 It's lunchtime. My name is Catherine Antley. I'm a physician from South Burlington. And I just want to thank everyone who's come today. This is a very important topic. Many of our community, many of us don't know a lot about this. Dr. Kinfin knows an enormous amount about this. And hopefully, we'll learn something during this hour. We're honored to have him come from Colorado. He flew all day yesterday to get here. Thank goodness. Dr. Kinfin has practiced pain medicine in Colorado Springs for about 20 years. He served on the Colorado Medical Marijuana Scientific Advisory Council. And he's also the executive board member of the American Board of Pain Medicine and has been on their exam council for 17 years. Dr. Fin's worked on this for many years. He's been invited to Canada to testify at the Canadian Parliament. And he's also going this summer, been invited to London to testify there. So we're deeply honored that he's done a G-Tour and come up to Vermont to help us out. Nice to meet you. Thank you. I grew up, spent a lot of my youth in Lake Mamasin here in Vermont. I learned how to ski. I learned how to play broom hockey in Vermont. So Vermont really does have a tie to Vermont. So I have friends that live in Vermont. So this is really a little more important to me than Rhode Island, no offense to the Rhode Islanders out there. But I think it's very important that we really understand what's going on here. Again, I served on the Governor's Task Force for Women's 60th Ward, Colorado, when they went legal. I was on the Consumer Safety and Social Issues Workroom. I did spend four years on our state's medical marijuana scientific advisory council. I do a lot of public speaking on this. I'm very involved in my community. I'm very involved in our Colorado Pain Society that's pushing back on opioid epidemic, which we'll get to in a little bit. But I'm really here as a conduit of information. I'm not here to convince anybody of anything. I want people just to know what I know. And all of the stuff I present is referenceable. I have references. You can get the copies of my slides. I have no problems with that. So if I do say something that may not go with the way you think, please do not be offended. I am always hoping to be free to disagree. So if you ever played that game before Slava, I think everybody in Pompeii played that game, OK? These are my talking points. And again, this is my abridged version of what I know. My talk shift only goes about an hour and a half or longer. I do want to keep it relatively efficient and quick, give you the information that I want you to know in here and open it to Q&A in the end. So if you can save those questions for later, that'll be great. When you talk about exposure to the unborn, Eneta actually did a study going back in 1978 and following 200 of the offspring from the neonatal period into adulthood and found changes in brain function and higher rates of drug abuse, even in maturity, compared with controls, age-match controls. In Colorado, they had a survey of marijuana dispensaries that I think there was over 400. And they did recommend to the public health department official that called to use during first trimester pregnancy for nausea. And very few of the dispensaries encouraged the discussion. So I love this report saying that the number of babies born exposed to drugs displays our meth problem. But if you look at the data in Colorado Springs, methamphetamine exposure and marijuana exposure are exactly the same. I do a lot of work with the neonatologist. Is there something going on with this? The neonatologist and pediatricians that I work with in my community say these numbers are under-reported. It's a lot more than that. I'm just going to yell louder. So if you look at the Colorado Department of Human Services, the statewide data, if you look at the number of exposures in neonates, 865, 52% of the exposures are for marijuana. Our meth problem was only 20% of the exposures. And we know that there are risks and effects to those fetuses that are exposed to marijuana during pregnancy. Alcohol is very low. Heroin is very low. Opioids are very low. But marijuana leads the pack. So there's areas of the brain that are impacted when the baby is developing. And so we know that exposures to marijuana can be harmful for the developing brain up from 1 to 11 years old. And there's newer evidence showing that there's a very strong correlation to birth defects that parallels rise of cannabis use in Colorado. So with commercialization in Colorado, we are seeing an increase in other abnormalities, birth defects like heart defects, autism rates. And I'm not sitting here to prove that they are related, but the correlation is very strong. Women who reside in states with legalized recreational marijuana are more likely to use marijuana during preconception, prenatal, and postpartum periods. And this is for the women in the room. They always point at the women. They're using during pregnancy, but there's some studies out of Duke University. Susan Murphy published a paper that men who use alter the autism gene. So even though that the mom may not be using, there may be a potential risk for having an autistic or a spectrum disorder child if the dad is using. So commercialization may have a negative impact on future generations. Because what they're finding in animal and human studies is that it's intergenerational. So even the offspring, even if they don't use, they may have problems that pass on to their generation. And this is kind of new and emerging data. And I think there's a lot of work to continue to do before we can really come to any conclusions about that. But the American College of Obstetrics and Gynecology has a very clear position statement. If you're pregnant, thinking about getting pregnant, lactating and breastfeeding, really don't use marijuana. For eons, women have made it through the first trimester without it. And now we have other drugs that can help with that. So if these are animal and human data over time, and I didn't know this, but do you know why they study mice? Anybody? I didn't know this. I had to look it up. The reason is because the lifespan of a mouse is about three years. So they can evaluate neonates, adolescents, adults, and elderly effects in a short period of time compared to humans that can live to 80 years old. But if you look at the neonatal, the animal models show low birth weight, hyperactivity, anxiety, memory issues, socialization issues. Opioid-seeking behavior in animal models, the ones that are exposed to cannabis during development when they put these mice or rats up against opioid treatment. They tend to push the lever for heroin, the ones that are exposed to marijuana. So the human studies are looking at low birth weight, aggression, anxiety, hyperactivity, depression, drug-seeking behavior, as well. I have these open conversations with my patients these days, and I always ask them about marijuana use. So here I have a patient who's in mid-20s. His information's taken out, so this is no hip violation. But he works part-time in an autism center, and he also works as an installer for some type of device. When I asked about marijuana, he uses every hour of every day with his report. So if I was a parent of a spectrum disorder child or an autistic child, I wouldn't want this guy to run my kid around on a bus for an activity. When he reports, I smoke every hour, every day. Then I got in this conundrum, and it's like, do I report that to his employers at a hip of violation? Because I think the employer needs to know, and I don't know if the employer is doing random drug testing or not, or they're turning a blind eye. I'm going to talk a little bit about commercialization and youth use. Marijuana is the most prevalent substance found in completed teen suicide in Colorado. The most prevalent substance found. Kids are not overdosing on marijuana. They're not smoking a joint and dying. We don't know why this is. I think it has to do with commercialization. It started in 2012 right around commercialization in Colorado, and it's remained number one since then. And before commercialization, alcohol was the number one substance found in completed teen suicide in our state. And as of 2017, because you're still behind, it's the highest it's ever been. Our kids are struggling with mental health issues, pressures, social media. Are these kids using because they're depressed? Are they depressed because they're using? I don't know, and I can't say that. But all I can tell you is that marijuana is found in Colorado most often when a teenager kills themselves, and that's a frightening statistic. This is all age groups where marijuana is detected in completed suicide. We had medical marijuana in 2001. We had de facto legalization or commercialization in 2009. We voted to legalize it. It implemented in 2014. And the presence of marijuana in completed suicide across all age groups continues to go up. In Vermont, it was the eighth leading cause of death in 2017. In 2017, death rate was 18 per 100,000. So it's coming back in Vermont. And this is not just a Vermont issue. This is not just a Colorado issue. We have a national issue with mental health. We don't have the resources for these kids. You don't have resources for adults, for that matter, to get mental health treatment. So Vermont tied for 15 for highest rates of suicide. This is from your state health department data. I'm sure you guys are very familiar with this. In Colorado and Washington, kids 12 and older, the first time kids are trying for the first time at record numbers. And actually, I think we have number one for first time use based on national survey of drug use and health data. Vermont has this very, I mean, you guys have done a really good job with having these things available. So I would encourage you to go to the public health department website and look at this stuff. They did a great job. But you talk about early continuous use of marijuana increases risk of not completing high school, not enroll in completing college, lower income, unemployment, welfare dependence, reduction in IQ and middle adulthood. I think the numbers were eight points drop in IQ. But when we had lead based paint that dropped your IQ by four points and went, oh, get rid of the lead based paint. And nobody's doing anything about this drop in IQ for marijuana. Here's some of the percentage of Vermonters 12 and up using in the past month, higher than the national average. Here's the most recent data from SAMHSA, the Behavioral Health Statistics, National Survey of Drug