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Good, useful, and full of wonder.

SDPB. Call to order. Thank you. I want to greet everybody here today and all our listeners. We'll be starting with our Medical Marijuana Oversight Committee, the 2nd meeting, October 13th, 10— I guess it's 10:05. So reminder, please turn off your cell phones or set your phones to silent. Those who are presenting to testify in the front, please register. If you're online, please use the QR code and register. Welcome, everybody. Hope you're all having a great morning. I'm going to ask the secretary to call the roll, please.

Andera?

Here. Nelson?

Here.

Arneson?

Excused.

Bostic?

Here.

Entwisle?

Here.

Palmer?

Schock?

Here.

Thum? Excused.

West?

Excused.

Carley?

Here.

Garcia?

Here.

Madam Chair, you have a quorum.

Thank you. I'd like to go ahead and ask all the members— we're going to go around and acknowledge ourselves as who's present and who's not for the people listening and those present in the room. So we can start with myself, Representative Garcia, Chair, Watertown District 5.

Senator Carley, District 29, Meade County.

State Senator Lauren Nelson, District 18, Yankton and Clay Counties.

Kasey Entwisle, patient representative. Julie Bostick, certified nurse practitioner, Hartford, South Dakota.

Andrew Schott, chief medical officer, Great Plains Geriatrics. I am a PA in the entire state of South Dakota.

Representative Andara, I am Sioux Falls District 10, Minnehaha.

Are there any members online? Please, I, I would appreciate if you could identify yourself for those here present. Hello there. Good morning. Christy Palmer, could you unmute yourself and identify yourself for those of us here? Thank you. Okay. If she's unable to, we'll just acknowledge that she's present and there's something with the muting. I'd like to go ahead and do approval of minutes. So moved.

Second.

Second.

Okay.

Thank you. Minutes are now approved. For those of you that are presenting today, we have quite a few and the agenda is quite lengthy. We are going to ask that all the presenters will be waiting until the public comment to present or comment at that time so we can keep the flow going. Before we start, I'm going to bore you one more time with the codified laws as to why we are here and the duties referring to 34-20G-19-1. What the oversight committee duties are? There are seven, so I know you've all heard these, but I think just for completeness' sake, it's important that we go through what is our purpose here, and everyone is on the same page. So the oversight committee shall meet at least two times per year for the purpose of evaluating and making recommendations to the legislature and the department regarding the ability of qualifying patients in all areas of the state to obtain timely access to high-quality medical cannabis, the effectiveness of the dispensaries and cultivation facilities in the. individually and together in serving the needs of qualifying patients, including the provision of educational and support services by dispensaries, the reasonableness of their prices, whether they are generating any complaints or security problems, and the sufficiency of the number operating to serve the state's registered qualifying patients. Number 3, the effectiveness of the cannabis testing facilities, including whether a sufficient number are operating. Number 4, the sufficiency of the regulatory and security safeguards contained in this chapter and adopted by the department to ensure that access to and use of cannabis cultivated is provided only to cardholders. Number 5, any recommended additions or revisions to the department regulations or this chapter, including recommendations relating to security, safe handling, labeling, and nomenclature. Any research studies regarding health effects of medical cannabis for patients. Any medical and clinical aspects of the medical cannabis program. The oversight committee shall ensure that it seeks relevant input from qualifying patients, designated caregivers, pharmacists, school boards and administrators, parents, municipal representatives, state agencies including the Department of Health, the South Dakota Division of Criminal Investigation, and the Department of Public Safety, and medical cannabis establishments. And with that, we'll go ahead into our first presenter. So I believe we have Mr. Grant, the Attorney General's Office, for the federal— to discuss the federal rescheduling discussion. Good morning, sir. Thank you. Please identify yourself. Just a reminder, all questions go through the chair. Thank you.

Good morning.

Good morning, Madam Chair, members of the committee. My name is Grant Flynn, and I'm an assistant attorney general with the South Dakota Attorney General's Office. Last month, the members of this committee contacted the Attorney General's Office for a legal opinion on the impact of the federal government's rescheduling of marijuana. To a Schedule 3 controlled substance and what impact, if any, that change would have on South Dakota's medical marijuana program. So certainly keeping in mind and with respect to the procedures of this committee, as I would do if I were in court today, I have prepared a presentation. But just like as if I were in court, I always prefer a hot bench or a more conversational, you know, sort of approach. So if at any point there's questions, Please don't hesitate to stop me, to interrupt me, you know, if you want to discuss things. Otherwise, I, as an attorney, there is no sound sweeter than that of my own voice, so I will fill up as much blank time as you give me. But in response to the committee's request, myself, along with several members of the Attorney General's Office's team, reviewed the recently Proposed or changed federal rules, recently implemented changes to the federal rules, and then compared those to our own medical marijuana statutes in 3420G as well as our criminal statutes in 2242. I'm so sorry. Have I been talking that whole time without my microphone on? Wonderful. Well, thank goodness. But so it was certainly a valuable and educational exercise for us because, you know, this isn't an area that we delve into a lot because our state has very qualified and capable people, including this committee, to make sure that the medical marijuana program is running smoothly and as it was intended to. But it is valuable for us to— and me personally— to have this understanding. So I'm grateful for the opportunity. As we noted in the opinion that we provided to the committee members, because federal law or the new federal rules explicitly accommodate South Dakota medical marijuana programs, and partially it appears based on the rules that were implemented that part of the purpose of this program was to get federal law more in line with many of the state marijuana programs or medical marijuana programs. The federal rules or the information published by the feds when it talks about— in the Federal Register, sorry. They talk about the expansive frameworks that the states and their medical marijuana programs have set up. And so it appears that rather than continuing to be in conflict with those where, you know, the feds schedule marijuana as a Schedule I substance which has no medical purpose, they recognize that I think they said about 40 Right. 33 states now have enacted some type of medical marijuana program and recognize that that's something that they should probably start to accommodate, I guess, if not get a little bit more in line with. That being said, the AG's opinion focused solely on the rescheduling, as was requested by the committee members in the email provided. Is there remaining uncertainty around marijuana in general, whether it's recreational or medical, and how that interplays with federal law and state law? Absolutely. And as with any area, as the law evolves, it has to be interpreted, right? The first step is that the laws get enacted or the rules get put in place. The next step is if there's challenge or debate as to implementation, then the courts take a look at those. But on the very front edge, as we are with some of these things, some of that case law interpretation is yet to develop. But in general, it appears that the federal rules and the Federal Register are attempting to accommodate programs like South Dakota's. So as everyone here knows, the medical marijuana program was initiated with IM-26 during the 2020 election. The program has evolved a little bit over the course of its existence, but it also has has remained the same. One of the things I took a look at as I prepared for this was just exactly what changes have been made. Currently, Chapter 3 has about 92— pardon me. Can we— is it working now?

Wonderful.

Okay.

Sorry about that. So ultimately, again, assuming my count is right, about 12 statutes that existed when IM 26 was passed have been repealed. Approximately 11 new ones were added. Currently, from the Department of Health's numbers, there's around 19,800 approved patients on the medical marijuana program, and about 19,100 of those are South Dakota residents. Um, so, uh, only about 600 are, are non-residents. Um, when we talk about the interplay between federal and state law, most commonly what we end up talking about is the pre— is the Supremacy Clause and the concept of federal preemption. Um, and that arises from the, the constitutional principle that federal law is the supreme law of the land. However, the way that the federal versus the state governments were granted power is very different, right? The US Constitution gives the federal government specific authority to do specific things. Here's a list of stuff that you can do. Um, and then, it reserves the rest of, of the regulation of our society to, to the states. Um, likewise, our state constitution provides a limit on, on powers, right? Here's a list of things that you cannot do, and then, uh, presumptively, anything that you're not forbidden from doing, the legislature is capable of doing. Um, so, preemption can exist in essentially 3 ways. Express preemption, where the federal government says, we're in charge of this, and the states don't get to, um, don't get to have a say, or they have to do what we've said, or they at least have to rise above the floor that we've set.

Um-hum.

