 Let's see, first, Shane, you're coming up, and I think, is Anthony coming up with you? Yeah, Anthony's coming up with you. He'll sit down first here on ground chair. Senator Sears is not here today, he's having his hand operated on. Oh. So, he'll be back tomorrow. Alright, well thank you for having us. Shane Lin, Champlain Value Dispensary and Southern Vermont Wellness. Yep, Anthony Brock, I'm representing Vermont Patients Alliance. I'm going to need to re-apologize this. She has a schedule conference today, it's not available to be done. Thank you. Appreciate the time being spent on the medical bill, and at this time, with the realization of Canvas last year for adults, we've seen a real impact on the dispensary program at this point, and we've had some suggestions here that are probably over the past year talking to our patients and hearing what their needs and thoughts are and have come up with a list of items to help streamline the dispensary program and create some efficiencies and reduce the hardships of the patients to sign up to the program. One of those areas is removing the few-month consulting relationship with a healthcare professional, we'd like to remove that because that does create an undue burden for patients wanting to sign up to the medical program. We would love to see medical patients using Canvas make the process as easy as going to see the doctor like any other credential prescription that they use and so that removing that three-month period would help with that. Along with that, we'd like to recommend removing patients currently who designate a dispensary, pick a dispensary. They can change if they'd like to, but we'd like to remove that requirement that they have to pick one and back to allowing patients, if they're traveling in Chittenden County or Wyndham County, to visit the dispensary in either county without having to be on the registry list just for one. We think that would be important, and we hear that from our patients quite a bit. For us, we'd like to suggest possession limits to increase for home growth, for medical patients growing at home. We'd like to increase their plant counts to three mature plants instead of two. We'd also like to increase their ability of a patient to buy three ounces instead of two ounces every 30 days. We do hear from patients that do use Canvas over the years that they do build up the tolerance of being able to purchase additional amount of dried flower or edibles would be helpful for them. Let's see here, next step would be, we'd like to see the registry include out-of-state registered patients so that you wouldn't have to be a Vermont resident to use the medical program. We do have people that obviously travel here, vacation here for maybe a week or two weeks. They're not comfortable traveling with medical Canvas. This would give them ability to visit a dispensary and make a purchase if they have a medical card in another state. So then they could have access to medicine. And again, with Canvas still being federally legal, traveling with Canvas is against all overstayed lives. Another suggestion we have is a reduction with the fees for people that have product disease, people that may have HIV, AIDS, L-mass disease that is something that's going to be living the rest of their lives, that they wouldn't have to sign up every year and pay $50 to a doctor that they could sign up one time and not have to renew every year. It seems like an undue burden for folks. So we'd like to remove that burden. We've also, in removing, if we're currently, I'll back up currently, our inventory is based on the number of patients that we have in the program. So may it be our dried flower inventory or the number of plants that we have. If we have 100 patients, we have to make sure our inventory matches kind of there in sync. If we are able to remove the destination of a dispensary for a patient, we'd like to remove the kind of inventory limits that are placed on us currently so that we can just operate as a business and manage that as any other business does. And I think over the past six years, we've demonstrated that our compliance and the law in the past and that we can manage our inventories and security systems to guard back. We have talked about testing in the past. We've always supported testing. Currently, we do potency testing on all our products. We also work with VPA in testing one another's products to ensure that the accuracy in our potency testing. We do not have the systems for microcontaminants testing. That would probably be a $300,000 to $500,000 investment, something that we're not able to do. We have talked to the Ag department and carried it before. And I think the Ag department is ready for potentially testing us on those other issues or areas of concern. We would invite that. We'd invite the DPS to take the samples and be able to bring into the Ag department to be tested. We'd also do feel, though, with our $25,000 licensing fee that those tests should be included in that to have additional costs potentially in the range of another $5,000, $10,000 or $15,000 would be a burden on us and it would hope that we could come out of the current licensing fee structure. And lastly, last year, which was great, PTSD was put on the qualifying list of conditions. There was a little burdensome, though, that they had to have multiple health care providers certify that for them. And again, in light of cannabis being legal here now in Vermont, it would be great if people with PTSD didn't have to have additional steps to sign up for the registry. And removing some of those burdens again would help the program survive. The goal here is to have a medical program that will endure some of the challenges that are currently in place with the change of cannabis last year and have it survive into the future years. Those are kind of a real quick brief on some of our requests. Happy to answer questions and Anthony's available as well. Are these all in the draft? They are in the draft, right? The PTSD is not. That would be an extra. Yes. So the health care professional would make just a determination that we wouldn't have to go to multiple? Yes. Just to have one physician just like any other person currently on the registry. Because that is an extra step. It's an extra bill, most likely. It's additional time. Probably more stress as well. Okay, Anna. I mean, do you know where we are? So, did you... Another question, Jeanette? Joe? So I had a question with... We had a little discussion about this before with regard to shopping at different dispensaries, you know, being able to go to whichever one you choose. And so for doctors, there's the... with regard to prescription, there's the prescription monitoring piece that they have to do. What would be the preventative for a patient going to... I mean, you know, the answer is already going to your shop one day and the next day going to another shop? You can have a piece of software. So a third-party piece of software exists. I worked in Arizona in the medical market there and all of the programs talk to each other. And so if you visit a dispensary, let's say our location in North Phoenix and make a purchase of an ounce there and you went to a location in East Mesa, Phoenix, it would not allow that patient to make a purchase because the program talks to each other. So we would know that patient had already reached their limit for whatever window was preset by state regulation. And of course, this is not in place now. I mean, how much... So a piece of software is not that expensive traditionally. It's in J-Freeway or, you know, any piece of software that's basically developed can monitor that type of purchase limit. So with regard to that, I'm thinking we should put that in the film that we will talk to each other? Yes, we mandate those types of things. Absolutely. So currently, yeah, well, I think state has had issues with databases in the past and so finding the right one might be... take some time. Currently, the dispensaries... each of it... MJ-Freeway is the software we currently use and so we do