 Aloha! Welcome to Think Tech Hawaii's Movers, Shakers, and Reformers. This is the Politics in Hawaii series. Today, we are going to be talking about medical cannabis. We've got a couple of guests here today, Jari and Terry, that we're going to talk about from the patient and caregiver perspective, what it actually means, what the dispensary issues are, what some of the challenges are and where we are at the moment with regards to the ability for patients to use and really how caregivers have come about their decision-making for the usage of it and application of it. So, first of all, let me welcome our guests, Jari and Terry. Thank you for joining us today. Aloha! Aloha! Aloha! This is an important topic. Actually, it's a relevant topic. It's a current topic because just this last legislative session, in 2016, we passed the dispensary bill, correct? Actually, that was in 2013. They transferred administration of the program to PSD, from PSD, Narcotics Enforcement Division to DOH, and in 2015 is when DPH assumed the Department of Health, I'm sorry, DOH. DOH, Department of Health. And they did, so it's more like 2015 that started rolling around. That's when the act was signed. Was there not legislation in 2016? Was it 2015 that the last legislation came out? The inactable part came around in 2016, where they say the dispensaries thou shalt open. There are actually several huge pieces of bills for an act and everything that covers all that. And currently, one of the things that's going on, what happened last week with Act 230, they stood up a legislative oversight committee for, they call it Medical Marijuana, we prefer cannabis. Darry is one of the patient advocates. We don't have very many patient advocates in the system, and she happens to be one. And she went last week for their second meeting that they had, and this working group is going to meet for two years. Okay, so we'll get into that in one second. Let's go back a little bit and say, Terry, you're a patient. Yes. And Jari, you are a caregiver. Correct. And you are both advocates. That's correct. Okay, let's ask, okay, so you are a patient. How long have you been a patient? And can you tell us about what got you here? I've been a patient since 2000. That's when Hawaii enacted a medical program. And what got me really active was because Narcotics Enforcement Division at one time met a request from a paper in Hilo. They said, how many patients do you have? And what they did was they turned the entire database over to the paper. That database included where I grow, who my primary caregiver is, all kinds of personal medical information. And they just turned that over. And all I got was a little letter of, oh, we're sorry. We just turned over all your records. So that's what got me started as an activist. What about as a patient? I was a patient in 2000 because I have multiple sclerosis. There are several qualifying conditions. Multiple sclerosis is one. Jari on the other hand is a caregiver for someone with epilepsy, a child with epilepsy. So when did you get active? So I started back in October 2013. I applied for a certification that she has a qualifying condition. And epilepsy was part of the qualifying condition. So she was eligible to receive her medical marijuana card. She was in 2013. Since then, she's currently still utilizing medical cannabis. She has been a patient since then, 2013. My role as her parent is her caregiver in this process. And we basically just, we acquire, we grow, we extract. We do everything possible to get the most out of this plant. And we administer it to her for her condition. So you're both the parent and then the, as far as the regulations or as far as the process is concerned, you're also considered the caregiver. Yes. Because it's a category in order for you to be able to dispense. Two. Is it your daughter? Daughter, yes. Okay. How old is your daughter? She's now seven years old. She's now seven years old. And when I first met them, she's still non-verbal to, you know, most non-verbal. I would guess she would categorize it. But she was not walking. And when she walked into the governor's office, when they signed this bill, I still, I was just seeing through tears. I mean, I just couldn't believe it that that child got up and walked in. You know, it was amazing. So that's one of the benefits of utilizing this medicine is that it enabled your daughter to be able to walk. Well, yeah. So the one of the benefits is... You can explain some of what happened there. Right. So we were able to see some seizure reduction and that fluctuates because of our consistency in growing the planet and extracting the oils. But there is a huge benefit in her cognitive ability has improved. And her gait has always been a little wobbly, but that has gotten better over time. Okay. So she's getting stronger and more aware. Very aware, very sharp. She's still very hyper, no matter how much THC you give her. It's a balancing act. How long has she been taking this medicine? So from October 2013. So it's been about three years or so. About three years. And how quickly could you begin to