ion basically so yes please please anything we can do to substitute or support opioid use disorder opioid prescriptions even alcohol use disorder you know other addictions as well absolutely and if you guys ever want to sit down i'll chat with you for hours specific i have all the research i've presented on this yes yes please i i have some education for for everyone for detail and for medical dispensaries i'm also wondering how much endocannabinoid education is in a nursing license or do physicians get or do naturopaths get just in general in a medical education unfortunately none you have to seek out the education yourself that's why we started this vermont um nursing program because the national nurse statute state that every nurse needs to know about cannabis but it's not in anybody's nursing curriculum so you have to seek it out for yourself so yes it is it is we'll get there eventually are there like a approved CLE type um courses for nurses or physicians to use that will you know count towards your CLE count depending on your your license absolutely absolutely and the one we're doing with the vermont nurses gives you a couple hours i work with another program i think it gives you 12 CEUs which is a much larger comprehensive program there's several programs throughout the country some are UVM has ones um UVMs is i'd say pretty expensive compared to a lot of other programs if you're looking at financial feasibility i've taken UVMs i've taken pretty much most every program out there vetted it um so yeah there's a few programs there's not a per se national standard or certification as in a lot of other certifications you can kind of start it in your bedroom or the garage right and call it a certification so there you know institute has won several different colleges are now putting things out there's cannabis coaching certificates so you could choose one and go with it or i really like Meredith's suggestion of i i think it would take a little bit of of work for sure but i think vermont could create their own program and do it really well but as i mentioned before my concern would be that one um does the medical dispensaries have the medical professionals to be doing this training or the continuing ed and also in some ways i think this medical training should come from someone in some place that is not attached to making financial gains so the dispensary themselves maybe shouldn't be the ones educating their staff at a statewide level because of that financial gain possibility great thank you i know i got more questions but we're running behind schedule so i'll turn it i'm done asking questions right now uh mr chairman i'm sure julie has a lot more too but i recognize it's 12.08 yeah thank you jesse jesse lane i mean you've been an incredible resource for the board already um and we uh and prior to the board's formation as well so but but thank you for your for your advocacy thank you for your help um understanding these issues thank you for the kind of um work you've been doing on the intersectionality with opiates but uh and i'm sure we'll be working with you in the future um i i would like to turn to public comment um you know our quorum rules will require at least uh at least two of us to be here i know we haven't had a break yet so julie or kyle if either of you want to step out for lunch um that's great i can um conduct the public comment um but i do see a few hands raised so i'd like to do it um for those with their hands raised i'd like to just really limit your public comments to two minutes each and um we'll start with the people that have uh joined via the link um that have their hands raised the first one that i see is eric read eric if you could unmute yourself um if you have a comment um great okay am i on we see you we hear you here okay uh to what meredith said to what eric said to what jesslyn said um because of federal legalization i think your bud tender should minimum know the endokinabic system um i too i will not do uh i won't do your medical registration anymore um just for all the reasons that they mentioned um i couldn't afford it and you were talking minimum five thousand bucks a year uh i took five grand and i um i now have my own ethanol processing lab and what they're saying about it takes this much flour right there's a half a pound of flour to make a few tubes of fico and it just really it we need we need a higher plant count um for sure we absolutely have to have a higher plant count um i think you guys are crazy if you don't get jesslyn on somehow involved to put her in charge of some kind of curriculum to educate and have her um or somebody like her have her the one um to educate people i've learned more about the endokinabinoid system from her and i went to a lime specialist uh here in vermont and i took the hygienics test i took the western blot test and i score i hit more markers than anybody she had ever seen i was well over 200 pounds um because of cannabis i've lost close to 75 pounds uh every day i do 100 push up push ups chin up sit ups um for three years now i go to mental health counseling um because of cannabis my life has and and i've lost covid forget covid i've lost my dad i've lost relationships i've lost so much and because of cannabis and him and thc um i can get up every day and i can be the most positive i've ever been i get up at four or five in the morning um and i again i so here it is i have light i have fire in me because of a plant and the way that we are um regulating it the way that we don't because the federal regulars because of the federal legalization i watch what goes on in israel and i watch what goes on in canada there's so much research that's the key to that federal legalization and once that's open then you can answer a lot of those questions because doctors can't prescribe it they can't and they don't know and with the cultivars we we need research we need scientific data we need to know which ones um you know put uh send prostate cells into uh apoptosis versus uh the colon cells so the bud tenders i think we should just get them educated on the endokinabic system learn about 2ag learn about andondomide eric thank thank you thank you for the the public comment i really appreciate i think that's been a consistent theme that we've heard over and over and over again today so so thank you for kind of you got it reinforcing that for us absolutely thank you for your time thank you thank you thank you eric i totally agree that federal legalization will open a lot of research doors to a lot of the institutions that you know the federal government has a partnership with appreciate it thank you so much um next on my list is tito tito if you could just unmute yourself and provide public comment and please if you can keep it to two minutes i'll let you know when that when that marker is okay for sure i'll be quick so ever since i started down the road uh for advocacy of tax and regulate i've really uh enjoyed trying to work with other business owners and and people along the way and so i feel compelled to talk about the vermont cannabis trades association that virginia brought up that was started by shampton valley dispensary um i went to these meetings and it started off great it kind of felt like oh we're gonna get everybody involved and um and then the the the meetings kind of fizzled out and then um since i'm a patient i as you know i have to designate a dispensary as my personal dispensary so i get their emails and i was surprised to see the vermont cannabis trades association still being touted in their emails as if it's uh something that's inclusive and it just it feels extremely disingenuous to me i reached out to them um through email multiple times nobody's ever answered me back and um so i just i felt compelled to talk about that because um i think we need to keep we need to keep things genuine as we move forward thank you thank you uh does anyone else who joined via the link uh the um want to provide uh public comment and if you do please just raise your kind of virtual hand all right does anyone who's on the phone um want to provide public comment and again to unmute yourself you hit star six okay um well we're going to take a break um we're going to be back at one o'clock in about 45 minutes um we're going to be hearing from the chair of the marijuana for symptom relief oversight committee as well as the uh physician appointed member of that committee who's in surgery right now and hopefully will be able to join us um but uh nely if you could maybe just uh for the next 45 minutes throw up our away message and uh you could pause the recording as well and we'll all be back at one o'clock okay uh this is uh james pepper chair of the cannabis control board we're resuming our meeting it's one