05/28/17 Rachel Knox

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This week on Century Of Lies, more from the Patients Out of Time National Clinical Conference on Cannabis Therapeutics, with attorney and veteran Brandon Wyatt and physician Dr. Rachel Knox, plus California Assemblyman Ken Cooley on regulation of medical and non-medical cannabis in the state of California.

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TRANSCRIPT

CENTURY OF LIES

MAY 28, 2017

TRANSCRIPT

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Well folks, the Patients Out of Time National Clinical Conference on Cannabis Therapeutics wrapped up last weekend, it was May 18, 19, and 20. While there, I got some good audio. A couple of the people I wanted to interview, Brandon Wyatt, he's an attorney in Maryland and DC, a military veteran, who's part of the Weed For Warriors Project, and also Dr. Rachel Knox, she's an MD, in practice up in Portland, Oregon. Both of them are strong advocates for the patients, and well, I got them both there at the same time and figured that the best way for this to work would be for them to interview each other, so, here they are.

BRANDON WYATT: All right, so, my name is attorney Brandon Wyatt. I'm here at the Patients Out of Time conference, who've been leaders in cannabis education and advocacy since 1995. I work with the Maryland Medical Cannabis Commission as a diversity consultant, I'm a civil rights attorney, and I'm also a proud member of the Minority Cannabis Business Association.

RACHEL KNOX, MD: All right. And I'm Doctor Rachel Knox. I am the current medical chair of the Minority Cannabis Business Association, and I'm also a co-founder of a group of physicians who call ourselves the CannaMDs, and co-founder of the American Cannabinoid Clinics with those same docs, that happen to be my mom, dad, my sister, and myself.

BRANDON WYATT: Well, it's super, super awesome to be standing here with you today, Doctor Knox. One of the things we talked about this week at the conference was really eliminating barriers, discrimination, and bias, and also some of the conflicts in policy as it relates to being able to treat patients. One, from a rudimentary level, even talking to them, and two, from a business level, what happens as far as punishments and restrictions that doctors are placed on, or that even attorneys are placed on, when we try to assist in the terms of cannabis.

So, in your opinion, what are some of the experiences that you've gone through with the demographic of citizens that you've treated and helped, and how are they affected by different policy coordination issues?

RACHEL KNOX, MD: Well, I think that's hard for me to answer, because when I see patients, that's exactly what I'm doing. They're coming to me for the very service that I provide them, and the things that I hear patients complain about the most is not their access to me, they're thankful for physicians like me, but it may be access to affordable, you know, medicines.

In Oregon right now where I primarily see people, there's just a dearth of therapeutic grade options in the dispensaries now that we've had this recreational overhaul, so that's been an issue. Plant limits has always been an issue. Identifying your own growers continues to be an issue in the state.

BRANDON WYATT: I think you guys this Tuesday have an election coming up [sic: there are bills currently in the state legislature, not before the voters], on Tuesday, to kind of determine what should go on with how the medical patient caregivers are able to sell to dispensaries, and being able to keep that market open --

RACHEL KNOX, MD: Yes.

BRANDON WYATT: For individuals who've been treated by one physician and one caregiver for years --

RACHEL KNOX, MD: That's correct.

BRANDON WYATT: Seeing that on the ballot now is a challenge, it's very interesting. After speaking with a young man, Mister Sajo [sic: John Sajo is actually in his late 50s], a longtime activist and grower up there, he noted that that industry would have a surplus in your state of almost a billion dollars of cannabis if they just allowed the current patient caregivers and growers to sell back to the dispensaries, and making sure that their patients are taken care of. In the business sense, a billion dollar waste just not to help patients, it seems to be directly correlated to, what do you think?

RACHEL KNOX, MD: That's outside of my purview, Brandon.

BRANDON WYATT: Well, I guess that brings me into my fight, you know.

RACHEL KNOX, MD: Yeah.