Use and Health. Again, 2017-18, they're behind. There's a ton of data that they have to plow through to come up with these reports. And if you look at white columns here, those are states that do not have medical or recreational marijuana. Green or the medical, red or both. I'm going to zero in on the top 20 when you have ages 12 to 17, 18, 25, 26 and up. Vermont leads the pack in those age groups to middle adulthood, to 25 when the brain is pretty much fully developed. And number two for those that are over 26. So Vermont has a problem with marijuana use kind of across all age groups. But it's almost like this contest, who leads the pack and this and who leads the pack and that. It's not an award you want to have. Like Colorado, we leave a nation in vaping for our kids. And that's based on the YRBS. And it's interesting, the Youth Behavioral Survey, Denver, which is the largest city in Colorado, probably has the most number of kids in the state. They haven't participated in this survey since 1995. So even though we lead the nation, that doesn't account for a huge chunk of our adolescents. And you can talk to any school resource officer in my state, and they will tell you the biggest problem they have is marijuana. Students using vape or vaping were more likely to use other substances. And so the odds of the past or current use with use that use an e-cigarette device or vaping device is three and a half times higher than those that don't use any cigarette or vaping device. And legalization of recreational marijuana increases the risk of cannabis use disorder among adolescent users. I asked this question earlier. Somebody might know the answer. But Dr. Christian Thurstone is an adolescent psychiatrist. He runs the Adolescent Substance Use Treatment Center in Denver. Can somebody tell me what percent of kids that he sees for any substance use disorder are there for cannabis use disorder? Take a guess at what percent he's treating that had cannabis use disorder. 97% and there's a lot of co-use, you know. But if you talk about cannabis use disorder, 97% of the kids that he's treating are there for cannabis and maybe some other substances. Opioids, cocaine, meth, heroin, the leader of the pack is marijuana. And of that data, 23% of those kids get their weed from their parents. And another 23% or so get it from a sibling or friend. So you have nearly half of the kids that are being treated in Denver at one facility for substance use treatment are there for cannabis use disorder and they get it from a family or friend. This is part of the whole normalization of drug use. When you commercialize, you have more potent products, more vaping products among these. I mean, that just kind of, the more accessible and available it is, the more kids are going to use. So then the NIH in monitoring the future data, vaping of marijuana is going up in teenagers. Cannabis use in e-cigarettes increased among youth based on the National Youth Tobacco Survey from last year. You know, I had this number earlier, I think, Montpelier's, what, about 6,000, 7,000? Is that right? Breckermage, where I spent a lot of time skiing, they had about 5,000. So a little bit smaller than Montpelier, but based on the police report, hundreds of minors in a town of 5,000 are caught using fake IDs to get their marijuana in Breckridge, Colorado. So when you have post-recreational marijuana laws, increased use of cannabis use disorder for teenagers and increased frequent use and cannabis use disorder among adults 26 or older, brings a public health concern to the table. This is from the New England Journal of Medicine from last year, a very well-respected journal, I would guess, but if you look at Colorado, kids that are using e-cigarettes or vaping devices that are not marijuana, they were very clear, are the kids that are using vaping devices. And this is the Healthy Kids Colorado Survey, 47,000 survey, 45,000 responders. And they looked at the data of the kids that are using recent use of electronic vapor product, not marijuana, but more than 50% have used marijuana in the past 30 days, more than binge drinking. So in Colorado, if you're gonna use an e-cigarette device, you're probably likely, 50% of the time, gonna use some sort of marijuana in the past 30 days, and there's some other behavioral concerns and drug concerns. That being said, in Vermont, vaping has gone up between 2017 and 2019. And we know in Colorado, kids are vaping, they're also using marijuana, at least 50% of the time. And I would think that kids in Colorado and kids in Vermont are probably very similar. Oh, and Joules, you know what Joules is? It's a little vaping device, charge it in your computer, it's not a Joules here, it's for my pointer. But Joules, the executive at Joules knew and knowingly knew that they mailed a million tainted cartridges around the country, and you can find that online as well. So here's some of the comparisons, this in 2017 and 2019. I mean, smoking is just not a healthy choice, but they added dabbing. Does anybody know what dabbing is? Ever, not the dab, but the dab with the vaporizing device. I mean, this is really high potency stuff, very high potency. Some of these products are, they're crystalline. They look like meth, they're crystallized. Anne, who's from, she was a bug tender in Massachusetts over at Anne Hassel, talked to her about her experience as a bug tender on the industry side and what she saw. And she used and she can tell you her story, it's fascinating about her experience on the industry side of marijuana in Massachusetts. But these products are dangerous. They're dangerous products. People are dying from vaping, you know, the avali deaths. You know, tobacco won't kill you within days, weeks, or months, but these vaping devices certainly can. So here's, you know, between 17 and 19, primarily vaped marijuana in current users in Vermont. These are the adolescent data, is that correct? So 17% are vaping marijuana. This just came out yesterday. There's a big cannabis company. They have dishonest conduct, misrepresenting marijuana vapes out of Oregon. They have a dishonest conduct section in the lawsuit because their marketing is 100% marijuana, but there's other stuff in there that could be harmful when you're vaporizing it. And this is interesting. The health effects are unknown for these types of products when they're heated or vaporized and that's not completely true. If you're looking at THC or CBD or terpenes, the primary parts of the marijuana plant that you use to get high, they're all oils. You know, they're oils. They're hydrocarbons, that's what we call them. And some of the terpenes are already listed on the National Health Data Sheet as a carcinogen and lung irritant. And when you heat a hydrocarbon, which like avocado oil, sesame oil, they're all oils. They decompose into other things. And we do know that when you heat a hydrocarbon, they can be toxic and lung irritants. And some are already listed. Like I think it was a, I can't remember which terpene it is, but it turns into some other stuff that is bad and they're already listed and known. We don't know what the long-term effects of that is. And I think that's why we need to keep track of this information. But here's some of the data from Vermont. I mean, really used use really hasn't gone up a lot over the past 10 years. I'm sure there's ups and downs and fluctuations. The 7% are smoking cigarettes, 15% binge drink, but 27% are using marijuana. And here's just a little tip. I couldn't find any current data. The pupil, the per student funding in Colorado, so we already had medical in 2001 and then commercialization and legalization. The funding per student continues to go down and we're way below the national average. I mean, if there's any people in education, teachers, administrators, thank you for what you do for our kids, it's probably one of the lowest paid jobs for what they do for our kids. Adolescents who view marijuana advertising. You know, there's all these loopholes around every state. I can tell you in Colorado they're saying, well, we can't advertise, but you drive up and down I-25, you drive east and west on I-70. There's billboards sponsored by industry businesses like Maggie's Farm. So you come to Maggie's Farm and buy your marijuana. They can't use certain terms, but it's very clear what they're advertising. You can go to Texas Roadhouse and they have the TV screens scrolling ads. You can bring your children there and you will see CBD ads, Maggie's Farm ads. And they're not saying marijuana, but they're getting a very clear message and the Rand Corporation published this paper a couple of years ago saying the more kids see it, the more kids are likely to use. And that just kind of makes sense. Past month use in legal states is 40% higher than non-legal states. Past year use in legal states is 30% higher than non-legal states. First time use is 30% higher in legal states compared to non-legal states. So despite what everybody wants to say, we don't want kids using, they're using. And when you commercialize and legalize and expand programs and businesses like that, your kids are going to use. Again, it's a competition. Massachusetts overtook Colorado as a top ranking state for overall first time use, but now we're number two. So I mean, it shouldn't be a competition. We want to be 50, we want to be last in the country. We don't want to be first. Teen visits to the emergency department increases after legalization and it's very important to understand 71% are mental health visits. 