The November meeting of the Act 230 Legislative Working Group tasked with improving the laws and regulations overseeing Hawai‘i’s medical cannabis industry came to a close today, on November 21, 2017. In the audience were almost a dozen members of the Hawai‘i Dispensary Alliance, representing every aspect of the industry. The Committee’s chief concern was discussion of the draft recommendations from the Patients and Education subcommittees. The Department of Health gave a brief update on the status of the registry system, the dispensary system, and laboratory certification. There was also a brief update on the financial options that the state is pursuing as it searches for a long-term banking solution for the industry.
The University of Hawai‘i Public Policy Center administers the operations of the working group and posts all documents generated by and for the committee to their website. If you would like to sign up for the working group’s email list, email your request to Act230wg@gmail.com.
This article will cover everything that happened in the meeting today in a detailed narrative, much like a Q&A, organized according to the meeting agenda. This record is not verbatim, but it is as close as our notes will allow. This meeting was not broadcast on Olelo or on the legislature’s internal broadcast network and will likely not be available outside of this record and the minutes that will be posted to the Act 230 Working Group site sometime in December.
Panel Members Present
The meeting began with a brief introduction of all of the committee members. The list of participants at today’s meeting and their affiliation include:
Present Panel Members
- Representative Della Au Belatti, Guest Co-Chair filling in for John Mizuno
- Senator Will Espero
- Christopher Garth, Hawai‘i Dispensary Alliance
- Garrett Halydier, Hawai‘i Dispensary Alliance
- Carl Bergquist, Drug Policy Forum
- Wendy Gibson, Medical Cannabis Coalition of Hawai‘i
- Richard Ha, Lau Ola, Hawai‘i County Dispensary
- Karen Kahikina, Department of Transportation, Airports Division
- John Paul Bingham – CTAHR
- Ally Park – Clinical Laboratories/AEOS Labs
- Stacy Kracher, APRN/RX
- Michael Takano – Pono Life Sciences Maui
- Thayne Taylor – Kauai Dispensary Applicant
- Michael Contrades – Hawaii Police Department
- Patricia Wilson – Honolulu Police Department
- Shana Metsch – Parent of a patient who is a minor
- Keith Ridley – DOH
The Working Group is administered by Dr. Susan Chandler and the University of Hawai‘i Public Policy Center, with assistance from Center Director Collin Moore, Dr. Michelle Ibanez, and Joy Agner, policy assistant. A guest moderator, Jose Barzola from the Public Policy Center, managed the November meeting in place of Dr. Chandler who is on sabbatical.
Review of Minutes – Rep. Della Au Belatti.
We will postpone the review of the minutes until the next weekend.
DOH Monthly Update
Since all of the dispensaries have presented on their status and upcoming plans over the last eight months, DOH started the meeting with its monthly update on the progress of the Registry, the Dispensaries, and the Laboratories.
You have the report in front of you, but I will go over it very quickly. We also have Dr. A. Christian Whelen, from the State Laboratory Division, here to speak on the laboratory status. I will be addressing the registry and dispensary status.
Patient Registry Program
Please check the DOH website – Patient counts are updated monthly.
The Registry Program is receiving 1,700 applications per month on average – from the beginning of year to current. This means about 11 applications per hour – and includes new applications and renewals.
The Registry Program for this month through Nov 19th received 1,100 applications and has approved 741.
Turnaround time is growing – It is now up to 10 business days. The increase is attributed to staffing levels. The Registry program has 6 positions, 3 are vacant. Additionally, one new office position is being established and will be open for recruitment in January 2018. The vacant positions have been posted, we are waiting on a list of applicants.
As has been reported previously, we have been prioritizing applications. We continue to expedite hospice patients, cancer patients, and minors. Turnaround is either same day, next business day, or two days max for expedited applications. So far we have been good at maintaining that. We approved 45 patients through this process since last month, 20 are pending.
The Registry Program is also looking at IT system enhancements and how to use IT to their advantage to move current human resources to work on other applications. Currently the system for managing changes to applications is done manually. We need to create an online system to help with completing these requests. We receive about 61 application change requests per month that must be processed manually. We can process about 45 a month, the rest are carried over. About 60% of one person’s time is dedicated to just those applications. So we need to automate them.
Regarding the process of creating new ailment categories. The final ailments decision is on its way to the Director of Health. The decision is to be made in the middle of December.
Q. Carl Bergquist, Drug Policy Forum – Question on the numbers, on October 31st it was 230 more patients than today, was that an error or did it decrease?
A. Keith Ridley – No, in the early part of the month there is a decrease from the expiration of cards for that month, while the applications for renewal are received and processed. So the numbers drop and then recover.
