiology and quite by accident ended up in the legislature as a doctor of the day of the medical society in 1980 when they were discussing a medical marijuana bill and uh they asked me as a doctor who was just happened to be there you know what do you think of it and i said i don't know they define as far as i know and i was uh listed as testifying in favor of the medical marijuana bill and all of that bill uh passed and was signed by the governor nothing ever happened with it and so when it came around in 2000 they were going to do this again uh virginia was uh taking care of mark tucci at the time i think and uh so they asked me to to uh testify potentially and so i have kept track of the research since then uh in cannabis and it's you know very interesting and uh the the board as jim has said has uh gone through lots of things i think we've always been very patient centric and uh consequently we haven't had a lot of input from and haven't run a lot of need for input from the security people and and so on but uh that's how i happen to be here quite by accident and um delighted to be participating and i'm very grateful to the committee for that is the ccb for uh incorporating us uh as you have and i look forward to the better uh pathway bring information to the legislature by bringing it to you and um having you the opportunity then to actually speak to legislature with a voice that they'll hear but i have lots of things so we can get on with those after uh jim takes off now thank you uh joe um you know i think the really amazing thing in listening to this morning's witnesses uh you know that are clear as a the medical marijuana program in vermont has a very passionate and involved community of both patients and caregivers as well as the dispensaries themselves that are eager to participate in the discussion and our experience on the oversight committee is that people have been eager to participate in the discussion all along the oversight committee however is really uh in somewhat a relic of the beginning of the medical program in vermont um and uh james is correct i think in in pointing out its existence in in many ways because of the coal memo um and i just want to um drop people's attention to the statue that originally created the cannabis or medical symptom relief oversight committee it is title 18 under the vermont statutes and chapter 86 the therapeutic use of cannabis and then they created a sub chapter uh 002 in which they created uh this oversight committee and the membership of the committee uh which initially was a registered patient from each dispensary a nurse and a registered patient appointed by the governor a physician appointed by the vermont medical society that's dr joe um and then also a member of the local zoning board appointed by the vermont league of cities and towns uh uh member appointed by the vermont sheriff's association and uh a representative of the department of public safety and just the fact that the medical program was in the department of public safety it sort of is uh tells you uh that it was started out almost uh protecting the the public from uh the medical program and the risks of uh there being legal cannabis through the medical program um half of the members are were from either public safety or you know uh league of towns that type of thing i think the concern was that people want a dispensary in their community uh was it going to be safe and uh over the years as as joe pointed out there turned out to not be really uh any problems uh in any major way that had to do with public safety or the cannabis getting from the medical program into the uh public stream of usage and a lot of the members who were from law enforcement really stopped attending our meetings i think because it was really just patients and caregivers uh talking about how to give patients the best access uh to the best medical program that they could um and the way that the committee was asked to originally report to the legislature uh also said a lot about the the uh the cold memo and the fact that the committee was was really uh there in a big part for for uh cover and public safety but we were asked to report uh at the beginning a january of each year uh in writing to the legislature and that's what we've done the committee was not really given any other uh avenue to communicate to the legislature there's no uh you know a requirement for them to call anybody as a witness or anybody to testify and as a result we often the reports uh are well researched and well put together we did this mostly with the support of the department of public safety who manages the registry currently and facilitated this committee and the department of public safety you know has has been a great partner but uh clearly you know sets the tone that public safety is more of the issue than somebody from the department of health or the department of human services uh being involved in in the medical program but clearly the times have changed uh medical marijuana is uh legal in the majority of states uh recreational cannabis is now uh legal in a huge number of states all throughout the northeast and so with the changes really in the prevailing uh attitude about medical marijuana I think we've realized on this committee that there also needs to be changes made to what this committee looks like how it's made up and how it reports to the new cannabis control board and as the laws were being made to create the recreational marketplace on the committee we were concerned that uh the amount of money that was potentially there for both the dispensaries that were in business now uh and for any businesses that were going to get involved would really uh drive the conversation in terms of how the new law was created and what the medical program would look like under that we even heard uh anecdotal stories of legislators saying you know if you have recreational why do you even need to have a medical program anybody can just go buy marijuana at that point which really tells you the sort of the the lack of understanding in the legislature of what the medical marijuana program is but also from the side of the the oversight committee the lack of our ability to really communicate to the legislature other than in that report we didn't really have any mandate to be activists about it and show up and when the laws started getting created for recreational it became clear that the dispensaries did have a great you know lobbyists working for them and you know I think that the fact that the law did get passed two years ago without anything written in for oversight of the medical program it says at least something about you know whether or not patients and caregivers needed or do still need their own advocacy in this program at the beginning of our our session this year we took a survey of the of the reality that the law had been passed and read through it and realizing that there the oversight committee would end in march of 2022 I believe when the certain parts of the new laws kicked in we decided the best thing that we could do was deliver our 2019 report