Special Committee Meeting on Medical

Committee Chair Baker and committee members.

Thank you for hearing this very important topic on . I very much want to talk to you today from the viewpoint of a cannabis nurse who knows the medical potential of plant therapy and the subsequent improvement in quality of life that many patients across Kansas will experience once they have access to medical cannabis. I must make it clear that I am for controlled medical access not recreational use. Many cannabis supporters who are medical professionals across the state have been in the past, reluctant to speak up about cannabis. The stigma tied to “marijuana” (cannabis) use is being lifted and we are no longer willing to stand by in silence while patients suffer. I have reached out to hundreds of nurses in Kansas and the majority support medical cannabis use. Science verifies that Cannabis offers us a legitimate alternative to pharmaceutical products to treat medical conditions. It has been used for over 4000 years safely worldwide. Research and technology tell us cannabis should not be categorized as schedule one for many reasons, the most important being it does have accepted medical use. Since the beginning of prohibition truthful information about cannabis has been suppressed. The Federal government has provided and still does provide cannabis to glaucoma patients, (two on the program are still alive and continue to receive pre-rolled cannabis cigarettes) and the Federal Government has had a patent on CBD since 2003. If the Federal government acknowledges the benefits of cannabis, why can’t Kansas? What I am asking you to do today is to include input from cannabis educated medical professionals when formulating any cannabis legislation. We offer patient centered considerations that may be overlooked by those not familiar with how medical cannabis is being used for healing. Raw cannabis, dried cannabis, flowers and leaves of the plant are critical for treating many illnesses and science supports this. There are a lot of critical considerations you will be asked to make about this issue and sadly you will have to sift through negative personal bias and statements that are made to protect those who stand to lose or make a lot of money if Kansans laws change. We have a unique opportunity being one of the last states in the union to formulate medical cannabis legislation. We are being afforded the opportunity to examine what is working in other states as well as what is not working and come up with amazing legislation that is truly focused on patients.

I would like to explain what a cannabis nurse is. First and foremost, we are patient advocates. We strive to advance excellence in cannabis nursing practice through advocacy, collaboration, education, research and policy development. Cannabis nurses have advanced training in the endocannabinoid system and its functions, cannabis products and their use, dosage guidelines, safety while using cannabis, drug interactions, standards of practice, and we offer cannabis education to other medical professionals and general public. Thousands of nurses across the nation have formed professional cannabis nursing organizations. We attend and present National Symposium on cannabis, review medical studies, learn from scientists, researchers and physicians about the latest studies and trends in the industry. Our knowledge base is strictly backed by science and our organizations are led by nurses. Physicians, and nurses have clear standards of practice and continue developing cannabis use guidelines. We offer cannabis education, and act as a resource for patients, other medical professionals and are developing college curriculums for medical and nursing students relating to the endocannabinoid system. Many of us are involved in cannabis product development, formulation, sales and have developed patient centered businesses like care clinics. Kansas will realize many business opportunities that will encompass every aspect of this industry, from seed to sale including patient care when cannabis for medical use is legalized. Therefore, we feel strongly that you involve cannabis knowledgeable nurses and physicians when laws are being formulated. We know what patients need.

