Monday, March 24, 2014

Registry hosts Town Hall Meeting

The Colorado Department of Public Health and Environment is hosting a Town Hall Meeting on March 28 from 1:00 p.m. to 4:00 p.m. at the State Capitol Building in the Old Supreme Court Chambers.  Dr. Larry Wolk, Executive Director, will discuss proposed legislation to address Office of the State Auditor’s recommendations regarding contractors and caregiver limits, introduce a new department policy on the review of medical necessity, and provide the opportunity for public comment to the proposed legislation as well as the department's new policy on medical necessity review. 

The Department is accepting comments from 9:00 a.m. on March 24 to 5:00 p.m. on March 26. 


  1. Colorado Coalition for Patients and CaregiversMarch 25, 2014 at 10:29 AM

    It grieves me to see the CDPHE continue fighting the People's determination, now finally being confirmed through research, that cannabis is medicine, to work with other prohibitionists in State government to try to abrogate the prerogatives of patients and their caregivers and intimidate doctors, and even to contradict the few explicit requirements of our Constitution with regard to the medical cannabis program. This is just a preliminary comment on one of the items on the proposed agenda for the Town Hall Meeting. The agenda makes reference to "State Audit Recommendation #6a" (failing to note that it is referring to the recommendations made in the second part of the audit, as opposed to those made in the first part); the recommendation itself reads "Ensure the confidentiality of the Medical Marijuana Registry by: (a) seeking guidance from the Attorney General on what constitutes an “authorized employee” who can be given access to the Registry and work with the General Assembly if needed to define “authorized employee” in statute". In the agenda, proposed legislation to "ensure the confidentiality of the Medical Marijuana Registry" would instead "Define ‘authorized employees of the state health agency’ to include independent contractors ...". At the risk of pointing out the obvious, "employees of the state health agency" cannot include "independent contractors" or "other agencies employed to provide services to the medical marijuana program". The General Assembly can pass a law defining it to be midnight when the Sun is directly overhead, but it would be a no more ridiculous than to declare that authorized employees of the state health agency include people who are not employees of the state health agency. Extending access to the Register to independent contractors and other agencies (were it not illegal) could not but further compromise the confidentiality of the Register, so the provision contradicts not only the explicit language of Article XVIII, Section 14 of Colorado's Constitution, it contradicts the recommendation's own stated purpose. The proposed provision is offensive to patients, caregivers, and anyone who opposes making of our laws utter nonsense.

  2. Colorado Coalition for Patients and CaregiversMarch 25, 2014 at 1:40 PM

    Having dispensed with agenda item C. 1. ('employees of the state health agency' in Article XVIII, Section 14 of the Constitution means precisely that, and cannot be redefined in statute to include "independent contractors" or "other agencies"), I now analyze the rest of the agenda. The Legislative Audit Committee's findings and recommendations are deeply flawed because of the well-documented prohibitionist bias of its members. The duty of the CDPHE and everyone working for it is first to our Constitution irrespective of how determined or general legislators' intent to subvert it is. With regard to agenda item B, the Department cannot engage in any review of the medical necessity of recommending cannabis, both for historical and constitutional reasons. Having failed to investigate the appropriate medical use of cannabis throughout its administration of the program and having denied all applications to certify the recommendation of any medical use of cannabis despite being supported by evidence of medical efficacy, the CDPHE cannot be trusted to undertake any such review of doctor's recommendations -- its political motivation to act against physicians exercising the discretion which the Department has abused since the inception of the medical cannabis program is quite clear. The Constitution clearly reposes the authority for making the determination of whether the recommendation of cannabis is medically appropriate with physicians, not the state health agency, so do not presume to interfere with their constitutional prerogative to do so. With regard to limiting caregivers to no more than five patients each or preventing them from growing the amount of cannabis that doctors have recommended for their patients, these are entirely inappropriate infringements on the constitutional rights of patients, and the prerogatives of their physicians and caregivers. Caregivers are not competing with the overtaxed retail sale of cannabis, depriving the State of needed revenue, or evading needed regulation; they are helping patients, many of whom are poor, obtain the medicine they need. Caregivers are acquiring the empirical understanding of the appropriate medical application of cannabis which the CDPHE, in blatant misfeasance, has disdained to investigate for the entire course of its administration of the medical cannabis program. Caregivers' experience has already informed and should continue to serve to guide researchers in the design of the scientific studies which will establish cannabis' therapeutic efficacy. The Department should regard caregivers as a resource who might advance the cause of medicine and abandon its hostile, superficial determination that they have no more utility than personal assistants who supply cannabis. While no one can have any confidence that the CDPHE can administer SB155 (should it pass), it is clear that medical studies of cannabis cannot be undertaken in Federally-supported institutions -- please consider that any number of caregivers are capable of and interested in helping to conduct the studies contemplated in SB155 and can help enroll and monitor patients in them. The published agenda for the meeting about the findings of the Audit Committee and the determinations of regulators regarding medical cannabis must be rejected as representing the intent to flout both the letter and spirit of Article XVIII, Section 14 of the Constitution. Medical cannabis represents a conundrum for many in the Establishment, but our Constitution is clear enough with regard to the outrageous proposals being made to assuage their sensibilities -- you cannot declare non-employees employees, second-guess doctor's recommendations of cannabis, arbitrarily limit caregivers' prerogatives to help patients outside of a medical system that is both unwilling and unable to provide cannabis as a medicine to patients who need it. Continuing to presume to do so is antithetical to the interests of the practice of medicine and an affront to every taxpayer in Colorado.