which had been delayed because of the pandemic but also start to make a strong case for the oversight committee or some form of oversight being included in the advisory panel for the new cannabis control board and were gratified that so quickly the law was updated this year with s25 and that we are now very excited to be at the edge of the opportunity to look at what oversight should and will look like in the future make recommendations to the cannabis control board our plan is to do that by the end of the summer to give you time to go through it and ask us questions and make updates as you see needed before getting into the legislature this morning you know as I said was a great I think you know case for why oversight is is really needed all the issues that were brought up of affordability you know types of conditions that qualify for the medical program limits laboratory testing you know everything including you know use of excess funding from the medical program are issues that we have dealt with and that are are coming up constantly and yet it is neither probably a wise thing for the dispensaries to monitor themselves and in looking at the makeup of the advisory panel to the cannabis control board they really clearly seem to be a need for at the very least oversight of the program but also hopefully more than that this morning also pointed out that we're at the beginning of a very exciting time where the prevailing attitude in the country is one of not only legalized recreational use but a way more serious approach to the number of medical marijuana programs that there are and how they're funded and how they exist within the federal tax codes and other federal laws so you know it would seem that we're at the at the beginning of changes that will be happening where the idea of things like insurance might be a bit down the road there are states that already do have grants available through their own coffers there will be all kinds of I think issues brought up as more research is done as to you know what the appropriate ways for the FDA to speak about medical marijuana will be and then that one in turn make things like insurance and medical practitioners more comfortable education that people talked about this morning is a huge problem there is not a a unified solid training program for bud tenders for people that work at medical dispensaries and the same standard of care needs to be created for medical patients that exists for medicine regular medicine heteropathic medicine in terms of the types of medicine that are prescribed and the types of advice and treatment they get so all of these things are things that the oversight committee in the future should be able to look at speak with the public get input from caregivers from patients and also hopefully be looking at our neighbors throughout the country see how other medical programs are operating and make recommendations to the cannabis control board about how to proceed I think it's really true that we have a good medical program now it is not the best program in the country you know but Vermont is if anything excels at wanting to be at the vanguard of things and there's no reason that our state should not be a model for how a medical cannabis program should go how new research is vetted and accepted and you know I sense that the people on the cannabis control board that you all are excited about that opportunity but I also hear from people in the community that they're excited so what we need to do is create a an oversight committee that is new and different and that can function in the right way in the future and we need to look at all these issues as as to whether we still need to incorporate public safety into oversight the league of towns whether those things are covered in other areas of your advisory panel so those are all things we will be holding meetings this summer and looking at hopefully within the next two or three weeks we'll have our first meeting to get public input and discuss with the board you know how we're going to go about aggregating and pulling everything together to make our recommendation and you know I'd like to say that I don't want to ignore all the issues that came up this morning I think myself and Joe would be happy to talk about any of them I all of them were in our 2019 report and I'd be happy to go through them and I'm talking about you know reciprocity and possession limits and but I really do think it's more important that we get the opportunity to talk with the board about the future of the oversight committee itself and get the nuts and bolts out of the way so that we can get back into the business of being a clearing house for oversight and and good medical information and that will be one of the big challenges as people pointed out this morning medical information that there's not been public funding for a lot of research done on humans the medical industry doctors are not comfortable in my experience as a patient I've had a neurosurgeon an orthopedic surgeon just stare at me blankly when I tell them that cannabis has been part of my treatment and yet all the nurses and surgical nurses know that I've been able to use less opioids by using cannabis so it's education and it's and it's a good education from trusted sources and that will be a challenge I think and I was hoping Dr. Joe could speak a little bit as our medical representative on the oversight committee about the challenges of even getting a medical appointee to the board who would be the the advising body that we would go to that would be we want somebody that believes in the use of cannabis as a medical therapeutic treatment and Joe do you want to jump in here oh sure I have lots to say about lots of things and the first thing that I would love the board to do for us is change the name to the medical cannabis oversight committee it was called symptom relief because they didn't want to call it medical marijuana and marijuana is a term that applies to something that I don't know what is cannabis is a well known plant and its use in medicine is really ancient 7 000 years or so so I would hope that you can consider that and I would I'm also agreeing with the idea of less emphasis on the enforcement vendors and more emphasis on the research based testing and the symptoms and yeah that's those are the things that I you know particularly interested in to sort of illustrate the diversity of products that are needed there is a course at UPM I think it's the first course of medical school since 1941 that deals with cannabis and its function and part of that I did make a little spreadsheet up that showed all the terpenes and terpenoids as well as the cannabinoids and what they're thought to do so if you have somebody who's taking pain medicine for instance they have taken the morning I've taken the evening they're going to be two different kinds of cannabis because cannabinole and linolol sedate the patient that's good for bedtime but pineene and limonene are alerting and energizing and so you'd want to have a chemovar I think they call them out and be able to choose those