71% of the kids that use that go to the emergency department or urgent care are there for a psychiatric issue. And here's, I've edited a medical textbook and Sam Wang is one of my authors and the effects on the pediatric population, the effects in the psychiatric population are just becoming a big problem. So you can see de facto legalization here in commercialization to 2012, when we said yes. And even though we said yes, 72% of the municipalities in Colorado said no, they opted out, opted out. People don't understand that Colorado is a box. And when they said yes, we want legal marijuana, 72% of the municipalities said, yeah, we voted for it, but we don't want it in our community. That's to happen in California where it was 80%. It happened in Michigan. They said 80% don't want it in their community. Why are the states passing these programs but most of the communities don't want it? I don't know the answer to that. So you look at poison control in Colorado, marijuana related exposures from commercialization and legalization goes up in all age groups as well as youth zero to 18 age groups. So and the number of just just marijuana exposures after we had the medical here, commercialization, legalization, I mean, I'm a visual learner. I'd like to see instead of, trust me, I get tired of hearing myself talk. I don't like to talk a lot in public, but I'm from New York and it just comes out. But I think the visual that you get from this, and this comes from the Rocky Mountain Poison Controls and Drug Center, I can't explain it. I think it's pretty self-explanatory. Oklahoma had the same thing. This just came out earlier this week. The number of calls about marijuana to Oklahoma Center for poison and drug information went up from 94 and 17, 85, and then last year 235, and 50% of them were between zero to 19. So half of the people in Oklahoma that are calling the Poison Control Center has to do with marijuana. And people don't understand, and because I talked to Dr. Wang about this, a little kid, zero to five, if they get into grandma's cupcakes, they can end up on a ventilator. They can stop breathing. And I have all these links, and you can find them online, but kids that ingest accidentally need oxygen control, they're breathing, they have paranoia, hallucinations, very drowsy and sedated, there's the healthcare cost. So if there's any school resource officers in the building, you talk to any SRO in my community, the number one problem they have is marijuana. These things are very covert, they're very insidious, they're very secretive. These kids are savvy. I mean, they make these little screw-off Dr. Peppercans with their stash in there. They have those little chapstick, they just have, they don't care, they're just put in their backpack in a little Tupperware container. They don't use drug dogs in Colorado Springs and in Colorado anymore, do you guys know that? And do you know why? Too much there, they've been barking all the time. Well that's, yeah, they'll be barking all the time, number one, but I was asked to speak of one of our large high schools by the dean of students a few years ago, Darren, I said, Darren, why do you need me to talk? You and I know there's a problem, because the reason I want you to talk, because I want you to talk to our kids and our parents and our teachers. I go, I'm fine, I'll do that. I said, why is that? He goes, because I know the kids that are using, I know the parents that are using, and I know the teachers that are using. And then one of the other reasons they don't use drug dogs, is that you have a dog jump out of a patrol car, the kids are on their phone and they're texting their friends and they're texting their teachers to hide their stash. They're teachers, they're texting their teachers, get rid of your stash, the drug dogs are here. So they're training the dogs now not to smell marijuana. They don't want them to, because it's too prevalent. The dogs are going crazy. And then kids are done, we've all done dumb things. They love social media. So here's a girl drinking Southern comfort at school, and I got this from the SRO in my community. This is not something I took it on my own or staged. So she's drinking Southern comfort, smoking a pot, and she's posting it to all of her friends and look how cool I am. She's not in school. She's gonna eat lunch break, who knows. But potency is an issue. Potency is a big issue. I got yelled at by normal. You guys know who normal is? Or any normal people here? Are you gonna yell at me? Anyway, it's a national organization or a former marijuana laws. They've been around for a long time, and I had a representative from Wyoming yell at me because I wasn't recommending God's Plant. And my response to her was God's Plant doesn't exist anymore because the potency of God's Plant was down here. And now we have, I'm not gonna talk about CVD, I'll talk about that later. Now this is from the University of Mississippi. So this is like the place that if you wanna do medical research on marijuana, you get your Mississippi weed, you have to go through NIDA and DEA, it's a process. You know, as part of our Scientific Advisory Council, we had to do a review, a request for a proposal for the scientific studies that they were looking at marijuana. They had to get it from Mississippi. And one of the studies we were looking at was a PTSD study, and Johns Hopkins was part of that study. And they're smart people at Johns Hopkins. So when they got their Mississippi weed that said 10% on the label, well, Johns Hopkins said, well, hmm, let's test it and see. Guess what? It wasn't 10%, it was 12% in that part of the plant, and 6% there, and 50%. So that's the problem with studying a plant or a crop. It's very hard to study plant material. Give me the molecule, and we can study that, I'm fine with that. And we have a lot of data and science on some of the molecules, like CBD and THC. We already have cannabis-based medications like Dronavanol or Maranol for chemotherapy associated in nausea and catechia. We have Navillum. Those are already cannabis-based medications. They are synthetics. They're not natural. Just some of the reference. All right, I'm gonna shift gears and get into the opioid epidemic. This is a very important slide to look at. This is from the CDPHE, the Carbon Department of Public Health and Environment, about our opioid overdose deaths. So we voted on a medical marijuana in 2000. We had de facto legalization and commercialization in 2009. We voted in 12 to legalize it for recreational use, and it was implemented in 2014. And if somebody can show me where on this graph, because in Colorado, 90%, 92% of the medical marijuana recommendations were for pain, right? 92% were for pain. If somebody can show me where on this graph, marijuana helped with our opioid epidemic, please point that out to me, because I can't see it. It went up. And actually, 2017 was a record number of opioid overdose deaths in our state. 2018 was second place. And I had the preliminary data from our Public Health Department. 2019 might take second place. So we have not impacted our opioid epidemic in Colorado. And I'll get to some other states in a minute. But we don't have an opioid problem in our country. We have a drug problem. We have a polysubstance problem. If you look at the methamphetamine overdoses since commercialization, heroin, cocaine's making a comeback. Between 17 and 18, our fentanyl-related deaths went up 26% in one year. So we have a drug problem. We are becoming a narcole nation for lack of a better term. This is gonna be a very impactful slide set coming up. But I wanted to know, having roots in Vermont, I'm like, I love Vermont. I heart Vermont. Remember that back in the 70s? They still have them. But I wanted to help. Where does Vermont compare to where I live? I mean, I live in El Paso County, Colorado, about an hour south of Denver. That's where Colorado Springs is, Air Force Academy, very high military prent entrance in my community. Vermont has about 9,600 square miles, about 600 plus thousand people. We have 2,100 square miles, about 700,000 people. So we're a little bit bigger than Vermont in terms of population. But much smaller, so much more dense. Although, when I first moved there, my wife said, I will never live in a pot on town like Colorado Springs. And here we are 26 years later. So here's El Paso County, where I live. So you can fit the entire population of Vermont in El Paso County, where I live. And this little blip right here, they tell our county that's where Pike's Peak is. So I live right out the foothills of Pike's Peak. So this is our Colorado opioid death rate. Going back to 2002. And again, remember, medical marijuana, 90% pain for all medical marijuana patients in the state. So it's gonna help our opioid epidemic. But here's our drug deaths, going back to 2002, Pike County, and the darker the color, the more problems we had with death through 2014. So again, if anybody can show me where marijuana's impacted our drug overdose deaths, our opioid overdose deaths, point it out to me. Let's go to California, let's go to the other side of the country. So we have the number of opioid prescriptions. I just downloaded this last week, February 16th. And again, a lot of these states, including Colorado, have very user-friendly tools that you can look at. You can look at data pretty easily. You look at morphine milligram equivalents, which is the CDC says you shouldn't be taking more than 90 milligrams of morphine in Colorado. It's up to 120. But back in the day, as a referral-based provider, I was seeing people on 1,000 milligrams of morphine a day laying on my doorstep and go, it's your problem now. I'm like, okay, great. As a pain physician, people think we're just pushing pills and that's actually not the case. We try to get people off of the medications. We use medication-assisted therapy like buprenorphine here. The buprenorphine prescriptions in California are going up for opioid use disorder. The number of prescriptions are going down. The morphine equivalents are going down. The co-prescribing of opioids and benzodiazepines like valium and xanax is going down, but their deaths are going up. What's up with that? They've been very liberal. They've had a medical marijuana program since 1996, I believe, and they went recreational a couple years ago. Here's the ER visits for opioids, synthetic overdoses, death rates, prescription death rates. It's incongruent. You would think if you're doing more treatment for opioid use disorder, you're prescribing less. The number of, the potency is going down, but they're still dying. They're still dying in California. They're still dying in Illinois. If you look at the number of prescriptions, morphine equivalents, their overdose deaths continue to go up. And Vermont's not immune to this at all. Opioid fatalities tripled, nearly tripled between 10 and 17 here in Vermont. And here's just kind of a summary, because whenever I go to another state or community, I want to have a better handle on, well, what did you do? So 2004, you approved medical, four dispensaries, a thousand patients, yada yada. But despite that, you still have people dying. And here's the most recent data. And again, when you go back to El Paso County, where the entire state of Vermont population can fit in the county I live in, we're pretty similar. We do have more people, but you had 110 total deaths. We had 130. So it's not just a Colorado problem or a California problem or a Vermont problem. This is a national problem. It's a national emergency, it's an epidemic, and we're doing the best we can to fight