BRANDON WYATT: I guess that brings me into my fight, and the reason I say, you know, that, is because as a veteran, my demographic doesn't have access to physicians that they can speak to. They don't have access to the VA doctors to talk to them like they may talk to you.

In addition, too, they don't have access to medical strains, so what we've had to work with at the Weed For Warriors Project is finding ways to give that away, and also finding ways to show businesses corporate social responsibility, and to make sure that they work to make political decisions and vote in ways that allows individuals that are disadvantaged to have access to the medication, and access to the physicians, you know. So it seems to be kind of a two-fold fight.

RACHEL KNOX, MD: It is a two-fold fight. I know one of the commissioners from the OLCC in Oregon contacted me about my thoughts on patient allowable limits. So, what's going on right now is that recreational growers are going to be allowed to grow for medical patients, which, I even asked her, I didn't get a direct answer to this question, was, is this a play to push out the caretakers, the growers by opening up, you know, the recreational cultivation to the medical portions, and, I didn't get the answer to that question, but I was able to break down medicine for her.

BRANDON WYATT: Right.

RACHEL KNOX, MD: You know, not being asked up front what makes sense for a patient is a little frustrating, but I was very grateful for the opportunity to impart some wisdom, and my response to her, because right now there's supposed to be a three pound annual limit for patients. Is that enough? Well, for a person who just smokes all day every day, maybe. For somebody who's making their own tinctures or their own topicals, or people who need full extract cannabis oil, or people who juice their cannabis?

BRANDON WYATT: There's absolutely not enough.

RACHEL KNOX, MD: That might be 72 pounds of raw plant annually.

BRANDON WYATT: Right. Right. Because it's used differently. They don't understand the different methods of consumption.

RACHEL KNOX, MD: Exactly, and how much raw material it takes to produce some of those administration methods. Right? And so, the issue there is that if you don't directly address that discrepancy, you're going to have people growing, you know, hundreds of plants on their own anyway. Going to their neighbor, going back to the black market. You're not going to capture that money.

BRANDON WYATT: In a business sense, it makes sense to stay patient oriented, even as we push forward legislation.

RACHEL KNOX, MD: You have to stay patient oriented.

BRANDON WYATT: Having to stay patient oriented.

RACHEL KNOX, MD: I feel like I'm saying this ad nauseam, like, cannabis is medicine first, and if you lose sight of that, the industry's going to go under.

BRANDON WYATT: Absolutely.

RACHEL KNOX, MD: It's going under, and it's absolutely going to bend to big pharma.

BRANDON WYATT: Absolutely. And, you know, I guess just to kind of tie it all together, last year, when we first got the opportunity to meet and speak, I put on stage a young man who's 81 years young, veteran from Vietnam, and he had Agent Orange, to the point he would not go outside, it would have outbreaks on his face, have outbreaks on his hands, and it was very uncomfortable for him to even be seen.

The medicine that they gave him at the VA was camphor oil, which irritated his skin, and it took the Project to find another veteran. And this veteran actually owned a business, like, a massage therapy business, to actually make the kind of extract and oil that wouldn't irritate his skin, but it was cannabis based. He started using it, and this man hasn't had an outbreak, where he was having one every three weeks, he hasn't had an outbreak in almost six months.

RACHEL KNOX, MD: That's wonderful.

BRANDON WYATT: So he was able to actually at 81 finally now start to regain full function of life, and I think that's important for, you know, our veterans, I think that's important for our patients, I think it's important for kids. So, you know, having these conversations --

RACHEL KNOX, MD: It's most the important thing.

BRANDON WYATT: Right.

RACHEL KNOX, MD: Having this conversation.

BRANDON WYATT: Having this conversation with you, you know, and that's the thing, you know, once again, hearing from medical professionals, you know, actually aligning and saying that this is the most important thing, gives me a little bit more fight in court, because it overcomes medical necessity. Sitting here looking at one of the leaders, Irv Rosenfeld, now, who's had the ability to, you know, receive cannabis from the federal government for years, following on the case of Robert Randall, it does make sense that medical necessity is at the forefront now, and that we're not bickering over whether it's a question of it.