o'clock um we have uh two witnesses on the agenda i believe i saw both of them here um dr joe uh and uh jim are you are you on the are you on the line could you turn your cameras on yeah i'm here oh great i'm here as well well let me give just a quick if you don't mind let me just give a quick orientation um as to why i asked you all to to join us today so essentially um you know we are uh the cannabis board is is taking over the medical program on january 1st 2022 and um you know i think that the medical program we've heard from a few witnesses today feels like in some ways that it's been frozen in time since its inception with a few minor kind of adjustments over the years but um really it seems to be kind of based in a coal memo mentality which is i think it was an important um you know it was important at the time it's still important to this day about doj enforcement but i do think that now um that we're moving into a world of adult use cannabis in vermont i think it really makes a lot of sense for us as a board to reconsider some of the restrictions that exist in this program and really try and make sure that uh we're achieving a patient-centric medical program here in vermont and i think that what's interesting is that the um the legislature i think recognized the need to have a um a group like the marijuana uh for symptom release oversight committee to help advise them on um you know changes to the system that needed to be made over time and i think that your reports which i have read um are incredibly instructive and uh incredibly helpful in trying to achieve that patient-centric focus um but uh you know for one reason or another there's competing priorities in the legislature i'm not sure that you've gotten the attention you deserve but i think again this is a time and they've directed you all to really rethink the membership of the marijuana for oversight um committee us you know solidify the relationship between your committee and the cannabis board and think about how you can provide some good information to us um to really help you be the conduit for patient voices in uh through the cannabis board and we can be kind of a megaphone for for you all and the recommendations that you're making to us so i'd like you guys to talk about whatever you would like to talk about um but i think that some of the things that uh we've discussed offline are um how to be more patient-centric how to really focus on quality affordability and accessibility of the program and um talking about your kind of 2019 report which i think um you know really focused on those issues and really anything else that you'd like to like the board to know um keeping in mind that we do have a report back to the legislature on november first of this year with some recommendations specifically around how to reconstitute and how to restructure um the marijuana for symptom relief oversight uh committee so that i'll turn it over to you joe or jim if you want to start thank you very much uh chairman pepper um and i want to write from the start uh thank you all for your support so far and this morning's testimony was was really uh uh enlightening it's certainly the the type of uh testimony and information we've been receiving uh for these many years and putting in our reports um but it's clear that the cannabis control board is interested uh and incredibly supportive of the medical program here in vermont and uh that's makes it uh exciting time now because as as we've seen the the medical program has been a little bit of the wild west so i'm going to just quickly introduce myself and my colleague and then talk a little bit about uh the marijuana for symptom relief oversight committee i'm jim romanoff i've been the chair of the symptom relief for oversight committee for this year i've been on the committee for six years i believe i'm a registered patient uh was initially appointed by champlain valley dispensary and uh the besides that i've never spoken to them uh about being on the committee again and uh i also want to introduce my colleague dr joe mcshary joe do you want to joe as the prior chair give a brief introduction of yourself well sure i uh was a chair from the inception uh but i have other responsibilities and i really was looking forward to someone else being here now which is why jim is um basically uh i come from a background of physics at 1965 from harvard i went to school got an md phd in 1971 from baler and then all sorts of other uh degrees and especially all of these i do clinical neuro physiology and quite by accident ended up in the legislature as a doctor of the day of the medical society in 1980 when they were discussing a medical marijuana bill and uh they asked me as a doctor who was just happened to be there you know what do you think of it and i said i don't know they define as far as i know and i was uh listed as testifying in favor of the medical marijuana bill and all of that bill uh passed and was signed by the governor nothing ever happened with it and so when it came around in 2000 they were going to do this again uh virginia was uh taking care of mark tucci at the time i think and uh so they asked me to to uh testify potentially and so i have kept track of the research since then uh in cannabis and it's you know very interesting and uh the the board as jim has said has uh gone through lots of things i think we've always been very patient centric and uh consequently we haven't had a lot of input from and haven't run a lot of need for input from the security people and and so on but uh that's how i happen to be here quite by accident and um delighted to be participating and i'm very grateful to the committee for that is the ccb for uh incorporating us uh as you have and i look forward to the better uh pathway bring information to the legislature by bringing it to you and um having you the opportunity then to actually speak to legislature with a voice that they'll hear but i have lots of things so we can get on with those after uh jim takes off now thank you uh joe um you know i think the really amazing thing in listening to this morning's witnesses uh you know that are clear as a the medical marijuana program in vermont has a very passionate and involved community of both patients and caregivers as well as the dispensaries themselves that are eager to participate in the discussion and our experience on the oversight committee is that people have been eager to participate in the discussion all along the oversight committee however is really uh in somewhat a relic of the beginning of the medical program in vermont um and uh james is correct i think in in pointing out its existence in in many ways because of the coal memo um and i just want to um drop people's attention to the statue that originally created the cannabis or medical symptom relief oversight committee it is title 18 under the vermont statutes and chapter 86 the therapeutic use of cannabis and then they created a sub chapter uh 002 in which they created uh this oversight committee and the membership of the committee uh which initially was a registered patient from each dispensary a nurse and a registered patient appointed by the governor a physician appointed by the vermont medical society that's dr joe um and then also a member of the local zoning board appointed by the vermont league of cities and towns uh uh member appointed by the vermont sheriff's association and uh a representative of the department of public safety and just the fact that the medical program was in the department of public safety it sort of is uh tells you uh that it was started out almost uh protecting the the public from uh the medical program and the risks of uh there being legal cannabis through the medical program um half of the members are were from either public safety or you know uh league of towns that type of thing i think the concern was that people want a dispensary in their community uh was it going to be safe and uh over the years as as joe pointed out there turned out to not be really uh any problems uh in any major way that had to do with public safety or the cannabis getting from the medical program into the uh public stream of usage and a lot of the members who were from law enforcement really stopped attending our meetings i think because it was really just patients and caregivers uh talking about how to give patients the best access uh to the best medical program that they could um and the way that the committee was asked to originally report to the legislature uh also said a lot about the the uh the cold memo and the fact that the committee was was really uh there in a big part for for uh cover and public safety but we were asked to report uh at the beginning a january of each year uh in writing to the legislature