track each of our dispensaries. I'm not sure if you're on MJ-Freeway. So our different locations, we can definitely track a patient's purchase every 30 days. It'd be something different for the state, potentially, to be checking each dispensary's, you know, purchases. What could happen, instead of just software at the state level, is that a dispensary at the end of 30 days could send an Excel spreadsheet to the government, to the DPS, and the DPS could see if people were basically shopping at different dispensaries at that point. But what I'm saying is, in our own dispensaries, we could track every 30 days. Yes. Yeah. You could all do that if you put that in. There's a lot of pieces there. There's a lot of pieces there, for sure, so... I think currently we leave it up to the patient. If the patient has more than they're supposed to have, they're in violation of the law. I mean, that's... Yeah, personal responsibility. The same as we do with non-patients. They could get as much as they wanted to from wherever they wanted to, but if they have more than they're allowed by law, then they're in violation. And that's where we could track, at each individual dispensaries, we could see a patient coming in each day, track that through every 30 days to ensure that we're not overselling. If that person, though, were potentially had gone to another dispensary, then they would potentially be breaking the law if they'd went over those limits, and we could let them back to personal responsibility if the state didn't have the capability to track all that. And that'd be DPS, depending on what happens on the other bill that's going. Right, but that will be a year and a half away. It's still DPS for a year. I think it's a year and a half. And in fact, I guess the current bill with tax regulation, I'm not sure if there's any tracking in that one either. And so... I don't remember. Yeah, so I think that our program would be very similar then. If we didn't have a software at the DPS, it would just be following the TNR model. And back to the personal, individual responsibility. All right. Any more questions for Shane? I'm sorry if I missed it, but I just want to follow up on that testing issue. Yeah. Because some of our Sears had, at the last one, we already have done a mock-down discussion around what is concerned around dispensaries testing their own products. And when we talked about whether there really isn't any requirement in statute or role-round testing, I mean, you have to do... You have to make sure that your labeling is correct and that you're going to compliance with that. But so I had been looking a little bit at what were the possibilities and we have the new language expanding the ag labs authority to be able to be tested for cannabis and so we'll hear from Harry about that. But I was wondering about, you know, whether or not there's capacity at all right now for, like if you weren't doing your own testing and either for ag to be doing it, but for others, I'm just wondering about is the system big enough with only five dispensaries to be... to acquire you guys to do testing but not to test yourself? I'd say no. The sense of the business scale of there being a third-party lab out there being able to afford the smaller samples that we'd be providing and look to ag to work with us on doing those other testing. So basically, we could test in-house on our potency. We can then have ag certify our testing which is in the bill basically so that we're our standard operating procedures, our methods are approved by ag and then ag could be doing audits on our testing in the sense either coming to our facility a production facility to audit the lab itself and or going to the dispensary you could have the DPS products at the dispensary bring them to the ag department and the ag department could do those tests to ensure there's no contaminants or to ensure a potency accuracy. It is, you know, back to the cost involved in that and Kerry can probably speak more to the cost of having a fully operational lab test for five dispensaries is I don't think that lab would be able to support itself because the investment would be considerable. You know, we're talking probably a million dollars of investment and then the staffing of that. So again, we've looked for the ag to basically certify our processes say yes, your methods are correct methods and then the DPS could be doing audits and send those samples to the ag department to ensure that our methods are working and that they're consistent and inaccurate. Do you think that the language that's in there now would be sufficient? I think there's some detail that's needed and I don't know if that would probably occur during rulemaking, I would assume but the overall framework for it working is in there and Kerry could probably speak more clearly to the number of times potentially that they'd have to make visits or the sample size and then there's a lot of detail that does need to be flushed out but the framework again is in there for ag and DPS be working to ensure that our methods are certified and accurate. So I'm just thinking about it if folks can be thinking about what if anything would be the language in the bill to make sure that that could happen if a committee wants to do to address the testing issue just because if we do push it to rules it's going to be another year and so I'm just wondering about if there are some little things not that they wouldn't still go through and adopt those with a little greater detail but I'm wondering if there's anything to do in the bill that kind of gets a little closer to having the verification of the testing so that it accomplishes your goals here in a little quicker time here than waiting for another year for rules to be developed. So are you asking? I was just thinking I mean I can talk to people offline about it Right, I'm just trying to think about because I know Senator Sears expressed that and I said well that makes sense and I'm trying to think about how you get a little closer to there being verification of the testing processes so by utilizing the ag lab without having to wait for another year cycle for rule making Right, so Senator Sears had mentioned the issue of you know conflict of interest in your own product so this addresses that in terms of just the lab Yeah, in the sense that hey ag is coming in to certify the testing and then that there would be an audit potentially throughout the year to make sure that the results were accurate and again Carrie can attest to that kind of program and back to that getting a certification from the ag department basically in the lab world there's a lot of different methods to testing for cannabinoids especially when it comes to animals and the different sugars and different ingredients in the animals so having the right method to determine in that cookie how many milligrams of cannabis are in there it could be different for all the different animals browning a cookie and so the ag department would come in and say alright you have the right method in determining how much cannabis is in that cookie and then we do those tests with that method that they have certified and then they'd come in and do an audit over the year and say alright we took that cookie off the shelf we're gonna go back we're gonna test it to make sure the numbers are the same numbers that you were putting on the label and at that point if they're not you could have a three strike system of hey we've got a letter of warning a second strike and again Carrie probably has procedures like that in other areas that they test for and then back to contaminants that would be the same process basically to ensure because we've worked with ag department over the years at this point for standard operating procedures and what we can or can't put on the plant and so that part is you know it's one it's one thing like in the future potential tax regulate market where you don't know where the cannabis is coming from or which grown or whatever but with us being vertically integrated we're very you know we know exactly what