DOH Program Update
The Dispensary Program’s report is in the notes that are being passed out (and available here).
We are seeing good movement on Hawaii Island, they are generally waiting on local permits to be approved to build their cultivation facilities.
Lau ola has its permits to work on its cement pad foundation. Richard Ha, any status update?
Richard Ha, Lau Ola – That is correct.
For Hawaiian Ethos, we are waiting to hear from the licensee on the naming of a new CEO. Former CEO William Richardson unexpectedly passed in recent weeks. This does not impact their license
We have received word on Hawaiian Ethos’ construction process on their production center. They have completed the cement pad, framing, plumbing, and electrical. The rest of the building and outfitting remains.
On Kauai – They have informed us that they have submitted retail plans to the county for approval. It is just a renovation of an existing retail space, not construction from the ground up.
We have conducted over 100 inspections of site locations and buildings for all licensees. This includes the various stages of inspections as indicated in previous Dispensary Reports – Does the location and building comply with zoning and other requirements. We are looking to see when construction is finished that it meets requirements of the administrative rules and security issues. This work has consumed 329 staff days to date. The inspections will continue.
For the industry as a whole for the last few months:It is curious that in Sept-Oct, the number of customers nearly doubled. This was likely due to the opening of two new dispensaries.
The customer encounters are counted by the ping to the 329 cards. That verification is made prior to entry into the location.
The unduplicated patient count is the number of individual patients that have used the dispensaries.
Despite the increase in customer encounters, the patient counts did not go up.
So the patients that did go to a dispensary may have gone multiple times in a period.
Gross sales did go up quite significantly, but then they went back down, we anticipate that they should go back up.
Q. Carl Bergquist, Drug Policy Forum – Back to your question regarding patient counts being lower, what might account for that is the lower renewals at the beginning of the month? So as the counts go back up in November the rest should go up as well. Have you in the past been able to look at that?
Keith Ridley – It is still early on. The data is new. The first couple of dispensaries opened in August. So we only have 2 full months of data.
The last item is laboratory certification. The third lab has scheduled an onsite audit in December for chemistry and microbiology studies. They have provided validation studies and those have been accepted. This is for plants and concentrates.
I’ve attached the certification status with additional information.
Q. Carl Bergquist, Drug Policy Forum – Regarding Staffing – There are 3 vacancies in the Registry Program, who are you missing in the Dispensary Program? It seems short staffed? Are you advertising those positions publicly? Whats the timeline for filling them? Especially a replacement for Peggy?
A. Keith Ridley – In the Registry Program – Those positions are civil service and are being recruited. They must go through the civil services process – internal recruitment then external recruitment. That is a process that is ongoing. We are equally concerned about wanting to turnaround cards as quickly as possible. That is what IT systems enhancements are for, less manual intervention. Those things will help.
For the Dispensary Program – We have 4 vacancies out of 5 positions. We have one of two surveyors. That’s it. He is conducting inspections today and will conduct them throughout the year
Those positions are exempt positions. We are looking for suitable replacements but have not found any. As a result, a result, we are in the process of early converting those positions to civil service positions. The Legislature had previously allowed us to extend the exempt status of the positions, but because they are vacant, we are converting them early. That is happening right now. So then we can go through the civil service process.
DOH Questions & Answers
Q. Carl Bergquist, Drug Policy Forum – So in the history of the program – is this a normal level of vacancies? It seems unusual and like it is having a negative impact across the board?
A. Keith Ridley – I couldn’t say whether it is unusual or not. There are programs of various sizes throughout the executive branch. We are a smaller size program. Any vacancy can have a small impact. Our goal is to fill those positions immediately.
Q. Rep. Della Au Belatti – I am very concerned. You have one person in the Dispensary Program. What is the timeline for replacing Peggy Leong?
A. Keith Ridley – I don’t have a specific date – The process to establish the positions in civil service take a long time.
Q. Rep. Della Au Belatti – We gave you flexibility to not establish civil service positions to speed things up, now your taking this approach to make it even longer. How is that a good leadership program. Please convince me why they need to be civil service? We gave you flexibility. I am quite confused?
A. Keith Ridley – At the time we asked for flexibility, we were not in this situation, there weren’t vacancies. We asked for an extension to maintain a stable program for our exempt employees. At this time, our justification for extending the exempt status was to maintain the program, that is not a justification at this time since the positions are all vacant.
Q. Rep. Della Au Belatti – The justification to be exempt is you need to hire people quickly. Taking 2 years to fill the positions is 2 years without oversight of the industry. I don not want to belabor the point, but I caution the Department, it is not in the interest of the industry to let the positions go unfilled. It is not a good decision.