And, uh, typically, that has to be done pretty explicitly. Um, the federal government says, th— this is ours. Um, another way that they can do that is sort of through implicit or, or what we call field preemption, which is that Congress's regulatory scheme is so pervasive as to make reasonable the inference that Congress left no room for the states to supplement it. Um, and then finally, there's conflict preemption, which just means that the federal law is in direct conflict with what the, the state law says, and so, In that contest, if there's a tug of war, federal law wins. Here, we don't have any of those preemption concepts that have been satisfied because the federal rules as they've been enacted in the Federal Register specifically accommodate the state medical marijuana programs. So assuming those state programs are willing to jump through the hoops that the federal government has set up to make sure that they're properly registered, then the new federal scheduling will accommodate those programs. So there's some additional steps that have to be taken, but ultimately the states were reserved the authority to dictate health, safety, welfare, and morals, those traditional police powers. The federal government has not expressly preempted or so completely occupied the field that the states have left no room, because in fact it has has set forth a framework for the state programs to be essentially kind of validated or recognized under federal law. So we have none of those conflicts. The DEA rescheduled marijuana through its authority under the Controlled Substances Act. The questions that the committee presented, although there were several of them, when we looked at them, essentially it's sort of distilled down into kind of one primary question, right? How is what the federal government did going to have an impact on what we do every day through our medical marijuana program? And I believe that the short answer to that from the research that we, you know, that we conducted and what we found was that the federal program specifically accommodates this. It acknowledges that, you know, at least that's part of the thought process for why these changes were made. Was to allow for a little bit more consistency between federal law and state law. And so there's really no, you know, no conflict as everything exists currently. How the legislature chooses to address that or how they want to change that is certainly a policy decision that falls with the legislature. That's outside of what the Attorney General's Office is, I think, sort of Scope of authority is. You know, we certainly have our opinions and policies that the Attorney General supports, and things that we've joined both you know locally and nationwide as far as setting those policy policy positions. I believe one of the the questions that the committee had was one. What statements or you know what actions are the Attorney General's offices across the country taking to you know to implement the new federal rescheduling? And another one was was just sort of some opinion questions about how the the Attorney General's office you know views or or whether or not we have an opinion on on certain changes. And so we have submitted some of those policy positions. We've signed on to a couple letters, you know, to Congress. One, you know, we signed a letter where we were initially opposed to the rescheduling to Schedule 3. The South Dakota Attorney General's Office and several others said, you know, we're not sure this is a great idea because we're a law enforcement entity. Right. And so that's our position as far as, you know, marijuana overall. But again, that goes as far as how much influence that opinion can have. Once the vote is taken and, you know, and the policy is enacted, then it's the Attorney General's responsibility to enforce the law, whatever the policymakers determine that that law should be. So we have, you know, weighed in. We've also weighed in on the closing of the hemp loophole in, you know, under the 2018 Farm Bill and under, you know, the other federal laws, which I'm sure this committee is very familiar with, and all those, you know, kind of unsaid sanctioned. In my— well, I guess I shouldn't accuse my whole office. I call them the diet weed products, you know, the ones that you can buy at the smoke shops and things like that. You know, so we've taken policy positions on those matters, but overall the Attorney General's Office has not really gotten involved with the medical marijuana program because quite simply it's not criminal in nature. You know, this is a regulated healthcare program. Our Department of Health has very Very capable folks. In fact, they just poached one of our attorneys not too long ago, and so you know I know that they have have good people over there who are working on this program. Secretary Magstead and all of her staff. So it's just not something that we have occasion to get involved in. You know, save an investigation into something that's going on outside the the scope of what's permitted under the program. And I think that was another question that. Since I brought it up, I can just touch on really quickly was you know additional enforcement actions that have been taken by the Attorney General's Office. There was a very I guess I shouldn't say very public, but there was several investigations of smoke shops that the Attorney General's Office engaged in last summer that got a certain amount of attention and. So the question I think was posed: Have we done anything else in that vein? You know, has that that project continued? And there have not been any significant updates. We certainly continue to enforce the law. You know, whenever it's it's been broken. But I think the intent was, and I think what we said at the time was that those raids or investigations or whatever they might be were intended to sort of be a blueprint or a formula for how local entities could enforce against those smoke shops if they chose. Chose to do that. Generally, the statutes that they were violating, you know, unless they were selling to folks who were underage, were, you know, were misdemeanors. And typically the Attorney General's Office doesn't investigate a lot of misdemeanors. We do those bigger, you know, high-level felony investigations and things like that. And so generally being the marijuana police across the state was not something that we ever intended to take on. It was just to say, you know, this is a problem. We're not— it's being kind of enforced differently depending on the location in the city or the county or that kind of thing. So here's a way if you want to go in and enforce these laws against these places that you can do that and you can do that effectively and you can get convictions for that. But again, that was not something that was ever intended to be kind of a permanent component of our repartee, I guess. So that's essentially what I had prepared for you folks. If you have any questions, I will certainly do my best to answer Madam Chair?

Yes, go ahead.

Good morning. Thank you for your time. Kasey Entwisle, patient representative. I'm just curious about the criminal status, if the AG's office is going to change some of the laws for the people of South Dakota. Right now, I believe they face felony charges if they're in consumption of an oil-based cannabis product, and the chief of police testified that the stores also were just getting misdemeanors, and there seems to be some confusion there.

Thank you so much, Mr. Chair— or Madam Chair, I'm sorry. I sincerely apologize. I promise you the only reason I did that is because my email came from Senator Carley, and so that's where my My discourse is bad. I've been married for about 15 years, so I've gotten good at those saves over the course of time. Miss Entwisle, my first response to your question would be that the Attorney General's Office doesn't change the law at all, right? That's not something that we have the capacity to do. That's with the legislature to take care of. Now, I'm not aware that we have any intent to, you know, to make any changes to those laws, but the The confusion or the difficulty in prosecution when it comes to felonies versus misdemeanors, you know, in the marijuana space has existed for a long time. You know, South Dakota is unique because one, we don't schedule marijuana, right? It's not a Schedule 1 through 5 anything. It's just its own deal under 2242. And so then, but what we do schedule is tetrahydrocannabinol, right? We schedule that in 3420B. And we have listed that as a Schedule 1 controlled substance. And there has been some debate about those statutes over the years and whether or not that statute includes naturally occurring tetrahydrocannabinol. Does it only include synthetic or manufactured tetrahydrocannabinol? To my knowledge, there's not been a, you know, on-point guidance from the Supreme Court on that case. I think just because they've procedurally not ever, you know, kind of made it to that point. But so we don't— I mean, as far as I know, we have no intention of going in and trying to amend those statutes. But the discrepancy about prosecuting, you know, extracts as felonies versus, you know, marijuana as a misdemeanor and those kind of things, those have existed, I think, for a long time in our statute, and they're just kind of open to interpretation.

Madam Chair.

Yes, you have a follow-up.

Maybe just a question for you. The Attorney General's Office stated that they provided an opinion to the committee. Is that going to be on record? Did we receive that opinion? I have not laid eyes on that opinion.

This would be in the committee documents for you.

Thank you. Yeah, thank you. And yeah, that letter would be placed in the documents by the LRC staff. So just a couple quick follow-ups. Thank you, Mr. Flynn. Maybe a 2-part question. One, since there's still some discussions of how this implementation on the federal level will happen from Schedule I and Schedule III, Does your office— is your office going to kind of keep aware of and watch what finally happens in the implementation and kind of just stay lightly aware of kind of how that eventually gets implemented and perhaps in the future provide any further feedback? And then the second question is if the AG office has looked at— I believe the South Dakota Department of Health proposed some amendments to some of the rules. Have you guys looked at that? Have you had any feedback or supportive or or questions on that. So kind of two-part question there.

Certainly.

Um, Madam Chair, Senator Carley, I appreciate the question. As far as, um, will we continue to sort of monitor the lay of the land, absolutely, because that's what we do on a lot of different levels, right? Not only will we continue to do that from the policy perspective, which is the part that I'm more involved in, of just kind of monitoring You know, the positions that our state, other states have taken on these things, and you know how the laws evolved from an enforcement standpoint. You know, we have lots of involvement with federal law enforcement and task forces, especially in the drug space and things like that. So from a law enforcement standpoint, we can't not stay updated on those things. It's an absolute necessity.

Absolutely.

So, I think that is what we are going to continue to do from an enforcement standpoint. But likewise, from a policy standpoint, we are always going to need to be watching this conversation for exactly the reasons that we talked about, right? That it is going to continue to evolve. It is going to continue to change. And we have a responsibility to be a part of that conversation to the extent that is appropriate. The second part of your question, I believe, was about the Department of Health rule. We do not routinely monitor other agency administrative rules. There's just not someone in our office. You know, we have attorneys who are assigned to different state agencies, and so every state agency has, you know, sort of a contact person within the— excuse me— within the Attorney General's Office that they can reach out to, or at least they have the option of one. I guess I shouldn't say every. I don't want to say every, because that will come back to bite me. But for the most part, you know, if they want to— if any agency wants to have a contact person here. So I can't say whether anyone in our office, you know, worked with the Department of Health or communicated with them as, you know, as these rules were in development or things like that. But again, we generally, you know, don't follow those as a matter of practice unless there is something that directly involves us. And again, we specifically have not done that with regard to medical marijuana because that's a Department of Health program that's well overseen and well regulated, and we just have faith in the competent subject matter experts who are over there who are making these decisions. So if they had questions for us, we would certainly be happy to assist with those in any way we could, but no. And I did take a look at the rules package this morning. I flipped through it. I hadn't looked at it until The committee brought it— committee members brought it to my attention this morning, but having looked at it, I don't have any concerns about the changes that they're making.