against it. I mean, as a member of Colorado Pain Society, we were at the table, you know, and I do want to say to the people from the house here, from the Capitol, I've never been in a state where I can just waltz in to the Capitol building and talk to people. Thank you for that. I mean, I can tell you, it's, can't do it in Colorado, I can tell you that. So here's Vermont Opioid Summary as well. Prescription rates in Vermont. I mean, all physicians across the country are trying to battle this epidemic. We're trying to write less prescriptions. We're trying to use medication-assisted treatment. But despite that, our neighbors and friends and families are continuing to die for that. You know, if you go back to a Bach-Huber study in 2014 where they said, oh, look, medical marijuana states have a decrease in people dying from opioids. Yay, we're doing a good job. And you know, I love the, I like the concept of get people off opioids, maybe use marijuana for their pain. Day does not there, it just does not support that theory. And so Keith Humphries from Stanford followed up with that, with the paper last year and actually medical marijuana states have a 23% higher incidence of opioid overdose death than non-medical marijuana states. So that trend back in 14 has reversed. This is part of the lawsuit of Purdue Pharma. I mean, it's a big money grab. I mean, everybody's suing Purdue. They want their piece of the pie. And this was in my newspaper locally. I think this was in 2018 or 2019. And you can read this and I left the word blank. So hundreds of US cities and counties are parties to the suit claiming big name. Manufacturers and distributors use deceptive advertising and marketing to overstate the benefits of blank and understates the risk of addiction. The blank is opioids and understate the risk of addiction. As a result, the suit says governments had to pay more for social services, law enforcement and other government functions. Put tobacco in there. Same thing. Put marijuana in there. Same thing. You know, we have, we've done a terrible job with the three legal substances we have, alcohol, tobacco and opioids. And nobody's been able to tell me how another addiction for profit industry is going to make it do it better. Cause they're not. You already, we already talked about our suicide not a lesson use data. People get mad at me when I say this, but it's true. And I have, there's no evidence, zero. There's no evidence in the medical literature supporting the use of dispensary marijuana for chronic non-cancer pain. The only evidence out there is for neuropathic or nerve related pain and cancer pain with products that are not available in the U.S. called SATAV-X to one-to-one THC-CBD ratio or synthetics, which are, we've had cannabis-based medications, adrenabinol and abalone for years. But that's the only evidence there. There's no evidence for substituting opioids with marijuana. And I will hear anecdotes from people in the audience about the people that are using. I got off my opioids and I'm using marijuana and I'm like, good for you. And I've had a couple patients, I'm like, fine. I don't have to worry about giving you a narcotic. But I can tell you that's a very, very low percentage of the patients that I see with chronic pain. Very low percentage. And the data, and it's interesting going on experimental pain models, which is consistent with what I see in my clinical practice and my colleagues at the Colorado Pain Society, the intensity of their pain doesn't change. I've had a few patients that come in on high doses of morphine. They have their pains eight out of 10. They're using marijuana, they're gonna get off. They're off their opioids, they're still using marijuana, but their pain's still an eight. Still an eight. So it doesn't change the intensity of the pain. Portugal, the model for decriminalization. In 2018, they had the highest number of drug overdose deaths in five years. So their model is starting to fall apart. So commercialization may have a negative impact on the opioid epidemic. There's some of the references. I can give you more. I've got a whole lot to list in them. I'm gonna talk a little bit about public health and crime and safety. Commercialization will increase that. Why would Greeley, a small town in Northern Colorado, launch a campaign late in 2019 saying marijuana is not harmless? They locked the city, the small town, launched this. And where I live, they have marijuana shops are getting busted. It was a Mexican restaurant with money laundering with ties to El Chapo down in Mexico. Burglaries in Denver hit a three, dispensary burglaries, hit an all-time high in 2019. So now they're getting robbed. Because cash business, a lot of money is changing hands. So it might be an easy robbery to get a dispensary because it's all cash. Homicides. Denver saw the highest number in 14 years. And people, well, there's more people moving there. But it doesn't matter because if you look at the population growth of Colorado, it's plateauing, it's tapering. Despite that, in 2018, we saw the highest number of homicides in the city. So we had, Denver had most officer-involved shootings, nine in nine months. And Detroit, if you look at Detroit, their data, they had, I think in the month of January, they had like 24 homicides in January, Detroit. And they opted out of marijuana, by the way. Detroit, I was surprised. Colorado Springs, where I live, we had seven shootings, five of them were fatal. Thankfully, none of our men or women in blue were killed, but they have been killed. I do work with John Lopey, who's a sheriff coroner in Northern California. I talk about, I'll get to his little spiel in a minute, but he's been to more funerals in the past year for his colleagues that have been killed related to marijuana grows, dispensaries, psychosis, and that sort of stuff. The state of Oregon, and I can send you this report, they issued, they did an audit of their marijuana program. Is anybody familiar with their audit report? I can send it to you. I think I have a link in here somewhere. They said, okay, well, let's see what we're doing in Oregon. They have a long history of medical and recreational marijuana. The state has only been able to do a compliance inspection of 3% of its stores and 1 third of its growers. They cannot ensure that tests are reliable and products are safe. 3% is not a good pass rate in my mind. 97% would be much better, but they were only able to do a compliance inspection of 1 third of their growers and 3% of their stores. And actually, medical marijuana is not required to be tested in Oregon. So, in Colorado, the Denver Public Health Department is the only public health department that will issue a recall, right? And I said, well, what about El Paso County, where I live? Nope, because I know the folks there of the board of our public health department. Nope, we're not required to test it. And the only way I get a PSA from Denver Public Health Department is if I find it on their website and I register for the recall, the public service announcement. But the problem with that is that if these products are contaminated, by the time I get the announcement in my email or stamp holder or whatever, I probably consume the product. But they're not testing it, you know, peanut butter or it's crackers, romaine lettuce, it's all over the news, right? Contaminated marijuana products? No, and some of these products have a chemical called mycobutinol, which is anti, which is to keep the fungus off of it and there's residual mycobutinol on the plant. And do you know what it turns into when you heat it? Hand nose. Hydrogen cyanide muster gas. Cyanide, cyanide. So if you treat your marijuana plant with mycobutinol anti-fungal agent and it's still residual on the plant and you heat it, it turns into hydrogen cyanide. Marijuana related homicides in Colorado Springs. And I think the data is somewhat flawed because I do a lot of work with DNI and our local sheriff and our law enforcement folks and the guy in charge of DNI said, well, in 2018 there were zero marijuana related homicides. So I, you know, I'm very busy and I went to their website and I looked it up and I go, hey, Sean. I said, I found these two people were shot at the same time in the same place related to a marijuana robbery. He goes, oh, then there's two in 2018. I said, well, maybe there's more, I don't know if there's more than two. But I actually had to tell the DNI guy about the marijuana homicides in his town. But Sean's a great guy. I've known him for many, many years. He does a very good work. And last year, 12% of Colorado Springs homicides were marijuana related. So commercialization breeds black market, breeds crime, breeds death and homicide. And here's our violent crimes in Colorado Springs over time. Again, we had, this is just past, this is when we voted for, yes, let's do it. Let's implement it. And our violent crimes are continuing to go up. I love this slide because I poached it before they changed it because her name is Janet, couldn't localize Colorado on a map because Colorado is disguised as Wyoming. USA Today. She probably can tell where Juana is if she can't tell where this big box is. So here's some of our interdiction seizures from the United States Postal Service. They're mailing product in the mail, parcels containing marijuana decents for other states, commercialization, nothing. And then we legalized and it's gone up. The amount of poundage of marijuana going through the US Postal Service has gone up post legalization, going out to other states. I'm gonna mention this one little story because this happened about end of month last year. I mean, end of last month. This woman was divorced. Her husband moves to Colorado to get in the industry. Per the divorce decree had to have visitation. So she lets her son go visit dad who lives in a mobile home. And then he runs over and kills their child. So they go to his mobile home. When we had a place on Lake Bombay scene, it was a mobile home. So I've lived in a mobile home. I know how small they are. But he had butane hashyl extraction lab, 79 plants, 100 pounds of marijuana. Colorado math, it's a medical. You can have six plants, three flowering, three not flowering. Who's investigating and who cares? Six equals 600, right? Here, that's Colorado math. A loaded ruger was in the pantry next to mac and cheese. He had assault rifle, hunting rifle, a three-year-old kid running around. Mom's not there, but the visitation, the car to see dad. Neighbor has cameras and the footage shows him leaving the driveway at 