A. Keith Ridley – Thank you.
Q. Michael Takano – You said 5 positions, is there not a 6th education position?
A. Keith Ridley – No. Just the 5.
Q. Michael Takano – So you’re filling Peggy’s role right now?
A. Keith Ridley – Yes.
Q. Michael Takano – Looking at technology and streamlining the certification schedule for patients. This concerns certification from a physician, is it possible to create two or three year re-certification options instead of something that takes so much time every year for both patients and the Department.
A. Keith Ridley – Even an annual submission will take time, but I’ll take it back to the Registry Program.
Q. Michael Takano – We are all stakeholders and we work well together. One thing, maybe consider waiving our (dispensary) registration fees next year since we are undeserved by the lack of staff in the Department.
A. Keith Ridley – What does the fee have to do with it? How were you delayed in getting the program opened? Do you have a retail location open?
Q. Michael Takano – Sure, but we are waiting on branding first. That is our business decision.
Q. Rep. Della Au Belatti – We created a fund and put the industry fees into that fund. We are tracking the numbers. We want data about the sales. The industry is expecting money, they expect a level of service. But the fact these positions are not filled, sure we are saving money and rolling it over. But we can be doing better, there is still time for flexibility. Still things in the rules we can update. It is fair for them to ask about waiving the fees, though I do not agree. It is a fair question that when you look at the positions that are not filled, we are going to see a decrease in services. The one surveyor. I’m sorry I’m the one ringing the fire alarm bells, but we need to know and fix this so we don’t have these questions go forward.
Q. John Paul Bingham – We have provisional certifications for pesticide. What is happening to help the labs become fully certified?
A. Dr. Christian Whelen – The difference between provisional and full certification is just oversight. The provisional certification just means we are subjecting laboratories to additional monitoring. Originally the concept was that it would allow the laboratories to provide services until full ISO accreditation is achieved, which can take up to 3 years in the food safety industry. That timeline was not necessarily predictable in the cannabis industry. So even though some of the ISO certification came much quicker than anticipated, we still believe the laboratories will benefit from additional guidance and oversight from DOH until the industry gets a little more mature.
Q. Rep. Della Au Belatti – Mr. Ridley – I understood that DOH went to the Denver Medical Marijuana Management Conference. What was the team and the experience. Any takeaways? Next is a financial management update, any takeaways for ya’ll?
A. Keith Ridley – We found a great diversity of approaches. The taxes and fee schedules vary a lot. The use of labs and the strictness of lab testing of products was quite varied. I think to a good degree Hawaii stands out as one of the leaders as far as testing requirements and results to date. Several of us came away thinking that while we have more to do as a state, we compared very well to other jurisdictions. There were jurisdictions that were also struggling with staffing issues. And we passed business cards to see if we could recruit people. There was a good exchange with our colleagues there. Dr. Whelen also attended.
A. Dr. Christian Whelen – I took a micro and chemistry certification officer and we attended together. I wanted to echo Keith’s comments about how diverse and fragmented the approaches where across the states. In Nevada – the application for any element of the industry was just checking a box on the application, just check the box and pay the fee and you were a certified lab. I came away from that meeting feeling much better about what we are doing here. I am thankful for the efforts of everyone who has been involved in this state and glad I wasn’t in any other state.
Q. Michael Takano – The working group and subcommittees are in the final stages of providing recommendations. From your meetings in Denver, anything you can add to hot topics like vaping or reciprocity?
A. Keith Ridley – Nothing in terms of vaping. In terms of reciprocity, a conversation was started between Dr. Pressler and her colleagues in other states. They are really cautious. So in terms of reciprocity I don’t think we have anything new to provide as far as changing the statute
Q. Michael Takano – Regarding technology. Is there anything you can do to increase efficiency in the Registry Program, including regarding reciprocity?
A. Keith Ridley – No – If we decide to go that way, we will have to examine that scope of work.
Q. Carl Bergquist, Drug Policy Forum – How was the content addressed, what was the context, were there any reactions to different types of products in Nevada? Will Nevada be in trouble with the feds?
A. Dr. Christian Whelen – In Nevada it is all managed by the Department of Taxation. There could be other levels of oversight. I intended to ask about additional credentials required for licenses, but I was not able to ask it regarding labs.
A. Keith Ridley – Regarding drinkables and edibles. There were no presentations. There was not a lot of surprise about Hawaii not having edibles or drinkables in personal conversations. So it was not a part of the discussion.
A. Dr. Christian Whelen – There was additional restrictions in packaging. Part of the experience was a tour of grow site and retail location. You can remove bunnies and animals from packaging but they are still cookies and things that look like candy bars. So in terms of not confusing children or other folks about what those products actually are. There may be more that needs to be done in that vein. Just a personal observation of a medical and recreational display.