and that's what we've done the committee was not really given any other uh avenue to communicate to the legislature there's no uh you know a requirement for them to call anybody as a witness or anybody to testify and as a result we often the reports uh are well researched and well put together we did this mostly with the support of the department of public safety who manages the registry currently and facilitated this committee and the department of public safety you know has has been a great partner but uh clearly you know sets the tone that public safety is more of the issue than somebody from the department of health or the department of human services uh being involved in in the medical program but clearly the times have changed uh medical marijuana is uh legal in the majority of states uh recreational cannabis is now uh legal in a huge number of states all throughout the northeast and so with the changes really in the prevailing uh attitude about medical marijuana I think we've realized on this committee that there also needs to be changes made to what this committee looks like how it's made up and how it reports to the new cannabis control board and as the laws were being made to create the recreational marketplace on the committee we were concerned that uh the amount of money that was potentially there for both the dispensaries that were in business now uh and for any businesses that were going to get involved would really uh drive the conversation in terms of how the new law was created and what the medical program would look like under that we even heard uh anecdotal stories of legislators saying you know if you have recreational why do you even need to have a medical program anybody can just go buy marijuana at that point which really tells you the sort of the the lack of understanding in the legislature of what the medical marijuana program is but also from the side of the the oversight committee the lack of our ability to really communicate to the legislature other than in that report we didn't really have any mandate to be activists about it and show up and when the laws started getting created for recreational it became clear that the dispensaries did have a great you know lobbyists working for them and you know I think that the fact that the law did get passed two years ago without anything written in for oversight of the medical program it says at least something about you know whether or not patients and caregivers needed or do still need their own advocacy in this program at the beginning of our our session this year we took a survey of the of the reality that the law had been passed and read through it and realizing that there the oversight committee would end in march of 2022 I believe when the certain parts of the new laws kicked in we decided the best thing that we could do was deliver our 2019 report which had been delayed because of the pandemic but also start to make a strong case for the oversight committee or some form of oversight being included in the advisory panel for the new cannabis control board and were gratified that so quickly the law was updated this year with s25 and that we are now very excited to be at the edge of the opportunity to look at what oversight should and will look like in the future make recommendations to the cannabis control board our plan is to do that by the end of the summer to give you time to go through it and ask us questions and make updates as you see needed before getting into the legislature this morning you know as I said was a great I think you know case for why oversight is is really needed all the issues that were brought up of affordability you know types of conditions that qualify for the medical program limits laboratory testing you know everything including you know use of excess funding from the medical program are issues that we have dealt with and that are are coming up constantly and yet it is neither probably a wise thing for the dispensaries to monitor themselves and in looking at the makeup of the advisory panel to the cannabis control board they really clearly seem to be a need for at the very least oversight of the program but also hopefully more than that this morning also pointed out that we're at the beginning of a very exciting time where the prevailing attitude in the country is one of not only legalized recreational use but a way more serious approach to the number of medical marijuana programs that there are and how they're funded and how they exist within the federal tax codes and other federal laws so you know it would seem that we're at the at the beginning of changes that will be happening where the idea of things like insurance might be a bit down the road there are states that already do have grants available through their own coffers there will be all kinds of I think issues brought up as more research is done as to you know what the appropriate ways for the FDA to speak about medical marijuana will be and then that one in turn make things like insurance and medical practitioners more comfortable education that people talked about this morning is a huge problem there is not a a unified solid training program for bud tenders for people that work at medical dispensaries and the same standard of care needs to be created for medical patients that exists for medicine regular medicine heteropathic medicine in terms of the types of medicine that are prescribed and the types of advice and treatment they get so all of these things are things that the oversight committee in the future should be able to look at speak with the public get input from caregivers from patients and also hopefully be looking at our neighbors throughout the country see how other medical programs are operating and make recommendations to the cannabis control board about how to proceed I think it's really true that we have a good medical program now it is not the best program in the country you know but Vermont is if anything excels at wanting to be at the vanguard of things and there's no reason that our state should not be a model for how a medical cannabis program should go how new research is vetted and accepted and you know I sense that the people on the cannabis control board that you all are excited about that opportunity but I also hear from people in the community that they're excited so what we need to do is create a an oversight committee that is new and different and that can function in the right way in the future and we need to look at all these issues as as to whether we still need to incorporate public safety into oversight the league of towns whether those things are covered in other areas of your advisory panel so those are all things we will be holding meetings this summer and looking at hopefully within the next two or three weeks we'll have our first meeting to get public input and discuss with the board you know how we're going to go about aggregating and pulling everything together to make our recommendation and you know I'd like to say that I don't want to ignore all the issues that came up this morning I think myself and Joe would be happy to talk about any of them I all of them were in our 2019 report and I'd be happy to go through them and I'm talking about you know reciprocity and possession limits and but I really do think it's more important that we get the opportunity to talk with the board about the future of the oversight committee itself and get the nuts and bolts out of the way so that we can get back into the business of being a clearing house for oversight and and good medical information and that will be one of the big challenges as people pointed out this morning medical information that there's not been public funding for a lot of research done on humans the medical industry doctors are not comfortable in my experience as a patient I've had a neurosurgeon an orthopedic surgeon just stare at me blankly when I tell them that cannabis has been part of my treatment and yet all the nurses and surgical nurses know that I've been able to use less opioids by using cannabis so it's education and it's and it's a good education from trusted sources and that will be a challenge I think and I was hoping Dr. Joe could speak a little bit as our medical representative on the oversight committee about the challenges of even getting a medical appointee to the board who would be the the advising body that we would go to that would be we want somebody that believes in the use of cannabis as a medical therapeutic treatment and Joe do you want to jump in here oh sure I have lots to say about lots of things and the first thing that I would love the board to do for us is change the name to the medical cannabis oversight committee it was called symptom relief because they didn't want to