10.30, backing over the boy. He comes back 14 minutes later, picks up the boy and leaves. So the kid's dead in his driveway for 14 minutes. He admitted to ingesting a dab, right? You know what, we talk about dabbing. And they ask him, how high are you? 10 is being the worst hot, the most high you've ever been in your life. He was a two or three. He wasn't sober. He admitted to being hot and he ran over his son. The state of Texas has about 10% of the entire country's population. So I think they're a good representation of the country. So does, I mean, I don't want to get into politics or all this is just data. So a good representation of the country's populace, right? So when you have a dead kid in Texas, right? So child abuse or neglect, fatality. You know, the Department of Family Service, Public Service goes in and they look at substance abuse by perpetrator, active use, past use. Here's marijuana, here's nothing. And then you have alcohol, cocaine and meth. When there's a dead kid in Texas, more likely than not, marijuana's in the mix. It's in there somewhere. They fall asleep, the kid falls in the pool, drowns, I mean, they're not killing their kids. These are typically accidental fatalities. Again, I'm not gonna get into politics, but this is very interesting. Russian money coming into cannabis, Giuliani's, Ramon Le Partake. This was in October last year. So we have this industry that is being funneled a ton of money from other countries. Even into Colorado, CBD products, so this guy got indicted. So Russia is supporting politicians who can help them obtain retail marijuana licenses around the country. Around the country, they are targeting our country, I think, in a certain respect. So there's our six plants. You know, three flowering, three non-flowering. This is a very nice neighborhood in Denver, half a million dollar homes. And the folks I work with in law enforcement say they will use these homes as rentals and they will not live in them. They will cultivate them in them. They will grow in the toilet and the bathtub in the wet bar. Their plants are everywhere in the house. They may have a small area to live, you know, but the purpose that they rent these houses on Craigslist is to cultivate marijuana. And no community is safe according to my law enforcement friends. They're in high income places. They're in low income places. They are everywhere. In El Paso County, which is a confidant, everybody in Vermont, in El Paso County had over 650 illegal marijuana grows that they knew of. They knew that there's more. And they were in every community. Doesn't matter the wealthy or non-wealthy or wherever. Why are they wearing hazmat suits and rebreather masks? Why, you know, it's just a plant, right? It's natural. It's harmless. But these may have micabutin on them. One of my patients was a DEA agent, and he was a big dude and he ripped his hazmat suit and he got oils through his skin and he said he felt weird. Did he get a contact high? Did he get a poison or an insecticide? I don't know. And the folks that I work with in Pueblo, Colorado, which is like an epicenter of a nightmare of how bad this can be, they're having people coming in the industry with unexplained rashes, with breathing difficulties, because there's no OSHA requirements for masks, for skin protection that I'm aware of, and the folks that I know and who are about for this, even though they may say you have to wear masks and protection, how many do? None. None, they weren't giving it. They weren't giving it, there's the answer. So here's the Rocky Mountain High Entity Drug Trafficking Area Task Force. And I find this interesting between 16 and 18, the number of plants went up, but the tonnage went down, but concentrates have gone up. If you have a pound of marijuana, compared to a pound of concentrate, you can probably fit that really nicely into a backpack or something more covert. All right, so I've poached these for my DEA friends. These are residential homes, and I love Christmas, and my wife won't let me do the Christmas tree because I want more, better, and chubby chase and Christmas vacation. But these are what they're finding inside people's houses. These are the electrical things that they're doing. I mean, these are hazards, fire hazards, ultra electrical wiring issues, the Jimmy rigging them. They're just like adding onto the next surge protector, the next one and the next one. But if this house catches on fire, there's entanglement hazards. I mean, if there's a person that has fallen because of smoke inhalation, and they're in this little crawl space, that puts the first responders at risk. And you can find lots of examples online of people that have died from, and wildfires that have started from illegal marijuana grows. And my law enforcement friends tell me they have these undocumented workers that come up from Mexico, and they say, well, let him hot tap the transformer, and he does it, and then he gets electrocuted and they dispose of him, because he's dead. I mean, these things happen. This is commercial grade lights in evasement. I don't know what the energy requirement for these are, but they're very high, and they generate a lot of heat. You have do-it-yourself ventilation, and the agent charge in Denver told me about the R rating, you know, you have 30 minutes to get out if your house is on fire. But once you start poking holes in the drywall around the house, because, you know, they have the meth registry, if you sell a house, you have disclose, you don't have that for marijuana, right? So you may go in and buy a house that was a former marijuana grow house, or butane hash oil house, and it's all patched. It smells good because they put fresh paint on it, but your R30 rating turns into an R5 rating. And if you have a young family with a couple little kids and you don't know that, you gotta get out of the house in five minutes at a 30 or you die. These are some of the grows that they're finding in residential homes. There's the mold that is oozing out of the outside of the house and the inside of the house. Drywall is not a good medium to grow crops. It's very humid, takes a lot of energy and heat, but that's what they're finding. And if you look at the dispensary, the cannabis industry workers, as an American Journal of Industrial Medicine a couple years ago, I can't remember the number that they polled, it's a few hundred, but the workers, when you go to a dispensary in Colorado, most of the population is asking for advice. What do I use? And the requirements to be a worker in Colorado is you may need to be 21 years of age, experienced with marijuana and have a pulse. There's no medical requirement for being a blood tender, right? The person behind the counter does not require medical training. But the people that are using six to seven days a week, 23% use before they go to work, 14% during work and 50% after work. So they're using a lot during the day. And that's what patients, especially elderly, that may have questions about this go to dispensary, not knowing that the person behind the counter might be impaired or tolerant or what have you, but they're using. I'm gonna be at university tonight, but last week the Dean of Marquette University was killed by a stone driver. He was under the influence, failed sobriety testing, so impaired, the car smell, the marijuana. I don't know what his toxicology is because it's so new. I may never get it because it's an active investigation. You guys familiar with the Planned Parenthood shooting in Colorado Springs a couple years ago? Yeah. He was a known pot user, moved to Colorado for marijuana. He had online posts, finding people to connect with and smoke marijuana with. He didn't like Planned Parenthood, killed a few people, injured a few people, didn't do drug testing on him. No drug testing. Chances are he probably had something in the system. This came out earlier this week regarding CBD. Oh, it's benign, it's fine, it's not gonna get too high, which is true, but it's not benign, it's not benign. Have you guys heard of Epidiolex? And so it's the only FDA approved natural CBD on the planet. It's a medication, comes at the prescribe, it comes through a pharmacy window. Too expensive, my mind, because don't get me started on big pharma. But it's not benign. If you go to the Epidiolex website, and I would encourage you to do that later, look at the warnings and precautions. And under warnings and precautions of the purified FDA approved CBD is liver damage, suicidal ideation and behavior, somnolence and sedation, it has effects on the kidney. I mean, it's not benign. It's not psychoactive, not gonna get you stoned or high, but it's simply, you know, they say it could be plus sleep and sedation, lethargy, and people that are driving school buses, that are driving your kids around, my autism therapist who's smoking every hour, every day, those are the things you need to avoid. So here's a CBD product, or hemp product, excuse me, in Colorado, sold at the grocery store, because you see CBD everywhere and hemp everywhere, and Charlotte's web. You guys have heard of Charlotte's web, right? And I live in a small community, so Charlotte Fiji was a young girl that her mom brought her to Colorado to get hemp for her seizures. And, you know, the Epidiolex works for seizures, you know, but you have to monitor liver function, that sort of stuff. So Charlotte's mom page is married to a friend of mine, because I do, even though Coward Springs or El Paso County is bigger than the population of Vermont, I know a lot of people in the community, and Charlotte's stepfather is a friend of mine. But here's Charlotte's web oil. There's no labeling on theirs, just as it's a hemp extract oil, has other things in it, a coconut oil, it's organic, it's, this one's 60 CCs, but there's no labeling. How much CBD is in this one? Is there any THC in this? I don't know, it's behind the counter, it's expensive, it's crap, it's 175 bucks, right? We taxed $170 for, it's about the equivalent of a cap full of Nyquil, right? But in the certificate of analysis from the Stanley brothers in Boulder, Charlotte's web, 84 milligrams of THC, 84 milligrams. Do you know what, does anyone know what a dose of marijuana is? By five? No, 10 milligrams. 