A. Keith Ridley – There were a few vendors at the display, hosted by the city of Denver, there were a couple of vendors from out of country, Netherlands and Malaysia. Stark contrasts in their approaches. Much freer in the Netherlands, though still restricted in product locations. In Malaysia, they are far behind in recognizing medical cannabis. The speaker was very sympathetic to the needs of patients, and her words was that she was trying to work hard with the Minister of Health to be less restrictive.
Q. Carl Bergquist, Drug Policy Forum – The third lab is on the verge of opening on Oahu?
A. Dr. Christian Whelen – Yes.
(Editor’s note: There no open job opportunities for any of these positions currently posted on the DOH job website. We will monitor the site and update the industry as soon as those jobs are posted).
DFI Update RE: Cannabis Industry Banking Strategies
Commissioner Iris Ikeda
I just wanted to share a little bit about a California white paper from the Treasurers office.
They identified 4 alternatives for their banking solution:
- They looked at cash handling for taxes. They recommend using armored car services. In Hawaii we looked at that, but it was not an option here because our only armored car services refused. So none of the options will serve the interested parties in Hawaii.
- Access to online banking services. They want an online portal to aggregate data from cannabis businesses for banks to have access to, so that local banks would be more comfortable with opening accounts. The Commissioner in California doesn’t think this will work, banks are still risk averse. Everyone fears the black suburbans and TV cameras showing up to raid and shutdown a bank.
- State backed financial institution like a banker’s bank. More removed from actually opening the accounts. The Treasurer recommended a feasibility study. Capitalization, risks of seizure, and ownership structures are all discussed.
- Full access to banking system. The federal solution. Multi-state consortium, all of the players joining in a multi-state consortium. So far the states of Alaska, Maine, California, Oregon, California Credit Union League, Nevada Credit Union League, and many others listed in the White Paper have all signed on to the Consortium.
That was of course the Treasurer’s report. The Banking Commissioner that is part of Brown’s administration is researching something similar to a banker’s bank. They want one of their existing correspondent banks to process the payments from banks that serve cannabis industries. We explored here, only 2 and they are unwilling.
This is the thing we talk about every 6 weeks in our Bank Commissioner’s Committee phone call. Everyone knows it is a problem and that it needs a solution. We all know it is a problem. No good solution. There is a lot of cash walking around. We continue to host these meetings.
Q. Rep. Della Au Belatti – Most intriguing is the potential for a state backed bank. What is the process for joining the consortium?
A. Iris Ikeda – The Treasurer in California is reaching out to counterparts. They will lobby or get movement at the congressional level.
Q. Rep. Della Au Belatti – They are not forming infrastructure for regional bank?
A. Iris Ikeda – No. Also on the commissioner side we are providing testimony to Congress about a safe harbor for banking. Our solution is that if a bank wants to bank a cannabis business, if the only law in violation is the CSA, then that wouldn’t be a violation of other laws on its face.
Q. Rep. Della Au Belatti – So is there any response at the federal level for us to move on, or just information?
A. Iris Ikeda – Just information. We looked at all of the solutions, none of them worked here. Every state will be different.
Q. Carl Bergquist, Drug Policy Forum – You spoke to your California Counterpart. Governor Brown and your California counterpart are considering state backed banking as well.
A. Iris Ikeda – The Bank Commissioner is looking at trying to convince a correspondent bank.
Q. Carl Bergquist, Drug Policy Forum – We are not yet there yet, what about a feasibility study?
A. Iris Ikeda – We did one on another issue, minimum requirement of 36 million in capitalization.
Q. Rep. Della Au Belatti – Was that state money?
A. Iris Ikeda – It was state money. Just for capitalization, not including operations.
Typically it is a lot more, the last bank that opened in 2006-2007 in Hawaii spent $150 million to start up. We had to close it. So there is no guarantee.
Q. Carl Bergquist, Drug Policy Forum – California – given that they are about to embark on a recreational program. Are there separate accounts. What are they doing? Or is this just a bank focused on cannabis.
A. Iris Ikeda – Just cannabis in general.
Working Group Discussion & Consideration of Subcommittee Recommendations
Q. Rep. Della Au Belatti – Senator Baker regrets her absence. She went home ill yesterday. What I’d like to propose for this part of the meeting is that we wrap-it up early. We have three reports – Education, Patients, and Licenses. We want to get through as much as possible. No voting.
So we want to discuss how to make recommendations first. There are a couple of ways – majority rules straight up and down or by consensus.