and preferably with the knowledge of what you're doing which brings me back to my interest in research and that is if we could find out from the patients what they're using and know what the chemical composition of that was and what it helped we could begin to put together more research than is available in the world right now although people have been studying this in Canada and stuff and there are programs for doctors and things you learn about cannabis in the Canadian cannabis society so the the need for testing and regulation I've actually in 2001 I suggested the medical society go on record favoring cannabis for medical purposes and another resolution that I offered was as a public health issue to make it legal for everyone because at the time you're still buying stuff off the street this marijuana which you have no idea what is and that's still kind of what you're getting as long as it's not tested by a third party tester and there are people apparently in the state who do that that is test for all the terpenoids heavy metals which are toxin obviously other things that the pusher might have added for enhanced excitement are things that you don't want in there and so I'm really grateful but I think it's it's the recreational program that needs the testing as well as the medical program that's vital as a public health issue you the makeup of the board out where we get that data I've also Jim and I have talked about wouldn't it be nice if your board had a little chapter for patients to register their observations and we could look at that and get an idea of what the patients actually want because we do always have patients on the board and they can tell what they and the other people they know have it's the way of problems like you know there's a mountain between me and where I can buy it so you need some geographic distribution of the patients and the getting getting getting the good collection of patients is difficult but if they're all depositing information on your website that's great and I can also then send out a questionnaire on the website for instance listing all the cannabinoids and things like that and I could fill out my spreadsheet much more accurately in the future and that would be something that would be really helpful and would be the sort of thing that the bud tenders or practitioners could also reference that is they could know if you have back pain in the other this one may be what we have a lot of so that's good for you that's not totally right much better for them to know that actually what you're going to do these three things here probably and try them out start low and build up gradually the affordability question is interesting and I hope there will be sliding scales and then we can also encourage insurance coverage if everybody is covered by insurance you wouldn't need to have the Canada's control committee subsidizing people and so increasing position possession limits is another thing which I just see you should not make it more restrictive than recreational in terms of possession and again the possession limits originally were set up when it was worried that everybody's going to have you know teenage kids are going to have back pain and want to pot and the doctor was going to say sure and then they might solve the difference I don't think that's real and I think that in terms of the dispensaries they remain you know again I have no financial interest in anything except you know retirement funds whatever they are but if the patient could go to any to any place that was selling cannabis in the state with their card and they could run their card and they wouldn't have to pay taxes at that point that would get them in a good place and it would also I assume the software would report back to us or somebody who's looking at how much the patient is using last day be doing that and going from store to store and sorry for their friends but I think it would be something that could be monitored well but I think it would be much more sensible and having people tied to a particular dispensary or a particular location because it's hard for people to get to them and delivery of course is a great idea too but it's going to cost some extra stuff we've heard about increasing the patient to caregiver account and that's super with me except that I remember originally the caregivers were allowed to grow cannabis for their patient if a patient couldn't grow it and if each patient has five caregivers that's about 70 plants and if each caregiver has 10 patients and they can grow 10 plants per patient that's 140 plants which is getting into the small scale grower category I think in terms of square footage and all so I think that we will need to define better how what what the caregivers and their responsibilities are so most caregivers I assume are just there to get the patient to the medicine in the middle of the school day and I'm not sure you know that that's illegal now but that's the sort of thing that we'd have to get the lawyers to tell us what you actually need in the way of a caregiver there if it's a matter of supplying them with uh cannabis that has been grown specifically for them that's great but again you need to have one caregiver per patient doing all that growing and so anyway I'd love to know more about the caregivers and how to stratify that and then let's do it in terms of the numbers of plants I don't know but 14 doesn't seem unreasonable to me if you're actually starting out from seed because you're gonna not know 50 percent of them perhaps are going to be slaughtered when they show their sexuality and you never get a 100 yield and if you grow them out with the sunlight whether it's outside or in a grow room or something like that that is environmentally highly desirable and you got to get your whole year's worth of cannabis in the ground and growing so that by October you're finishing up your harvest and you're good until the next October those are the sorts of things we can work on for you and I'd like to and other things there was this other category that James sent around is anything else and I want to tell you you've got to brace yourself for the elderly they're the fastest growing body of users and actually the more they get the recreational exposure the more demand you're going to have from them for medical because old people have pain anxiety sleep disturbances and dementia and cannabis helps with all those things in certain situations so they're going to want to move from recreational to medical and if you've got a very carefully defined list of symptoms which are diseases that the patient has to have the elderly are going to want to expand that considerably and a tantalizing area of ongoing research is the effects on addiction so that it's well known as Jim has mentioned sorry there are many articles that people who use cannabis who've been using opiates use less opiates for their pain and maybe not at all there's also tantalizing research on cocaine and perhaps rodents where they you can't get it they're out to get addicted if you give them you know cannabidiol and likewise