10 milligrams is the dose of marijuana, and it's completely arbitrary. I think it's like the decimal system, it's easy, 10,000 easy to divide. But this one at 84 milligrams of THC in an unlabeled, over-the-counter hemp product. Fatal crashes, testing pods from marijuana, doubled in states where recreational use is legal. In Washington, it doubled since 2012. People who drive higher up to twice as likely to be in a crash. So legalization of recreational use may increase THC pod of drivers involved in fatal crashes. Everybody that smokes pot is not gonna get in a wreck, right? Everybody that goes to the bar, gets behind the wheel, is not gonna get in a wreck. You know, is drunk driving good? No. Is marijuana used during driving good? No. I was mentioning to somebody earlier, I can't tell you how many times I've driven up and down I-25 between Denver and Colorado Springs, and I've seen people driving with their knee and their elbow and lining up a bowl, going 75 or 80 miles an hour. And then I wanna take a picture, but I'm a distracted driver, so I can't. So I ask my wife, I say, get a picture, get a movie. Help me, I'm trying to avoid everybody else on the highway. So here's the survey of 11,000 anonymous marijuana users in the state of Colorado, 11,000 is a big number. 70% said, yeah, I've driven high before, right? And our fatality data is going up, which I'll get to in a sec. But they say, well, we have a problem with alcohol, we have a problem with opioids. So if we pass and commercialize marijuana, we have less problems with opioids, which I already told you didn't help. And we're gonna have less problems with people drinking because instead of going having a glass of wine at dinner after dinner, I'll go home and have a joint. So we're gonna see less alcohol. But in Colorado, we became alcoholics because here's legalization, and this is from the liquor excise tax, department of revenue, in terms of gallons consumed since commercialization and legalization. So they're all party drugs. They're all people like to drink and smoke and do both and take opioids and, you know, so if you look at the traffic fatality data, if I have that here, it's somewhere here, the traffic, the marijuana related fatalities have gone up over time. There it is. So when an operator tested positive for marijuana through 2018, it actually dropped between 17 and 18. And I think that's in part because our law enforcement is doing a great job at, you know, click it or ticket, drive high, DUI. So there's all this messaging about, you know, impaired driving, and this is probably the first time the lowest in a while, a couple of years, but 17 was a record number of, you know, driving late in marijuana fatalities. And the thing I've noticed, and this is based on the law enforcement folks I work with, is that a lot of these things happened during the day where alcohol related fatalities typically happen at night and weekends. And we're seeing a lot of people, pedestrians, cyclists, or poor cyclists are getting run over all the time now. One was personal conveyance. I think that was like a hover round or something. But yeah, this is, it's crazy. You know, you commercialize, expand, normalize, increase use. You have more people on the roads and impaired. Not everyone's gonna get in a car crash and die, but you know, just by percentage wise, it's gonna go up. The environment. This is one, this is a piece of information nobody really likes to talk about or hears about. But you're talking about, this is Northern California. And I was talking about a sheriff, John Lopey at Siskiyou County. He declared a state of emergency last year, late last year, fall, because of the illegal marijuana activity in the national forest in the Shasta, Mount Shasta area. They're using banned pesticides, ones called carbafurin. You're not supposed to use it. An eighth of a teaspoon will kill a 300 pound bear, right? And they paint the plant, the rabbit comes in, the mouse comes in, they die. The endangered spotted owl comes in, they're dying, they're diverting water. I mean, California can use every drop they can get. They're clear cutting, there's erosion issues, water diversion, fire issues. California's governor pulled the National Guard from our border down in Mexico and California. Why did they do that? You know, we were talking about border control, but it's so bad in California, the governor pulled the National Guard from the Mexican border. This is from John Lopey's slides. These are just the illegal marijuana grows from an eagle bird's eye view. They're everywhere. They're everywhere. They're estimating 60 to 80,000 illegal marijuana grows in the state of California. And this is what they're finding. They're finding dead animals everywhere. You know, deer, bear, rabbits, big corn sheep, mountain lions, the poachers, the cartels they go in, this is one gross site. This is the irrigation tubing from one gross site. There's miles and miles and miles of tubing. And when they're feeding their plants, and depending on what resource you go to, I mean, it could be, I've read anywhere from four to six gallons per plant per day, I've read up to 12 gallons per plant per day. But let's keep it simple. Eight gallons per plant per day, you have a grow with 600 plants through the math per day. Growing seasons, about three months, it adds up quickly. And when there's 80,000 grows in the state, that's a lot of water. And California needs every drop they can get. Here's a bottle of the carbaphera. So they put in a little Gatorade bottle, throw it on the side. I mean, these are really in remote areas of the forest, so the chances of a little kid coming or stumbling across that are very low. But here's trash, insecticides, fungicides, rodenticides. He now needs, Dr. Marod Gabriel now needs DEA and law enforcement escort to go investigate these illegal trespass grows in the national forest. And DEA said, 30% too dangerous. Booby traps, snare wires, arm guards, guard dogs. And this is what they're finding in California. And as anybody heard of the Waldo Canyon Fire in Howard Springs a few years ago in 2012, I was evacuated for a week. We came really close to my house. Thankfully, I didn't lose friends, family. Only two people died, 38,000 acres. After the fire was out, 2012, pre-legalization, 2012, fire was out, they found a 22 acre illegal mare I want to grow in the burn scar. 22 acres, that's a big chunk of land. They find bears, dead bears. Here's the San Isabel National Forest in kind of southwest of Pueblo. First responder of a friend of mine who was an ER physician went hiking in and said, here's the trail going through here. And he stumbled across all these random marijuana plants in the national forest, right? And I can tell you, I was in Utah last year and I invited the president of the Chiefs of Police for Utah from Ogden, Utah. And I said, I can tell you, because they were just passing medical, and I go, I can guarantee you it's in your national forest. And he's like, yep. And I can guarantee you in Vermont, it's there. I know it's there. And law enforcement back there are like, oh, yeah. It's not going to grow in the winter time, obviously, but summer's growing season. I'm going to talk a little about revenue, because it's like, let's fix our budget crises with pop money. So here's Colorado's tax revenue over time. It's making money. Goes back to January 14. And it's a little complicated, and I'll show you the slide, why it's complicated. So by year, it's gone up every year. 2019's we're in a million. 2018, $266 million. I'm going to use that as a reference point. Over the six years, $1.2 billion of revenue. Wow, we're swimming in money here. There's the budget. That's how much marijuana comprises of the state budget. 0.9% of the state budget. That came from the governor's office. Other states have, do you want to go back? Wait, yeah, I have to. That's what we wanted to wrap. And my slides will be available, too. So no worries. So every other state is fall flat. California predicted they promised the voters a billion dollars, and they got 92% of that the first year, 72% the year after. Washington state, Alaska, Oregon, in terms of their percentage of budget, very low. So here's kind of the schematic for where the money's supposed to go. So somebody said, well, isn't Medical Mirror one of more expensive? I know. Medical Mirror one is cheap. They only taxed a 2.9% sales tax. So there's a kind of a push or, because I've had patients come in and say, I use marijuana for my pain. I need to get my card every year. I go, why don't you just go to the store? It goes too expensive. I only pay 2.9% here, but I pay 30% between the sales tax and the excise tax for my retail marijuana. So there's a disparity between the taxation if it's a medical or recreational product, even though the products are the same. You're still going to get, what is it, Peyton Manning, Bud there, and you get Peyton Manning, Bud there. And they're both Peyton Manning marijuana, but you're going to pay less as a medical marijuana patient. Also, I think you could be 18 as a medical marijuana patient. Yes, good point. Yes, and that's a huge point. You can be a medical marijuana patient and be 18 with no parental consent. So if you turn 18 December of your high school senior year and you can become a medical marijuana patient because you don't need permission from your parents, and I've had patients, I've had people that I know come in and say, well, what was your exam like? I say, well, they touched my knee and said I have arthritis and I get my recommendation. So I go to the dispensary and I became the school drug dealer because I can go, even though there's no monitoring of the two ounces I can buy at a store. And so there's more marijuana stores in Colorado than McDonald's and Starbucks combined. There's more pot shops than McDonald's and Starbucks combined in the state of Colorado. So there's no restrictions of me going to your dispensary, get my two ounces, and then five hours later, go to your dispensary, get two ounces. I load up my trunk. I become the school drug dealer. I happen. I know people that have been affected that way. And again, I live in a very high military penetrance community. We have Fort Carson, Air Force Academy, Peterson Air Force Base. I have front row seats to Armageddon because the NORAD is like right there. I can see it from my house. So we have a lot of military people in my community. And I have had active duty military come to my office and they might be taking a low dose of opioid and they're using a CBD cream, right? And they, so my drug tests everybody. And a lot of these CBD products have THC in it, like I mentioned, and they will test positive for low levels of THC. Well, guess what? If you are on post and you get randomly drug tested, your 25, 30 year military career goes bye-bye because you are using a CBD safe, non-TAC product. So you have to