has got into the plants and on the plants so we don't have any questions about that and we're confident about the final product however that does change as the marketplace opens up and a lot more this is this with this you might be buying other products other people's currently the dispensary program can have wholesale so we can purchase from BPA we do have a program right now between BPA and CBD where we purchase dry flour we purchase edibles from one another and so this program that is currently outlined here would help ensure that those numbers for potency are accurate and that there are no contaminants and that that would be administered through the DPS working with the app go ahead Shane somebody goes into shows you every month medical card you have a way of cross-checking that against something yeah we get an updated list every Friday from the DPS so every Friday we get a spreadsheet saying here are the current numbers on your registry that have designated you somebody comes in from Nevada and shows you a Nevada card how would you cross-check against that we'd have to assume and we'd probably have to educate our sales associates to distinguish between a fake and a valid card just like with drinking you know in the sense that obviously there could be forgeries but that we would ensure that we had samples of other states cards and we could verify those cards we wouldn't be able to call the state though to verify it I just I understand the three month that being rid of that and we did eliminate that for people who have terminal illnesses right so yes for sure people that are cancer or terminal illness the state call in C and the program immediately so if we eliminated it entirely it still is up to the physician to make the decision and if the physician feels that he or she doesn't know the patient well enough doesn't have enough contact with them then the doc isn't going to sign off on it I would assume it puts the responsibility in the hands of the making the decision about how well they know the patient healthcare professionals are the gatekeepers to get on the program okay I would like to ask Michelle a question actually Michelle if we're changing the language of registered patient to eliminate the residency requirement there's still language there that says the person has been issued a registration card by the department so how would somebody from Nevada so I'm sorry I've missed that part of Sheen's testimony but I think you would have to is it the duress for reciprocity from other states so basically if you are from another state are you looking to qualify another state to automatically be able to qualify for the registry and then they would get their own Vermont card or it's somebody who is like just visiting and they could use their card and use it since you're driving up you're here in Vermont for two weeks you'd like to use a dispensary program Maine has a similar law in the sense of reciprocity of other states so that's not in the bill as introduced you'd have to change that but if somebody moved here presumably they would end up getting a Vermont card yes for sure and if they had a card from another state though they could be using that yes and they kind of if they're not here so if I'm we put a number of these changes in place would we be saying that someone so this asked for free ounces so someone from another state could come here with their card by free ounces here and drive out of state there could be a potential back to personal responsibility making chances you'd be illegal you'd be illegal you know free ounces is we've always been talking about lesser amounts free ounces is a quite a lot of product and a lot of these requests are a reflection of last year and having legalized cannabis here in Vermont and back to some of the realities of being able to purchase cannabis even on Church Street at this point this is really trying to make a protocol program update it so that we can have a more sustainable business I have to say that's and I understand that's a reason for being for you but for me that's the least compelling of the reasons that we've been talking about and I felt this way during the discussion of the recreational bill too adult use adult use bill you know the dispensaries I understand are now anxious about their market share but I don't think that we can be in the business ensuring the market I think the concern should be the medical situation of patients best match between that and public safety and then if it also grows your market that's one thing but I felt at points during that discussion and at points looking at this is that what we're really doing is a thumb on the scale to make sure that a market stays there so if someone can get a card and buy 3 ounces at a time currently they can get 2 ounces but I mean we're 3 ounces begins to look like I don't know it strikes me differently so I'm just saying I see on the back of this sheet it talks about PTSD patients will be able to purchase marijuana on their own why would they choose to go through this process I guess from my point of view they don't choose to go through this process I don't have a worry about that in other words I'm not, as you are I'm not worried about necessarily whether the dispensaries maintain a robust market share against the adult use market just as as two competitors in marketplace I don't really want to put my thumb on the scale in that way I guess in fact market share versus sustainability of the marketplace so I can start to look at roughly 5300 patients on the registry right now 5 businesses serving 5300 people and then a future tax-regulate market that could have potentially 80,000 people on it the reality of that business model is unbalanced you know I think some of this approach is having to find a level playing field as things start to change here to ensure that we can have some efficiencies in our operations because some of this is about or a lot of it is about being able to supply the patients the products that they need it would be a certain milligram dose that they need or a certain flower or strain in that consistency in doing that because there get to be real challenges in having a diversity of products the smaller market like any business the smaller your market is to have 300 skews isn't possible and so where do we find that balance to make sure that we're offering not only the service and the products to folks it's really important that we do you know back to your wording of market share it's more that we do have a program that's sustainable and if you look to other states usually it's about 3% of the population that uses medical cannabis Vermont is under 1% at this point and so some of this is you know how can we provide easier access for more coming to this program to purchase cannabis I was required to chime in there you know when a patient comes to a dispensary to purchase something that they drove across Vermont to being new to Vermont I've been here just under a year now and a lot of people in the rural communities there's you know less than 10 dispensaries total across the state if you're a patient in a little area that drives through a dispensary on that day and you could acquire as much cannabis as possible let's say 3 ounces as a PTSD patient maybe that person uses quite a bit of cannabis or if it's a severe pain patient in whatever condition they may have they want to stock up again speaking to supply knowing smaller scale types of grows here in Vermont it is very difficult to keep strains in stock so when we grow batches and we have certain strains that are highly desired we can't service the entire patient population at the dispensary with the grows that we currently have so we have to grow small amounts of everything all the time and so when a patient comes in and they say wow this strain really works for me they want to be able to sometimes buy as much as they can of that strain at that point and go home and so that's a great advantage in increasing the possession amount at that time I think is a good idea I just feel pretty strong that's a great