There are a couple of key points I would like to make about cannabis with the first being that we must understand cannabis is an herb. Herbal products work differently in our bodies than single pharmacologically active substances. Herbal drugs are considered less potent than prescribed medicines. The latter usually contain one highly concentrated active ingredient(s), while herbs may have several active ingredients that are chemically similar. Scientific research supports that cannabis has over 425 known compounds that are contained within the plant. Because we are uniquely individual, how one person responds to herbal plant products does not necessarily mean another person will respond in exactly the same way. Secondly, the most important point I can make today is that using cannabis as medicine is NOT about being intoxicated, it’s about triggering the endocannabinoid system we all have within our bodies and relieving symptoms. This is important when we look at restricting amounts of cannabis that might be allowed. Patients that are using cannabis for pain control in a hospice setting will require a much higher dose than someone who uses it for arthritis or inflammatory problems. We must also take into consideration that raw cannabis has its medicinal value too. Raw forms of cannabis are nutritious and NON-intoxicating. Cannabis has long been recognized as a nutrition herb and in the past was grown in gardens throughout the US. Patients must be allowed to grow a limited number of plants. New research for TCHa and CBDa the raw forms of THC and CBD shows great potential for use as an anti-inflammatory, neuroprotectant and pain killer. In an exhaustive review, the National Academies of Science and Medicine recently confirmed the efficacy of cannabis for chronic pain in adults. Interestingly, when given access to cannabis, individuals currently using opioids for chronic pain decrease their use of opioids by 40–60% and report that they prefer cannabis to opioids. Cannabis is being used to successfully treat opioid addiction with resulting drops in overdose deaths. We should have this option in Kansas. THC continues to be vilified in Kansas for reasons I don’t understand because scientific research continues to show it is necessary for the synergistic healing effects within our bodies. In other words, it takes all the plant constituents to work in harmony to effect change within the body. It is true that a lot of cannabis plants contain higher THC content than ever before because the illicit growers were meeting consumer demands from the recreational market. As we continue to evolve treating disease with cannabis, we realized the importance of other . Plant breeders are working to bring back cultivar, (old cannabis strains) that contain lower THC levels and higher levels of other cannabinoids. This will be a wonderful opportunity for our Ag related colleges to take part in developing cannabis cultivar and researching plant constituents.

Cannabis brings lifechanging healing to many but is not for everyone. There are some serious considerations patients will have to make before using cannabis. Some people simply can’t and should not use cannabis. This must be a personal decision made between the patient and physician not something dictated by the state. Cannabis trained physicians and nurses are aware of potential problems and work hard to educate patients so they can avoid untoward side effects. Access to tested, organic cannabis will also protect consumers from health complications seen when users consume contaminated illicit cannabis. I currently travel and teach a “Cannabis 101” class to nurses. I also have talked to hundreds of Kansans about cannabis over the last 2 years. Nurses are one of the most trusted medical professionals and as such people tell me a lot of things they would never admit to others because I don’t judge them or pose a threat by exposing their information. At all my classes I start by asking if attendees use any type of cannabis or know someone who uses cannabis for medical reasons. Consistently I have a 90% positive response. I ask people who admit they use cannabis where they are getting their cannabis from and I have discovered it comes from many sources. Some is obtained from licensed dispensaries from recreational states and is brought back in vehicles or by plane when returning home. Some comes from Kansans who grow cannabis and sell it to those who use it as medicine or recreationally. Some is obtained on the illicit market in legal states because the cost of tested products from dispensaries is more than people can afford. Some get cannabis from family members who live in legal states. Lastly, some grow plants at home and make cannabis products for themselves or family members. People have realized they can improve their health by using cannabis. Because patients must do all this in secret and alone without support, we are seeing problems that we would not see if they had guidance from medical professionals.

We have concerns just as you do related to overuse syndrome, safety for self and community, prevention of child access as well as meeting educational needs of consumers. These concerns can be successfully addressed in our state just as they are successfully being addressed in other states. In the past we have heard concerns about children and teens having access to cannabis if we allow medical use. It is critical to remember medical cannabis products are not marketed for children, teens or the recreational market and we will need to educate parents and youth about cannabis safety. When you are presented with statistics please examine them and ask yourself if it is a statistic that reflects recreational use or medical use? Can medical cannabis products be diverted for recreational use? Of course, they can and that being said, it will be important to have stiff consequences for diverting medical products for illicit use. We have a geographically diverse state. We struggle in less populated areas of the state to provide social and medical services now. We have the chance to improve access with revenue gained from cannabis sales. Providing access to our aging rural population is a big consideration. The largest population of new cannabis users is over the age of 55. Patients must be able to grow their own plants if they are unable to get to a dispensary. There are many reasons people may be physically unable to visit a dispensary. Limiting factors include the distance to a dispensary, finances, reliable transportation and limited physical mobility. Caregiver options work well in other states and must be considered here. Caregivers are licensed community members who agree to grow plants for those unable to grow plants themselves. It is strictly controlled. Other states have effectively reduced the illicit market when affordable cannabis products were easily accessed by patients. I know there is a fear that plants will be grown and sold by licensed patients. There is new technology for plant tracking that other states are employing. We can make this work here; these challenges are not insurmountable.