be, when people ask me, because I have, you know, I'm not a nihilist. They say, well, I want to try this. I go buy or beware. Because what's in the bottle may not be able to put it on the label because we're not testing it and they're not monitoring it. And there's no, you guys have a prescription drug monitoring program, correct? Yeah. I think Missouri is like the only state that doesn't. But there's no PDMP equivalent for medical marijuana dispensaries. So they're not tracking patients' behavior. I just found out recently, as much as I know, in the state of Colorado, you can make a medical marijuana recommendation for opioid substitution. So I sent Jim Burrack, who's head of our MMAD, your Marijuana Enforcement Division, I go, okay, are you vetting that? Because if you are getting a patient, medical marijuana patient says, I'm using this as an opioid substitution because there's 8,000 patients now in the state that have it for opioid substitution. Are you cross-referencing those patients to the PDMP to make sure they're not getting opioids? No response. Our insurance rates have gone up in Colorado. Six percent increase in insurance collision claims. This came from the, Colorado, Oregon, and Washington Institute of Highway Safety. So I don't use, but I'm paying more. Sometimes I feel people can't spell P&L because if you're looking at numbers, right, and I'm using 2018 as a reference, $266 million in marijuana revenue from medical, recreational, concentrates, all this other stuff, ecologists from NHTSA, National Highway Trafficking Safety Administration, did a report several years ago that on average, a person that's dead from a driving fatality is about $1.4 million. It doesn't matter if I fall asleep at the wheel and run into a telephone pole, about $1.4 million. So I've got property, indemnity costs, all that other stuff. And in 2018, we had 114 million, I mean 144 marijuana-related fatalities. So that's $201 million in L. And they had 266 in P. So, and I don't have numbers. A lot of these are intangible. Adolescent use and addiction and addiction treatment by 97% for cannabis use disorder, et cetera. Law enforcement costs, you know, I can tell you, I work with our sheriff. Sheriff Elder, Bill Elder, he's done an amazing job. I know a lot of the folks in CSPD. California's pulling the National Guard with environmental costs, you know, $70 billion. So I'm gonna leave those aside. But you look at healthcare utilization, hospitalization rates related to marijuana since medical marijuana, commercialization, legalization. You're looking at the Centennial Institute. I've put a report out there in Denver. For every dollar generated costs 450 to regulate. I don't think I agree with that number. I think it may be a little inflated, but I don't think it's zero. I don't think it's a positive number. I published a paper a few years ago. You know, I live in a modern-sized community for Colorado standards. What happens in my community? So between 2009 and 2014, one of the two hospital systems in my community lost $20 million just for marijuana-related ER visits. All right, so if you take that across the state, that's about a half a billion dollar price tag. So average $83 million a year, just on the cusp of legalization. So you're two CC6 in, you've got your 83 out, you've got your, where did it go? 200 out. You have cannabinoid hyperemesis syndrome. You guys heard of that? The people that are using the hot baths to kinda, I don't understand why. Maybe you can explain that later. I don't understand the reasoning why the hot baths make them feel better, but on average it costs about $6,500 for one cannabinoid hyperemesis patient. And so if you allow one patient per ER per day in Colorado, that's about $59 million a year for one per ER per day. My emergency room colleagues tell me they are seeing two to three per doc, per shift of cannabinoid hyperemesis syndrome. I'm gonna keep it conserved, so you're $59 million in healthcare costs, so you're already upside down just with that. And there's a lot of these things I don't have numbers for, because a lot of them are intangible. So these are just kinda things to consider by doing this for so many years. I've had people ask me, and I always think about what about this? You should have mandatory drug testing for all violent crimes. Like the Planned Parenthood Shooter was not drug tested. I don't know if you guys heard about the Colorado Springs Stabber from a couple months ago. Just went downtown Colorado Springs, stabbed by eight people, no drug testing. Poency limits. There's a risk based on the European data. Anything about 12.5%, you have a risk of psychosis. First episode of psychosis was 12.5% TAC. That doesn't exist in Colorado anymore. Home grows equals black market breeding ground. Support law enforcement with funding, school funding, drug prevention. Have the state data easily acceptable and advertise it. Tell the public, tell your communities what's happening in your state. Don't just have it on a website that somebody has to know how to maneuver through a website to find it. You need to have those PSAs out there, about suicide, et cetera. Monitor public health impact, health care utilization, ERs, environmental impacts, adolescent use, big problem. Smoking is just not a healthy choice, so just discourage smoking, discourage vaping. Don't use during pregnancy lactation. Toxicology on all suicides. Doesn't matter what age, Vermont does not do that. You should have mandatory toxicology on any suicide across the state. Driving fatalities, you guys had a big one last year. Five kids, you know, run over by impaired driver. I don't know if there was Xanax or something in there as well. But that happened in Texas. The Sutherland and the Sutherland Shooter was the bigger one. Support FDA drug development. I have no problem with a cannabinoid that works for a condition that comes from a pharmacy and I write a prescription. I am fine with that. This free-for-all of growing your medicine in your home has got to stop because that's not medicine. That's not a medication. That's just a plant. I mean, we have Strychnine and Hemlock and Digitalis, you know, from the Fox Club plant. We already have a lot of plant-based medications that are useful. And we have epidiolex for seizures and I think it works. I think there's components of the plant that might be helpful, but we're doing it the wrong way. Support the FDA in developing these things for medical conditions and follow the science, not the money. The money is not there. It's not gonna be your windfall and solve your budget crises, but follow the science. And I think the science should direct any type of policy because that's where it is at and for the safety of your communities. I poached this from day for two. I modified it to make it my own. Marijuana is not the most dangerous substance on the planet. The danger with marijuana is in that disparity between what's perceived as harmful and what's really harmful. That's where the danger is. Again, Bromley has a telomarket that was me at Brecker Ridge a few weeks ago. I'm really bummed out because I can't go to the Tally Festival. Bromley, tomorrow, I wish I could. I know of several people that will be there. That's Garden of the Gods and Colorado Springs. It's like five minutes from my house. So I opened a Q and A. If anybody has any questions or concerns and I thank you so much for letting me come and share what I know. I guess I'm just a conduit of information. I'm not trying to convince you anything to make a decision on anything today. I just want you to know what I know so you have information to take to your friends and colleagues. Yes, sir. Sir, thank you, first of all, for being here. Every member of that Vermont legislature within the stones throughout this building should be here listening to this. This was compelling and shocking. Well, thank you, but thank you. I can tell you, like I said earlier, I went to the state house. I walked in to the state house. I can't do that in Colorado. So thank you to anybody from that building that does allow that and I am more than happy. I had a front row seat to Canadian Senate and the British Parliament and I think that the legislators that I've run into here were very open to what I had to say and they want more information. I can't do that in Colorado. Won't happen. Yes, sir. 60 Minutes article last fall, I believe, talked about the California market, the illegal market and how they're not even prosecuting for marijuana violations. It's more for the water quality and the chemicals that you're talking about. Is Colorado doing the same thing? Are they holding off on any? No, they're turning a blind eye. I don't think, I think California is probably the worst and the people that I know in law enforcement and HIDA at the state level, elected officials, I know it's happening in Colorado. Nobody's really generating the data or the information that the public needs to know about but the folks that I know at the Department of Wildlife say, oh yeah, we're running into poisons and garbage and trash in our national forest. But I think that's, to me, that is the tipping point that will make marijuana in this industry completely outstripped alcohol and tobacco combined is the environmental impact. Huge. And you know, you have people like indigenous, you know, Native Americans that rely on water and growing crops and if they're contaminated from upstream poisoning and coming into their, it already hits the food chain in California. John, I mean, it was Dr. Gabriel said, you know, he's a big hunter of fishermen and he's the one that stumbled across these illegal trespass grows. He said people, you know, the deer eat the crops and the people shoot the deer, they test the meat and the meat's poison. They're finding traces of these poisons in the food chain and people don't hear about that. He was invited to the Sierra Club to talk which is, you know, very natural environmental but when they found out what he was gonna say they uninvited him because they didn't like it and all of Maraud Gabriel's wall is filled with plaques and they're all law enforcement plaques. There's no plaques or awards for Dr. Gabriel from the industry, from the Sierra Club, from any environmental organization. He actually reached out to the marijuana industry in California and said, look, you're killing our planet here. You're killing, the spotted owl has been spotted in years in Northern California because they're eating the dead mouse and rabbit that's eating the poison plants and he's like, give me some money so I can