point you know back to these strains you know they're like other products out there some really do work better than others the patients seem to like certain things they're growing one strain and then it does shift you know potentially after eight to nine months something shifts and you're like oh now people are buying this strain and so you shift your productions and so for us that means looking at six to eight months ahead to make that change though because if someone says hey if you don't have enough of this strain it literally will take six months to eight months to grow more of it and that means we have to remove something and stop growing that other we don't just add on we're not able to do that with an expansion so something has to come out of the rotation and so those are some of the you know the tensions and back to be able to you know patients you know have personal preferences and so I do think some people would definitely be purchasing potentially three ounces of what they like and works for them for symptom relief and then there's the folks that are using you know potentially for rick simpson oil and other things at home that they're maybe making and need these quantities to their own formulas and so that's you know that's the request that we've heard from people and yeah so anthony did you have some testimony you wanted to give basically I don't have a major point to use I think Shane hit on basically everything I would just say that I would love to discuss further as I'm sure everyone with the testing parameters and Kerry will obviously have lots of information to give around those and you know basically making them consumer safety minded above everything it's not about convenience for dispensaries or costs to the state it's about consumer safety and I feel strongly about that I'm just making sure that the products that are hitting the shelves are safe for consumption and having common sense rules in place around that so that it's not impeding dispensaries from being able to do business and also bottle neck at the testing level so that people actually have access and that's what I've seen in my experience in other states as two things that can happen it can become very costly for the businesses to do the testing and it can actually be bottlenecked by regulatory testing parameters I just did Michelle get the language about the I see that we're going to be marking this up do we have enough language around that we're not going to mark it today it says it on the chart but we're not oh okay then never mind we can spend some time with that maybe after the witnesses and I'll get what you need but then it's scheduled for the week after coming here got it I just read by lawyer it didn't sit on there okay thank you okay thank you very much thank you for your time so um Jessa? hi Jessa tell me did you just do it electronically? yeah I didn't bring paper copies I can bring some lose track of which committees still like paper and they don't and they don't want paper so that's yes well thank you very much for having me I appreciate the opportunity to speak to you about S117 I'm Jessa Barnard with the Vermont Medical Society and we shared some of these concerns when you were talking about S54 as well so I will try not to repeat myself I know you've heard some of our perspectives already we have a concern with some elements of the proposal some we have no position on but I'll just highlight the areas that you have concern and I appreciate Shane's testimony about wanting to treat this like other conditions and I think in some ways we share that perspective but our perspective of how to accomplish that may be a little bit different and based on what we've seen in other states in our experience so for example eliminating the three month health care professional patient relationship I understand that maybe a little bit of an inexact proxy for a meaningful ongoing relationship so I hear that concern but I think on the flip side what we've seen in other states that don't have some kind of requirement like that is clinics that set up specifically for the purpose and only for the purpose of signing the paperwork to participate in the registry program and we in fact saw a clinic like that try to open in Burlington pretty recently but there are I mean it's in pretty much many states Colorado California and so if we're saying we want this to be treated like other conditions I think those and again it's the requirement would be on the health professional to be operating appropriately but there should be requirements like other health professionals have in terms of being available for ongoing follow up I would like to see them have EHR electronic health records so they can share information with other providers and so other providers know so my concern is people go in they get the card no one else currently in the system may know about that so it is treated differently that it's not exactly parallel because of some of the problems with cannabis just being illegal but also I think the way studies can set up for this purpose alone and I would like to see an explicit requirement that they're meeting current standards of care as other health professionals would be able to meet this requirement that's what I'm asking about how would someone come in from out of state and be able to meet this requirement if we didn't I'm sorry which requirement well there are already exceptions and Senator White alluded to this there are exceptions for patients who recently moved to the state patients changing health care providers recent diagnoses so I think as time has gone on the legislature has I think added appropriate exception so if somebody is you know it's a new you haven't been diagnosed for three months you've just moved to the state you actually already have exceptions to that requirement if I'm coming here to ski from South Carolina all of a sudden I pop up with my South Carolina medical card how is it if this provision is kept in place that someone would have access to our medical card well I think that's a good question I again since that wasn't in the current draft when I was looking at the responses I actually not sure we'd have a concern with reciprocity for other cards except for the questions I think maybe you asked about making sure it's a legitimate card and how do you verify I don't know what the out of state requirements would be but we would have for people of requirement a relationship with the doctor but how do we know South Carolina would have anything I think that's like many instances of state law when the age you can get married how early you can get your driver's license I mean we I think we have reciprocity with different requirements and many similar instances like that so I don't know I have to think about that a little further I don't think that's a major area of concern for us I mean obviously they could have different requirements I don't know I have to think again since it wasn't in the proposal I hadn't thought through all the details of that so I had it had not even donned on me a clinic for this purpose so unless there maybe we should require a CON for them and get rid of all parking lot clinics sorry about no I'm not I'm not I mean I think there is a good conversation around CON for any urgent cares and others yeah that's a topic for another a bigger topic but how do we you're right how if somebody sets up a clinic specifically to to say to sign off on they don't have the follow this urgent care centers don't have necessarily follow up and don't provide I think the distinction I know that's actually it's a good question but I think again it's a distinction because urgent care supposedly is for time-limited you know this is a condition that you know you need something right now these are I think that's not what I've heard is the need for marijuana typically or cannabis and more ongoing chronic conditions do require a follow up and I was actually thinking of this as I was preparing my testimony I for example I have type 1 diabetes to me the now and I have to take insulin I will