Recently two more National Organizations have come out with support statements for cannabis. They are the Arthritis Foundation and AARP. This is huge and speaks to the acceptance that cannabis does have merit and we must have law changes to study it in depth. More and more powerful influential organizations are coming out with support statements. We can no longer use the tired old excuse “it needs more study before we can move forward.” Despite scientific support, support from the medical community, and National Organizations there is still major pushback from Kansas Law Enforcement. I whole heartedly support and agree that law enforcement are the experts when it comes to illicit cannabis use and the problems it presents. They are not however the experts on medical use, cannabis trained medical professionals are. In the past they presented statistics about crime and illicit market increases that we may see if we allow medical cannabis. We must look at other medical only state’s statistics not recreational state statistics to get an accurate assessment since we will be medical only. Kansas also needs to keep statistics that will show more detailed information if we wish to track cannabis related information in the future. Law enforcement organizations like Law Enforcement Action Partnership speak out about ending drug prohibition because it does not work. To quote from their website “The Law Enforcement Action Partnership recognizes that currently illicit drugs pose different risks, requiring different models of regulation. “and ”The Law Enforcement Action Partnership believes that adult drug abuse is a public health problem and not a law enforcement matter,”. We have two members from that organization working here in Kansas. Polls done on a national level show that 68% of police officers are for some form of cannabis legalization. We must find a way for all Kansas law enforcement agencies to work together for the betterment of public health and safety when patients are allowed to use medical cannabis. We are seeing a movement to decriminalize possession for small amounts of cannabis in Kansas communities. Laws are going to continue to change and decriminalization for small amounts of cannabis is going to continue to expand across the state as cities adopt this cost savings option. Changes in the law have brought confusion for all Kansans. There is conflicting, misunderstood information out there and we must take steps to ensure all involved with cannabis have easily understood accurate information. At some point law enforcement will have to find ways to meet the challenges these changes will bring.

Research tells us that pain conditions are the number one reason people want to use cannabis. Opioids their side effects and resulting addictions have led patients to look for alternative methods for pain relief. Opioid deaths and suicide continue to rise in Kansas while in states with cannabis laws they decrease. We have a critical shortage of mental health services throughout this state. If you are un-insured or under insured your access to counselors, psychologists or psychiatric services is limited or non-existent. People undergoing a mental health crisis are often told “there is no room at this time, and you will have to wait until we have space open” to get help. Some are even told inpatient services are unavailable and they must make do as an outpatient. This leads to many social problems as people spiral into depression, lash out at others or commit suicide. Many other states use revenue gained from cannabis to bolster up lacking or non-existent mental and social services. It is critical that Kansas do this. When we look at how cannabis has benefited other states we see statistics that show numerous economic benefits such as job creation, increased tax revenue, increased mental health services, drug abuse programs, help for homeless, school improvements, and addition of other social services benefitting all age groups.

Lawmakers must take steps to ensure that cannabis used in Kansas is grown, processed, made into products patients want and use, and sold by local businesses to patients supported by medical professionals. You must take steps to keep license fees affordable so Kansans can develop cannabis businesses. Other states have passed laws effectively blocking out any opportunity for their residents to own or operate growing facilities or dispensaries due to high licensing fees. Big business was happy to take over production, manufacturing, sales as well the income generated from all sales. We must not let that happen here. What ever legislation is enacted does not have to be overly complicated. Care should be taken to exclude influence from alcohol, tobacco and corporations. Oklahoma got so many things right and Missouri took their example and improved on it. We can avoid pitfalls that some other states experienced because we have data showing what works and what does not. We have learned from past mistakes and now have the opportunity to pass legislation that will not require ongoing amendments to fix oversights or omissions. Take for example when Oklahoma tried to require Pharmacist oversight in dispensaries. They determined it is not needed because we are dealing with a plant not a pharmaceutical product. We do not need to make that mistake. We must implement plant tracking, child protective packaging, testing guidelines, and mandate education for all workers who sell cannabis. Medical professionals working with cannabis patients must have mandatory educational updates. Studies show that the illicit cannabis market decreases when legal cannabis is kept affordable. One of the most common complaints about medical cannabis is that it becomes too expensive to purchase legally. We must also consider a program that will help get cannabis products to those that need it but can’t afford it. Missouri has a program that addresses this.