Madam Chair?

Yes, Ms. Entwisle.

Thank you. One more question. I don't know if I just misunderstood this, but because of the rescheduling that President Trump is doing at the national level, I know that South Dakota, we still have Scheduling 1. Sorry, Kasey Entwisle, patient representative. Lord. Anyway, scheduling 3 is happening, right? Our state statutes in South Dakota still say schedule 1. Is your office going to edit that to the new recommendations for scheduling 3, or how was that— how would that work, I guess?

It's— Madam Chair? Thank you. Grant Flynn from the Attorney General's Office. Ms. Entwisle, so a couple things. One, South Dakota does not schedule marijuana as a Schedule I right now. Never has. Again, it's not scheduled at all. It doesn't exist in 1 through 5. It's sort of its own animal criminally regulated through South Dakota codified law, Chapter 22-42. So we don't have it, you know, we don't have it scheduled. With regard to the scheduling of controlled substances, Those are set forth in 3420B, Chapter 3420B. And every year, I take that for granted. Maybe there's a year that they won't have to, but I doubt it. The Department of Health brings a bill amending the list of scheduled drugs to, you know, if there's things that need to be added, isomers, salts, you know, all those kind of different things. Or as you know, the chemists of the underworld, you know, change one You know, one carbon atom, then it becomes a different thing. And so they work very, very hard to keep up with that. And to the best that we're able, again, we don't interfere with their statutes. And if we have concerns about scheduling, we would work with the Department of Health to make that a part of what they do. Again, at this point, we don't have any intent to make that change because, again, from the medical perspective, I think that's squarely within the The Department of Health and your folks' role overseeing the medical marijuana program. And from you know outside of that, outside of the medical marijuana program, we want to keep it exactly where it is: regulated as as it always has been, and and criminal to use and possess unless you go through the proper channels.

Madam Chair, Representative Mandera, go ahead.

Representative Enduro, thank you very much. The question I have is that we have approximately 19,000 people who are currently participating in this program, and is the Attorney General's Office going to be putting out some clarification information on this? Because there's a lot of people out there asking these questions about. If this goes through this scheduling, then how is that going to affect me? Just for purposes of a public, you know, understanding. And if you're not going to do it, are you going to be working with the Department of Health to put something out there for the people who depend on this program?

Madam Chair, go ahead. Representative Andera, thank you again for that question. I'm not aware. Of any plans to provide that guidance, again, I think I don't know to what degree the Department of Health communicates with those 19,000 participants on a regular basis. I assume there's a mechanism for that to take place, but I don't know if that's the case. So I don't know if there's an intent on that end to address that at all. Again, from our perspective. One, I'm not aware that we've gotten many questions on this issue, so I just— I don't know that there's a burning need. Certainly, the Attorney General's Office is happy to take questions if folks, you know, if we're to the extent that we're able to. You know, citizens call us every day with questions about how to interpret a particular statute, and while we can't give them legal advice, we certainly do our best to, you know, to try to guide them, or this is the part of the law you need to look at, or this is, you know, a potential way to read this. So we would be happy to answer those. I believe that there have been instances in the past on separate issues that have, you know, nothing to do with marijuana, where the Attorney General's Office has done, like, press releases or something like that, just to say these kind of changes have been made, or this is something to put out there. But I think the other difficulty there would be, I'm not 100% sure what that press release would say. Because we don't think anything has changed, right? So it would just be a release that says the feds did this, but I don't think it affects your program. And so there's always the risk that that creates more confusion than you know than what it solves. And so I think at this point our intent is just to continue to answer those questions on a case-by-case basis when they come up, as opposed to you know. Sending out, you know, something statewide. But if that need arises, I'm confident we'd be open to having that conversation, whether it's with the Department of Health or this committee or whoever else, if that's something that would be more beneficial than harmful. But it's not something that I'm aware that we're talking about.

Thank you.

Madam Chair, Kasey Entwisle, patient representative.

I'm sorry, one moment. I think we have limits. I have a question for Mr. Flynn real quick. I'll let you go this one time.

Patients, patients, patients, right? This is what this program is about. Big topic on— this triggered my memory when you had spoke on that big topic on guns. Scheduling 3, obviously guns are off the table. As a patient registering for the state of South Dakota program, we have a little pop-up menu menu that says that if we register, our gun violations could be in effect or something to that nature. I work with the veterans. That's been a huge topic for everybody. I'd love your opinion as the Attorney General's Office on how we can educate people on that since it is a scheduling 3 now and we are moving forward with this plant-based medicine.

Madam Chair, please. Ms. Entwisle, I guess I don't know that I have an opinion on that. Again, Part of what concerns me about what you're recommending is ostensibly, and this is a conversation that I have to have with folks often who call our offices. We want to be helpful, and we want to be educational and informative. But also, I can't be your lawyer. You know what I mean? And so I can't. I've told folks before on the phone. You know, at some point, your issue could potentially take you to court. And if you're standing in front of a judge saying, well, Grant Flynn at the AG's office told me, it's not going to do you a whole lot of good. Nobody cares what I think. So, you know, that I think becomes one of the struggles with what you're talking about is everybody's situation is different, and everybody's situation is unique. And for every, you know, piece of general advice or guidance you try to put out, there's going to be some exception or, you know, some change to that. Yeah. And so that's why, if anybody's listening, my encouragement would be to contact your own attorney, to contact a private attorney, or to do your own research, or to reach out to, you know, to some kind of legal aid or advocacy organization for patients and say, hey, you know, I need someone who can give me some advice that if I do have to go to court, if, you know, if I do get in trouble for possession of a weapon or something like that while I have a prescription or while I'm in possession of marijuana, I have someone who can go advocate for me and help me because the AG's office can't do that on an individual basis.

Mr. Flynn, the chair, Representative Garcia, I have a question. I'm trying to stay on task, but this is more of a public safety but also pharmacist angle. Do you know from the AG's department, or could you enlighten me on, are there any barriers that prevent the pharmacists from Being able to participate in this program and manage. I know that you might have received something on the email from some of the pharmacists, but I am as well, and I'm just concerned. They are the most educated in this area. Is there any way with the codified law that it exists now, a possibility of amending what exists for the safety of the people? Because they are the ultimate educated ones on this drug, on this service.

Madam Chair, thank you for your question, and you have successfully stumped me. I really— I don't have an answer to that question off the top of my head. I have not done the research. What I can tell you is that based on the research that I have done, I have not seen any— well, that is not true. The way— see, this is why I shouldn't guess. I really don't know. And I would be happy to research that question for you and come back to the committee with something that, you know, is a little bit more well thought out. And I'm sure there's folks in this room who can answer that off the top of their head. The thing that immediately pops into my mind is that under 3420, dispensaries are specifically specifically regulated, right? They have certain rules that they have to follow. I have not compared what those rules are to the rules that a pharmacy has to follow. Or, you know, at the very least, I would think a pharmacy would also have to get licensed under the 3420B or 20G chapter as a dispensary as well as being a pharmacy. Is there anything within all those statutes that specifically conflicts that prevents that from happening, I don't know. But I think that would be the very first threshold is you would just have to jump through the hoops to do both things. Do you want to fix that to make it just one thing? You know, again, that's within the province of the legislature. So I don't know if there's anything that would prevent that from happening or not.

So just so I could hear you correctly, so it is a possibility it could be amended because the pharmacists are state and federally licensed. So there is a way that you're thinking— well, probably have to give more thought, but comparison I get in analysis what you're saying. But is it a possibility? Because again, it's the safety of the public, right? That's my concern.

Madam Chair, sure. And of course, I should have started my previous comments with, I think this is the most appropriate question for the Department of Health and the Board They are the folks who regulate the pharmacists and they are the ones who have a good working knowledge of how pharmacists are, you know, and pharmacies operate and how they are regulated and all those kinds of things, which I certainly do not. As far as the conflict between state and federal law, again, the Federal Register comments and the federal rules seem to be very deferential to the state programs. Sort of said, you guys have done a good job setting these up. We are going to try to figure out a way that they can continue to function. So I don't know that you would have any, you know, any specific federal conflicts. And as far as state law goes, you guys can change state law to say whatever you want, as long as it doesn't infringe, you know, violate the federal or state constitutions. So the legislature could certainly look at doing those things. But, yeah, I have not— I could not competently speak on the specifics of that, and I have probably gone far farther than I should have.