if they are addicted they don't spend so much time pushing the lever for the cocaine if you give them the cannabidiol opiates as I say that's mostly humans that are any pigs for that and nicotine it seems to have a an association with reduced nicotine use which is a good thing also but it's all association as opposed to cause all of this they don't have a good scientific basis for why it interferes with addiction yet but they do know an awful lot about addiction and I'm looking forward to being able to provide additional information on that which brings us back to Jim's point about who do you want for your medical and perhaps botanical input I think you need to vet people because as I say I did propose in 2001 that the medical society go on record favoring medical cannabis and medical for recreational cannabis and that was not well received and I've done that occasionally since then and it's still not well received a lot of doctors are like regular people and they have opinions that are formed when they go to medical school and they don't get changed after that except by the drug pushers who come around give them lunch and tell them about their specialized new medicine for headaches so it's there's a lot that we can do and provide you and the research is interpreted by people and their bias comes through in their interpretation and I think it probably came out in some of our annual reports that the Department of Health has particularly poor advice and I just checked them out last week and they still are using an article from 2012 a study in New Zealand and the people who wrote that article were thoroughly mocked by the other people in the research community and eventually they rewrote the article so it moved from cannabis causes you to lose 10 IQ points after you're 21 years old to actually adverse childhood events is associated with poor outcomes in your younger adult life but the Department of Health is stuck with the 2012 one you know it's going to cause you to get stupid if you use cannabis which turns out not to be correct so the other things that were brought up I think were exempting PTSD diagnosis from physical exam and that makes sense if a psychologist and psychiatrist makes a diagnosis if I make it for myself that may not be so good exempting chronic conditions from annual provider forms yeah if people have a terminal disease hospice they're in hospice they have ALS or multiple sclerosis they're going to have that for the rest of their lives and you don't really need a medical recheck but if you have pain like Jim you got to check in with them every once in a while because they might actually get better or PTSD anxiety sleep disorders those people may need some sort of follow-up to keep them in the medical program once they're there so is that enough talk for now thanks Joe thank you I'm trying to keep it short but I have lots of hands for any questions that you're available yeah and we at any point please interrupt us for some questions I would say one one more quick thing that I think is important to this discussion part of the challenge of the sheer volume of input that the public that patients and caregivers have as well as the really what is probably going to be a flood of research and science that will start coming out in the next few years we are a volunteer committee at this point and a lot of the challenges we've had disappointments from members of the public when you know we we don't have the resources to send people over to the legislature to follow up on things we don't have the resources to in a large way have experts come in tell us what is the current state of thinking from both medicine and caregiving as well as the economics of using cannabis for medical care we don't have the funds to do a survey or have a website where we can get public input and so I think that is for oversight to successfully work in an industry that's going to be have a lot of money coming into it because of the recreational side of things I think it'll be hard to challenging to do a good job at this without the legislature creating a body that is going to have the kind of terms and at least the kind of permanence for instance that the cannabis control board will have multi-year terms as well as some kind of funding to both keep the diverse group of experts and people we want on the board able to come and do the work we're asking them to do but also fund some of the surveying and at the very least competitive research we need to do to understand what medical marijuana programs are looking like in the rest of the northeast the rest of the country and what is coming down the pike in the ways of therapeutic science that we're going to have so that we can then in turn advise the board on changes that need to be made in the legislation and that stuff's all down the road there's truly a lot of anxiety right now that the medical program will get in the left in the dust of the money that's to be made in the recreational side of things and it is understandable that the dispensaries are going to have hard choices to make about making a diverse selection of products that might not line up with what the most profitable products are going to be or the most popular in terms of a public adult use marketplace and you know so that does really again speak to the need for a third party oversight group to be involved in order to help look at these things and you know make sure that all sides are getting looked at but before I go any further do you do you deserve are there any questions from from the board Jim you almost read my mind there my first question you know having the chair and the former chair here was if we were going to kind of set aside a little bit of money for the for the oversight committee what would you do with it and you know that was a perfect response to the question that I hadn't posed yet so that's that's great I think that should absolutely be part of your recommendations to the to the board and ultimately to the legislature and keep in mind when you're thinking about the construction of the the committee that it's pretty common place these days to offer per diems to your members that might you know not be able to kind of volunteer otherwise volunteer their time so I think it's pretty typical to give $50 per day which is kind of a double-edged sword in a way because it allows people to participate but because there is this kind of appropriation that goes along with it sometimes the legislature needs to limit the number of meetings that you're entitled to but just something to keep in the back of your mind when you're thinking about kind of who can participate. Julie Kyle I've got a few questions but I'll turn it over to you first. I think I'm going to ask a question that's similar to quite a question I've asked throughout the day about patient education. Does your committee talk about patient education and you know I wonder you know if somebody's you know PCP agrees to fill out the forms and they go off and they go to a dispensary or they begin to grow you know what what could be available for patient education