Revenue from cannabis must be used to address mental health and addiction needs. We must bring back social services that have been cut due to insufficient funds at the state level. We must bolster senior services, develop cannabis education for the public and begin cannabis education with elementary students. Simply telling teens and young adults not to use it does not work. They can be taught scientific facts about use and risks at an early age so they will be better able to make good choices about what they put into their bodies as they grow and mature. There are concerns teen use will increase if we allow medical cannabis and that cannabis use will lead to other drugs. Research does not reflect that this is happening. The drugs most teens start with are alcohol, tobacco and caffeine. We see nicotine addiction already in children as young as 11 related to vape pen use. There are concerns that the developing teen brain will suffer damage such as lowered IQ if they use cannabis. Newer research does not reflect this happening as scientists have discovered no changes in IQ tied to cannabis use. What they did discover is that there are other psycho-social factors that contributed to IQ decline that was originally blamed on cannabis use. Addiction to any substance is such a complicated issue and there is no clear answer why some users suffer from overuse syndrome and so many others do not. The persistent myth that cannabis is a “gateway” drug has been debunked time and time again over many, many years. Studies continue to show it is an “exit” drug because of its ability to allow opioid reduction and reduction of many pharmaceutical drugs. Trained medical professional oversight offers self-assessment tools for cannabis users that can help recognize signs of cannabis over use syndrome and appropriate help can be offered.

I have included links to studies that support research I have talked about. I thank you for your consideration and willingness to listen to how medical cannabis use can be a positive change for all Kansans. Again, I look forward to new cannabis legislation that meets the needs of cannabis patients. I also hope you will also consider adding cannabis trained medical professionals to ensure patient needs are met when drafting new legislation.

Sincerely,

Cheryl Kumberg RN, CMT

Member American Cannabis Nurses Association

Cannabis Nurses Network

References:

Prohibition information-http://www.drugpolicy.org/blog/how-did-marijuana-become-illegal-first-place

Why Kansas should legalize medical cannabis- https://www.kansas.com/opinion/opn-columns- blogs/article223398620.html

Data on who uses cannabis- https://www.washingtonpost.com/business/2018/09/20/marijuana-use-is-now-common- among-baby-boomers-it-is-among-teens-federal-data-show/

Qualifying conditions for cannabis use- https://www.marijuanabreak.com/qualifying-conditions-for-medical- marijuana-2017

Simple guide to endocannabinoid system- https://www.healthline.com/health/endocannabinoid-system-2#how-it- works

Support for policy reform- https://www.mpp.org/issues/legalization/support-for-marijuana-policy-reform/

https://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html

Economic benefits https://cannabiz.media/the-economic-impact-of-marijuana/

Social impact of legalization- https://cannabiz.media/the-social-impact-of-marijuana-legalization-in-the-united-states/

Packaging information- https://cannabis.ca.gov/2019/03/07/new-resources-for-packaging-and-labeling-of-cannabis- and-cannabis-products/

American Nurses Association Position Statement- https://cannabisnurses.org/acna-position-statements The NCSBN National Nursing Guidelines for Medical Marijuana https://lookaside.fbsbx.com/file/2018%20- %20The%20NCSBN%20National%20Nursing%20Guidelines%20for%20Medical%20.pdf?token=AWwEMO_y_o_DhmO0aL EdUz_BV6OLVuW9Sc9lrCnKLPoFmk4QSZ9kQCfXetx9YMCAvzQNWfQoccdD1D6H8vxl- 3a7NaE_s84fAoaRAYpSUDD202ld2EcwPViid7awuYgCqMNF5eSWYbCPl11Tk8d13APt