Thank you very much. I appreciate your time. Thank you for answering all the questions as well. We will have to take a short break because we are having some technical— 30 seconds for technical difficulties.

Madam Chair.

Yes, go ahead, Senator Carley.

Yeah, I think we're ready to get started. We got the technical issues worked out. Just a comment for the next speakers. I think we have next on here is, let's see, Dr. Madras. Just would mention when we start We're running a few minutes behind, but that's okay. We're not going to cut the presenter's time. So whoever subsequently joins, don't worry about that. And, you know, feel free to do your normal presentation. So, Madam Chair.

Thank you, Senator Carley. Yes, your next presenter, Dr. Majerus, thank you very much for waiting, and we're ready for you. Thank you.

Thank you very much. Can you hear me now?

Yes, we can. Thank you.

Excellent. My next question is I'm just trying to do a screen share with my slides, and I'm wondering if you can guide me through the—

We'll be right with you, Dr. Madras. Sorry, we're having some IT difficulties. One second, please.

Yeah.

Dr. Madras, this is Senator Carley. Just, you could look on your screen when you're ready for share. There's a— there should be a share button. That's a little icon with a rectangle and upward arrow in the meeting controls. You should be able to see that somewhere. And when you click that, it'll let you pick which window you want to share. Do you happen to see that? Okay, we lost your audio for one second, but we think that's our side. So we're going to fix that momentarily. And I'm sure your mic is still unmuted. So we'll let you know when we're ready. Ms. Madras, we're still here, so no worries. We got you on video great. And our team— why don't you go ahead and speak and let's see if we hear you this time. Let's see. We don't hear you yet, so we have one of our tech team here firing it up. If you can hear us, can you give me just a thumbs up because we can see your video? I do see the little icon next to your name. It does have a It shows a muted icon currently, correct? Okay, now it doesn't show the mute, which is good. And can you hear still us okay? Can you give me a thumbs up so just so we can see your video if you can hear us? Or a wave?

Okay.

Okay, we're still working on it. Okay, stand by. We've still got our team on it, so we'll be there in just a moment. We see our, our video now. Can you hear us okay?

I can hear you perfectly. Excellent.

We hear you too.

Wonderful.

Yeah.

Thank you, guys.

My last challenge is, can you give me— enable a screen share for me so that I can get my slides up?

Okay. We are going to make you the presenter in about 5 seconds here. One of our crack IT team members is going to turn it on for you. Hang on one second.

Excellent.

Okay, top corner should be a share button. It says share top right with a little black arrow on it. Do you see that?

Oh, now it turned on.

Perfect.

Yeah, we just activated it. Let's see if that lets you share, and then you should be able to pick the screen you want to share.

That is just great. Thank you. Yep.

And we see and hear you great. And so we'll just see if your presentation comes up. Excellent. We now see all the screens there. So yeah, if you click on slideshow and start slideshow, it should go full screen.

Perfect.

We see that. Great. Go ahead, ma'am. You're ready to present. We're not cutting your time.

So go ahead.

Thanks for—

Awesome.

Standing by while we worked out some tech issues.

All's well that ends well.

And yeah, if you could introduce yourself just to start. Thank you.