A. Senator Will Espero – Majority would be easier.
Q. Rep. Della Au Belatti – Would you want to indicate the closeness of votes?
A. Senator Will Espero – You could put vote totals in the report. It is still just a recommendation.
Q. Michael Takano – If it is a close vote, would we allow a point-counterpoint discussion and re-vote?
Q. Rep. Della Au Belatti – So majority and report?
A. General – Yes.
Q. Carl Bergquist, Drug Policy Forum – Is member presence required?
Q. Rep. Della Au Belatti – Generally yes, with some allowance for out island folks.
Q. Rep. Della Au Belatti – We will send a Doodle poll to establish the next date.
Education Subcommittee, Stacy Kracher, Chair
We started with a survey of stakeholders. There was very little participation. The purpose of the committee was to make sure that the providers, patients, and caregivers have the education they need. So we realized we have to look at this differently. So our first recommendation:
1. Establish and support with funding a Coalition for Medicinal Cannabis Research and Education to conduct and disseminate scientific research, provide education, and to guide policy development for the adoption of a statewide policy on the medicinal use of cannabis and educational material for the general public, providers, patients and caregivers.
From this group can come a lot of education and research that we can disseminate throughout the state. Based on a review of other state legislative rules based on education. One way to get education out is to mandate education for providers that are providing education to APRN’s and physicians. So
2. Based on recommendations from the Coalition of Medical Cannabis Research and Education, require the certifying physicians/advance practice registered nurses complete twelve (12) continuing educational hours, annually. The courses and hours should be monitored and tracked by the Department of Health. The educational material should be offered through an on-line learning portal, managed by the Department of Health. The curriculum should be relevant and based on up to date trends including but not be limited to:
a. The cannabinoid and the endocannabinoid system,
b. Uses, benefits, potential health risks of cannabis,
c. Diagnostic criteria, physical examination for qualifying medical conditions,
d. Ethical issues,
e. Navigating the system of care for medical cannabis patients, including laboratory testing, dispensary use, community resources available related to medical use of cannabis, etc.
f. Cannabis use in children, the elderly, and other vulnerable groups,
g. Role and responsibility of the Caretaker, and
h. Reviewing the patient’s controlled drug prescription history in the prescription drug monitoring program database.
Essentially, DOH needs help. The recommendation is to help provide education to patients. Providing caregivers with education whether via online through DOH or other venues based on the Coalition’s recommendations. We want to get correct and valuable information to patients. It is those providers and caregivers who educate the patients.
3. Based on recommendations from the Coalition of Medical Cannabis Research and Education, establish qualifications to become/remain a patient caregiver status. Caregivers should complete six (6) hours of continuing education, annually. The completion of courses should be monitored and tracked by the Department of Health. The educational material should be offered through an on-line learning portal, managed by the Department of Health. The curriculum should be relevant and based on up to date trends including but not be limited to:
a. The cannabinoid and the endocannabinoid system,
b. Uses, benefits, potential health risks of cannabis,
c. Ethical issues,
d. Navigating the system of care for medical cannabis patients, including laboratory testing, dispensary use, community resources available related to medical use of cannabis, etc.
e. Cannabis use in children, the elderly, and other vulnerable groups, and
f. Role and responsibility of the Caretaker.
Another recommendation is that UH schools be required to include the endocannabinoid system in curriculum. The University of Vermont is one of the first programs to have cannabis science in their medicine program they are a certification program.
4. Universities in State of Hawaii should consider including the study of cannabis and the cannabinoid and the endocannabinoid system in the curriculum of medical, nursing and pharmacy programs. This can ensure physicians; advance practice registered nurses and pharmacists have access to high-quality education on up-to-date research and clinical applications of cannabis for therapeutic use. They can also benefit from education on the history of cannabis, cannabis law, policy, plant biology, chemistry, and the effects of cannabis on human physiology, and the issues related to cannabis’ legal production as a medicine and the benefits and risks of its medicinal use.
Finally, passing to Karen from DOT for a few more recommendations.
Karen Kahikina – So within the report we provide some statistics on medical marijuana in Hawaii pre and post passage of the marijuana law. We think it is a problem and will be a problem. So we:
5. Recommend with funding the implementation of widespread and comprehensive educational initiatives to address public safety concerns, including but not limited to:
a. Public education campaigns by the Department of Health, Department of Transportation, the Department of Public Safety and other law enforcement agencies
b. Educational materials and information on personal responsibility and public safety provided by medical marijuana retail dispensaries to their clientele
c. Increased use of effective and efficient methods for training law enforcement personnel, including Drug Recognition Experts, to detect or measure the level of impairment of a motor vehicle operator who is under the influence of marijuana by the use of technology or otherwise.
d. Maintain and/or increase training and other support to enable law enforcement officers and prosecutors to pursue cases using available evidence.