see some of the progress? So early on we saw immediate progress in terms of her seizure control, but some of the other benefits we're just seeing now, and it's three years later. So she has been on it for three years, but the benefits, we're not always right away and we lost some control here and there with the growing and the extractions. We're getting better with that, but we do see her progressing and her quality of life improving. Okay. You say you lost control of some of that. What was that based on? Well, so once you qualify, she has a qualifying condition which enabled her to get a card and be a part of the medical marijuana program, the rest of the responsibility after that falls on the caregiver or the patient. So it depends on how well you grow the plant, what strains you can acquire, how well you extract the product. Do you connect to the growers and or the supplier? Currently we have no way to test our patient grows, okay? So we're taking guesses at what, you know, what will work, you know, how much, and if you're growing from seed, that's an even bigger gamble. This is like the little blue card, right? That's the call, 329, card 329. It used to be blue, I think now it's beige or something. Okay, so it used to be 329. The blue card. The blue card. We always call it the blue card. It's not what it's in your wallet. It's a card. Okay, and having that card mean, now I thought, and correct me please, I want to learn this, I thought that you get this blue card and it was then your responsibility to connect with a primary care physician who would prescribe this and then you have to be connected to a specific grower and how does that, I thought that that's, it needed to be more specific or aligned. How does that work now? Yeah, it actually works online now. You start the process online because the state's going to get its portion right away. That's where you apply with a debilitating condition. You go online, fill in the blanks. It's a very cumbersome interface. It is not intuitive at all. It has just been stood up by DOH recently. Hawaii DOH? Yep, the Department of Health has just fielded that recently in the past year. It's burdensome for the physician. It's burdensome for the patient and they want their money up front. So you apply there. You still don't get anything, say, in your patient. Then your physician, your qualifying physician or APRN, I think they're called, the nurses now that can qualify to do it because so few physicians want to, it's not actually a prescription. It's a recommendation that this particular herb will help you. Based on the qualifying condition. Right, and so then they apply. They go to their portion of that online software and they fill out their portion. And then after that, you're still not issued anything to say even you're being considered, used to back in the old days. You got a temporary card right away that said, you know, it's being processed. Well, now we don't get that. We pay more and we get less, but we don't get that. So we wait then further for the physician to fill out his portion and then finally you're issued a card, hopefully sometime in the following year. And then at what point through this process do you get to start taking the medicine? You're not supposed to do it according to what they say until I have the card in my hand. And that could take weeks? That could take six weeks. You know, I'd say six weeks. I said a year because I was being kind of sarcastic. All right, a little hyperbolic. A little hyperbolic there, okay. A little bit. So it could take six weeks. Six weeks. But if you are in need of the care, six weeks can feel like forever. What if you have a child? Are you going to wait six weeks for your child to stop having seizures? If you're a cancer patient, are you going to wait six weeks until you get that to go with your chemo? It's an urgency. It's a personal urgency. Recognizing that there is an urgency. They still are criminalizing patients, by the way, they're doing it because they have no consideration for how dangerous it is out there. So okay, let's jump back to, what happened recently, and let's put it into some context. The idea of medical, back to 2000, medical cannabis was first authorized in Hawaii 15 years ago. And it took until 2015 to actually have the dispensaries. So now that there's dispensaries, well, are there dispensaries yet? We've been going through that process because once you make the law, then you have to make the administrative rules that implement that law. So they've been going through those processes. Sort of in the backgrounds, I guess fight to some extent as well, just to make that happen. So we're not there yet, so the dispensaries aren't there yet. But there are many people, such as yourself, who have that card, and there is still currently a way for you to get what you need. And so is that the same process that has been there since 2000? Yeah, it's a grow your own. You have to grow your own and create your own medicine, whether it be concentrated, or the quantities. Tell us about that. What are the restrictions and what are you able to