My name is Bertha Madras. I have been in South Dakota, uh, actually twice, um, to present on marijuana to a number of, of individuals and legislatures over the years. I'm very fond of your state, but for the sake of brevity, I won't go into my rapturous comments about South Dakota and just go forward with the presentation. These are my disclosures. There are no conflicts of interest. I just would like to talk about the 6 fallacies with regard to medical marijuana. That people in South Dakota should be aware of, both the public policymakers, physicians, everyone. The medical conditions, the conformity with FDA standards, clinical evidence for effectiveness, clinical evidence for safety, the rescheduling of marijuana, and the summary. Let's take a brief look at medical conditions in terms of history, in terms of state by state and users' reports. The first solid evidence that marijuana was used as a medicine is an excavation in the Middle East of a 14-year-old girl who died in childbirth. It— her Her date is approximately 400 in our common era. She died because her pelvis was too small to deliver a breech child, infant. And beside her nose were ashes. The ashes contained delta-8-THC, which is a metabolite of delta-9 on combustion. And it was conjectured that the marijuana was used to try to promote uterine contractions. But at the present time, we have to fast forward in terms of our own lives. We have a substance that's introduced with therapeutic promise but weak science. That's true for alcohol, which was in the U.S. Pharmacopeia. As a medicine until 1919, that's true for tobacco, which was endorsed by physicians; marijuana, cocaine, which was originally endorsed by Sigmund Freud and a number of other physicians; that's true for ephedrine or mahuang, which became which was converted into MDMA as well as methamphetamine, amphetamine. Cocaine, which is Schedule II still, and currently in very high profile are the hallucinogens, peyote as well as psilocybin, LSD. Across drugs, the pattern is similar. A substance is introduced with therapeutic promise without hard science behind it. Early adverse events are framed as exaggerated and moralistic. Usage spreads from medical to recreational, and new products are made. Early warnings by physicians, by families, are dismissed as alarmist. The harm becomes visible, first among the most vulnerable and then broadly across communities. Regulators and clinicians reassert control on the drug. The crisis fades. A new generation forgets the cycle and repeats it. Certainly true for opioids. Certainly true for marijuana. The medical use of marijuana has been debated on the basis of the science as well as compassion. To listen to people who are using, to provide care, relief, dignity, and hope— these are the— and empathy. These are the kind of words that have been used consistently to try to advocate for marijuana as medicine. On the other hand, there is research on cannabinoids, clinical studies, hard data, hard evidence. Patients self-report benefits. They report that cannabis helps relieve pain, sleep problems, anxiety, nausea, depression. And these reports identify symptoms for which people seek relief and perceive benefits. They develop their own patterns of use. They develop their own product preferences with the help of budtenders that have absolutely no real training in clinical trials, in the science and whatsoever. Or do they base the recommendations on anything but gut reactions and their own experience? The signals of the patients deserve investigation. But we have to be very wary of these. The quality and criteria for clinical evidence is very critical. There are 3 different meanings of evidence: patients' self-reported benefits, published clinical studies, and FDA approval. A defined product produces clinically meaningful benefits that outweigh risks. For a defined indication. That is the summary basis of FDA approval. Even published clinical studies do not achieve the high bar of the Food and Drug Administration. And patient-reported self-benefits— one can delineate the same reported self-benefits for people who've been using alcohol or cocaine or a number of others. A number of other drugs. So there are 4 distinctions that matter. Claims become conclusions only when the evidence supports a specific product, a specific outcome, and the risks are defined. So use is not the same as assuming efficacy or safety. Self-reported benefit is not demonstrated efficacy. A publication is not adequate evidence. Evidence for one cannabinoid product cannot be generalized to medical cannabis as a whole. What we find now in the United States, as well as in Canada, is that the potency of medical versus recreational is the same. Some dispensaries dispense both. But it's the same. The products are the same. Cannabis use disorder, the prevalence of it amongst users for medical or recreational purposes is about the same, with even increasing evidence that some people using for medical have higher rates of cannabis use disorder because they justify daily use and many, many times daily use. And very high intake of THC, the psychoactive product, a constituent of marijuana. Medical regulation and consumer protection does not exist either for recreational or medical use. Most U.S. medical users also use for non-medical use. A vast majority use for both medical and recreational. As a smaller minority used for medical use and a certain percentage for recreational use. This is a summary of almost half a million U.S. adults. It's used more often for medical than recreational only. Less than 50% have a chronic disease, arthritis, asthma. Chronic obstructive pulmonary disorder, depression, diabetes, heart attack, kidney disease. Fewer use it for chronic disease, yet the people who use it for medical indications are very frequent users. The perceived improvement can reflect context and timing, the expectation, placebo effects, natural fluctuations in terms of their own mood and their own symptoms. Symptoms and concurrent treatment with approved medications. They may misinterpret the drug effects. Sedation is mistaken for improved sleep. Intoxication or emotional blunting may be interpreted as relief. Relief of cannabis withdrawal after repeated use may be interpreted as medical benefit. And in terms of reporting and selection, recall and selection bias, discontinuation by people who did not benefit, or is unknown because most people are not surveyed for discontinuation, and a participant's desire to justify continued access is also part of the reporting and selection. Why is frequent cannabis use important in terms of non— these are Canadian data, but they're extrapolatable to the US. Most people who use daily, that number is increasing for non-medical use, and that number is high for medical use, daily use. Approximately 30% of daily users self-report cannabis use disorder, whether using for medical, recreational, or both. Another bizarre, bizarre contradiction is that if the qualifying conditions for cannabis, for medical cannabis, Are based on hard science. Why do different states list different medical conditions? The poster child is Illinois, which lists over 46. Some list very few, some list more, some list overlapping conditions, others list unique. But there are over 100 qualifying medical conditions. How many have been proven by quality clinical trials? At the level of the Food and Drug Administration criteria, none of them. None. So cannabis has been hyped as a medicine for opioid addiction, for glaucoma, cancer, Crohn's disease, post-traumatic stress disorder, Parkinson's, Alzheimer's, autism, amyotrophic lateral sclerosis, hydrocephalus, or for use. With any other medical condition for pain, sleep, depression, anxiety, for which high-quality evidence doesn't exist? Does it conform with Food and Drug Administration standards? What's— what must be proven before the Food and Drug Administration designates a drug as effective? The product has to be defined. The disease has to be defined in a defined patient population with standardized chemically characterized product in terms of dose, formulation, and route. The testing is defined. There's a random allocation of subjects and appropriate controls. There's blinding to minimize expectancy and bias. There's a pre-specified clinically meaningful endpoint, and the samples must be adequate, and a statistical plan must be presented. In terms of confirmation, there has to be account for withdrawals and missing data, for replication or credible confirmation, for favorable and unfavorable findings. The evidence for generic cannabis It just does not achieve any of these. The product quality potential Sources of variability are genetics, cultivation, processing, and storage. Marijuana contains numerous cannabinoids and other constituents whose concentrations vary with genetics, cultivation, processing, and storage. There's no such thing as a standardized cannabis. The FDA benefit-risk assessment approval does not mean completely safe. There has to be a dose-response curve, which hasn't been done. Some of the products sold in dispensaries are 90% of THC at doses that are much higher than FDA-approved products. The drug-drug interactions are unknown. Cardiovascular effects have not been documented. Abuse potential is high, yet it's not documented amongst people using dispensary marijuana. Cognitive and psychomotor impairment is a side effect. Psychiatric effects and vulnerable populations: the developing fetus, the teenager, the pregnant woman, the elderly. Plus dependence and withdrawal. The FDA always weighs the demonstrated benefit versus known and reasonably accessible risks. Is the demonstrated benefit sufficient to justify these risks with marijuana? So FDA approval has not occurred with regard to generic cannabis or generic marijuana. It has been approved for very specific cannabinoids. Low evidence, false and outrageous therapeutic and safety claims have created a recreational market by the healthcare industry. They have circumvented FDA. They have threatened, and what this has done is threatened The FDA approval process by erosion of professional standards and trust. And marijuana has been granted the status and trust of medicine without ethical, scientific, or professional standards. Just quickly look at the composition of matter. Compare marijuana to tobacco. They're very similar, except that tobacco contains nicotine and marijuana contains cannabinoids. The long-term risks of cannabis products, the potency, the frequency of use, the mode of delivery, and the age of onset. None of these have been standardized for medical marijuana in our country in terms of percent THC, the amount that is safe to use, how often to use, whether or not it's inhaled, smoked, or ingested. And the age of onset, perinatal, adolescent, and adulthood. The potency has risen from 3% up to 90% because there's more profit, there's more addiction. The higher the potency, the higher the risk. The greater the high, the more use, the faster onset of cannabis use disorder. The more frequency of cannabis use disorder, the more severity of cannabis use disorder in terms of tolerance, craving, and withdrawal. And we all know that craving, withdrawal, and tolerance drive repeated use. Use of other drugs. The higher, the more potent, there's greater use of other drugs in terms of initiation, the number of other drugs, And social problems. There's also an association of higher potency with psychosis, with bipolar disorder, with anxiety disorder, post-traumatic stress disorder. Yes. And with schizophrenia, a lower age of onset, more risk and more relapse. Greater potency is also associated with impaired memory, driving, impaired cognitive function. More medical emergency care, more cannabis hyperemesis syndrome. Just one example of 3 cities: London, Amsterdam, and Paris. In terms of use, never use compared to daily use of greater than 10% THC, the risk for psychotic disorder increases dramatically as More frequent use is and higher potency use is is encouraged in the population, and in this case it's only 10% cutoff, not 20%, which is now common in dispensaries. What is the clinical evidence for effectiveness? These are reports in Canada which has been documenting the cannabis story much better than the United States. In Canada overall, most people, the majority are using it for sleeping and insomnia, for arthritis, for chronic pain, anxiety, depression, acute pain, headaches, migraine, ADHD, PTSD, and weight loss. In British Columbia, which I just recently gave a talk, pretty much the same indications. But what is the published studies? What is the evidence? From anecdotes to rigorous randomized trials. In the randomized trials for cannabis use, patients were selected primarily with previous experience. They didn't want dropouts. They didn't want people shocked at the intoxication to just withdraw from the study. So they used people with experience in using. Imagine if you did that with antibiotics. We're only going to recruit patients who have a serious infectious disease if they've already been on antibiotics before. That just doesn't make sense. They exclude patients at greatest psychiatric or cardiovascular risk. The formulation across these studies, different THC to CBD ratios, different doses, different routes across studies. They compare with placebo but not with established treatment. The products are unlike those sold in dispensaries. The evidence for one product is not extrapolatable to another. And a trial of a standard dose of oral THC to CBD does not establish efficacy or safety of smoked high-potency marijuana or a dispensary edible or a vape concentrate or an unlabeled CBD preparation. The limitations continue with regard to clinical trials. The sample sizes are small. The subjective endpoints are not defined. There's short treatment and follow-up, multiple outcomes without adequate corrections, comparisons with placebo Inadequate monitoring of adverse events, functional unblinding, incomplete assessment of unblinding. No monitoring of tolerance, withdrawal, or cannabis use disorder. No monitoring of adverse events with chronic use. So is cannabis effective for pain by FDA standards? Reduced chronic pain, improved quality of sleep. But the effect sizes are of questionable importance. The evidence is insufficient on whole plant cannabis, topical CBD, or other cannabinoids. No effect on acute pain. No studies for cancer pain using herbal cannabis. There's moderate certainty evidence that nabixabols are ineffective when relieving moderate to severe opioid-refractory cancer pain. Chronic pain, very low evidence for long-term effectiveness. The International Association for the Study of Pain said due to lack of high-quality clinical evidence of efficacy and safety, it does not endorse the use of cannabis or cannabinoids for pain relief. Anxiety and depression, I can go through all of these. No significant outcomes, insufficient data, absence of randomized controlled trial evidence for headaches and migraines. Mixed results, poor evidence, effectiveness decreases over time, mixed results. Prospective randomized controls are needed to determine efficacy and safety for use of cannabis in the treatment of anxiety, depression, and sleep issues. No consistent improvement, little to no effect. These are huge meta-analyses. These are looking at all the data, 18 studies, 14 studies. No better than placebo. May worsen symptoms. Weight loss, no significant benefits. Anxiety, very low certainty of reduced anxiety. So the evidence does not generalize to define cannabinoid preparations. We cannot establish efficacy for smoked marijuana, dispensary products, or edibles. It just doesn't exist at the present time. There's no significant benefit for sleep anxiety, and so on and so forth. No adequate trials for depression, ADHD, smaller or uncertain clinical benefit for chronic pain, and so on. So what is the clinical evidence for safety? Because safety is a very critical component of approving a drug. There is very strong evidence that high THC cannabis can have adverse effects on anxiety, panic, can produce paranoia, confusion, altered perception, and is associated with serious mental illness. There is Evidence that high potency marijuana can induce nausea, vomiting, abdominal pain, and diarrhea. Cannabis hyperemesis syndrome. There is mounting evidence that that cannabis can have effects on heart, on cardiovascular system, with increased heart rate, elevated blood pressure, chest pain, and susceptible individuals. There is mounting evidence that. Cannabis is associated with more motor vehicle accidents because of impaired reaction time, poor judgment, and coordination. Most effects resolve within hours as THC levels decline, but this is acute effects. The adverse poisoning effects in terms of inhaled cannabis more likely to produce it to appear in the emergency department with cannabis hyperemesis syndrome. Edible cannabis is more likely to be associated with acute psychiatric symptoms and intoxication and cardiovascular. And the ratio of inhaled versus oral, there are more ED visits on a comparative scale with oral compared to inhaled.

So, Dr. Madras, we're just going to give you a 5-minute— we have to wrap up, so just want to give you that time. Thank you.