for the rest of my life the analogy would be for me going to somebody just to prescribe my insulin doesn't talk to any of my other healthcare providers and it doesn't even talk to the pharmacy and it's actually the pharmacy that determines the dose the quantity the formulation because the physician or whoever's saying you can take insulin doesn't have the information or understanding of the dosing side so it's not an exact parallel between how these systems operate and I think our physicians do have concerns about if as we expect these clinics may become in Vermont they're not talking to the rest of the healthcare system or operating like the rest of the healthcare system what just trying to set up in correct it's in the there's actually a link in our testimony to the some of the press coverage about it and they were quoted as saying that the three month requirement was a limiting factor on that because it was hard for them to get people back and they had to see people and then have them back in three months so they're operating in other states it's sort of a chain of another clinic and the other states don't have that requirement so that was an impediment to them making a viable business model in Vermont Can I ask them are just to stir it down are you opposed to lifting this? I have concerns about that paired with the elimination of this three month requirement for that exact reason that I see people and I lived in California about 10 years ago and this on every corner a little green marijuana leaf you go in get your card that day and then go to the dispensary so I think if you combine these two I fully would expect to see a clinic you walk in from any state and get the card and I have to say I have real questions about lifting this residency requirement too to go on what I was saying before I feel like there's a couple things that work here one is the desire to make it more attractive to be on the register so you can hire more in the recreational bill there was a provision about discounts that we ultimately eliminated but that was going in the same direction so try to create real tangible reasons why people would prefer to go to a dispensary whether they actually needed to or not and the kind of clinics you're talking about would be the gateway that would allow people to do that I have talked to a number of people from California I used to live there I still have lots of friends there and they told me the exact same thing that in fact people out there for a time were using a tele-doctor in Arizona so you went into a room and on the screen was a doctor in Arizona and you could get a card so one of the things I always liked about our program here is that I think we've had very few problems because it's been heavily controlled and a number of this pieces of this seem to be trying to lift that control as a way to beef up the market for the dispensaries in anticipation of stiff competition from the adult use market so I think that's something we should be careful about that's all I'm saying so if I'm trying to separate from 30 days I get that and I don't know how we mm-hmm so if we if you're a New Hampshire resident you look right over the border so your health care professional is at puppy medical services so if you're not a Vermont resident but your health care provider is in Vermont that would limit people I mean well I think you're out of state I'm correct you can already be a New Hampshire place of health you're doing opposite you can be a Vermont resident you're staying the opposite so I'm not talking about the guy that comes here for two weeks mm-hmm we can deal with that as a reciprocity but the person who lives in Hinsdale and they have no doctors in Hinsdale who use ground pearl mm-hmm physicians should that person be allowed to get because they're getting their health care in Vermont they're using they're getting their prescriptions written by the doctor and they're going to the hotel pharmacy because there's not a pharmacy in Hinsdale so they're doing everything health care wise in Vermont so if you didn't have to be a Vermont resident but they had to be receiving their care from a Vermont provider I don't think I'd have a concern with your concept I don't I I don't know how to do it but I don't think that's a concern I think we're less concerned about where the person lives than the meaningful you know the meaningful relationship so there's that I'm trying to separate the issues here so that we could deal with that for that person then there's the three month right and I I have concerns about lifting that not because it's making it easier for anybody but because I think that there should be some kind of an established relationship with a health care provider but and I thought that the health care providers would be conscientious about that and I think most of them would but then I am concerned if there are chains that are wanting to set up clinics here for that stress purpose I have a concern about that I'm full on you get through your testimony I'm sure no I agree and actually my next point I think directly relates I appreciate kind of the way you're articulating it we our philosophy of the physician's philosophy is that this should be an evidence-based program set up to help patients and based on the evidence and exactly as you said not about how many patients that means or what industry we're helping or not helping so our concern with removing the list of conditions as we shared in S54 is that that is currently where rightly or wrongly is look to which conditions are appropriate for using marijuana since the evidence is hard to find and not as easy as other FDA approved medications we share that if there are other needs or desires of people to use cannabis they currently can grow it and eventually it looks like they will be able to purchase it for adult use and that if it's not an evidence-based condition they will still have access to it if they need it I also see some conflicts with S54 if I'm reading it correctly as S54 has passed it still has a look for the medical pieces of that bill listed conditions so you're setting up if you passed S117 as proposed you're setting up a conflict where for the next year and a half there would not be limited conditions but once chapter 86 goes away and you're under the whole new framework under S117 there are lists of conditions that the new medical program would be limited to if I'm reading that correctly I think that setting patients and physicians up for confusion so 54 has introduced to have the same language that was in this and then based on your testimony they changed it and they went back to existing law and so now we still have this introduced so they were the same as introduced right so that was my understanding of reading it that you set up the system where for the next year and a half you'd have an expanded program that would then back or don't change back and that I think is a problem and we prefer the S54 language and then continuing that consistency with how the program would change my final point is about the eliminating the need for renewal of a patient's registration I hadn't focused on the fee part I don't think we fee is not we don't care you know or we're fine with there not being a fee though the DPS may disagree with that but it's again if we're treating this like other we're trying to treat it as parallel as possible to other medications that would be like saying a patient never needs to get a renewal for a prescription or see their clinician again for a renewal of the prescription on conditions again I have diabetes I'm going to for the rest of my life I'm going to need insulin for the rest of my life I still every year I have to see them more often than once a year but at least once a year you need to check in and say I need a renewal I'm still on this medication I need a renewal in this case the language proposes basically say it's up to the patient to remove themselves from the registry so it's really giving the patient the determination is this still an ongoing benefit are there side effects the patient