call it medical marijuana and marijuana is a term that applies to something that I don't know what is cannabis is a well known plant and its use in medicine is really ancient 7 000 years or so so I would hope that you can consider that and I would I'm also agreeing with the idea of less emphasis on the enforcement vendors and more emphasis on the research based testing and the symptoms and yeah that's those are the things that I you know particularly interested in to sort of illustrate the diversity of products that are needed there is a course at UPM I think it's the first course of medical school since 1941 that deals with cannabis and its function and part of that I did make a little spreadsheet up that showed all the terpenes and terpenoids as well as the cannabinoids and what they're thought to do so if you have somebody who's taking pain medicine for instance they have taken the morning I've taken the evening they're going to be two different kinds of cannabis because cannabinole and linolol sedate the patient that's good for bedtime but pineene and limonene are alerting and energizing and so you'd want to have a chemovar I think they call them out and be able to choose those and preferably with the knowledge of what you're doing which brings me back to my interest in research and that is if we could find out from the patients what they're using and know what the chemical composition of that was and what it helped we could begin to put together more research than is available in the world right now although people have been studying this in Canada and stuff and there are programs for doctors and things you learn about cannabis in the Canadian cannabis society so the the need for testing and regulation I've actually in 2001 I suggested the medical society go on record favoring cannabis for medical purposes and another resolution that I offered was as a public health issue to make it legal for everyone because at the time you're still buying stuff off the street this marijuana which you have no idea what is and that's still kind of what you're getting as long as it's not tested by a third party tester and there are people apparently in the state who do that that is test for all the terpenoids heavy metals which are toxin obviously other things that the pusher might have added for enhanced excitement are things that you don't want in there and so I'm really grateful but I think it's it's the recreational program that needs the testing as well as the medical program that's vital as a public health issue you the makeup of the board out where we get that data I've also Jim and I have talked about wouldn't it be nice if your board had a little chapter for patients to register their observations and we could look at that and get an idea of what the patients actually want because we do always have patients on the board and they can tell what they and the other people they know have it's the way of problems like you know there's a mountain between me and where I can buy it so you need some geographic distribution of the patients and the getting getting getting the good collection of patients is difficult but if they're all depositing information on your website that's great and I can also then send out a questionnaire on the website for instance listing all the cannabinoids and things like that and I could fill out my spreadsheet much more accurately in the future and that would be something that would be really helpful and would be the sort of thing that the bud tenders or practitioners could also reference that is they could know if you have back pain in the other this one may be what we have a lot of so that's good for you that's not totally right much better for them to know that actually what you're going to do these three things here probably and try them out start low and build up gradually the affordability question is interesting and I hope there will be sliding scales and then we can also encourage insurance coverage if everybody is covered by insurance you wouldn't need to have the Canada's control committee subsidizing people and so increasing position possession limits is another thing which I just see you should not make it more restrictive than recreational in terms of possession and again the possession limits originally were set up when it was worried that everybody's going to have you know teenage kids are going to have back pain and want to pot and the doctor was going to say sure and then they might solve the difference I don't think that's real and I think that in terms of the dispensaries they remain you know again I have no financial interest in anything except you know retirement funds whatever they are but if the patient could go to any to any place that was selling cannabis in the state with their card and they could run their card and they wouldn't have to pay taxes at that point that would get them in a good place and it would also I assume the software would report back to us or somebody who's looking at how much the patient is using last day be doing that and going from store to store and sorry for their friends but I think it would be something that could be monitored well but I think it would be much more sensible and having people tied to a particular dispensary or a particular location because it's hard for people to get to them and delivery of course is a great idea too but it's going to cost some extra stuff we've heard about increasing the patient to caregiver account and that's super with me except that I remember originally the caregivers were allowed to grow cannabis for their patient if a patient couldn't grow it and if each patient has five caregivers that's about 70 plants and if each caregiver has 10 patients and they can grow 10 plants per patient that's 140 plants which is getting into the small scale grower category I think in terms of square footage and all so I think that we will need to define better how what what the caregivers and their responsibilities are so most caregivers I assume are just there to get the patient to the medicine in the middle of the school day and I'm not sure you know that that's illegal now but that's the sort of thing that we'd have to get the lawyers to tell us what you actually need in the way of a caregiver there if it's a matter of supplying them with uh cannabis that has been grown specifically for them that's great but again you need to have one caregiver per patient doing all that growing and so anyway I'd love to know more about the caregivers and how to stratify that and then let's do it in terms of the numbers of plants I don't know but 14 doesn't seem unreasonable to me if you're actually starting out from seed because you're gonna not know 50 percent of them perhaps are going to be slaughtered when they show their sexuality and you never get a 100 yield and if you grow them out with the sunlight whether it's outside or in a grow room or something like that that is environmentally highly desirable and you got to get your whole year's worth of cannabis in the ground and growing so that by October you're finishing up your harvest and you're good until the next October those are the sorts of things we can work on for you and I'd like to and other things there was this other category that James sent around is anything else and I want to tell you you've got to brace yourself for the elderly they're the fastest growing body of users and actually the more they get the recreational exposure the more demand you're going to have from them for medical because old people have pain anxiety sleep disturbances and dementia and cannabis helps with all those things in certain situations so they're going to want to move from recreational to medical and if you've got a very carefully defined list of symptoms which are diseases that the patient has to have the elderly are going to want to expand that considerably and a tantalizing area of ongoing research is the effects on addiction so that it's well known as Jim has mentioned sorry there are many articles that people who use cannabis who've been using opiates use less opiates for their pain and maybe not at all there's also tantalizing research on cocaine and perhaps rodents where they you can't get it they're out to get addicted if you give them you know cannabidiol and likewise if they are addicted they don't spend so much time pushing the lever for the cocaine if you give them the cannabidiol opiates as I say that's mostly humans that are any pigs for that and nicotine it seems to have a an association with reduced nicotine use which is a good thing also but it's all association as opposed to cause all of this they don't have a good scientific basis for why it interferes with addiction yet but they do know an awful lot about addiction and I'm