Thank you very much. So what I would just like to summarize is that there are 12 risks of marijuana use. The risks are teen brain development, psychiatric risks, which includes psychosis, schizophrenia, mood disorders, suicidality, Cannabis use disorder, impaired learning and memory, compromised academics, use of other drugs, risk for pregnancy in the fetus, amotivation, other medical problems including stroke and and and coronary and and heart attacks. In fact, accidents and safety, legal and social follow-ups. And lower job opportunities. I won't get into all these adverse events for the sake of brevity and time, but every single parameter is worse among adolescents in terms of progression to addiction, in terms of academic achievement, and even in the adult adverse outcomes in adults with no preexisting medical or psychiatric disorder. Number of studies that show symptoms in terms of psychosis, psychosocial functioning, motivation, executive functioning, working memory, anxiety, attention, all of these. The age of onset is critical. It's worse if use begins before 14. Frequency of use and potency and cumulative amounts used all feed in. to these adverse effects. So rescheduling, in summary. In 2014, I testified for the U.S. Department of Justice against rescheduling. In 2026, I testified against the U.S. Department of Justice for rescheduling. The challenges to the Controlled Substances Act Schedule 1 have been the states who who want to deschedule or reschedule, the courts and the legislative branch. In 2023, President Biden asked the FDA to look for reasons to reschedule marijuana. They discarded our very critical 5-part test and called it impermissibly narrow. They set out To reform marijuana by rescheduling, by just changing the regulations to make marijuana fit. Rescheduling of marijuana now has been ordered by the U.S. Attorney. And why rescheduling is important: it implies marijuana is a legitimate medicine which is safe and effective in terms of the cost-benefit ratio. It is not approved. It does not fulfill our rigorous 5-part Controlled Substances Act test or 8-factor analysis. The claims are questionable. The labels are inaccurate. And the budtenders serve as medical advisors. It is not— cannabis is not an FDA-approved cannabinoid such as the ones that have been approved. So summary, high-quality evidence does not exist for cannabis or cannabinoids used in endorsed medical indications. Clear guidance from clinicians is essential to support safe, evidence-based decision-making. South Dakota should weigh benefits against risks in informed discussions about cannabis or cannabis use. And for those who claim it's only a plant, Let's consider this. Natural plants produce toxins to poison insects and other predators. Nicotine, cocaine, THC, morphine, psilocybin, all of these have been shown in the literature to impair predators eating the plants. We have to remember, for those who say it's only a plant, Nature is not a benevolent pharmacist. It's a chemist without conscience. What people seek to alter their minds was designed by nature to use as a defense to damage or kill. Thank you.

Thank you, Dr. Madras, for your presentation, and we're going to move on to the next presenter. Hi there, Dr. Kevin Sabat. Yes, thank you, Doctor. Go ahead. Thank you so much for waiting.

Great.

Thank you, Chair Garcia, Vice Chair Carley, members of the committee. Thank you for your thank you for having me, and thank you to your staff for making the remote connection. Appreciate that. I'm Dr. Kevin Savett. I lead Smart Approaches to Marijuana, a national organization I co-founded with former Congressman Patrick Kennedy in 2013, as well as former Bush advisor David Frum. SAM is the leading nonprofit fighting against the commercialization of marijuana, which we view as a detriment to public health and safety. We have a science advisory board with researchers from esteemed institutions across the world who inform the work we do every day. I've worked on drug policy for over three decades, including as an advisor in three presidential administrations. So today I'll cover three things. First, where federal rescheduling actually stands, and let me just say I completely agree with everything Dr. Madras had to say. Very insightful, very important research and data update. But I'm going to cover three specific things. First, where federal rescheduling actually stands and what it means for South Dakota, because that's key. Second, how medical programs drift into de facto. Non-medical programs. Some would say recreational. I don't love the term recreation because that's really—I mean—that's sports and and hobbies. It's not taking mind-altering substances, but non-medical markets. And third, specific options for this committee, the legislature, and the department. You also have my written testimony, which includes all the citations. So part one, where federal rescheduling actually stands. I know you've heard that in August it's still under review. And for the broad question, that's right. But for medical marijuana in South Dakota, the change has already happened. So there are 2 separate federal tracks. First, Track 1. On April 28th, the Justice Department order took effect moving 2 categories of marijuana into Schedule 3: marijuana in FDA-approved drugs, of which there are a small handful— those are approved, you can get them at pharmacies, etc.— and marijuana held under a state medical license. That is the new part. The product in South Dakota's licensed medical system is now federally Schedule III. So that's right now. That order is, of course, being challenged in the federal appeals court in Washington. On September 9th, the court declined to put the order on hold while the case goes forward, which was not a ruling on merits. It was just on a treaty. So that wasn't a ruling on merits. That was just procedure. But the order rests on a treaty provision that lets the Attorney General act by order instead of going through normal rulemaking. And whether that was lawful is the question the court will decide. So the order is in effect today, but it could still be struck down. Track 2, though, is the broader question. Should all marijuana, including non-medical, so-called recreational, move to Schedule 3? DEA held a hearing on that this summer. We now wait for the judge's recommendation and then a final decision from the DEA administrator. And then probably, almost certainly, more litigation. So there's no deadline there. That could go on for a long time. What does Track 1 mean for you? It makes South Dakota's own decisions more important, not less. So here's what changes. First, your state license is now the federal on-off switch. The order sets up a fast-track DEA registration for businesses that hold state medical licenses. The state license is treated as conclusive proof of state authorization. And if South Dakota suspends, revokes, or doesn't renew a license, the federal registration is automatically suspended as well. Every licensing and enforcement decision your department makes now has federal consequences. Before, it was completely ignored because it was completely against the law. Now it has federal consequences. Second, a South Dakota certification now does the job of a prescription. So for a registered dispensary, the federal government accepts whether certification whatever certification your state law accepts, as long as it's dated, signed, identifies the patient and practitioner. But this is not actually a prescription. It doesn't name a product. It doesn't set a dose. It doesn't limit quantity. Whatever standard you set for certifications is the only standard there is. Third, federal rules step aside for state rules. Registered businesses can follow state law, not DEA's rules. On labeling, packaging, security, and disposal, and rescheduling brings no federal potency limit, no product restriction, and no advertising rule. So if South Dakota doesn't set a standard, nobody will. Nobody does. Fourth, the industry will have more money now. Businesses under a state medical license are no longer hit by a federal tax provision known as 280E that block normal business deductions. We don't like that because that means more capital for marketing, expansion. Advertising, promotion, and commercialization. Now, the department told you in August that it had more questions than answers, including whether businesses have to register with DEA. The short answer is this: under federal law, handling a Schedule III drug requires a DEA registration. Businesses that applied by late June can keep operating while DEA reviews their application. I'd encourage the committee to simply ask each licensed establishment where it stands. Did it apply for it or not? Now let's talk about what the order does not do. 4 things. It's not FDA approval. Nothing on a dispensary shelf in South Dakota has been reviewed by the FDA for safety, effectiveness, or dose. It's also not a verdict on South Dakota's program. And I want to be precise here. The order does recognize state licensing, but it makes no judgment about whether any state's Its qualifying conditions, practitioners, or products are appropriate. It limits registrations to medical purposes and to the scope of the state license. Also, it does not limit your authority. This is very important. Federal law does not preempt state law unless there's a direct conflict, and if you ran a stricter program than Washington would tolerate, that's not a conflict. You remain free to narrow conditions, cap potency, restrict products, and tighten certification, and I urge you to do so. So it also does not cover non-medical, so-called recreational or unlicensed marijuana, which is in Schedule 1 currently. So if Track 2 is finalized and all marijuana moves to Schedule 3, the federal line between medical and recreational goes away. That would not legalize so-called recreational marijuana, and it would not change South Dakota law, but it would make the design of your medical program the main thing standing between medical access and the commercial market your voters have rejected. Twice, which I think is very important to remember what your voters have done twice. Part two: How medical becomes de facto recreational. This is my second topic. So how does a medical program essentially become a non-medical program without anybody voting for that? Oklahoma is the cautionary tale. Its program has no list of qualifying conditions at all. A physician can recommend for any reason, and it grew into thousands of dispensaries. The state eventually had to freeze new licenses. Now, thankfully, South Dakota is nowhere near that, but the same forces are at work in every program, and the design choices are what holds them back. So your choices are very, very important. I've watched this happen elsewhere around the country. Some medical programs stay very small and clinical. Others become markets you can't tell apart from the non-medical or so-called recreational. And that difference isn't the ballot language. It comes down to 4 design choices. One, how broad the qualifying conditions are. Programs built around specific diagnoses when they're very, very limited can stay somewhat medical, although there's not much medical evidence on anything of any of this, but they can at least stay somewhat medical. They're built around symptoms, really, especially pain. And because pain is self-reported and common, it can't really be objectively verified. And now look at your own data. I was doing that in August. 70% of South Dakota patients qualified under severe pain, 14% under PTSD. So that's 84% of your program. Cancer, 4%. Multiple sclerosis, 1%. The program grew by a third in a single year, now nearly to 20,000 patients. I wanna be clear, I'm not saying those patients aren't hurting. I'm not saying they're all lying about their conditions, but the evidence does matter. It matters for policymakers. And a randomized trial published a few years ago found that adults who got a card for pain, anxiety, depression, or insomnia developed a cannabis disorder at twice the rate of those who waited with no significant improvement in pain, anxiety, or depression. So the data is very clear on overall no significant improvement. The second thing is how easy it is to get verified. The warning signs are clinics that exist to sell certifications, one-time visits, Zoom visits, a handful of practitioners certifying a large number of patients. South Dakota has done a lot right here. I see you have in-person exams, a real practitioner-patient relationship, no certification during pregnancy, which is key, uh, and a notice to the patient's regular doctor and anti-kickback rules. But certifications can last a year, and so the statute still allows a certification-only relationship on referral. You have about 211 practitioners for nearly 20,000 patients. Now, what you don't have yet is a public picture of how those certifications are spread across practitioners. That one Would tell you more than almost anything else does. So you can ask yourself: when a card says severe pain, does anyone know what product the patient should use at what dose, or whether anything else was tried first? Under the current system, that answer is usually no. Number three: potency and product. Marijuana today is not the marijuana of the 1990s, let alone the 60s and 70s. Average THC in federal testing quadrupled between 95 and 2022. Many concentrates. And vapes are sold today that exceed 99% THC, and the heavy use of high-potency products is linked to psychosis, hyperemesis syndrome, which is uncontrollable vomiting, addiction, IQ loss, etc. One large study found that daily users of high-potency cannabis had about 5 times the odds of psychiatric disorder. And your state statute has no potency limit. Your purchase limit, which is 3 ounces every 14 days, I believe, works out to about 6 grams a day. That's far beyond what therapeutic use would ever require, and it leaves real room for diversion, which I think is a big issue. Number 4, supply oversight. Exactly. Can the state see where the product goes? Your department has worked hard to rebuild its inspection program this past year, and that does deserve credit. But home cultivation has grown from 61 to 715 patients in 4 years. It sits outside seed-to-sale tracking, outside testing, and likely outside the new federal federal framework. Part 3, what you can do. So what can you do? You know, the legislature can do several things. First, tie pain and PTSD to documentation. A certification for severe pain should name the underlying diagnosis and show the conventional treatments were tried. A PTSD certification should rest on a diagnosis from a qualified health professional. So that's— and that would be real medicine. It's somewhat close to real medicine. Second, give the department clear authority over potency and product form. THC limits no greater than 10 to 15% potency, ideally restrictions on product types. The legislature should prohibit inhalable products like joints or vapes due to the additional health risks. It should also limit edibles, which are often appealing to kids. Third, if you do keep other product forms, right-size the purchase limit either below 3 ounces every 2 weeks or as a monthly THC limit that accounts for concentrates would be good. Fourth, make certifications clinical. Have the practitioner state a product from a form and a maximum daily amount. Let the tracking system enforce it. Consider a shorter first certification with an in-person follow-up before renewal, and require the check of the prescription monitoring program. Fifth, tighten home cultivation, for example by limiting it to patients who don't have access to a dispensary. Sixth, update the advertising provision in your statute so the department can prohibit health claims and youth appealing marketing, especially now. Now that the tax change will free up marketing dollars, that's really key. And you should require an annual public report, a public inspection report, certifications by practitioner, qualifying conditions, sales by potency and product type, home grows, enforcement actions, and health and traffic data. For the department, it can do many things within existing law. It can adopt the standard certification form your statute already allows, use the tracking system. Them to flag outliers like patients buying the maximum amount every period and practitioners with unusual volumes, and you will find them, and refer concerns to the licensing board where the statute permits. Put clear warning labels at the counter about psychosis, hyperemesis, addiction, driving, and pregnancy, and set up a line of communication with DEA since your enforcement actions now suspend federal registrations automatically. And for this committee, ask for the data: federal registration status for every establishment, certifications by practitioners, and sales by potency. So let me close with this: whatever happens in court, the federal government has now put South Dakota's own rules in the driver's seat. If you have to keep a medical marijuana program, patients with serious illness are best served by a program that looks something like medicine: specific diagnoses, real relationships with clinicians, known doses, and honest labels. My organization is glad to be a resource to the committee and the department as you work through this. Thank you, and I'm happy to take any questions you might have.