can continue forever unless the patient decides it as opposed to the healthcare professional so if you don't object to removing the fees for those people I wouldn't know but they would still have to renew but not have to and again and I haven't thought I don't know I don't have a problem rethinking how that renewal looks or works I don't think I don't want to be an administrative barrier for patients I just think it does make sense to have at least to check in with their healthcare professional once a year at that point to see if there's an ongoing need because even with chronic conditions things change or side effects may change or so from the healthcare professional perspective that makes sense to us it would be different if we didn't charge them a fee it would be different than the way we do healthcare generally which is because you have a chronic condition doesn't mean you don't continue to pay for co-pays right well it's a little different because they're still paying for the cannabis and they're still paying if they have to have an appointment with their healthcare professional they still be paying for that I mean is it a little different of saying basically you need to pay just even to there's another fee on top of that simply for the filing the paperwork so it would almost be adding every year if you need to renew your prescription not only you pay them for the medication but you pay another $50 charge just to file that paperwork so I think there actually does sound like there actually is an additional sort of very fee on top of paying for the paying for the cannabis and paying to see your healthcare professional if you have if there's a charge because you don't pay before he could write you a new prescription right you pay a also okay or her yeah yeah you pay it for the appointment and then you pay for the prescription but you don't pay for another registration fee right so those are our concerns thank you for hearing from us happy to be involved or answer questions through the process good morning here is your gear we can see about agriculture I understand we want to talk about the the proposal for the agency and agriculture to do some work for the dispensaries we to speak real quickly to Michelle's question about timing more currently in the process of writing a procedure for what this looks like for the health industry it's the regards of what folks say it is the same plan sort of you know in my mind it's sweet corn versus field corn they're both corn currently this year we are doing this is the language that's already in title 6 and it just adds marijuana it's got hemp and marijuana in there if you want to just go with cannabis that would be fine cannabis and cannabis if used in these products would be both hemp and high THC cannabis what's going on right now is we're in the process of sort of developing a certification process for third party labs we've got approximately 90 people registered for processing hemp of those processes about 40 of them are also licensed registered whatever we're going to call it as laboratories so we do have approximately 40 other labs plus two dispensary labs that will develop certification processes for the devil is in the details and when we're talking hemp we're analyzing hemp on a dry matter basis that sort of elevates the cannabinoid content of the flower when you're talking what the dispensaries are selling they're analyzing it as an inner on and sole basis so it's roughly 12 to 15% moisture that's left in the product while it's being tested little intricacies like that currently we do know exactly what pesticides are being used on the medicinal crop when this goes to a tax and regulate market we do have about half a dozen pesticides that we've reviewed and approved for use in Vermont in conversations with the dispensaries our inspectors do go and look at their pesticide use sales and storage they're licensed to be applicators it's going to be harder to wrap our hands around that in a tax-regulating market this is finally building into the medicinal bill is consumer protection and quality control piece the dispensaries have been left on their own to do that they have reached out to the agency in order to sort of do that on their own this sort of codifies it in law and somebody else is looking at the consumer protection piece and quality control which I don't see in the tax and regulate bill yet any other questions we are in the process of moving our laboratory we got washed out of where we were in 2011 with Irene we've been squatting at UVM the Hills building until about a week ago we'll be up and running here after telling me so we'll it was designed for us to move in the winter not the gross season we'll be up and running here shortly we're at V2C we're in the cornfield at V2C sweetheart field corn so we are all the the list of animal and my part is to do is like Shane mentioned the microtox so I guess the question is are you going to have the capacity to do this so the as envisioned then we've talked with DPS and the dispensary about this is sort of spot checking so yes, yeah spot check can be done on a surprise basis it doesn't necessarily have to be because as envisioned the dispensaries would be collecting the samples so whenever the representative from the dispensary or DPS showed up they would grab a handful of samples and send them to our lab it could be surprise or not we've done both for the hemp industry we've worked with other agencies we've had complaints about something maybe not being helped we've taken those samples whenever we got a complaint that something wasn't hemp we went out and checked but aside from that of the 400 growers we checked approximately 10% just randomly and that was primarily for THC compliance not the other list of components we have checked other value added retail products so obviously we did promise I think it's fine it's language we've seen I don't know Michelle what, four years in a row now so we're comfortable with it and is everybody moving to the new lab? yes we lost actually five people we've taken hardship risks we're in the process of refilling those positions including our lab director all the questions do you have anything else on testing? if you wanted to put in there go live July 1st we would be capable of that you could go live July 1st I'm just wondering about whether or not there needs to be anything more specific around directing kind of going after what she talked about in terms of doing this DPS just spot checking yep that's we when this was added to a bill last year it didn't pass we were moving forward with developing an MOU in the Department of Public Safety and pretty much brought that almost to the finish line it was paying for samples that that we didn't sort out the Department of Public Safety and I'm North Chris Veric I propose that the dispensaries submit samples to us and pay for them and themselves and that was sort of a interim test and the results would be submitted both the dispensary and DPS and you've heard testimony today that the fee that the dispensaries pay is large enough to cover some testing so all that really needs to happen is that it needs to be sorted out if the commissioners are prepared to go the regulatory language in the bill that you have directs that DPS pays the fee to Ag so that's already sorted out in the bill I'm just wondering about whether or not the committee would want something that directs saying that you know either there shall be an MOU between DPS and Ag you know on compliance testing and if you want something like that you don't have to have to pay actually you already have in that Ag it says that DPS pays directing to get the idea out there that there's going to be tests going to be compliance testing and that it's going to be and that DPS and Ag have to put together to make that happen but you don't have to have it sounds like they're going to do it anyway but if you feel more comfortable why don't you put it in and let's discuss it if you would like to say anything yeah I do any questions thank you thank you so we're not