Richard Ha – The UH System needs to be teaching about this system that is so critical to our bodies’ health. The Human body has the ability to use cannabinoids to maintain balance in the body. Only about 15% of medical schools teach this in the country. If we started to teach this at the forefront (For example, I went to the Las Vegas conference, it grew form 8,000 to 18,000 people in two years). If we are on the forefront it would help us attract more students and thus doctors to our communities.
Stacy Kracher – Thank you for the opportunity to work on this committee
Q. Carl Bergquist, Drug Policy Forum – Excellent report, very brief. On the education part requiring physicians and APRNs, so existing CE’s and CME’s would count towards that. Anyway to encourage other programs to offer CE’s and CME’s? We need more, can we mention that as one of the goals?
A. Stacy Kracher – We can add that in.
Q. Carl Bergquist, Drug Policy Forum – On the drugged driving, it is in the Patients report as well. We provide additional context for the Hawaii Department of Transportation. As long as it is in one report, when they are combined. That context is important.
A. Stacy Kracher – Some of the research from the states we looked at mandate that providers pay for this certification. We don’t have anything like that at all for providers or caregivers here. It is a strong idea that that is an important aspect. So when we look at education and the needs, we start with the people who are working with the patients.
Q. Ally Park – Are these purely THC related driving statistics. Are these only THC related accidents?
A. Karen Kahikina – I’ll check on that…
Q. Sen. William Espero – Regarding a coalition. Would this be a state function or coalition. Or are these legislative suggestions or in general?
A. Stacy Kracher – Our thought is that we tried to reach out to stakeholders, there are a lot of great stakeholders, we might get more people involved at that level. We are looking at a diverse group to be apart of the Coalition.
Q. Sen. William Espero – We don’t need legislation to form a coalition. You can form that tomorrow if you wanted to. You do need funding, but that could be funded by the private sector. We do have our own source. If you come to the state, I am concerned with mixing research and education. 321 already mandates Education in DOH, that is already in the law, I want to take the patient database but keep confidentiality, but allow the database to be used by the medical school and see if anyone wants to voluntarily participate in research programs. So research is one thing, education is different. Need to do it separately? Maybe work with the dispensaries on their own research? Once the state is involved it is a different animal.
A. Stacy Kracher – I hear you. We hit a lot of roadblocks trying to get participation. So we though this might be a better inroad. But you are right about the state involvement.
Q. Sen. William Espero – Are patients covered under HIPA privacy protections?
A. Crowd – No.
A. Sen. William Espero – It be used for science by the private sector.
A. Ally Park – Their patient data is HIPA protected, just not the fact they use cannabis.
A. Sen. William Espero – We could ask for voluntary participation if we had access to database.
Q. Rep. Della Au Belatti – I appreciate what you folks did. I’m concerned about certification requirements for APRN’s and Caregivers. There is immediate pushback. I’m nervous that this is not realistic. If we want to put this in, the caveat is very difficult. A cancer doctor may want to recommend to a couple of patients, but they won’t want to get a new certification just for a couple of patients. I don’t know where the balance is.
A. Stacy Kracher – I don’t either. But looking at other states, the way they are setup. The list of physicians that finished the training is huge. So there are states that do this. The information is varied right now.
Maybe we just require that a portion of current CE/CME be required to be related to cannabis.
For caregivers, it is just something we will have to do as the state. Sometimes caregivers are the only advocate and gardener, if we don’t ensure they have the education that is necessary for them to give them the best care and information. Not that there are barriers to that education now, it is just not encouraged.
cWe will get a lot of pushback on this.
A. Stacy Kracher – We said remain because things change. So we want to continue to want people to stay up to date.
Q. Rep. Della Au Belatti – Maybe craft the language as aspirational, not mandatory.
A. Stacy Kracher – We don’t want barriers but education.
Q. Rep. Della Au Belatti – Encourage completion.
Q. Sen. Will Espero – Is there anything like a permanent cannabis academy now?
A. Crowd – No, it is not permanent. Some mainland groups come through occasionally.
Q. Sen. Will Espero – We have had caregivers for over a decade. They know their stuff. We are here because the law said we have to be here. But how do we professionalize it into a module of information.
Q. Rep. Della Au Belatti – We can work on it to make it more aspirational.
Q. Michael Takano – To give some perspective and frame it out for a bit, DOH is out their educating stakeholders. From the beginning their priorities was the regulatory stakeholders. As we start to commercializes products, that means patients, caregivers, and providers need to be given education as well. The priorities for education need to be set so the industry receives its education. So when it comes to a recommendation, just toe help characterize who the education is for and what the goals are of that education. There may be a way of looking at that in the future, what tools were used and what reach was made to the different stakeholders and how did it go.