looking forward to being able to provide additional information on that which brings us back to Jim's point about who do you want for your medical and perhaps botanical input I think you need to vet people because as I say I did propose in 2001 that the medical society go on record favoring medical cannabis and medical for recreational cannabis and that was not well received and I've done that occasionally since then and it's still not well received a lot of doctors are like regular people and they have opinions that are formed when they go to medical school and they don't get changed after that except by the drug pushers who come around give them lunch and tell them about their specialized new medicine for headaches so it's there's a lot that we can do and provide you and the research is interpreted by people and their bias comes through in their interpretation and I think it probably came out in some of our annual reports that the Department of Health has particularly poor advice and I just checked them out last week and they still are using an article from 2012 a study in New Zealand and the people who wrote that article were thoroughly mocked by the other people in the research community and eventually they rewrote the article so it moved from cannabis causes you to lose 10 IQ points after you're 21 years old to actually adverse childhood events is associated with poor outcomes in your younger adult life but the Department of Health is stuck with the 2012 one you know it's going to cause you to get stupid if you use cannabis which turns out not to be correct so the other things that were brought up I think were exempting PTSD diagnosis from physical exam and that makes sense if a psychologist and psychiatrist makes a diagnosis if I make it for myself that may not be so good exempting chronic conditions from annual provider forms yeah if people have a terminal disease hospice they're in hospice they have ALS or multiple sclerosis they're going to have that for the rest of their lives and you don't really need a medical recheck but if you have pain like Jim you got to check in with them every once in a while because they might actually get better or PTSD anxiety sleep disorders those people may need some sort of follow-up to keep them in the medical program once they're there so is that enough talk for now thanks Joe thank you I'm trying to keep it short but I have lots of hands for any questions that you're available yeah and we at any point please interrupt us for some questions I would say one one more quick thing that I think is important to this discussion part of the challenge of the sheer volume of input that the public that patients and caregivers have as well as the really what is probably going to be a flood of research and science that will start coming out in the next few years we are a volunteer committee at this point and a lot of the challenges we've had disappointments from members of the public when you know we we don't have the resources to send people over to the legislature to follow up on things we don't have the resources to in a large way have experts come in tell us what is the current state of thinking from both medicine and caregiving as well as the economics of using cannabis for medical care we don't have the funds to do a survey or have a website where we can get public input and so I think that is for oversight to successfully work in an industry that's going to be have a lot of money coming into it because of the recreational side of things I think it'll be hard to challenging to do a good job at this without the legislature creating a body that is going to have the kind of terms and at least the kind of permanence for instance that the cannabis control board will have multi-year terms as well as some kind of funding to both keep the diverse group of experts and people we want on the board able to come and do the work we're asking them to do but also fund some of the surveying and at the very least competitive research we need to do to understand what medical marijuana programs are looking like in the rest of the northeast the rest of the country and what is coming down the pike in the ways of therapeutic science that we're going to have so that we can then in turn advise the board on changes that need to be made in the legislation and that stuff's all down the road there's truly a lot of anxiety right now that the medical program will get in the left in the dust of the money that's to be made in the recreational side of things and it is understandable that the dispensaries are going to have hard choices to make about making a diverse selection of products that might not line up with what the most profitable products are going to be or the most popular in terms of a public adult use marketplace and you know so that does really again speak to the need for a third party oversight group to be involved in order to help look at these things and you know make sure that all sides are getting looked at but before I go any further do you do you deserve are there any questions from from the board Jim you almost read my mind there my first question you know having the chair and the former chair here was if we were going to kind of set aside a little bit of money for the for the oversight committee what would you do with it and you know that was a perfect response to the question that I hadn't posed yet so that's that's great I think that should absolutely be part of your recommendations to the to the board and ultimately to the legislature and keep in mind when you're thinking about the construction of the the committee that it's pretty common place these days to offer per diems to your members that might you know not be able to kind of volunteer otherwise volunteer their time so I think it's pretty typical to give $50 per day which is kind of a double-edged sword in a way because it allows people to participate but because there is this kind of appropriation that goes along with it sometimes the legislature needs to limit the number of meetings that you're entitled to but just something to keep in the back of your mind when you're thinking about kind of who can participate. Julie Kyle I've got a few questions but I'll turn it over to you first. I think I'm going to ask a question that's similar to quite a question I've asked throughout the day about patient education. Does your committee talk about patient education and you know I wonder you know if somebody's you know PCP agrees to fill out the forms and they go off and they go to a dispensary or they begin to grow you know what what could be available for patient education because I understand that treatment works better if the patient understands the care that they're getting. So can you talk a little bit about that? Well we do talk quite a bit about education and communication to patients and it's in you know our reason for being that's written into the statute that we be looking and reporting every year on you know what's being done in terms of communicating to patients and whatnot but I would have to say it was in the original statute it's really written from the point of view of public safety and of making sure that they understand what they're supposed to not do give it to somebody you know it was really about protecting the public so those are things that we will obviously work on to recommend changing in the charter of what an oversight committee would do but we we do talk about it because the group of us that are patients you know you get a mixed experience of people that you speak to certainly I've never sensed any uniform training you know and or anything resembling what would be a standard of care that would be the term provided in a medical organization and a standard of how to speak to patients and when you get into something like growing just the whole idea that patients aren't going to the registry because they can all of a sudden grow at themselves I will tell you as somebody who's done it for several years and lives with a master gardener who's done this her whole life and career gardening it is not easy to do and it is not easy to figure out how to do and when you go to a garden center they don't speak in English to explain to you how to do it and it's a terrible idea because you could end up with nothing it could in Vermont it can be all killed by powdery mildew the same as your tomatoes in one bad week so nobody tells you that and nobody you know I I don't know nobody's showing me any numbers of why people are leaving the as medical patients but education is really difficult and and I thought I think Kyle said it earlier the idea of taking one of our little gems in Vermont like the Vermont tech school I was involved with them when we were I was helping them start their