RACHEL KNOX, MD: Think about this, like, cannabis can be used symptomatically, you know, palliatively. It brings back quality of life as you mention, but unless we figure out this health and disease thing that we've got going on in this country, people are going to continue to get sick, and we are getting sicker, at an increasing rate. Right? We are the sickest first world country, yet we have all the technology, all the leading scientists, researchers, and physicians. Right? We have top tier, world renowned medical schools, and residency programs. Right? Our training really is second to none, yet still, we have a very sick and dying population.

BRANDON WYATT: Right.

RACHEL KNOX, MD: Right?

BRANDON WYATT: Absolutely.

RACHEL KNOX, MD: Everybody is going to become a patient eventually, and we're putting all this emphasis on these recreational markets, which, yeah, it's, you know, federally outside --

BRANDON WYATT: It's trying to break it down into tiers that, maybe, we should just stay focused on one and complete before we try to move on.

RACHEL KNOX, MD: Focus on one complete roll out system, and we'll just suppose that's medical, which in my opinion it should be, but, if we do it right, if we are creating therapeutic grade, safe, clean medicines across the board, well then, we're not worried about what that's going to do to the recreational user. It's a safe product. It's medical grade, it's therapeutic. It's not harmful. But now we have this recreational model that's opening the door to less maybe rigorously tested products, that aren't medicinal.

BRANDON WYATT: Right.

RACHEL KNOX, MD: Or that might harm people.

BRANDON WYATT: The concept that, you know, we're learning here and I think has been communicated at Patients Out of Time, repeatedly, is that cannabis can be used to work in conjunction with pharmaceuticals, or it may in some instances be able to get people off pharmaceuticals.

RACHEL KNOX, MD: Yeah, replace them altogether.

BRANDON WYATT: I know that, you know, for a business interest, you know, it may not sound great to have patients off your medication, but having a success rate sure is good, too, you know, someone starts medication and they're able to complete, and successfully complete treatment, that would restore confidence, you know. For a lot of veterans, we don't have confidence in the medical systems and items that are given to us, therefore we don't medicate at all, which provides, you know, exemptions into the criminal justice system, easily for veterans, because now PTSD, these items, when untreated, undiagnosed, just look like an angry person.

RACHEL KNOX, MD: Right.

BRANDON WYATT: And, you know, that's really terrible.

RACHEL KNOX, MD: Well, and if you're going to talk about business and revenue streams, I mean, there are very few people who are benefiting, are profiting, off of the pharmaceutical industry. All right? And the numbers of people who are dependent on these drugs, you could argue, aren't necessarily having a great quality of life, or that productive in society. A lot of people are afraid of losing those revenue streams, but what happens when we have people off of these prescription drugs, using natural substances like cannabis to improve their quality of life and their abilities and capabilities? Now we have more productive citizens who are making money in other ways.

BRANDON WYATT: Well, let's talk about that. So, recently, in terms of business, you know, we're both part of the Minority Cannabis Business Association, and it's an honor to be in that with you.

RACHEL KNOX, MD: Likewise.

BRANDON WYATT: When we look at business purpose, removing barriers to workforce inclusion, right now we have a project going on that's going to expunge people's records if they've been convicted of a drug related offense, nonviolent or whatnot, then our program is, we're going to expunge their records.

I'd like for people to know that being able to treat yourself medically, and be recovered, is the removal of a workforce barrier. So it is a business interest there in having a capable, healthy, and mobile workforce.

RACHEL KNOX, MD: Absolutely is, and that's just another plug to get employment laws changed, too. Right?

BRANDON WYATT: Right. That's my job, Rachel.