Thank you, Dr. Subot. Anybody have any questions? Senator Carley?

Yeah, thank you, Madam Chair. Thank you, Dr. Subot. Just maybe 2 questions. One, you mentioned your written testimony, and I think you have submitted that to our LRC, so we will be posting that in the documents. Thank you for a copy of that.

Right.

Second, just to go back on a comment you made, you made a comment, something about a public picture of how the cards are spread across practitioners. That was a recommendation you made. Can you explain that further and expand on that?

Yeah, in most states that have a medical program, you have a very small number of your state overall practitioner population that is recommending a large number of marijuana recommendations. And I would just say you should look into that because it doesn't just mean that that's a doctor who's open to this. It could mean practices that would not be in line with normal medical practice, normal medical board. It could mean something you would never tolerate with any other prescription. Where it's being overprescribed. So I would just say that it's important to look at the spread and the distribution of how, you know, which doctors or what number of doctors are actually recommending the number of recommendations.

Any further questions from the committee? Okay. Thank you, Dr. Sabat. We appreciate your time and waiting on us. Appreciate your expertise.

Thanks. Sure. Thanks for having me. Appreciate it. Thank you.

We're going to try to keep moving along. We are now kind of behind, but if it's okay, the Department of Health, we if you're present, perfect. Thank you so much. Come on up. Thank you for waiting.

Whitney Brunner, Medical Cannabis Program Administrator. I just wanted to test that that was working.

Yes, thank you.

Go ahead.

Madam Chair, I believe the request today for the department—we're going to be answering some of those questions that were received at the last committee meeting.

That is correct.

Thank you.

You want me to go ahead and start? Okay. Yes. Well, thank you for the opportunity to come here and be able to answer these. Some of these took a little bit of time. We had to go back.

Thank you.

So these were questions that were submitted just by the public for the last meeting that we received during the meeting. And a lot of them have to do with revenue and expenditures. So question number 1 was, how much revenue did the medical cannabis program collect from patient, caregiver, nonresident, and establishment fees during FY 2025 and FY 2026? The answer to that question is $1.5 million. The FY26 values were shared at the August meeting, but I'm going to go ahead and repeat those today. So for cardholder fees revenue, we had $1,508,791. And sorry, this is FY26. For caregiver card fees revenue, we had $800. Interesting note about caregiver card fees revenue, we actually only generate revenue when a patient has more than one caregiver. So if they just have one, And that first caregiver is free, so revenue is generated on the second or beyond that. Home cultivation fees, $18,243. Establishment registration fees revenue, $1,035,000, for a total of $2,562,833 for those categories. For FY25, cardholder fees revenue, $1,300,000. $123,273. Caregiver card fees revenue, $1,935. For home cultivation fees, apologies to the committee. I noticed when I was preparing for this today that you were sent an incorrect value for home cultivation for FY26. The number you received was nearly twice what it should have been, so I do apologize for that. The corrected value there is $13,380. And I will pause for a I can take a moment and tell you how that happens. Anytime we go back prior to FY26, we do have to do manual categorical adjustments to certain categories that have the same fee. So in this case, it would be home cultivation and low-income fee, which is both $20. Back then, when the patient registry was kicking payments over to the payment processor, it wasn't consistently attaching a label to that payment, which would cause that payment to get randomly classified when it hit the processor. So we do have to go back and manually adjust that. So the number that you received the other day would have had some low income mixed in there. So we did tease out home cultivation to $13,380 for FY25. And then establishment fees revenue from FY25, $935,235, for a total in those categories of $2,277,000.

$73,823.