  3. In regards to the audit report’s recommendation #3 on page 45, I agree that it no longer makes sense for patients to associate with medical marijuana dispensaries. A statutory change that decouples patients from centers would remove cumbersome plant and weight restrictions that are not currently imposed on recreational marijuana centers. Without these limits, medical marijuana centers can utilize natural grow-cycles to provide all patients with a high quality, reasonably priced medical product. The MITS system would ensure the product is not diverted into an illegal market and only medical marijuana patients have access to the medical marijuana. Eliminating the association of patients and centers would do several things for the industry:
    1. Decoupling patients and medical marijuana centers would eliminate the need for medical marijuana centers to entice medical marijuana patients to designate the center as a primary medical marijuana center. Often time’s centers lure patients to designate them as the primary medical marijuana center with sales, discounts and giveaways. A statuary change eliminating the need for medical marijuana patients to designate medical marijuana centers would eradicate the industry of off- putting “gimmicks” better suited for the used car industry.
    2. As stated in the audit and as observed in the industry, patients have a tendency to “center hop,” changing their primary medical marijuana center as often as allowed to cash in on the “sign over specials.” Because medical marijuana patients do not have a legal obligation to notify their previous center when they change over to a new center, records (and reports generated by the centers and transmitted to the Marijuana Enforcement Division, or MED) are often inaccurate. Medical marijuana centers signing a patient over have a statutory obligation to notify the previous center of the change, but patients do not always disclose to the new center that they have a medical marijuana center currently designated in attempt to receive the specials at both centers. Furthermore, centers have no way to verify how many patients are assigned to their center, making the entire statutory requirement for plant and weight counts inaccurate and obsolete.
    3. Because medical marijuana centers can sell to all medical marijuana patients, not just patients who have designated the center as their primary center, the associated between center and patient does not help the CDPHE or MED determine where the patient is obtaining their medical marijuana.
    4. The current 6 plant and 2 ounce per patient limit is well suited for the caregiver model created by Amendment 20, but does not make organizational or economic sense for medical marijuana centers designed to grow and sell medical marijuana to all medical marijuana patients. The two ounce per patient limit puts undue burden on the medical marijuana centers to stay under a weight limit. This can be especially difficult during harvests when yield can vary between strain and plant genetics. The weight limit also restricts medical marijuana patient access to a variety of reasonably priced medical marijuana.

  4. you guys rock. please make being on the mmj registry mean something because there are a lot of idiots out there making the people who really need the medicine look like a joke

  5. Dear Dr. Wolk,

    I am a practicing physician specializing in cannabis medicine in Colorado for the past four years.

    As I am not a grower, I can give unbiased input on the impact of limiting primary caregivers to growing 6 plants per patient. It would have severe impact on the ability of patients who need higher cannabis doses to obtain the amounts they need.

    Some patients need higher cannabis doses to manage their medical condition. Two diagnoses that often require higher doses are metastatic cancer and advanced pain with opiate dependence. Appropriate dosing may be 500-2000 mg cannabinoid (THC + CBD) per day. These are the doses that I recommend for these patients.

    It is often difficult for patients to secure these amounts for consistent, uninterrupted daily dosing. Higher plant and storage limits are needed to produce the material. Specific strains may be required. Given that none of the cost is covered by health insurance, cost is often an issue. Being able to resolve the logistics of obtaining their dose is a hurdle that can prevent patients from using the doses that will benefit them.

    Patients have 3 options for securing their dose. One, they can grow their own plants and prepare their own products. Some very sick patients are able to do this, or there is a family member living in the same home who can cultivate their the needed plants. Most are not able to do this.

    Second, patients can try to secure their daily dosing through an MMC. However, it is rare that an MMC can commit to providing large amounts consistently to a given patient, prepared in the way they need it, using the strains that are most beneficial for that patient. The supply for that patient may be interrupted. And, cost is often prohibitive. In my clinical experience, it is unusual for a patient to be able to source high dose cannabis needs through an MMC for more than a short time.

    Third, patients can work with an individual caregiver. My input to you is that these caregivers are often the ones serving the patients who need higher doses. Because they work with just a few patients, they can cultivate the specific strains needed. They can commit to providing medication consistently, in the forms needed by the patient. They often provide personal attention to the patient’s cannabis needs that are not filled anywhere else in the Colorado medical marijuana system.

    Allowing caregivers to grow an increased number of plants for those patients whose physician has recommended it is a vital part of serving these higher need patients. Having an individual caregiver growing for them can make the difference between having the dose needed, and not.

    If caregivers are limited to growing 6 plants only for each patients, then patients who benefit from higher doses will either have to grow it themselves, or they will have to obtain it from an MMC. I know that for many of my patients, either of these will be impossible. They will have no way to source their cannabis. The bottom line is, they will be prevented from using the doses that I recommend. They will suffer from this, I am certain.

    I do urge you to look at ways the current system is working for patients, including high need patients. Please do not restrict caregivers to 6 plants per patient. This would force many patients to work only with MMCs, which often is not their best option. Many simply will not obtain the doses they need.

    Thank you for your attention.

    Best regards,
    Margaret Gedde