because I understand that treatment works better if the patient understands the care that they're getting. So can you talk a little bit about that? Well we do talk quite a bit about education and communication to patients and it's in you know our reason for being that's written into the statute that we be looking and reporting every year on you know what's being done in terms of communicating to patients and whatnot but I would have to say it was in the original statute it's really written from the point of view of public safety and of making sure that they understand what they're supposed to not do give it to somebody you know it was really about protecting the public so those are things that we will obviously work on to recommend changing in the charter of what an oversight committee would do but we we do talk about it because the group of us that are patients you know you get a mixed experience of people that you speak to certainly I've never sensed any uniform training you know and or anything resembling what would be a standard of care that would be the term provided in a medical organization and a standard of how to speak to patients and when you get into something like growing just the whole idea that patients aren't going to the registry because they can all of a sudden grow at themselves I will tell you as somebody who's done it for several years and lives with a master gardener who's done this her whole life and career gardening it is not easy to do and it is not easy to figure out how to do and when you go to a garden center they don't speak in English to explain to you how to do it and it's a terrible idea because you could end up with nothing it could in Vermont it can be all killed by powdery mildew the same as your tomatoes in one bad week so nobody tells you that and nobody you know I I don't know nobody's showing me any numbers of why people are leaving the as medical patients but education is really difficult and and I thought I think Kyle said it earlier the idea of taking one of our little gems in Vermont like the Vermont tech school I was involved with them when we were I was helping them start their flight pilots program there and there's expertise all over the state and elsewhere to bring into a school like Vermont Tech and the idea of being it's so exciting to hear everybody say this be a leader and perhaps Vermont show the way of how to educate people to speak to their patients it's difficult enough for doctors and nurses to do every day and we should expect a similar standard of care for patients in the medical cannabis program and quite frankly right now they're being spoken to by you know lower wage employees most of them younger some of them patients but you know nobody with any medical background as far as I know nobody who would understand what medications I take that it might interact with you know and I think you know being able to provide oversight in that area and recommendations and research how do we you know what would be the best way to speak to people I think in all industries it's going to be needed in this new world of recreational cannabis because in the gardening industry they need to learn how to talk to people growing cannabis it's different and yet very similar to growing your your fruits and vegetables and right now it's mostly people who are talking about growing it in their closet secretly and when they speak to you know my 75 year old uncle about how to grow a plant he doesn't understand most of it so standardized would be great Joe do you have anything to add to that yeah the research and who is going to give this education is a really tough question so that Stanford for instance published an article on what patients were using for their kids with epilepsy and it turned out that those who are using stuff that a little THC and it actually worked a lot better I mean they're all high CBD products but that a little THC is actually a very good thing for controlling the epilepsy in the patients but the research hasn't been done and in the in the rats we know a lot of preclinical that's the term you use for things that we don't know but mostly doctors have to listen to the patient and so doctors that listen to the patient are actually willing to fill out the paperwork and the doctors who don't know that cannabis doesn't do anything for any of your symptoms and you're just a pothead looking for access um so yeah you have to vet your your doctor um and the bud tenders are doing what they can they uh you know they get somebody says something works and they pass that word on but that is to me totally sloppy um and I would much rather have tested products and the patients you know preferably reporting in some place where I'd have access to the data um about what works for whatever symptoms they're dealing with and whether they take different things at different times of day and so on and then you could begin to get a spreadsheet or something for the doctors to be able to use who wanted to do the advising and there are you know lots of doctors I'm sure who want to do that um we don't have any pot doctors in Vermont but uh we have other folks who are good for recommending things but the research has to be done and this is something we could do and that's one of the reasons I'm really uh eager to get us a website where patients can report in and a mandated testing program so we can trust what they tell us this is uh orange blossom three we'll know exactly what terpenes and terpenoids are in that Jim and Dr. McSherry thank you so much for being here today it's really nice to meet you at least in a virtual setting um I have a question it's kind of building off of which you just mentioned Dr. McSherry you know one of the things well a couple things that you well if I'm backing up I'm really excited to help be a conduit for getting more data for the symptom oversight committee to really sink their teeth into a lot of this work in addition to being a vehicle or a megaphone as chairman Pepper alluded to earlier to make sure that some of your recommendations are not just another report that are lost at the state house but actually bring some life into into this program not let this program kind of be lost in the dust as we you know look to implement uh an adult use side of the equation um you know one of the things that's sticking with me and we've heard and it's no secret to anybody listening is you know it's a very restrictive list on the types of physical ailments mental ailments that qualify for the medical program and I think really understanding how we can expand that list might help this medical program really not be lost um as we look to do other things so I was I was curious um how the committee has kind of navigated um suggesting changes to you know what is what symptoms or what physical ailments mental ailments are available for a healthcare provider to make a recommendation that that patient use cannabis and then also you know what type of record needs to really be assembled in order for everybody to feel less anxious about expanding that list what have other states done