Support for Cannabis Nurses: Published in Forbes 2019 Cannabis Nurses: An Emerging Specialization And Vital Resource For Seniors https://www.forbes.com/sites/abbierosner/2019/04/18/cannabis-nurses-an-emerging-specialization-and- vital-resource-for-seniors/?fbclid=IwAR1AgGuThzi3KcwkYqXReG89_UW5vpf3eHI0AhPOw7poyVLpEAa1x27ow- M#1c61a35e3f7f

6. The Rise of the Cannabis Nurse-https://nurse.org/articles/cannabis-nurse/

7. What is cannabis nursing? https://cannabisnurses.org/Resources/Documents/Nursing-Policy/Nurse-Member- Publications/what%20is%20cannabis%20nursing.pdf

8. Caring for patients using medical marijuana- https://www.journalofnursingregulation.com/article/S2155- 8256(19)30148-6/abstract?fbclid=IwAR0Vrjv2OHpNyPCzSJ6Zbq9ZSi-HG_I8zjOlmO-gSzSShyYhoZyT9GlCSXA

Benefits of raw cannabis- https://www.marijuanadoctors.com/resources/methods-medicating-cannabis/eating-raw- cannabis/

Cannabis is a Nutritious herb https://www.leafly.com/news/health/a-dietitians-perspective-on-cannabis

Arthritis Foundation guidance for CBD. https://www.arthritis.org/Documents/Sections/Arthritis-Foundation-CBD- Guidance-for-Adults-PDF-9-23-19-(1).pdf?fbclid=IwAR2tK8n_1M0ROSM677a6mBskJaNqFt9zrJ0XjjtGmHl- x9mXK6GK8W6ro0s

AARP Article https://www.aarp.org/health/drugs-supplements/info-2019/basics-on-medical-marijuana.html Teen use study-. https://www.sciencemag.org/news/2016/01/twins-study-finds-no-evidence-marijuana-lowers-iq- teens

Recreational cannabis hurting medical patients https://sanfrancisco.cbslocal.com/2019/06/25/california-laws- medicinal-cannabis-hurting-patients/

High cost of cannabis https://www.staugustine.com/news/20180831/medical-marijuana-is-legal-in-florida-but-its-high- cost-puts-it-out-of-reach-for-many

Retail warnings about rising cost of cannabis-https://www.cnbc.com/2019/03/28/medmens-financial-troubles-are-a- warning-for-the-marijuana-industry.html

Brain study-https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-long-term- effects-brain

Brain study debunking damage reports-https://truthout.org/articles/latest-science-debunks-claim-that-marijuana- significantly-harms-brain/

Gateway drug debunking from Texas legislature- https://www.kut.org/post/no-experts-dont-consider-marijuana- gateway-drug-six-fact-checks-texas-legislature?fbclid=IwAR3JBLBtb0gi5pEWsQ7L7r15PytIkOjJpKzY_ZA5oR_KzgJkV6pO- her-A4

Debunking Gateway theory Drug alliance- https://www.drugpolicy.org/sites/default/files/DebunkingGatewayMyth_NY_0.pdf

Drugabuse.gov debunking article-https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana- gateway-drug

Legal cannabis reduces opioid overdoses. https://www.marijuanamoment.net/marijuana-dispensaries-reduce-local- opioid-overdose-rates-study-finds/

Decline in opioid overdose article- https://www.marijuanamoment.net/marijuana-legalization-causes-significant- decline-in-opioid-overdoses-new-research-finds/

Cannabis role in opioid use disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/

Pain pill reduction using cannabis https://www.marijuanamoment.net/two-more-studies-show-patients-are- replacing-prescription-painkillers-with- marijuana/?fbclid=IwAR2n3QcUzKOq4Wubku_DVwMs6YnRjpd66meO8eO8rGVU8WK733p3Td7kIzc

Drug policy Alliance status report. http://www.drugpolicy.org/legalization-status-report

Police favor cannabis https://www.pewsocialtrends.org/2017/01/11/police-culture/psdt_01-11-17-police-06-03-2/

Law Enforcement Partnership Information-Prevention- https://lawenforcementactionpartnership.org/our- issues/incarceration/

Law Enforcement Partnership drug policy information- https://lawenforcementactionpartnership.org/our- issues/drug-policy/