revitalize and reclaim these trespass crews. Nothing, not a dime. Yes, sir, in the back. Doc, thanks for coming. Thanks for having me. Once the biggest fall item, people crossing the border refer to them as undocumented workers. Aren't they really illegal aliens? Well, you can call it that way. I'm trying to be a PC here. Well, I know that they're the PC stuff. We all prefer to use the term illegal aliens. Yeah. Not all of us. You know, I have a 25-year-old son who's a consummate millennial. He would be so irritated if I said illegal alien. He's like, they're undocumented. I'm like, calm down. It's like, thank you. Yes, ma'am. Comment on hyperemesis and what, somebody said, I hear it as a term, but what is it really? The question is what is hyperemesis? That is a medical term for people that are using marijuana that makes them throw up, right? And so it's kind of a conundrum because people say, well, use marijuana for nausea like the pregnant women. If you're nauseous, use marijuana because they help with nausea. So people are using marijuana and they'll continue to throw up and they've abdominal pain and they test their drug, their urine and they have marijuana. So it's not a new phenomenon. They've known about it for many, many years. It's becoming much more prevalent. According to my emergency room colleagues, it's almost pathing demonic to hear what Bernite Lev coin scrumming. They're like screaming and vomiting at the same time. And there have been deaths reported from cannabinoid hyperemesis. There have been at least four reported deaths in the medical literature. People dying from electrolyte abnormalities. So this is not benign. And these high-potency products are very much part of that progression into cannabinoid hyperemesis. And one of the other signs is they like to take hot showers and vows all the time. That makes them feel less nauseous, right? But that's what cannabinoid hyperemesis is. But it's really, it's one of the most common presentations in the emergency department in Colorado for marijuana-related illness. Question for people that are here, because I know some of them, that are working with youth. What kinds of things are you seeing? You got the floor. Someone graduating from the U.S. Oh, there you go. There's quite a high percentage of people. So the question is what they're seeing in youth here and a lot of the youth are moving from vaping to dabbing, which is going from a moderate potency to a very, very high-potency product. And that's really, that's sad to say. Yes, ma'am? And one of the things you already mentioned, which is the low perception of harm, because of legalization and because adults are allowed to grow and have plants at home. And a lot of people are very confused about what's decriminalization, what's legalization. Is it legal, you know, it's not legal for under 21, but when kids hear it's legal, it's very confusing for them. And so there's a very low perception of harm. It's messaging. Yeah. And that kind of goes along with normalization of drug use. Because again, a lot of these kids are getting their weed from their parents. Well, mom and dad are giving me pot. It should be all right. It's medicine, right? It's safe, it's an herb. But they don't realize that that doesn't really exist anymore. It's the side-potency dabbing products that precipitate psychosis and then they add up in the ER. Yes, ma'am? So I'm a family physician that's been answering the questionnaires on drug and patients' follow-down, not children. People over 70 use marijuana in my practice. I am just a board. I used to practice in Michigan. I'm from Maine. I've never seen it like this. And that's the one thing that people don't understand, like CBD, for instance. If you go to drugs.com, Cannabidiol has over 500 drug interactions. That's... And most of my over 70 are... And nine of those drug interactions are severe. And one of them is buprenorphine, which is the medication use for opioid use disorder, right? So buprenorphine has a major interaction with CBD. And so this coumadin, which is a blood thinner, warfarin. It's a blood thinner that a lot of people in the elderly population, because they had a blood clot or they have a fib or another medical condition, they need to be on a blood thinner, CBD interacts with that. And that's what people don't know. And if you go to drugs.com or rx.drugslist.com, you can look at Cannabidiol and look at the drug interactions and what those are. We know these things, but the public doesn't. And that's... I had an anecdote. A heart transplant patient, right? So, and he has chronic sternal pain because his chest was cracked and he had a heart out and then in and sealed and infected and the plate got infected so in and out, so he has this terrible pain. He's on moderate opioid. He doesn't want to use more. I don't want to give him more. He goes, but what about CBD? I don't know that much about it. I said, buyer beware. I go, what's the story? He said, well, my friend's mom had a heart transplant. So my friend opened a store and my friend has given me product out the back door. I'm like, that's illegal. You shouldn't do that. Get your card or whatever. But I didn't know much about it. So I called the pharmacology department. You see health in Denver and I talked to his transplant pharmacist. He goes, bad idea. I go, why? He goes, because this is going to get sciency on you guys. So I'm sorry if I go over your head. CBD interacts or competes at the cytochrome 3A4, which is a liver enzyme, competes at the cytochrome 3A4 with the same drugs that keep him from rejecting his organ. So the patients that are using CBD that have organ transplant are at risk for rejection if they're using CBD, which is, it's safe. It's not. And it's not going to get you stoned, but it's not safe. I just want to say that the question isn't rocket Suzanne. Wow. The question isn't just what we're seeing among kids, but what our kids are seeing. I'll just, from my own experience, having an 11 year old, he's seen houses where parents were using out in the garage that uses now in the house in front of all the kids. He has places he can't go anymore. He smells it now all the time driving around the car when previously we didn't. He, I took him to Boston and to Manhattan for the first time this summer. And he stopped outside the cell station and turned to me. He goes, mom, too, no, I don't have any idea what a cigarette smells like, but I know what weed smells like. So it doesn't matter where we are standing in line. And so it's all that constant messaging. And so having a mom in prevention, we talk about it all the time. You know, he has a CBD farm right down the road from the house now. So now he smells that all the time, back and forth to school. Well, there's property value effects. I mean, there are car insurances that are going up. I mean, the ripple effect is huge. I mean, these are a lot, the unintended consequences that nobody predicted. I hadn't knew because of that. And that's like more normalization. Right. Yes, ma'am. I was just gonna add to my own comment on youth related concerns. I know the student, I was in the classroom with her that almost died on the gym floor two days before Christmas two years ago in central Vermont because a little dab. Well, do you? And do you. That'll do you. And I also know the father who son had a one night super high and he's now schizophrenic to the point that he can barely put together a coherent sentence. And that'll be for the rest of his life. That's a bridge you cannot uncross. And the psychotic kinds of concerns. I also have a nephew who's schizophrenic, nowhere near to the extent of the other one. But I'm just saying it is more problem. We haven't mentioned that in our discussion here. And I think it should be. Thank you. Yes ma'am. I appreciate the fact that you brought up with the tax issue and how there's, you know, the state might think that they're gonna get a lot. But it does penetrate that. That's what they, that's what the voters in Colorado were sold the bill of goods that this will bank a lot of money and our schools are gonna get better. They're gonna get a ton of money to ask anybody that you know in Colorado, in the schools in Metro Denver, Colorado Springs along the front range, how much money they got, zero. The money's going to rural, more rural communities, which is they do need that. They need those buildings repaired and boilers and they need that money. But every school doesn't get it. And that's what the voters thought they would get. And it doesn't happen. Which one? Thank you. That one. It's just tables. Is that table? Ponto. Ponto. Sorry. Yes ma'am. One of the arguments in here from the state house has to do with, well we have to control the black market. There's gonna be a vibrant black market here if we don't commercialize this. But your state of most commercialization breeds black markets. Yeah, our black market is alive and well and got worse after we commercialized and legalized. It actually got worse. It got worse. Because of the taxation. They were there. Huh? Because of the taxation. I don't think they had anything to do with taxation. I think it just had to do because of the laws that the foreign cartels can hide in plain sight of the law. So they can do their illegal activity. Law enforcement is hamstrung. They go in, they raid the house, they clean it out, and like cockroaches they come back. And they're so frustrated. Because they're putting their lives on the line. They're chasing people down the street. They're getting shot at. They have Kevlar, right? They get a back injury. I mean, it's just insanity. I mean, we have Russian, Loetian, Vietnamese, Chinese, Mexican, Cuban cartels living in nice areas in all over the state. All over the state. So our black market has not gone away. And if you can tell me, tell me a state the black market got better after legalization. Tell me what state it is. Because I don't know one. I don't know one. I'm not aware of one. Maybe there is. But I do a lot of work with law enforcement across the country. And it hasn't been the case. California is a nightmare. You know, John Lope in Northern California, I mean, he's been to funerals of his colleagues that were shot and killed at marijuana related crimes. He had, there was a funeral just three months ago. One of his colleagues was killed at a marijuana dispensary because there was a crime going on. You know, it isn't making things better. There was a question over here. Was that the haunted hand? Thanks guys. Thank you for letting me come here. And have a good day. Thank you.