I'm sure it's kind of like and that's a I'm sure that this answer could be an hour an hour plus long and I understand that and states are doing it differently but if we wanted to expand the list to allow a healthcare provider to make a recommendation that's not as strict as it is now you know what type of research needs to be done well yeah the kind of research needs to be done as far as I'm concerned um the if the patient says I've been using now the stuff that my grandkids had in the closet um and it seems to really help with a symptom I'm very eager to hear that and figure out what it does uh help with that is there are things like anxiety and pain where we have all kinds of mechanisms uh again from rats but also testimony from patients that it really helps with that uh the idea of alcohols interaction with cannabis a great public health question because you certainly don't want to drink alcohol and then smoke pot and drive but using cannabis you shouldn't smoke anything by the way but using cannabis late in the day may actually counteract some of the bad effects of the alcohol that you've had also and improve your sleep and their sleep is very important to making sure you don't get dementia which older people care about um because uh that's when your brain cleans out the garbage that is built up all day every day you make a lot of new connections but yeah you don't need all of those so you got to wash it out and uh people as they get older have more difficulty with that people who and there's all sorts of good data again that uh people who don't sleep on regular schedules and so on I'll get the med it earlier if you live near a freeway you're going to get the med it earlier than if you live further away but you're not going to get Parkinson's or multiple sclerosis by living next to the free way you're going to get dementia because it keeps you awake at night or messes up your sleep um so most of it uh I think is listening to the patient of the patient uh for instance has a sleep sleep disorder uh they have a COPD they're having trouble breathing at night and snorting and snorting and so on um it helps with breathing and maybe they have found that it helps with their breathing and uh you got to listen to them and if they say that then it's it's not going to be harmful for them to use it in a control sort of way um it's just not as dangerous as we might have thought a few years ago. Dr. Joe could I kind of put a finer point on that question if you don't mind? Does it make sense for Vermont? I mean the two ways that kind of the medical programs work around the country is one you have a long list of statutorily defined qualifying conditions the other way is if a physician recommends it or if a doctor recommends it you know it doesn't matter what the condition is it's their recommendation um do you do you personally um not you know as kind of former chair or member of the oversight committee but do you personally think that we should go one way or the other in Vermont? Oh yeah when I had patients who said that things worked for them I uh encouraged that and endorsed it and um you know tried to figure out which would have the best side effects for their other problems I don't see any problem with the doctor who recommends that this is helping my patient um letting that be a reason for that patient to take the cannabis and if there's some doctor in the state who is recommending that everybody take it then maybe they're just trying to get out of paying taxes um but you know once it's recreational it's not a matter that you're really saving the human race from exposure to cannabis um except if you're under 21 um and I think doctors uh who would be willing to file the paperwork in general can be trusted and if they again the statistics show that there's somebody who's 90 percent of all the recommendations in the state then maybe somebody needs to talk to them about did they suggest patient or did the patient suggest it to them? If I could just add go for it add to that Dr. Joe uh from the point of view of uh of a patient not a not a medical practitioner you know I think the list to a certain degree is is uh protecting the doctor uh the doctors are scared of of marijuana uh they are concerned about liability constantly uh our state didn't make it friendly we made it sound like it's dangerous but we're going to do it anyway uh for all kinds of reasons not that we need to look back at it but doctors just getting them to do the prescribing is is difficult so maybe adding in that it can be for a these reasons as well as a discretionary reason would be a good idea but in a bigger picture one thing I might say is that cannabis exists at a weird nexus in healthcare it is both in the realm of medicine and uh being used in that way it has been for thousands of years but it's even being seen that way now even in our country but it's also as we heard about naturopathic medicine and naturopaths being included it's it's in that area of natural health care uh that is more done often in consultation with a patient and how things are working for them but uh it's it's one of those things where you we heard from the story this morning uh with the child who is being treated uh for for cancer uh with high extremely high doses of thc uh to reduce the tumors um we're in the wild west still in terms of using cannabis in the in the eastern countries and the western countries uh as medicine and uh it's often being used you know like in that case because it's been read on the internet that uh there's a little study that shown tumors reduce but 10 families have said it really worked for them and that's not a comfortable place for a lot of my doctors to have somebody who doesn't have md behind their name saying you know look it's worked well and i recommend it so i think one of the things that we could do is foster a different kind of environment uh that includes medicine natural medicine and opens the conversation up in a way uh that a makes it clear we're past that uh cannabis is a scary dangerous uh thing that it you know reefer madness showed it to be and uh that it's just like areas of medicine that exist now sometimes you have a desperate patient who will try anything but many times you just have creative practitioners looking to keep their patient out of the office off of more dangerous pharmaceuticals and living a healthier life so i think some of it is is is not just giving them the science but uh turning down the level of fear and uh you know uh turning up the level of what an amazing environment we're in that we live in a state uh that looks at everything in such a progressive way in medicine we need to do it too here yeah i would add that i sent a new oncologist who came in uh a bunch of articles showing that uh brain cancer cells all get killed by cvd and thc uh but that didn't you know make any difference um but knowing that you know certainly if i had brain cancer i know how i'd be treating it and you know so it's not all and it's not good human research it's cell research but at least there's a lot of pre-science that could come