grow? How much are you able to grow? How much are you able to have on you at any given time that is legal along with that card? Because if you don't have that card and you get caught with it, it's a whole different problem, right? So tell us about how that works. So the physician basically just certifies that you have this condition. Okay. Once you have the card, you still have to wait until you receive the card. And then once you receive the card, if you want to grow it for yourself, wait four months before you even get to harvest. So for a typical patient, that duration is problematic. Once you are able to get the product, you're limited on how much you can have. Like you were saying, you can have four ounces at one given time. You're allowed to have seven plants. And so that balancing act is challenging. So the grower is allowed to have seven plants. Yes. Does it make it what size those plants are? We hear different things from when they're sitting around this table, this working group about, because we've told them how useless some of those plants, our small plants are for most patients unless they're juicing. Now if they're juicing, they're going to need 30 of those small plants a month. They don't even take that into consideration. Okay, yeah, the product and how that's going to work out. And how you take it. Do you smoke it? This child would never smoke it. So her mother has to make an oil which takes a lot of product. So they condense it down. You've heard of Rick Simpson's oil, Phoenix Tears. It's a similar process. You just, you reduce that down and we'll show you some of that later. You have to dilute it then from that particular form. In order to get it to the mixture that's appropriate. Right. And how does that work? Who determines what that mixture is or what the potency level is? How does that determine? It's basically trial and error. I mean, we were lucky that we were able to meet a lady and auntie who helped us with her testing of her products, of our products. She has a thin layer chromatography machine. So with that assistance, we were able to finally find the right dose for our daughter. But that takes time. So you had to test it to see how did this work, how did that work. How can you be consistent in another way? Now what about which version of the product you have to go through to test trial and error there? All of them. Some of them are more potent than others. Of course. So therefore, and then you have to find a preference. What does your daughter want? Right. And there's like 200 components in this. There's CBDs, CBGs, CBAs. I mean, these components all work together with this, to create this type of medication that will stop and control seizures. Okay. We're going to jump into that. We have to take a quick little break at the moment. So again, thank you for joining us. So welcome to Think Tech Hawaii's Movers, Shakers and Reformers. This is the Politics in Hawaii series. Today we're talking about medical cannabis. Thanks again to our guests for joining us. We'll be back in one minute. Thank you. Looking to energize your Friday afternoon? Tune in to Stand the Energy Man at 12 noon. Aloha Friday here on Big Tech Hawaii. Aloha. My name is Josh Green. I serve as Senator from the Big Island on the Kona side. And I'm also an emergency room physician. My program here on Think Tech is called Health Care in Hawaii. I'll have guests that should be interesting to you twice a month. We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii. We hope you'll join us again. Thanks for supporting Think Tech. Hello. My name is Crystal. Let me tell you my talk show. I'm all about health. It's healthy to talk about sex. It's healthy to talk about things that people don't talk about. It's healthy to discuss things that you think are unhealthy because you need to talk about it. So I welcome you to watch Quok Talk and engage in some provocative discussions on things that do relate to healthy issues and have a well-balanced attitude in life. Join me. Aloha. Welcome back to Think Tech Hawaii's Movers, Shakers, and Reformers. I'm your host, Carl Campania. Again, today we have our two guests, Jari and Terry, talking about medical cannabis. So, okay, let's go back a little bit. We were talking about how we get to what product we're going to be using for this. And it's a trial and error. And I think off-air, you were just saying it took three years to figure out. Can you tell us about that? Right. So a lot of physicians are hands-off because it's a Schedule 1 substance. And there's a lot of unknowns regarding medical cannabis and how it will affect their practice. So for three years, it took us three years to figure out how to grow the product. And then once we grew the product, we realized we had a high-tape C variety. It wasn't specifically in line with what our daughter needed. So the plant has a number of different cannabinoids within it. So it took us about three years to finally realize that she needs a variety that has high CBD, cannabidiol, some THC in there. And what really works for her is this cannabinoid called CBG, cannabigaryl. And that