RACHEL KNOX, MD: That is your job. That is your job, but I have patients ask me all the time, will this medical authorization protect me from losing my job, if I have a positive drug test, and the answer is no. And that is so unfair, and unreasonable.

BRANDON WYATT: It is very unfair. Very unfair and unreasonable, and that was the exact topic that I spoke about today -- not today, excuse me, on Thursday, I was able to teach. It's wonderful being here at Patients Out of Time with you. I guess we're going to wrap up, I never thought we would go so hard and so fast, but as the next generation of leaders, you and I have a real resolute responsibility to have these conversations, publicly, for individuals to see how it balances out.

RACHEL KNOX, MD: Absolutely.

BRANDON WYATT: So, talk to you soon.

RACHEL KNOX, MD: All right.

BRANDON WYATT: Bye.

RACHEL KNOX, MD: Bye.

DOUG MCVAY: That was Doctor Rachel Knox, she's a physician in Portland, Oregon, and an advocate for patients and medical cannabis rights, along with Brandon Wyatt, he's an attorney in DC and Maryland who is part of the Weed For Warriors Project, and also a US military veteran, and very much a strong advocate for medical cannabis patients and cannabis access. They were at Berkeley, California, at the Patients Out of Time Eleventh National Clinical Conference on Cannabis Therapeutics, which wrapped up last weekend.

You're listening to Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

One of the people who was an attendee at the Patients Out of Time conference, certainly at the legal seminar, was California Assemblyman Ken Cooley. Cooley was heavily involved in the construction of medical cannabis legislation in the last few sessions, he is a strong advocate for patients as well. He attended the legal seminar, came there on his own dime. Well, there was a hearing before the Assembly's Business and Professions Committee. Assemblyman Cooley's a member of that committee, and he had some questions for some of the folks.

This panel had Jason Kinney with California Strategies, and Richard C. Maidich, who's an attorney. Both were involved in the drafting of Prop 64. Let's listen to their exchange.

CA STATE ASSEMBLYMAN KEN COOLEY: Jason or Richard. I certainly see in the drafting of Proposition 64 an effort to kind of establish a workable structure, given the legacy law, Prop 215, the MCRSA, and then the adoption of this. At the same time from a substantive standpoint, as has been pointed out, the ability to amend is tied to Section Three, Purposes, and when I sit there and look at, you know, my review of Prop 64, Section One we've got the title, Section Two you have some intent provisions, the first one of which is about recreational use. The second one of which is highly laudatory about the legislature's work in 2015.

But it includes the all important line that with respect, going forward, you will try to consolidate and streamline, which is to me where I sort of see the footprint of trying to bring them together, but then you get into Section Three, and, there are 18 occurrences, starting at A, running down through there, nonmedical, nonmedical, nonmedical, nonmedical, nonmedical, nonmedical. Anyone reading the all important Section Three will have a strong impression that this is a measure that focuses on nonmedical marijuana. Section K again is very laudatory about the bipartisan work, in 2015, and then again, nonmedical nonmedical nonmedical nonmedical.

When you get into the substance of the bill, the definition of marijuana excludes medical marijuana. So again, we have an act with -- within its four corners I think testifies and presents itself as focused on the nonmedical side. This becomes important based upon the conference I was at that talks about how do we safeguard the interests of the medical, persons who need the medical, to have access to it, affordable access to it.

You have all of these pieces that sort of fit together. Clearly it seems to me that Prop 215, having as direct democracy delegated to the legislature to establish rules, which we did, in 2015. I see nothing in Prop 64 though you had ample opportunity in the drafting to say that we're going to undertake to redo that delegation. To the contrary, I see in Prop 64 maintaining a sharp differentiation. So, I'm left with a concern, since I, as I say, I actually am supportive of it within Prop 64, that the basic structure that has come from the governor's office to kind of put these two things together, to repeal the underlying statute, there are almost three dozen occurrences of that verbal form in Chapter 3.5, Section 19200 et cetera et cetera, which is, you know, running through the statute.