out and i think that the patients are the ones who can really tell you and us what really helps uh with their sleep disturbances or you know the multiple sclerosis patients were really big early on and getting this law passed in the first place um because it helps with a lot of their symptoms from the spasticity to the actually as an anti-inflammatory it also keeps them alive a lot longer because they have a problem of inflammation as the cause of their disease so yeah no i think you're right on let's the legislature is not the right place for the laws to get written um because people have to come and convince the lawyers and so on who live there that this is good for them i think that the cannabis control board can uh keep the medical cannabis oversight committee under control so if we get two rambunctious or they get two rambunctious um opening it up to people uh you can say no that's ridiculous but uh at least we can make the case for why um again dementia should be one of the causes that you can actually use a drug which sometimes causes confusion well i appreciate yo let me just say one thing which is to that last point which when you're considering the makeup of uh the board the new oversight committee sorry um really you know be driven by that which is kind of like you know if you give us the evidence then we can we can write the regulations you know but we need everything we do to be backed um by uh science and data and be driven by um kind of the voices of patients and caregivers and physicians so yep go ahead kyle sorry yeah no i was just gonna say an apologies if it's out i can't tell if it sounds like i'm if i'm yelling or not i'm in this big empty conference room and i feel like i've got to yell for some reason um i just wanted to say thank you febra for drawing that finer point earlier and then also well what you just said because the as well really really what i was getting at is if we're gonna try and figure this practice nut so to speak what's the best path to go and how do we build a record that we can really stand on that so that we're not just going and you know as dr joe just said getting a little too too wild with what we're trying to do but make sure that it's grounded in something that you know everybody can at least respect the record that we've accumulated based off of anecdotal testimony or other studies that are out there or whatever the case may be agreed thank you any any other questions julia kyle for our witnesses no thank you both i look forward to working with you likewise from us we look forward to it and please don't hesitate to reach out with questions and and comments at any time as especially as we start working on this recommendation and you know as i said our intention is at these meetings i'm sure will be having input from the public as well on both the future oversight committee and current situations that exist that will be passing along for your consideration yeah one oversight on my part was that our you know we've been holding meetings on thursdays generally from 9 30 to 2 and i realize that that actually is the day that your committee usually holds meetings on thursdays you know i attended your last meeting i thought it was incredibly informative from my perspective i'd like to continue to attend them but i hate to think that we're you know fighting for the same space same time but anyway that's just one side note jim maybe you and i can talk about that yeah we'll figure it out yeah okay absolutely both thank you both we'll be in touch of course we have an october or i november 1st report back so we can figure out kind of some sequencing offline a little bit later about how you all can get recommendations to us and we can kind of transmit those absolutely okay well thank you very much uh you're very welcome thanks for having us and for your advocacy we're looking forward to working with you all thank you very um the last thing on our agenda today is public comment um i would like to just before we move to that um one thank all of our witnesses for today um very powerful testimony very um helpful for us to remember just input at the forefront of our work and for the medical program and i would just on a programming note like to mention or reiterate that uh the board the cannabis board will not be meeting next week we're taking um the week off it was getting a little bit difficult to schedule witnesses so close to the fourth of july holiday so our next board meeting will be the following week on july 8th but any other thoughts julia kyle before we move to public comment you know i just wanted to say thank you to everybody as well we certainly are listening and hearing your recommendations and without getting into any specifics you know it's interesting from my perspective um because a lot of a lot of the recommendations without getting too specific to seem like a logical progression of where the medical program should should go recognizing not a lot of changes have been made so um that's just one of my general observations i don't have anything else julie any any i don't need to put you on the spot but any concluding thoughts before we move on uh i have pages and pages of notes to distill i think yeah and you know i appreciate the conversation and for some folks who've spoken to us they're really bearing some some personal information and that's to be recognized great thank you well our last thing on the agenda is public comment we're gonna again start with people that have joined through the link that on the video that can raise a virtual hand we'll then move to people on the phone um i'll let you know when that change happens and i see our first um public commenter on my list is loretta craigan hello i really appreciate this time to talk with you i also am on the oversight committee for a medical marijuana for symptom relief and i've been a medical marijuana patient for seven years um i want to clarify a few things first of all by statute there's only one meeting a year that this committee has to make and there only the dispensaries are represented there's no representation for any cultivators the nurse that has been assigned by the governor has not shown up for the two years that i've been on the committee as a member um and the only nurse participant that we've been having or medical participant other than dr joe is jesse lindolen now um so that gives us very limited time to hear from people and to express ourselves generally it's limited to a two hour meeting and there's times when no public comment was ever on the agenda i was an advocate for that um in the two years that i've been there and i'm the one that put that on the agenda however we've had very little public participation um so since there's no caregiver designated we haven't heard from a caregiver other than jesse lind really talking to us about her needs as a caregiver and that was enlightening to me it's very enlightening to me too that um just the dispensaries have the ability to do whatever they want to do with this medical program i am so so grateful for you guys hearing from the patients and the