balance of those three cannabinoids is really what's making her thrive right now. It's taken years to figure it out. So it's a combination of those three. For her, right? So it's very individualized. Is there a ratio of each? Is it a mixture? There's a balance that we use, like a four-to-one ratio of CBD to THC and a little bit of that. It took a lot to get Jari to put THC into the mix. We had to explain to her, because I mean, you know, that's the bad boy that everybody talks about, the hallucinogenic, the terrible thing, you know, people are going to reefer madness. So what we had to explain to her was this. The natural receptors in the body are THC receptors. You need just enough THC to open that receptor and then flood it with the CBD, the CBG, you know. But you've got to open the receptor. And that's a trial and error. And you don't want too much THC. We don't want MJ talking in the mirror to her friend too much, but, you know. So what I find interesting and fascinating about that is how all of that is placed in your hands, as opposed to every other medicine that is out there. The doctors are the ones that tell you this is what to do and this is how it's mixed and this is when to do it and how often to do it. And they have it prescribed. Now they say, well, we are giving you the reference or the recommendation for you to pursue this as you choose and it's up to you to figure it out. We actually need what the doctors have. They have a physician's desk reference. You go into a doctor, right? You see that big, huge red book? Sitting on their desk. And when it comes time to prescribe something, they pop open that book, they look at your symptoms. They think about a case they had two years ago that maybe had the same thing. And they're able to give you a prescription. Something to try, you know. And basically... Because it's trial and error for doctors who sometimes... That's why they call it practicing medicine. There's a reason for that. It is not perfection. But they give it their best shot based on empirical evidence, a database in their brain of past patient. They don't have that option right now. There are some people like, I believe they have. Zelda Corporation is working up a database that is... Yeah, because they would seem to me that that would be needed. You want to know where to start, you know? No, okay, here are the strings and here are the different processes to get from this to that. Because that's the whole thing. Now that you have a plant, then what? You have to figure out, well, okay, how do I want to use it? So let's transition now. Let's take that into what these products are. So first of all, pull out. Let's take a look at this. This is the plant. This is it. This is it. We want to make sure that everyone can see these numbers are here. Yeah, it is tagged according. It is tagged accordingly. It is tagged accordingly. This plant is a baby. It is useless to me. It has no flowers. I mean, it's nothing to me. If a person, like I was talking about juices, they would need 30 of these a month because they pull them up when they're leaves and nothing more. Throw them into a blender, you know, a juice maker, juice extractor. There's a way to... And it becomes... Boom, it becomes... There's a way to get a... Get a better look at that. There's no real easy way to see what this is. Ah, yeah. It's tiny. And we don't... We don't want to know, you know, that shouldn't count against my plant count. That is not a flowering plant. This is also from seed. I have no idea right now if it's male or female. So wait, this is... This is young. This is a baby. This is a seedling, basically. Yes. How long has this been growing? I'd say this one's been about six weeks. Six weeks. Yeah. When do you think it'll get to that level where... Four months at a minimum. So four months. So from the time you plant the seed, four months later is when it's usable. Yeah. So when you're under lights, I encourage growth and I feed them and I watch for pests on them. They have... This is not viable at this point. This could go whole four months almost and then it could suddenly pop open male, little male parts to the... Does that matter? It matters. Male plants are useless to me. They're compost. Oh. They're useless in her concentrate. They are compost. So the power is in the female? It is. Female. Always. It's important. We rock. And so we don't know that, though. We have no idea. I'll nurture this for three or four months before I know if it's male or female. So that's an important process to know that this may be a useless plant. That's right. So does this currently count? Yes. As a plant? It's supposed to count. And you're allowed seven. I'm allowed seven. So this is one of your seven. I think it's sick and dies in two months. I have to start all over again. Yeah, yeah, yeah. So this... And the dispensaries, yeah, let's get it off here. I'm getting dirt all over here. I actually wanted a little closer to you. So it has... You know, if you're juicing, like I said, this is nice, but you need 30 of them. 30 of them. Yeah. And let's say that we've gone the four