flight pilots program there and there's expertise all over the state and elsewhere to bring into a school like Vermont Tech and the idea of being it's so exciting to hear everybody say this be a leader and perhaps Vermont show the way of how to educate people to speak to their patients it's difficult enough for doctors and nurses to do every day and we should expect a similar standard of care for patients in the medical cannabis program and quite frankly right now they're being spoken to by you know lower wage employees most of them younger some of them patients but you know nobody with any medical background as far as I know nobody who would understand what medications I take that it might interact with you know and I think you know being able to provide oversight in that area and recommendations and research how do we you know what would be the best way to speak to people I think in all industries it's going to be needed in this new world of recreational cannabis because in the gardening industry they need to learn how to talk to people growing cannabis it's different and yet very similar to growing your your fruits and vegetables and right now it's mostly people who are talking about growing it in their closet secretly and when they speak to you know my 75 year old uncle about how to grow a plant he doesn't understand most of it so standardized would be great Joe do you have anything to add to that yeah the research and who is going to give this education is a really tough question so that Stanford for instance published an article on what patients were using for their kids with epilepsy and it turned out that those who are using stuff that a little THC and it actually worked a lot better I mean they're all high CBD products but that a little THC is actually a very good thing for controlling the epilepsy in the patients but the research hasn't been done and in the in the rats we know a lot of preclinical that's the term you use for things that we don't know but mostly doctors have to listen to the patient and so doctors that listen to the patient are actually willing to fill out the paperwork and the doctors who don't know that cannabis doesn't do anything for any of your symptoms and you're just a pothead looking for access um so yeah you have to vet your your doctor um and the bud tenders are doing what they can they uh you know they get somebody says something works and they pass that word on but that is to me totally sloppy um and I would much rather have tested products and the patients you know preferably reporting in some place where I'd have access to the data um about what works for whatever symptoms they're dealing with and whether they take different things at different times of day and so on and then you could begin to get a spreadsheet or something for the doctors to be able to use who wanted to do the advising and there are you know lots of doctors I'm sure who want to do that um we don't have any pot doctors in Vermont but uh we have other folks who are good for recommending things but the research has to be done and this is something we could do and that's one of the reasons I'm really uh eager to get us a website where patients can report in and a mandated testing program so we can trust what they tell us this is uh orange blossom three we'll know exactly what terpenes and terpenoids are in that Jim and Dr. McSherry thank you so much for being here today it's really nice to meet you at least in a virtual setting um I have a question it's kind of building off of which you just mentioned Dr. McSherry you know one of the things well a couple things that you well if I'm backing up I'm really excited to help be a conduit for getting more data for the symptom oversight committee to really sink their teeth into a lot of this work in addition to being a vehicle or a megaphone as chairman Pepper alluded to earlier to make sure that some of your recommendations are not just another report that are lost at the state house but actually bring some life into into this program not let this program kind of be lost in the dust as we you know look to implement uh an adult use side of the equation um you know one of the things that's sticking with me and we've heard and it's no secret to anybody listening is you know it's a very restrictive list on the types of physical ailments mental ailments that qualify for the medical program and I think really understanding how we can expand that list might help this medical program really not be lost um as we look to do other things so I was I was curious um how the committee has kind of navigated um suggesting changes to you know what is what symptoms or what physical ailments mental ailments are available for a healthcare provider to make a recommendation that that patient use cannabis and then also you know what type of record needs to really be assembled in order for everybody to feel less anxious about expanding that list what have other states done I'm sure it's kind of like and that's a I'm sure that this answer could be an hour an hour plus long and I understand that and states are doing it differently but if we wanted to expand the list to allow a healthcare provider to make a recommendation that's not as strict as it is now you know what type of research needs to be done well yeah the kind of research needs to be done as far as I'm concerned um the if the patient says I've been using now the stuff that my grandkids had in the closet um and it seems to really help with a symptom I'm very eager to hear that and figure out what it does uh help with that is there are things like anxiety and pain where we have all kinds of mechanisms uh again from rats but also testimony from patients that it really helps with that uh the idea of alcohols interaction with cannabis a great public health question because you certainly don't want to drink alcohol and then smoke pot and drive but using cannabis you shouldn't smoke anything by the way but using cannabis late in the day may actually counteract some of the bad effects of the alcohol that you've had also and improve your sleep and their sleep is very important to making sure you don't get dementia which older people care about um because uh that's when your brain cleans out the garbage that is built up all day every day you make a lot of new connections but yeah you don't need all of those so you got to wash it out and uh people as they get older have more difficulty with that people who and there's all sorts of good data again that uh people who don't sleep on regular schedules and so on I'll get the med it earlier if you live near a freeway you're going to get the med it earlier than if you live further away but you're not going to get Parkinson's or multiple sclerosis by living next to the free way you're going to get dementia because it keeps you awake at night or messes up your sleep um so most of it uh I think is listening to the patient of the patient uh for instance has a sleep sleep disorder uh they have a COPD they're having trouble breathing at night and snorting and snorting and so on um it helps with breathing and maybe they have found that it helps with their breathing and uh you got to listen to them and if they say that then it's it's not going to be harmful for them to use it in a control sort of way um it's just not as dangerous as we might have thought a few years ago. Dr. Joe could I kind of put a finer point on that question if you don't mind? Does it make sense for Vermont? I mean the two ways that kind of the medical programs work around the country is one you have a long list of statutorily defined qualifying conditions the other way is if a physician recommends it or if a doctor recommends it you know it doesn't matter what the condition is it's their recommendation um do you do you personally um not you know as kind of former chair or member of the oversight committee but do you personally think that we should go one way or the other in Vermont? Oh yeah when I had patients who said that things worked for them I uh encouraged that and endorsed it and um you know tried to figure out which would have the best side effects for their other problems I don't see any problem with the doctor who recommends that this is helping my patient um letting that be a reason for that patient to take the cannabis and if there's some doctor in the state who is recommending that everybody take it then maybe they're just trying to get out of paying taxes um but you know once it's recreational it's not a matter that you're really saving the human race from exposure to cannabis um except if you're under 21 um and I think doctors uh who would be willing to file the paperwork in general can be trusted and if they again the statistics show that there's somebody who's 90 percent