I just sort of feel we are being presented with a structure that on its face invites a legal challenge, because it undermines kind of the medical scheme that was delegated to the legislature, we followed up on, it was designed to safeguard things. I just don't see what the rush is to put them together, and I don't actually believe within the four corners as drafted that it supports that. I sort of feel for proponents of it, that is almost reckless. It's an invitation to a legal attack. I'm sort of interested in your observations or response to that.

JASON KINNEY: Well, I'll begin by saying that your absolutely right that it was our intention to protect and preserve the hard bipartisan work that was done by this legislature and the governor in drafting MCRSA rules and regulations, and we also believed, based on our studies in other states, that it was -- that the best way to strengthen a medical marijuana marketplace for legitimate patients was to create an open, licensed, overseen and regulated adult use market for non patients.

So, we endeavored to create a structure that protected MCRSA fully, but at the same time what we've seen in other states is that in the implementation oversight of a regulatory framework that there are inherent efficiencies, there's public policy rationales given public confusion that there are places where you want to align or conform the two systems.

Purely binary systems have failed in the states where they've been attempted to, been implemented, and so we attempted to give, knowing the dynamics of direct democracy, which is, you know, you get one shot at the best effort to do it right, in this case, voters wanted both simplicity and specificity about how it would work, but at the same time, we wanted to give this administration on the regulatory side as well as the legislature as much flexibility as possible to, as the process was implemented, once implemented, to make changes as we go, in a way that both protected the medical system as well as the nonmedical system.

ASSEMBLYMAN KEN COOLEY: Just in follow up, I agree with that idea, that over time you would implement it, but I see them as, you actually provided a study provision out in the future for studies to be conducted to bring forward recommendations on how to further implement and refine, so it seems to me, this is really a question about, I definitely see, side by side I see efficiencies, but you said streamline and consolidate, which you do when you put it at one agency, but then, when you go to those provisions, it's 3.5 in this chapter, throughout the whole thing, and then you have the study piece, which will bring us sort of reflective analysis in the future.

I just feel we're sort of short circuiting your plan, which jeopardizes your plan, because it's sort of upsetting the framework you established.

JASON KINNEY: Well, I don't want to forget the fact that our plan, and I want to turn it over to a real lawyer, here, but, I don't want to forget that our plan required ending the criminalization of otherwise responsible adult behavior in California, so we started there. From there, we needed to figure out as much as we could do in a short period of time to protect both the regulators, consumers, local government, law enforcement, but as well as create an efficient and legal marketplace so people could safely access this. And so, again, if I'm understanding, are you suggesting waiting would have been, or creating a longer time horizon? It, in fact, so that's why we had -- that's why we did it the way we did it.

We also want to align the timelines for both the --

ASSEMBLYMAN KEN COOLEY: I'm more suggesting that I don't think there's an urgent need to reconcile the two statutory programs at this time. I think you actually leave them in place, let them roll out a little bit, that actually supports your study idea, because you have one agency which knows how they've thought through the issues, two parallel schemes, they can learn from how they roll out, and the lessons they learn, as between side A versus side B, can inform ongoing studies, and it also avoids the problem of one of your almost three dozen references to 3.5 throughout 64, somehow that statute disappearing, or creating confusion as to, if marijuana for 64 purposes does include nonmedical, when you repeal 64, what does marijuana now include? Are we expanding the growth industry so you're now growing both sides?

It just, to me, it might even be that you end up finding a way to just leave 3.5 on the books for a decade, and have a sunset on it, so you know it's going to go away, but you don't lose those -- that statutory input right away. But thank you very much, that's responsive. Thank you.

DOUG MCVAY: That was Assemblyman Cooley, asking a question of Jason Kinney from California Strategies. Now, Assemblyman Cooley is polite, and I wasn't there, so the question that's left hanging right now, Jason Kinney referred to looking at experiences in other states when it came to drafting Prop 64. What in heck is that man talking about?