Q. Rep. Della Au Belatti – Number 5 is a well-worded recommendation.
Q. Michael Takano – Karen is there any new data on devices to test for impairment?
A. Karen Kahikina – Oral fluid testing. It measures recent use. But recent use doesn’t mean there is impairment.
Q. Sen. Will Espero – If I may say, 2-3 weeks, UH had a forum with continuing education. Some of the information there was just wrong. It was not accurate.
Q. Michael Takano – To establish a characterization of impaired driving, we want to protect our people .
Q. Michael Contrades – Great job to the Committee. I reviewed what was submitted and in terms of number 5 I thought it was well done
Q. Wendy Gibson, Medical Cannabis Coalition of Hawaii – You need a series of educational series that can be kept up to date. Instead of making it mandatory – just a recommendation. Maybe some check-off boxes.
Q. Christopher Garth, Hawaii Dispensary Alliance – Thank you to the Chairs, it make sense that it should be a recommendation, the idea of a Coalition in the private sector. Maybe we need an administrative body with an ability to engage with the industry effectively. Maybe a new office. Maybe a more comprehensive office than just DOH, they do not have the manpower staffing or desire to engage with education. Especially with these other stakeholders.
Patients Subcommittee, Carl Bergquist, Chair
Carl Bergquist, here are our recommendations along with supporting documentation and animating questions.
- Access to Cannabis 329 Cards for Those who Lack State ID’s
We have included specific recommendations for how to amend the HRS, DOH, and the HAR to accommodate these patients in hospices. Is there a way to meet their specific needs. Maybe even passport renewal. That could be acceptable and easier to do than state IDs.
2. Inter-island Travel.
We looked at a variety of approaches from other states. Removing the explicit prohibition on inter-island transportation would make the law silent and allow the case law to clarify. Whether it is in the case law or state law it meets federal requirements. Being silent protects the state. Some states even explicitly allow it. Massachusetts, Alaska, Washington all do. There is a way to be creative on this issue.
3. Housing Discrimination
There is some discretion in how the Public Housing Authority can give current tenants advice regarding evictions. For current tenants the laws are vague, but for new tenants they are clear. We want to provide clear guidance to the Public Housing authority.
4. Employment Discrimination
This is developing in case law around the country. A few years ago we tried to do this. There will be a lot of exceptions, including federal contracting. To have no policy is miserly. Many states have protections for the status of being a patient or passing drug tests. Case law is developing effectively in that area.
5. Health Insurance
Case law is developing here as well. We can’t necessarily require insurers to cover it. Kind of like requiring education, the requirement will meet resistance. But that is not necessarily a bad idea. One idea is to do it for a subgroup by amending Luke’s law, and then start there.
We should list it as medicine under worker’s compensation to allow the state to recognize cannabis as a medicine.
6. Adding Additional conditions
The addition of PTSD was a success, 1200-1300 patients now qualify under that conditions. Sometimes it is ok to add conditions by statue. It Helps a lot of people. There is an immediate effect. We are fighting the opioid epidemic now. We should consider following New Mexico about adding substance abuse or opioid use as a condition. There is contention on this issue, but there is a lot of good evidence for why this is a good idea. That is why the State Medical Board recommended adding it.
7. DOH Registry Recommendations
Finally a few recommendations for the DOH registry. Some of the patients want to make corrections for their applications. Right now they cannot. Some of these recommendations don’t even require changes to statutes or rules, just operational changes at DOH.
8. Finally on Drugged Driving
This was originally included, but it has been tweaked by DOT.
Karen Kahikina, DOT – We had concerns about the language in the drugged driving section, so I drafted a revision and I’ll share it with Carl so he can include it in the next draft. It touches on recommendations from the the Education Subcommittee. Including recommendations from Carl regarding a per se limit and against a per se limit for THC. Our recommendation, because marijuana can impair driving ability, we recommend that they not operate a vehicle until they are no longer impaired. Whether via education, or in some other way. It should be top of mind.
Carl Bergquist, Drug Policy Forum – This is a preemptive recommendation. We want to regulate against per se tolerance limits. Such levels simply lead to people in trouble who shouldn’t be and litigation. We don’t have a desire to do this, but wanted a recommendation against it.