Police poll graphic- https://www.pewsocialtrends.org/2017/01/11/police-culture/psdt_01-11-17-police-06-03-2/

Submission for electronic records 10-25-2019

RE: Special Committee Meeting October, 23, 2019

Dear Committee chair and members:

Thank you for holding a hearing on this important topic. Moving this issue forward is critical for patients and the state. We must take action to stop millions of dollars from flowing out of our state into other states for cannabis related products. There seems to be some confusion within the committee on terms used during testimony and about plant constituents. I hope that by clarifying some of them, you will gain better understanding. As a nurse and cannabis educator I did not feel that law enforcement could or should provide the information you needed and Dr. Voth made some confusing statements as well.

THC- THC and or delta-9-tetrahydrocannabinol or Δ-9-THC are all the same thing. It is “THC.” It is just one molecule or out of 113 in the cannabis plant. It is the one most people know as causing intoxication.

Psychoactive or intoxicating? All parts of the cannabis plant cause psychoactivity. Psychoactive effects occur when chemical substances change a person’s mental state by affecting the way the brain and nervous system work. Cannabis does promote relaxation, sleepiness, and relieves pain so yes, you can say it is psychoactive. Intoxication is a better description of the effects of THC. The intoxicating effects of THC include relaxation, sleepiness, and mild euphoria. Cannabis can cause undesirable side effects, which increase with higher doses. These side effects include decreased short-term memory, dry mouth, impaired perception, impaired motor skills, and red eyes.

More serious side effects include panic, paranoia, or acute psychosis, which may be more common with new users or in those who already have a psychiatric disease. Please know psychosis is a less seen problem and many factors come into play. Psychiatric symptoms can be manifested in people who ingest too much THC or those who are not sensitized to it. ALL symptoms are self-limiting and go away in hours. There have been rare reports of on-going mental health issues but it is unclear what if any part cannabis played. The degree of side effects varies from person to person, as well as with the amount of marijuana used. Patient education decreases the unintentional overuse of THC and lessens side effects. Cannabis used as medicine is grown organically, lab tested and verified free of heavy metals and contaminates. This process dramatically decreases the risks of side effects.

THC “Overdose” refers to over consumption of THC. It has been called “toxicity” but cannabis is recognized as being “non-toxic” as you heard during testimony. A person cannot lose their life as a direct result of ingesting too much cannabis. Scientific calculations for a lethal dose is 46 pounds of 1% marijuana ingested at one time. All untoward symptoms are self-limiting, go away within hours, and will not cause respiratory depression unlike many other legal and illegal drugs. Symptoms seen are nausea, vomiting, fast heart rate, anxiety, and paranoia. People who have health conditions such as heart disease may have problems that need medical attention if severe. Rare side effects may include sudden high blood pressure with headache, chest pain and heart rhythm disturbances. If a person develops these symptoms, he or she should seek immediate medical attention, just as with any other medication side effects. http://druglibrary.org/schaffer/library/mj_overdose.htm

Cannabis Plants- To quote cannabis physician Dr. Frankel, “the recreational market has ruined cannabis used for medical purposes.” Cultivar (plant types) were bred to produce high THC content to meet illicit consumer demand. As more people use cannabis as medicine, plant types are being developed to meet their needs. Older cultivar was much lower in THC and higher in other plant molecules. Plant breeders have been working hard to produce plants high in other cannabinoids (plant molecules) that trigger healing benefits. These cultivars include plants that are high in CBD, yet low in THC. There are over 750 plant types with more being developed at this time.