months and we're going to... Let's show them what we make with this. Yeah, let's pull out some of this. This is the next thing. So we have this and it grows and you get to the point where, okay, we have a female and it's of the appropriate size. So now what do we do with it? Yeah, I didn't... We didn't bring any grinds, you know, like the little buds, because everybody's seen those. But what you haven't seen is when we take this and she was talking about how we can have four or five ounces at a time, it takes a lot of this product. When we harvest that plant, we'll harvest the whole thing and we'll get maybe what, six syringes like that? Oh no, quite a bit. Maybe like over a dozen. Over a dozen syringes. Diluted though. Because that's going to be diluted. It is going to be diluted also. So what do we have? What do we have? Let's go through what we have here. So this is the plant itself. Right. What would it be? These are pills, so... So right, we would take the flower and then we would extract the oils from them. So like Terry was saying, we can come up with a concentrate and we've figured out that the alcohol is a better extractor. So from there, it's a very concentrated form. We dilute it down. Some people prefer it in syringes. Other people prefer them in capsules like this. You can always mix them into a transdermal cream. This is a transdermal cream. So this is the cream. So here. Try that. Here's the cream. Right there. Right. All right, and it looks like a butter. It looks like butter. Right? How would you consume this? You wouldn't. So people who have back pain or seniors that have arthritis or other issues that are pain-related are topical. Okay, so this is a topical application. I know somebody held off knee surgery for two years by using a topical. That's excellent. Yeah. That's excellent. So these you consume. If you don't like the taste of it, if it's very grassy or weedy for you, you would take it down. Imagine your daughter is marching to the knees. My daughter has a tube. So for us and a lot of children who have epilepsy, we dilute them down. Okay, so that's the syringe part. And we would syringe them into her stomach. So that's actually, it's actually chilled, but it's coconut oil infused. Coconut oil infused. Cannabis oil. And so therefore, how does, how has the flavor impacted? I don't know. She actually does it through her stomach. She does it through her stomach. Oh, okay, okay. It doesn't really affect her. All right, so this, okay, okay. What a dose looks like. It's really tiny. For her, it's about a mil every two times a day. One mil, two times a day. Yeah, very tiny. And it keeps her progressing. Right. So the version that we have for her now is, is on the con, not concentrated, but it's, it's not mild. I would say it's not like a five milligram THC dose. It's somewhere along like 10, 10 milligrams of THC is what she can tolerate. And that has been titrated up over the years, but it's not a, it's not a base. It's not a very low dose. Low dose. Low dose. Another way you can dispense it. Okay, so whether, whether it gets, now I, so there, there are, there's, there's this butter or cream. Cream, yes. You don't want to call it butter because people think it's heated. So it's a cream, a topical cream. And then we have the syringe that gives us the opportunity to, what are the different, I guess, is that the only way to, to administer this? Dozer. To dozer. Is through that? Or is there? She could do it orally, but she just prefers not. Which is very oily. For one mil. Flavor and all. It tastes terrible. Yeah, I would imagine. It tastes like grass. And then it's, you know, or, or, and how many, how, how many of these would, and that's all based on, you figure it out. It's all based on dose. So if you, if you were to have a book, such as the medical book you were talking about, it's all based on milligrams of THC, milligrams of CBD. Okay. And which of those works best for you? Right. Or based on your body weight actually and your condition. Oh, so as, so as your daughter gets older. Right. And as her condition might change. Her body weight increases. Her dosages will change. And that's a concern about the dispensary. It's really the affordability of products. Because as she gets older, right now something like this may run her $400. It's not just affordability, it seems to me. Tell me how this works as far as, you know, you said that there's one strain or one combination that works for you. Right. Those dispensaries have to have, I would imagine, all of these available. Right. All of these different strains and all of these different options available. They're going to look at a very homogenized strain that they can market quickly and move out. Because people are going to settle. Well, is that going to help though? That's, well, I don't see that our preservation of strains is a priority for them. So far they haven't said so. I think as far as understanding it, I think the key is understanding that fact, that some of these strains and some of these combinations are going to work better for some patients versus others. And a homogenized