doing the markup so that's what we're scheduled for alright okay I feel a little bit calmer then so there was some information that we received over the phone with regard to somebody wanting to say a few words and I have to say a few words if someone would like to do that I think they would like to do it I'm Francesca Thompson Francesca Thompson yes Francesca Thompson can you just say who you are or are you yourself Francesca Thompson I'm actually a medical cannabis success story I would love to say I am a Vermont medical cannabis success story but I'm not the system completely filled me and I have a caregiver in me that helps me I live down in Dorset my access was severely hindered by locations to dispensary my closest to sensory when I began was in Brandon so it was an hour and a half drive for me often times I would get there and I wouldn't have access to any medication any medicine they didn't have anyone that was educated there to really explain what strands were what they were going to do to me I would go in and end up leaving with all this product to go home and test by myself which was extremely costly I would say that I spent probably on average between $1 to $2,000 a month I depleted my 401k it's the financial impact on everyone it's not just the dispensaries I think that the problem is that the failure is right here at this table it's the legislature a system was created where the patients in the dispensaries can't succeed we have so many roles and regulations have been put into effect by people that don't necessarily understand the medicine I think a lot of people think that it's a rep market a recreational market that patients aren't necessarily patients I came down with idiopathic pancreatitis out of nowhere I rotated in and out of a hospital every two weeks I was put on this opiate supply that I can't even begin to tell you about it was after my doctors put me on fentanyl and I overdosed in front of my children while on my prescribed medication that I decided that opiates were no longer going to be something that were viable for me cannabis was viable only I had to figure it out on my own and I think that if the patients and the dispensaries were to come together to figure out how to care for the patient there's no empathy nobody feels the patient's pain I would throw up for an hour and a half on my way to a dispensary to get there to try to figure out how I wasn't going to be sick anymore if the patients and the dispensaries were talking about what strains were working if there wasn't so much legislation blocking this co-mingling of patients and caregivers we might be able to go forward but I fear that this is so broken at this point that the only place to start is the bottom you can't keep on nitpicking this and adding and subtracting because ultimately the patient care isn't changing the patients are still stuck in the system the dispensaries are stuck trying to figure out how to care for the patients I am going to mean and how to care for the patient I'm sorry go ahead and finish the election question because I am able to find a state system which supports patient care I think the patient is getting lost here in what could be achieved if caregivers were brought into the system more I think that the patients need to be recognized as human beings I think that we are criminals we have lock boxes that we have to bring into these dispensaries my point is that this is a legal substance in our state that's still being treated as though it's illegal on many levels and I think that the first thing that has to really be reined in is the care of the patient and how to achieve that and can we really go backwards from where we are right now and achieve that for the patient no please, please and I apologize this was last minute for me this has been really difficult for me so to come and put myself out here so I apologize please ask away so if I'm trying to understand I take the point about it need to be centered on the patient I'm just wondering so you're talking about people as dispensaries not knowing how to instruct the patient and a lack of empathy but are those things that are the fault of the legislation or the way a specific dispensary is being brought I think that with the way that everything is so vertically done the responsibility upon the dispensaries to serve many different capacities and can they be expected to serve as the entity that is providing all of that I think that the patients need caregivers I think that before I think we have to start at the patient and the individual and as it is now I think that it's hard for the patients and the dispensaries to be utilized in an efficient manner and I think that the legislation causes the hurdles and the walks to be there I think that a system that takes who's going to care for these patients first and foremost first so I I hear your frustration but I also have to tell you that first of all this is a product that hasn't been legal until a few months ago so it wasn't a legal product and when we first established the dispensaries because that was my committee that did that it was with the patient in mind because we had patients coming to us and saying I've got a card I can do this so where am I supposed to buy this am I supposed to buy this on the street we had an 87 year old woman who came and said am I supposed to ask my grandson where I can get this and we said no that doesn't make any sense we need to set up dispensaries and I'm not trying to justify it but what there's 180 people in this building and we needed to convince at least 16 people in the senate to sign and there was a lot of fear we've had 50, 60 years of hearing this product so we had to do something we had to set it up in a way that would pass and that that is the reality if we had not done that we wouldn't have dispensaries at all now so I am a little confused about why there are restrictions and there until this product is somehow recognized as not a threat there will always be some restrictions but I'm confused about why you feel that the way it's set up doesn't allow the patients to work with the dispensaries in terms of trying to figure out what kinds of things work because I've heard from patients who do work with the dispensaries and try and figure out and say well this strain works for this and this worked for me but this doesn't work for me so I'm confused about how the system doesn't allow patients and dispensaries to work together I think that it's a very individual experience and everybody's condition is different and there are so many variables within cannabis and for me personally I take oils that are produced in the state of Maine that I can't get here I try oils from the dispensaries and they were produced the same way that the oils are produced that are coming from Maine so I actually didn't have access to the product that works for me had I not found my caregiver in Maine I don't know if I'd be here right now without the knowledge of individual caregivers and people they're sorry I think thank you very much finding the right fit an organic good product that I wouldn't put into my body to heal me it doesn't have pesticides on it I don't want pesticides so I don't know that I can utilize from all the system if we're using pesticides and I question whether or not that's medicine to say you have access to this you have to make the concession to accept that you are going to be adjusting pesticides does Maine not allow pesticides at all? I don't know in the whole state I know personally where I get my medication it is 100% organic and I know what I'm putting in my body and I think that I should know what I'm putting in my body and that isn't available here and that's really important to me so the pesticides that are used here are only approved so they would be certified organic if there was a certification for cancer in Maine they're using organically pesticides it doesn't have anything to do with toxicity it's just about where the pesticide came from so what about contaminated products how do you handle that as far as your testing goes into