Q. Michael Takano – I contributed to the insurance topic. The challenges of the industry is that a lot of stakeholders, include HEMIC are trying to navigate decisions based on state law or federal law. When there is movement in those categories they are left on the sidelines and fail to act. In the workers’ comp area, where there are no restrictions, the courts are ruling in favor of the patients, in a lot of conservative states, not the more liberal drug states. So from a public policy framework, if those restrictions aren’t there, maybe allowing that what we want to do is leave it up to the Courts. So the idea of setting up a pro side of patient advocacy and a pathway is very important. We have an opportunity to do that now.
Q. Rep. Della Au Belatti – There is a lot to digest – We will start here next meeting with this. I’ll circulate the Licensing Subcommittee, Reciprocity, and the Products Subcommittee reports. This is a good discussion.
Carl Bergquist, Drug Policy Forum – If you have any feedback prior to next meeting, let me know early. I can change the report or address those concerns.
Q. Michael Takano – Is there any requirements to include any recommendation about edibles?
A. Rep. Della Au Belatti – If there is no consensus, then say that, and provide data if there is no workable recommendation. The recommendation is that the issue requires more attention.
Q. Sen. Will Espero – Regarding the School of Medicine symposium. They only talked 20 minutes about endocannabinoids. That was a big mistake.
Q. Jaclyn Moore – Lau Ola, Big Island Dispensary – I’m a community pharmacist – regarding third-party reimbursement for cannabis. You don’t see small pharmacies anymore because of third-party reimbursements. If you are looking at a sustainable model, make sure you factor that in.
Q. Pamela Lichty, Drug Policy Forum – I was concerned about JABSOM’s CME. It was sensationalist. There were a lot of comments about how there was not a lot of research. I wrote an article that will circulate soon. I have met with Dr. Bill Haning, UH, he said he includes the Endocannabinoid segment. It might be more productive to pass a resolution that UH should expand its offerings rather than mandating it.
This speaks to the continuing stigma and so forth in the medical community in Hawaii, in a lot of states, dispensaries underwrite CME. Here legislators say it will be suspect. But it takes money. Hopefully we get to a place where we can accept that funding and still see it as an objective scientifically based program.
Q. Terry Heady, Patient Advocate – Can we get copies of these reports? We have no context or frame of reference here in the audience. Della said the right thing. I’m out of time too, I’m a patient. I don’t have time waiting for renewals. Why have us renew? My MS isn’t going away. Thank you for your work.
Q. Dana Ciccone, SteepHill Labs Hawaii – We spoke a little bit last meeting about the cleanliness of local samples. We are currently conducting research statewide and will share that info with ya’ll. A few things, a few pitfalls of our industry on the lab side is BioTrack, we need some new tabs that let us give back the samples rather than destroying them. Also, how cool would it be if dispensaries could give back to lower income patients. We also need a retest tab for earlier failed samples in BioTrack.
Q. Pamela Lichty, Drug Policy Forum – Regarding vaporizing. How do we educate DOH that vaporizing is not the same as smoking. It is an idea whose time has come many years ago. What is the process for getting past this prohibition on vaporizing and the tools to do it. It is old fashioned and out of touch with science.
A. Sen. Will Espero – There will be introduced legislation to allow vaping. We just need to introduce a bill where we clarify that vaping is not smoking. Not sure it is as easy as that, but we have to start somewhere.
Q. Terry Heady, Patient Advocate – The public interface for the medical registry program – it is horrific, not user-friendly, I can’t find things.
Next Steps and Announcements
Announcement: To get on the email list, go to Act230wg@gmail.com. All updates are also posted to the Act 230 website.
The next meeting will be determined by Doodle Poll between the Committee members (Likely December 13th).
Now it is your turn! The Alliance has a role on the Committee and access to each of the subcommittees – Products, Education, Patients, Reciprocity, Licenses, and Laboratories. We need your thoughts, comments, and detailed considerations for any and all of these committee priorities that you would like to see action or deliberation on. What did we miss? What do you think we should emphasize? The Legislative Oversight Committee will generate the successful legislative and administrative progress the industry needs in the coming years, and this is your opportunity to guide our hand.
We want to know what you think! Email us at firstname.lastname@example.org if you have any suggestions or comments, find us on Facebook, Contact Us through this website, or give us a call anytime. You are invited to be as broad or specific with your submissions as possible.
Mahalo nui for your continued support as we build a better future for Hawai‘i’s legitimate cannabis industry!
It is the Alliance’s mission to provide up-to-date and relevant industry information to the patients, dispensary applicants, and related businesses of Hawai‘i’s growing medicinal cannabis industry. If you are not yet an Alliance member, join today to receive the HDA Cannabis Insider every month and to take an active role in the future of Hawai‘i’s medical marijuana industry. Contact us today and we will send you the Winter 2017 edition of the HDA Industry Update absolutely free to say thank you for your interest!