FDA Testing

1. Industry experts consider cannabis a plant, therefore an herbal supplement as defined by the FDA. Manufacturers do not have to seek FDA approval before selling dietary supplements, therefore this should not be a requirement for products containing cannabis. Conflicts do occur, however, when cannabinoids (CBD, THC) are added into food type products. These products would fall under the FDA guidelines. https://www.fda.gov/food/dietary-supplements

Study Information- It is critical when looking at statistics to compare apples to apples and oranges to oranges. We must be able to interpret information and look deeper using common sense. We are not talking about the illicit drug market. Thousands of Kansas are using cannabis illegally right now. They are driving and working. Have statistics changed drastically? We know drug addicts use many different drugs to enhance their “high.” Often meth, alcohol, cocaine, or heroin is combined with cannabis to enhance their effects. Kansas does not keep statistics (they need to start) that break out what was in people’s systems when involved in traffic accidents. How can we know the real picture if we have incomplete statistics? We are left to speculate. When you see a study that says “marijuana was present” you must ask what other drugs were present, what levels were present, and which drugs may have had such high levels that it resulted in the accident. It is well documented that cannabis levels in the blood do not indicate impairment.

When we look at child THC intoxication we must consider several factors. What led to the exposure? Parents that failed to secure the cannabis? An example: When Colorado took a hard look at exposure for some children it was evident that parents that worked in hotels took left over recreational cannabis products home and left it where children could consume it. All controllable conditions. Not one death has ever occurred from cannabis. Symptoms if severe require supportive care until they dissipate. Cannabis will not depress breathing or cause organ damage/failure like we see when children ingest household cleaners and pharmaceutical products.

Cannabis does not have a predictable window of effect. It is an herb containing many different molecules that effect the body in different ways. In 1992 researchers discovered we have an endocannabinoid system. This system is responsible for maintaining our health. Herbal therapy not like pharmaceutical therapy. There is a difference and some physicians are uncomfortable with that.

Addiction- Medical professionals are still working on terminology, but at this time, many prefer to call what we heard referred to as “overdose” and “toxicity” as overconsumption. Someone who uses too much cannabis on a regular basis has “overuse syndrome.” It is not a physical addiction like meth, heroin, or cocaine. It has a mental component and people will suffer symptoms similar to caffeine withdrawal when they stop using cannabis if they suffer from “overuse” syndrome.

Vomiting- There is a condition called cannabinoid hyperemesis syndrome. What that means is people vomit, sometimes severely, when they use cannabis and their body can no longer tolerate it for whatever reason. It is generally seen in people who consume a substantial amount of cannabis with high THC levels. This condition is mostly seen in consumers from the illicit market. There are some theories as to why this happens but no clear conclusions. Pesticides, fungicides, mold, heavy metals or high THC levels are known to cause untoward reactions. Cannabis grown for medical use will tested for contaminants.

THC overuse- is a result of educational deficits in most cases. When cannabis is used under medical supervision patients are given guidelines to avoid this. One thing we are seeing in Kansas now is that people do not understand how edibles work. They ingest some and then ingest more too soon leading to high THC levels and side effects. We have already begun educating health professionals and lay people on the different modes of administration and the onset of action.

Law enforcement- does not understand cannabis plant science. ALL cannabinoids in raw form (cannabinoids from live living plants) are NON intoxicating. They are denoted by their chemical name or abbreviation followed by a small a. So THC (a) tells us it is THC in raw form. THCa is NOT intoxicating. Some providing testimony did not seem to understand this. THCa has been recognized for its anti-inflammatory properties. It is used to treat arthritis and lupus, has neuroprotective properties for treatment of neurodegenerative diseases, treats nausea and appetite loss, and is useful for tumor reduction. The only way THCa is converted to intoxicating THC is by heat or drying. Using cannabis as medicine is not about being intoxicated. This being said, THCa does not make THC unnecessary. It is imperative to use both forms of THC to obtain healing effects. Whole plant therapy yields best results. https://healer.com/programs/strategies-for-non-psychoactive-cannabis-use/

Pregnancy-Cannabis is not recommended during pregnancy! It is unclear if there is real harm to the fetus. Studies from other countries where mothers consume cannabis during pregnancy have not noted developmental delays in children monitored from birth to 5 years old. Cannabis use should remain a physician-patient matter.

Dr.Voth- I refer to statements taken from verbal and written testimony. Support links below each section.

First and foremost I think it is important to refer to medical conditions using proper terminology. The term for vomiting seen when overusing cannabis is called cannabinoid hyperemesis syndrome. NOT abdominal vomiting syndrome as stated. Link below. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/

“I urge you not to place our citizens at risk and medical providers in the difficult situation of recommending an illegal, impure, dangerous substance to patients.”