The only states in -- when Proposition 64 was being drafted, it was voted on in November 2016, recall, so the only states in the United States which had adult use programs, at all, were Washington, Colorado, Oregon, and Alaska. Alaska's had not yet rolled out, it was having a lot of trouble trying to roll out. Oregon had a thriving medical program for many years, and had started dispensaries. In Oregon, the social use, the adult use marijuana, none of the licenses had yet been issued, they were still dealing with how to regulate and how to move forward with all of those. We had no experience in the state of Oregon.

The state of Washington has been a disaster, and medical users, the medical program has been rolled over and crushed by the roll out of adult use. That's certainly no model. As for Colorado, well, they've had fewer problems, certainly, but little by little, bit by bit, patients are being hemmed in. It's a decent program, but is it the right model? So again, what in heck is he talking about when he says they looked at other states and how it rolled out? There's not enough experience. What was he saying? Again, we don't know, because I wasn't there and Assemblyman Cooley was too polite to follow up and get tough. That's a pity.

Well, let's hear some more from that particular hearing. Again, Assemblyman Cooley, in this case he's speaking to Lori Ajax, who is the head of California's Bureau of Medical Cannabis Regulation.

ASSEMBLYMAN COOLEY: A couple of quick comments by way of actually segueing off of both issues my colleague from Los Angeles just raised. On the general issue of diversity, you know, I'm reminded that it was this committee, this Professions Committee, that three years ago we started the medical marijuana conversation in this very room, and as you say, the Five Amigos, we worked on that, and an aspect of the legislative process, when we were involved, is we were able to bring a lot of people with us. And that sort of is what undergirded progress in 2015, the ability of lawmakers to engage in a conversation, bring people along.

So, I think on issues of diversity, working with the legislature on substantive policy helps. It can seem some kind of more efficient route to just do the regulation, but you actually lose something in terms of how we bring along all kinds of communities to make progress on the conversation. And so then that, the place, I just want to say is there's a lot of regulations are out there that might actually be served by being brought into the legislative process and doing some of this work by statute, because then you end up having a group of champions who can carry the argument and explain it, and lend it some bona fides that it reflects a broader community.

So I know regulation can seem efficient, but I think in terms of advancing the conversations, it's not as efficient. Related to that, I just want to say, at the conference last week I heard from Doctor Igor Grant of UCSD on this issue of these studies, and he emphasized how the science is unresolved. Unresolved questions regarding public health and safety impacts of medical cannabis, e.g. driving. He had a lot to say about these studies, so, to lose that in the statute I think is, even though studies are going to go forward, I do think we're losing -- it sort of backs us up in the wrong way.

So if you want to comment about statute, regulations and statute, then I would just like to hear what is the administration doing to ensure access for low income patients of medical cannabis, which we've talked about a lot, Ms. Ajax. So on the issue of statute versus regulation, and access to low income, I'd appreciate some comments, and thank you for your time and being here, both of you.

LORI AJAX: So, I, you know, I defer to you, if you, we, we were tasked with, under both Medical Cannabis Regulation and Safety Act and AUMA to develop the regulations to further define the law. But, in those areas where it, you know, the legislature feels it's more effective to be in statute, you know, that's not up to me, so I'm perfectly fine. Just wanted you to know that we are trying to cover both things that aren't in statute through regulation, so we're just there to fill in where we need to on that.

As for what the administration is doing on low income patients, I think that is still being worked out through trailer bill language, that I'm unable to comment today.

DOUG MCVAY: All right, that was Assembly Cooley asking a question of Lori Ajax, she's the chief of the California Bureau of Medical Cannabis Regulation. And once again, in the interest of full disclosure, I must say that I am a web content and social media manager for Patients Out of Time.

And well, folks, that's it for this week. Thank you for joining us. You have been listening to Century of Lies. We'll be back next week with thirty more minutes of news and information about the drug war and this century of lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.

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