version isn't going to achieve the goal. And scientifically, we'll come away from street names, you know, like Maui-Waui at some point. Because this will be classified by terpenes. Let's make them Latin name. They'll be classified by terpenes and other aspects of the plant that that's how you'll classify it. You'll know how it's done like that. So we need science involved in this. That's why we were real happy about DOH getting involved. See, okay, so let's get back and then we're going to have to wrap up in a minute here. So yeah, we need to have the science involved. We need to make sure that it's clear. We need to be able to get as much information and as much case study information as far as here's how this worked for this case and for that condition. And so that we have the ability for the doctors, for the scientists to be able to go, okay, now that we see all this case study, now we can start labeling this the right way. Now we can start administering this or prescribing this perhaps in the right way. And that's sort of a direction that, I don't know, it makes sense, but people are afraid of because of its current classification still, right? It makes sense to legalize it because we're not going to get doctors unafraid until we do. Well, I mean, it's legal. I think we got to legalize it. It's not legal on a federal level. I'm saying we're going to have to go federally and legalize it. And when I first started as a medical advocate, I was not adamant about that because I really didn't care about recreational unit users. They were out there on their own. But it has become so difficult. Look how long it took over a decade to move. To get this, isn't it? And there are other aspects to it as well. Yeah, I just say let's legalize it. Let's stop scaring people with it. So just legalizing it from a medical perspective? Yeah. Because, I mean, if you take it off of that schedule. Yes. It suddenly becomes a different category. Yes. And that's one of the things I think they're afraid of from a policy perspective. We removed from this category all of a sudden what are the ramifications? What are the impacts at multiple levels, not just medical? And I think that some people are concerned about that. Now, a lot of people compare this to, well, it's better or no worse than alcohol, right? I mean, is it... Well, if they would focus on rehabilitation of people and what causes drug addiction, because drug addiction is a whole other animal. I mean, when you're addicted to something, that addiction is genetic, environmental. I mean, it's a very complex issue, and we need to work on that, not putting people in jail. You're not going to fix them by putting them in jail and criminalizing. How we put people in jail and number of people in jail and why they're in whole... That is a whole other... Well, we need to stop criminalizing patients. Absolutely. Stop it. All right, so let's... Last thing, there's a website, and then there's this working group. Tell us about that, and then we're going to have to wrap up. You want to chat? They do have, with the policy... What's that called? That they're... There's the Public Policy Center. Public Policy Center. There's a website. We're trying to get people to come out. And this is called a... You don't like this word, but Medical Marijuana Legislative Oversight Working Group. And they're going to meet once a month. They meet once a month. The public can only have 10 minutes for input at the end of their meeting. We are not encouraged to participate on the board. They don't even want us to call in experts. They have to... The Brain Trust is right there at the table, so I really need the public to show up. Who's on the board? Jari for one. Okay, good. Della Abiladi and Roz Baker are the co-chairs. Okay, okay. And then there are various people from the trade organizations, including Hawaii Dispensory Alliance, Drug Policy Forum, and has a representative there, but it is heavily... The whole thing is geared for the trade organizations at this point. Got it. Okay, okay, okay. Well, unfortunately, we are out of time, but thank you so much. I know that I have learned. I hope that people who are watching this and who will watch this will learn from this. There's much more, I think, to learn and much more to know. There's more policy that needs to come up. There's more awareness. And I think the key is awareness first. Policy can follow and can be more effective if there's more awareness and education about it. So thank you again, Jari. Thank you, Terri. Appreciate joining us here. Welcome back, please. When there's another level, another step of what's going on, please let us know and we can have you come back. Maybe we'll find out what legislation there is. You know what? I think that's going to be coming up shortly. We're going to talk about that. So thank you again for joining us. This is Think Tech Hawaii's Movers, Shakers and Reformers. I'm your host, Carl Campania. This is our Politics in Hawaii series. Thank you again to the staff and crew of Think Tech Hawaii, and we will see you next week. Mahalo. And that was camera.