1. Federally illegal yes- most every state in the union has adopted some form of legalizing. 2. Impure- organically grown is mandatory for human consumption of cannabis being used as medicine. Illicit market is impure because there is no control over growing conditions. We are not talking about illegal market. 3. Dangerous- Cannabis has been documented as being safely used for over 4000 years. World Health Organization is even calling for de-scheduling now. https://www.forbes.com/sites/tomangell/2019/02/01/world-health-organization-recommends-rescheduling- marijuana-under-international-treaties/#49bd625e6bcc

“Crude”or “Street marijuana” means illicit. We are not talking about illicit cannabis we are talking about organically grown, certified, tested, labeled, and medically supervised . Admittedly, people have free choice as to how they use it and we can not control every aspect once the products are in the consumers hands.

Synthetic THC or “Marinol” is a concentrated pharmaceutical product. It has side effects patients do not like, and it is expensive (2.5mg dose is 23.10 each or 693.00 for 30 days). It lacks the synergistic effects of real whole plant products and patient satisfaction is not always good. It also has addiction potential. https://www.goodrx.com/blog/marinol-vs-marijuana-whats-the-difference/ https://norml.org/marijuana/medical/marinol-vs-natural-cannabis

Epidiolex is made from one cannabinoid () and is a highly purified plant product. There are 113 cannabinoids in cannabis, each one plays an important role in triggering responses in our bodies. It takes all plant constituents (chemical compounds) to work best. Yes, CBD is at this time unregulated but reputable manufacturers of CBD products have each and every bottle tested with laboratory results available to consumers verifying what is in the bottle. It is up to the consumer to do their due diligence to ensure they are buying quality products, not unlike buying any herbal product. Education can help people make good choices.

“in order to be considered a medicine, drugs are required by the FDA to undergo several levels of carefully controlled scientific investigation.”

1. Cannabis is considered a herb. It is used as “medicine” but is not a pharmaceutical product unless it is made by a pharmaceutical company. Cannabis is a genus of flowering plants in the family cannabaceae. www.wikipedia.org/wiki/Cannabis

2. FDA states this-Herbal supplements are regulated by the FDA, but not as drugs or as foods. They fall under a category called dietary supplements. The rules for dietary supplements are here; https://www.fda.gov/food/dietary-supplements

Facts on PTSD symptoms becoming worse- I will just list 2, there are many more that refute this. Anecdotal reports from thousands of PTSD veterans has prompted a study by the VA.

Five studies were identified that evaluated the use of marijuana for PTSD. Clinical significance is unclear. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007739/

Lead author Dr. Alexander Neumeister stated, “There’s a consensus among clinicians that existing pharmaceutical treatments such as antidepressant simply do not work. In fact, we know very well that people with PTSD who use marijuana — a potent cannabinoid — often experience more relief from their symptoms than they do from antidepressants and other psychiatric medications. https://healthcareinamerica.us/cannabis-key-treating-ptsd-b4abf432215

Pain relief using Cannabis-Patients are getting pain relief from using whole plant cannabis products. https://www.practicalpainmanagement.com/patient/treatments/marijuana-cannabis/navigating-cannabis-options- chronic-pain

Teen use-Young people will not being put at any more risk than they are now. The illicit market is booming in Kansas. Teen use is a complicated psycho-social problem and we know that risk taking is part of teen growth/development. Cannabis is not recommended nor marketed to young people.

If we do not move forward to legalize cannabis immediately:

1. Kansas will continue to lose millions to other states. 2. Kansans will continue to close their business, sell their homes, and move into another state to have access to cannabis. 3. Kansas will remain on the “do not travel through if you have cannabis” lists and blogs. This impacts hotels, restaurants, and many other businesses. 4. Illicit cannabis markets will continue to flourish posing a health and safety risk to the public.

Lastly, we need to have reciprocity with all legal states for medical card holders. We need to encourage people traveling to stop and take advantage of all Kansas has to offer. Including purchasing legal cannabis products.

Sincerely,

Cheryl Kumberg RN,CMT

Kansas Nurses for Medical Cannabis