state how am I sure that I'm getting something that's clean so what we've allowed for use are all organically approved or do not leave a residue and there's a strong use of beneficials as well so I have spoken with folks in Maine and they're running on the same issues we do inspections and we know there aren't any pesticides in their storage areas that would be not allowed and I know this issue occurs in Massachusetts Maine all over anywhere Cannabis is grown and they're using pesticides that would not be approved for use luckily the specaries here are organically integrated and know what they've used on their product that doesn't always occur but I do have to figure out what you're saying that vertical integration that creates a system where they're watchdogging each other and they're watchdogging themselves and why are they taking samples that they're giving to be tested so I question whether or not that is a valid sample I think that there are things that are lacking in so many ways that hinder the program it's not the dispensary's fault it's not the patient's fault it's we did that but we had to start some place but we can't continue to expand what hasn't been working well there's the test increase that will be going into place through the department of publicity but is that testing if they are choosing what's being tested well they could do spot checks but they're doing spot checks that the dispensary takes the samples for if I understood the testimony that was just made transported by DPS yes DPS what you're talking about right now is under the current system there's no welfare model there's no third party testing I agree you're changing that we would love to have the ideal system but given the fact that it was an illegal product to begin with we felt we had to do start some place and then make changes and we're making changes as things come up and it isn't ideal for everyone I acknowledge that and I don't know how if you have suggestions about how we should change the whole system are you suggesting we do away with dispensaries I'm suggesting that you have to have a caregiver system that is why I I think she's thinking of a different model we don't have an expanded model nobody can be a caregiver for having like seven minutes okay I think you're interested in expanding the dispensary system to care that was allowing them to do everything the dispensaries are doing is that what I'm hearing so the patients are taking care of so that the caregivers can provide the product for the if that's what you're saying I want to be taken care of I want a caregiver like I have a legal thing but I want to stay in my state for my medicine I see what you're saying that's not in the bill we're considering right now we're considering all these other things what you're saying is you're losing your empathy for the patient the patient is the one that is losing here the medication is more expensive here I don't have the caregiving that I have so I have to go get it in me don't you want to be a state that can be a state that's looked at a program that is a good program I mean it seems to me like you just want to make you just want to piece it together so it can just kind of stay out there kind of work why not play the system that works I have to admit we have done hearings all around the state on this issue heard from many many people who are working with the dispensaries and are more than satisfied and I'm sure there are some as yourself who didn't have a good experience and that's unfortunate but I know that there are many people who are being cared for who are getting their product out of the dispensaries and are glad of it we've seen people who have had their lives improved tremendously by being able to get a product so you know I see what you're saying it's a different model but you'd like to have a place this bill are you against this bill where we would expand what we're doing now I am against this I think you can't expand a program that isn't working yet okay thank you thank you very much okay we're all done okay was there somebody else that wanted to say why would why medical program didn't work for me either all the way from getting a doctor to agree to get into bureaucracy my name is Rob I'm MS and yeah my doctors were all hesitant to get involved and that was early on with the medical program it was a little bit different then it would probably be easier now but I don't need medical program and at a quarter of the cost with better availability of products I mean now that you can grow your own well now that you can grow your own and there's the gray and black market to go through the Vermont Medical Program there's just too many girls this is how I made it this is my main medical certificate I also made it yeah I just take care of myself definitely but I would like the expansion of the caregiver system I believe that's necessary for the patients that have and serve that don't get it very often they don't get hurt because they simply don't get hurt I'm not to cry at one of the other patients you've said to you to think that an organization can take care of the genetics and the thoughts these are growing the retail the extraction and everything from beginning to end and have a wide variety of products that's just too much to put on a new business and that's what the dispensaries are dealing with right now you know they can't offer all the strains that are needed for covering all the patients and they have the extractors they have to manufacture their products they have to go they have to sell they have to manage inventory that's a pretty big organization that didn't exist before they just had to pop up and serve patients of the state and it's I don't think it works out too well and I don't think we could have just done an expanded caregiver model which we didn't we chose not to do that dispensaries instead or we could have done nothing and just not done dispensaries at all and just not done anything at all well so we can consider that but we did not do the expanded caregiver model when we did it that was a choice and the choice was because if we wanted to do anything we had to get a pass out of this body and I'm telling you that for 50 years people have been scared of this product and so getting anything passed out of here to even start was a major major step it was I mean I was here when we passed that I was not here when we I guess my first year was when we passed that allowed medical marijuana in the first place but and I agree that I mean I would like to actually treat it like tomatoes but we can't so that's where we are you left something in writing right? you just showed me this card from me I'm showing you a card from me and it's also a way for Vermont to deal with the issue of out-of-state patients as well what you do is you have your physician contact the main system they form to your physician physician signs it here in Vermont and then you're allowed to use the main caregiver system you mean you want that physician here in Vermont to sign up they sign up for the main program it's free again we had physicians even to sign up with an out-of-state medical program so I don't think that would be a little different but that's been resistance I understand do you want this bill or not? yes ma'am I would appreciate that if we could open the caregiver system beyond one person per patient that would be really great I agree with everything else you said I haven't seen the bill but I'm interested in the CBD side of the whole thing and I'm just wondering whether this is connected to that at all no and where do you go for something like that though? the local corner store you mean for CBD? well I actually produce products with CBD but there is like a lot of backlash with that part of it federal government oh I thought you meant where to buy it I thought you meant where to buy it I'm just wondering as far as you know state laws and where that's standing right now I have to be upstairs when the farm is going so I have to I also have to I also have to okay thank you thank you thank you thank you