cultivators i truly truly appreciate because i feel finally that my voice is being heard um so um even though the board is well intentioned we try we've been very limited so thank you for giving us uh this ability to have patients speak out and i think only good things can become of it thank you thank you loretta thank you uh next on my list is Amelia hello um i'll try to make it quick i've got a couple points uh the first is that um so rewinding a little bit jesse lind and i testify in gov ops and there is a 13th spot on the advisory board that has been changed from the original tent to go to the remont canvas trade association so jesse and i went in there and we asked that that 13th spot be then reverted to a patient or healthcare professional nominated by an avt the compromise that we got from our request was that uh representative gannon proposed that we add a 14th member and that'd be somebody from the symptom relief oversight committee and that's how that happened um i would propose as jess did earlier today um adding more medical professionals to that committee including um a nurse a naturopath she said a lab scientist i would also like to add we should have a pharmacist on that committee um for expertise in drug interactions uh and she also proposed an i support adding a 15th member to the advisory board as a second member of that committee i think that one of those members is already designated as the chair or chair appointee i know that the chair is a patient and a caregiver and i think that that's awesome i do think that there should be a second representative from that committee who is specifically a healthcare professional um so whether that be the doctor the nurse the naturopath the pharmacist however we restructure that board i think that if the um if the chair of that committee is going to be on the advisory board or as disignee is a patient then somebody else from that committee who is a healthcare professional should also sit on the board um so that was just uh something that i noticed another thing i i really just want to bring up quick that i've heard from a couple speakers today and i i i don't want to harp on it but we cannot stigmatize the illicit growers currently in our state um they aren't a large majority of them they're not dirty grows they're not closet grows they are clean organic living soil integrated pest management with predator bugs like these are not dirty grows with harmful chemicals that are just going like that have products being pushed out into the public um those things do exist but they tend to come from people who are not growing product themselves but are receiving products from other places in the country to then distribute and sell in the community they are not from people who are growing within our community um and i just wanted to make that point now because we have a lot of really talented really clean growers in the state and i don't want the misconception to be that the people who are currently growing illicitly are not doing so in a clean organic safe way thank you Amelia um next on my list is Tito hey there um so um now i want to talk about um a problem that i've been dealing with actually for several years uh first with Senator Debbie Ingram um and now Senator Chris Pearson and Senator Pearson suggested i talk to you about this now uh the board and that is that um a few years ago the legislature enacted a vape tax which was designed to curb the use of jewels in high schools which i 100 percent agree with i i mean i think you know nicotine is awful but they use language so broad that anything that has the word vaporizer in it now has a 92 percent tax and because of that you know there are some products like the pax vaporizer for example that they are these products are 100 intended for cannabis use no one would ever smoke tobacco out of one of these things and yet now pax won't even sell to vermont at all we can't get it we can't sell to our customers um and even worse the dispensaries can sell the exact same product without paying that 92 tax and um so it's just each two different rules for the same product and let me tell you in the burn gallery we serve this a ton a ton of medical patients and we're talking about them uh talking about these issues with them all day long um and uh and i just want to bring that to your attention hopefully we can just get some something changed in the words just to get an exemption for cannabis intended products and i don't hopefully you guys can help me with this thanks tito thank you guys virginia hi i just wanted to mention a couple of things um one of the things is under the existing law um a healthcare professional in new hampshire massachusetts in new york are allowed to sign the form for vermont patient uh and that was put in mainly because you know some vermonters go to dartmouth some go to uh boston for their services and then uh in new york as well so i just wanted to let you know that there are three states that we do allow um and i also want to bring up the caregivers and the fingerprinting that was put into act 164 when it was in the um conference committee and when i heard that that was being added i immediately reached out to some legislators and said why are you doing this because since this law went into effect in 2004 caregivers have never been fingerprinted they do a background check on them but never fingerprinted and here we are you know uh putting another restriction on to being able to get into this program so i think that as it has been mentioned by others that uh this is really a key piece that needs to uh needs to change so again thank you for all your time thank you virginia and thanks thank you virginia anyone else um from the video link want to provide public comment if you do just raise your virtual hand okay uh it looks like we have one person on the phone if you'd like to provide public comment please just hit star six to unmute yourself okay well um that was very helpful for me um and i'm just would reiterate um our gratitude to all of our witnesses today for bringing us up to speed orienting us to what seems like years worth of advocacy um and uh hopefully we can um use this opportunity that we're in right now to really think about how to refresh the medical program in vermine um kyle julie any any last thoughts before we adjourn thank you to all of everybody who provided testimony or public comment today um like julie said earlier i took pages and pages of notes i see a lot of recommendations that no matter who they came from felt like they were on a similar you know strain no no pun intended but um we got a lot to work with and thank you for all of your advocacy and input yeah i agree with with what vile said and i appreciate everybody's time and energy to put this meeting together and to take the time to spend uh with us and sharing all this information with us yeah great well um all we have left is to adjourn adjourn so i'll take a motion if anyone would like to make one uh i'll move to adjourn i'll try again all in favor hi hi hi okay thank you all again and uh see you soon thank you thank you