of all the recommendations in the state then maybe somebody needs to talk to them about did they suggest patient or did the patient suggest it to them? If I could just add go for it add to that Dr. Joe uh from the point of view of uh of a patient not a not a medical practitioner you know I think the list to a certain degree is is uh protecting the doctor uh the doctors are scared of of marijuana uh they are concerned about liability constantly uh our state didn't make it friendly we made it sound like it's dangerous but we're going to do it anyway uh for all kinds of reasons not that we need to look back at it but doctors just getting them to do the prescribing is is difficult so maybe adding in that it can be for a these reasons as well as a discretionary reason would be a good idea but in a bigger picture one thing I might say is that cannabis exists at a weird nexus in healthcare it is both in the realm of medicine and uh being used in that way it has been for thousands of years but it's even being seen that way now even in our country but it's also as we heard about naturopathic medicine and naturopaths being included it's it's in that area of natural health care uh that is more done often in consultation with a patient and how things are working for them but uh it's it's one of those things where you we heard from the story this morning uh with the child who is being treated uh for for cancer uh with high extremely high doses of thc uh to reduce the tumors um we're in the wild west still in terms of using cannabis in the in the eastern countries and the western countries uh as medicine and uh it's often being used you know like in that case because it's been read on the internet that uh there's a little study that shown tumors reduce but 10 families have said it really worked for them and that's not a comfortable place for a lot of my doctors to have somebody who doesn't have md behind their name saying you know look it's worked well and i recommend it so i think one of the things that we could do is foster a different kind of environment uh that includes medicine natural medicine and opens the conversation up in a way uh that a makes it clear we're past that uh cannabis is a scary dangerous uh thing that it you know reefer madness showed it to be and uh that it's just like areas of medicine that exist now sometimes you have a desperate patient who will try anything but many times you just have creative practitioners looking to keep their patient out of the office off of more dangerous pharmaceuticals and living a healthier life so i think some of it is is is not just giving them the science but uh turning down the level of fear and uh you know uh turning up the level of what an amazing environment we're in that we live in a state uh that looks at everything in such a progressive way in medicine we need to do it too here yeah i would add that i sent a new oncologist who came in uh a bunch of articles showing that uh brain cancer cells all get killed by cvd and thc uh but that didn't you know make any difference um but knowing that you know certainly if i had brain cancer i know how i'd be treating it and you know so it's not all and it's not good human research it's cell research but at least there's a lot of pre-science that could come out and i think that the patients are the ones who can really tell you and us what really helps uh with their sleep disturbances or you know the multiple sclerosis patients were really big early on and getting this law passed in the first place um because it helps with a lot of their symptoms from the spasticity to the actually as an anti-inflammatory it also keeps them alive a lot longer because they have a problem of inflammation as the cause of their disease so yeah no i think you're right on let's the legislature is not the right place for the laws to get written um because people have to come and convince the lawyers and so on who live there that this is good for them i think that the cannabis control board can uh keep the medical cannabis oversight committee under control so if we get two rambunctious or they get two rambunctious um opening it up to people uh you can say no that's ridiculous but uh at least we can make the case for why um again dementia should be one of the causes that you can actually use a drug which sometimes causes confusion well i appreciate yo let me just say one thing which is to that last point which when you're considering the makeup of uh the board the new oversight committee sorry um really you know be driven by that which is kind of like you know if you give us the evidence then we can we can write the regulations you know but we need everything we do to be backed um by uh science and data and be driven by um kind of the voices of patients and caregivers and physicians so yep go ahead kyle sorry yeah no i was just gonna say an apologies if it's out i can't tell if it sounds like i'm if i'm yelling or not i'm in this big empty conference room and i feel like i've got to yell for some reason um i just wanted to say thank you febra for drawing that finer point earlier and then also well what you just said because the as well really really what i was getting at is if we're gonna try and figure this practice nut so to speak what's the best path to go and how do we build a record that we can really stand on that so that we're not just going and you know as dr joe just said getting a little too too wild with what we're trying to do but make sure that it's grounded in something that you know everybody can at least respect the record that we've accumulated based off of anecdotal testimony or other studies that are out there or whatever the case may be agreed thank you any any other questions julia kyle for our witnesses no thank you both i look forward to working with you likewise from us we look forward to it and please don't hesitate to reach out with questions and and comments at any time as especially as we start working on this recommendation and you know as i said our intention is at these meetings i'm sure will be having input from the public as well on both the future oversight committee and current situations that exist that will be passing along for your consideration yeah one oversight on my part was that our you know we've been holding meetings on thursdays generally from 9 30 to 2 and i realize that that actually is the day that your committee usually holds meetings on thursdays you know i attended your last meeting i thought it was incredibly informative from my perspective i'd like to continue to attend them but i hate to think that we're you know fighting for the same space same time but anyway that's just one side note jim maybe you and i can talk about that yeah we'll figure it out yeah okay absolutely both thank you both we'll be in touch of course we have an october or i november 1st report back so we can figure out kind of some sequencing offline a little bit later about how you all can get recommendations to us and we can kind of transmit those absolutely okay well thank you very much uh you're very welcome thanks for having us and for your advocacy we're looking forward to working with you all thank you very um the last thing on our agenda today is public comment um i would like to just before we move to that um one thank all of our witnesses for today um very powerful testimony very um helpful for us to remember just input at the forefront of our work and for the medical program and i would just on a programming note like to mention or reiterate that uh the board the cannabis board will not be meeting next week we're taking um the week off it was getting a little bit difficult to schedule witnesses so close to the fourth of july holiday so our next board meeting will be the following week on july 8th but any other thoughts julia kyle before we move to public comment you know i just wanted to say thank you to everybody as well we certainly are listening and hearing your recommendations and without getting into any specifics you know it's interesting from my perspective um because a lot of a lot of the recommendations without getting too specific to seem like a logical progression of where the medical program should should go recognizing not a lot of changes have been made so um that's just one of my general observations i don't have anything else julie any any i don't need to put you on the spot but any concluding thoughts before we move on uh i have pages and pages of notes to distill i think yeah and you know i appreciate the conversation and for some folks who've spoken to us they're really bearing some some personal information and that's to be recognized great thank you well our last thing on the agenda is public comment we're gonna again start with people that have joined through the link that on the video that can raise a virtual hand we'll then move to people on the phone um i'll let you know when that change happens and i see our first um public commenter on my list is loretta craigan hello i really appreciate this time to talk with you i also am on the oversight committee for a medical marijuana for symptom relief and i've been a medical marijuana patient for seven years um i want to clarify a few things first of all by statute there's only one meeting a year that this committee has to make and there only the dispensaries are represented there's no representation for any cultivators the nurse that has been assigned by the governor has not shown up for the two years that i've been on the committee as a member um and the only nurse participant that we've been having or medical participant other than dr joe is jesse lindolen now um so that gives us very limited time to hear from people and to express ourselves generally it's limited to a two hour meeting and there's times when no public comment was ever on the agenda i was an advocate for that um in the two years that i've been there and i'm the one that put that on the agenda however we've had very little public participation um so since there's no caregiver designated we haven't heard from a caregiver other than jesse lind really talking to us about her needs as a caregiver and that was enlightening to me it's very enlightening to me too that um just the dispensaries have the ability to do whatever they want to do with this medical program i am so so grateful for you guys hearing from the patients and the cultivators i truly truly appreciate because i feel finally that my voice is being heard um so um even though the board is well intentioned we try we've been very limited so thank you for giving us uh this ability to have patients speak out and i think only good things can become of it thank you thank you loretta thank you uh next on my list is Amelia hello um i'll try to make it quick i've got a couple points uh the first is that um so rewinding a little bit jesse lind and i testify in gov ops and there is a 13th spot on the advisory board that has been changed from the original tent to go to the remont canvas trade association so jesse and i went in there and we asked that that 13th spot be then reverted to a patient or healthcare professional nominated by an avt the compromise that we got from our request was that uh representative gannon proposed that we add a 14th member and that'd be somebody from the symptom relief oversight committee and that's how that happened um i would propose as jess did earlier today um adding more medical professionals to that committee including um a nurse a naturopath she said a lab scientist i would also like to add we should have a pharmacist on that committee um for expertise in drug interactions uh and she also proposed an i support adding a 15th member to the advisory board as a second member of that committee i think that one of those members is already designated as the chair or chair appointee i know that the chair is a patient and a caregiver and i think that that's awesome i do think that there should be a second representative from that committee who is specifically a healthcare professional um so whether that be the doctor the nurse the naturopath the pharmacist however we restructure that board i think that if the um if the chair of that committee is going to be on the advisory board or as disignee is a patient then somebody else from that committee who is a healthcare professional should also sit on the board um so that was just uh something that i noticed another thing i i really just want to bring up quick that i've heard from a couple speakers today and i i i don't want to harp on it but we cannot stigmatize the illicit growers currently in our state um they aren't a large majority of them they're not dirty grows they're not closet grows they are clean organic living soil integrated pest management with predator bugs like these are not dirty grows with harmful chemicals that are just going like that have products being pushed out into the public um those things do exist but they tend to come from people who are not growing product themselves but are receiving products from other places in the country to then distribute and sell in the community they are not from people who are growing within our community um and i just wanted to make that point now because we have a lot of really talented really clean growers in the state and i don't want the misconception to be that the people who are currently growing illicitly are not doing so in a clean organic safe way thank you Amelia um next on my list is Tito hey there um so um now i want to talk about um a problem that i've been dealing with actually for several years uh first with Senator Debbie Ingram um and now Senator Chris Pearson and Senator Pearson suggested i talk to you about this now uh the board and that is that um a few years ago the legislature enacted a vape tax which was designed to curb the use of jewels in high schools which i 100 percent agree with i i mean i think you know nicotine is awful but they use language so broad that anything that has the word vaporizer in it now has a 92 percent tax and because of that you know there are some products like the pax vaporizer for example that they are these products are 100 intended for cannabis use no one would ever smoke tobacco out of one of these things and yet now pax won't even sell to vermont at all we can't get it we can't sell to our customers um and even worse the dispensaries can sell the exact same product without paying that 92 tax and um so it's just each two different rules for the same product and let me tell you in the burn gallery we serve this a ton a ton of medical patients and we're talking about them uh talking about these issues with them all day long um and uh and i just want to bring that to your attention hopefully we can just get some something changed in the words just to get an exemption for cannabis intended products and i don't hopefully you guys can help me with this thanks tito thank you guys virginia hi i just wanted to mention a couple of things um one of the things is under the existing law um a healthcare professional in new hampshire massachusetts in new york are allowed to sign the form for vermont patient uh and that was put in mainly because you know some vermonters go to dartmouth some go to uh boston for their services and then uh in new york as well so i just wanted to let you know that there are three states that we do allow um and i also want to bring up the caregivers and the fingerprinting that was put into act 164 when it was in the um conference committee and when i heard that that was being added i immediately reached out to some legislators and said why are you doing this because since this law went into effect in 2004 caregivers have never been fingerprinted they do a background check on them but never fingerprinted and here we are you know uh putting another restriction on to being able to get into this program so i think that as it has been mentioned by others that uh this is really a key piece that needs to uh needs to change so again thank you for all your time thank you virginia and thanks thank you virginia anyone else um from the video link want to provide public comment if you do just raise your virtual hand okay uh it looks like we have one person on the phone if you'd like to provide public comment please just hit star six to unmute yourself okay well um that was very helpful for me um and i'm just would reiterate um our gratitude to all of our witnesses today for bringing us up to speed orienting us to what seems like years worth of advocacy um and uh hopefully we can um use this opportunity that we're in right now to really think about how to refresh the medical program in vermine um kyle julie any any last thoughts before we adjourn thank you to all of everybody who provided testimony or public comment today um like julie said earlier i took pages and pages of notes i see a lot of recommendations that no matter who they came from felt like they were on a similar you know strain no no pun intended but um we got a lot to work with and thank you for all of your advocacy and input yeah i agree with with what vile said and i appreciate everybody's time and energy to put this meeting together and to take the time to spend uh with us and sharing all this information with us yeah great well um all we have left is to adjourn adjourn so i'll take a motion if anyone would like to make one uh i'll move to adjourn i'll try again all in favor hi hi hi okay thank you all again and uh see you soon thank you thank you


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