Question number 2 is, what were the program's actual expenditures during each of those years, broken into the major categories of administration, personnel, software, contracts, inspections, testing or laboratory support, and other significant expenses? So the medical cannabis program, just like any other DOH program, our expenditures are managed and tracked and coded by the office, the agency's fiscal office. So sometimes the categories don't look very much like med cannabis, they just look like how fiscal codes and tracks their expense categories. So what we did here in this case is we pulled out significant expenses from the program to fulfill the request. So I'll do the same thing here. I'll start with FY26. Personnel services salaries were $644,150, benefits $188,905. $1,405,000 for a total of $833,055. Travel, $26,504. Contractual services, we have state operating expenses, which is $211,021. That's going to be a lot of your— I call them unglamorous categories— your heat, your electricity, your water, your cooling, that type of thing. Then we have some contracts broken out here as well under contractual. We have cannabis Public Policy Consulting for $19,128. Accela, which is the establishment registration portal, at $152,082. Metric, which is the program's seed-to-sale inventory tracking system, that's $75,000. Burn Software, which is the maintenance company that supports the Accela system, $1,240. CloudPower, which is the patient registration Registry system, $185,220, for a total in those categories of $643,691. Supplies and materials, the bulk of this is actually going to be your patient card printing materials, $48,632. And capital outlay, which for us typically consists of hardware and telephone services, that's going to be $2,400. $450 for a total of $1,554,332 in those categories. For FY25, salaries came out to $569,283. Benefits are $166,911 for a total of $736,194. Travel is going to be $20, $222,328. Contractual services, again those state operating expenses, $170,480. Contracts, Cannabis Public Policy Consulting, $3,324. Accela, $146,232. Metric, $81,800. Byrne Software, $3,023. Cloud power, $190,400. DPS inspections, so this would have been prior to the program having 2 in-house inspectors. We often utilize DPS inspectors just to offset the workload. That was $6,203. And then HealthLink, this is going to be the second half of the implementation of our collaboration with HealthLink. That's $13,250 for a total of $600,000. $1,414,712. Supplies and materials, $42,102. And capital outlay, $11,263, for a total of $1,426,599 in those categories. So question 3 was what balance of medical—

Madam Chair.

Oh, yes.

Madam Chair.

Yeah, I'm sorry. Yes.

Yeah, just question before you move on so we can catch it there.

The—

can you explain what the $3K public policy expense is for in 2025 and what it is for 2026 and why it went up so substantially from $3K to $19K and what that's for?

Let's go ahead.

Thank you.

Yes, I can explain that. I was actually the reason for that increase. So cannabis public policy consulting is a third-party cannabis Well, basically public policy consultant that's used by several state medical cannabis regulators. So we utilize them when we just need we need research done. So research on what are other state policies in this area? What do other state laws look like? What are the caveats caveats and nuances to those laws so that we can compare those for our own rulemaking processes? That type of thing. And then we also sometimes will utilize them. If there's a big question that comes up from the industry and you know they want something done, we're not sure should we do it, should we not do it? We will often lean on them. So this contract has always had about $25,000 in it, and when I came into the program, it really wasn't being widely used. And I come from the grants world. I had a lot of contractors, and I like to utilize the contractors that we have. So I did increase the usage of that contract projects that we have done. With this. We've done— had them do some research on heavy metals and residual solvents and pesticides. We also had them do research on our entire rules package that we put forward just to make sure that everything looks okay and in line with how other states do business as well.

Follow-up?

Yes, go ahead.

Yeah, just the name of the company that was used for that service.

Yes, Cannabis Public Policy Consulting.

Thank you.

Go ahead.

Okay.

Okay. So question 3, what balance of medical cannabis fee revenue or program reserves remained at the end of each fiscal year, and what obligations or future costs are those balances intended to cover? And end of FY25, it was $867,316. And end of FY26, it was $1,000,000. $93,001. All remaining balances go back into the program to cover operations along with supporting a major software purchase in FY27. So I talked about this a little bit in August that we were trying to be very diligent to save funds for a new software purchase. Interesting thing to note, even with all of that saving, we were still priced out of half of the proposals we received. So we knew this was going to be a big expense. And we've done our best to prepare for that. What current— oh, question 4. What current cost analysis supports the existing patient and establishment fee levels, particularly given the statutory requirement that establishment fees be sufficient to offset the costs of program implementation and administration? So cost analysis is based on actual program revenues and expenditures alongside anticipated revenues projected expenses, and upcoming program needs. Because the needs of patients, the industry, and the Department of Health evolve from year to year, program costs naturally shift over time. So for example, I'll just repeat myself a little bit, but the Office of Medical Cannabis is making strategic investments in a new software system designed to strengthen the patient experience, improve establishment registrations, and streamline inspection processes. We anticipate that the cost associated with implementing and maintaining this new system will increase overall program expenses in FY27 and FY28. And then question number 5, since the former statutory annual report included program expenses and revenues and that reporting requirement has been repealed, what recurring public accounting will allow legislators, patients, establishments, and citizens to compare fees collected with actual program costs and balances. So although the statutory requirement for a medical cannabis program annual report has been sunset, the Department of Health continues to provide medical cannabis expenditure and revenue information along with other program data and updates in the DOH annual report. So in this case, rather than having a separate standout report, it just gets combined in with all the other DOH programs in the DOH report.

Thank you. I think we just need a minute to process the numbers. If we just sit there.

Madam Chair.

Senator Carley.

Yeah, thank you, Ms. Brunner. Are you— you're done with your presentation? You're able to take questions now? Okay. Let's see. We heard on a previous presentation— I know you were listening to it— a comment or question about can you see in your data now the cards that are issued, which of the 200 practitioners those are coming from so that you could look at that data and see, you know, this practitioner issued 500 and this issued 1 and this issued 1,000. Can you see that data?

Madam Chair?

Go ahead. Yes, thank you.

Yes, we can see that. In fact, I think we have an upcoming speaker today that requested that data and we did provide it.

Okay.

Excellent.

Excellent. Yeah, just follow up, that would be great if you could submit that to LRC, that would be great, just so we have that as well, or copy us on it, that would be great. Madam Chair, another question?

Go ahead, Senator Carley.

Thank you. Thank you, Ms. Brunner. Just a question. We heard some discussion on pharmacies earlier and pharmacists in particular. So just a question on Should a licensed pharmacist, or have you guys dealt with this where those that are working in pharmacy or trained in pharmacology or drug interactions, that sort of thing, dosing, medication safety, they should they be barred or should they be participating in any of this cannabis product since they seem to be trained in all those aspects? They they are trained in dosing. They're trained in reactions to other drugs. Does the Department of Health have any feedback on whether they should participate in the program, whether they can or can't now, and just your thoughts on that?

Yes. So currently, statute SD 3420G, it's in the definitions. I believe it's definition number 21, defines practitioner as a physician, physician assistant or an advanced practice registered nurse. So in order to expand to pharmacies, it would require a statute change. I can't say that the department would be for or against that. That would really be up to the legislature if they want to pursue that. But there is that current limitation there in statute.

Any other questions from the committee? Madam Chair, Representative Andera.

Thank you, Representative Andera. Ms. Brunner, I'm curious what this is. I'm asking your opinion on this. Okay, so Mr. Sheehan here states at the bottom, my interest is simply whether a fee-supported regulatory program has a clear recurring public accounting of what it collects, what it costs, and what remains. The one thing that sticks out to me is, do you and your department feel that a fee-supported regulatory program is enough to support the program? Are the fees going to be able to support this program? Because what you're telling me with All that you had left over, you're still not able to get the amount of money that you need to support the program for the new software. So could you answer that for me, please?

Yes, please go ahead.

Yes. And we were able to procure a system. It was just we had to take our proposals and put half of them to the side because we were priced out. But no, I would say overall though, our fees have been sufficient to support the program. It's just this is such a significant purchase that has such significant cost attached to it that even, even we underestimated how much it would cost to do this project. But for overall, we do have enough to continue running the program through fees.

Thank you.

Thank you.

I have a question. So the chair asking a question, actually a few. One In your numbers that you— will you present those numbers? Are they submitted, those exact numbers, to us? Do we have those numbers?

Yes, other than I will revise the home cultivation fee from FY25. Otherwise, yes, you should have all of those numbers.

Okay, thank you. I am particularly— I'm a business person, so particularly interested in the amount for the cards. You said $48,000. And we had last session come with an agreement with the Department of Health for the digital cards. Will that be absorbed in this new software? I didn't hear you mention that. That was my first part of the question. And the other is, I didn't hear anything on the inspection fees and laboratory support. What were those fees? I may have missed it, but I didn't hear it.

Madam Chair?

Let's go ahead. Thank you.

Yes.

So a digital card will not raise the fee to patients. They will continue to pay a $75 fee. So unless— the only variation we would see in revenue moving forward from patients would just be that fluctuating patients coming into the program, patients going out. But the digital card will not be an extra cost to the patients. And then— I'm sorry, could you please repeat your second question?

Sure. Question number 2 is specific. There's a specific breakdown here of clearly it's like a forensic audit. What is going on with the Department of Health and the monies? That's what that question is really asking. So I'm just saying, did you mention the inspecting testing fees and the laboratory support fees? If you did, I missed it. Could you repeat those numbers? Thank you.

Yes. So how I— as I started the presentation is that our fiscal office does manage the the expenditures, and so they often will put expenditures into whatever their coded categories are. And so I would— first of all, we don't really pay anything for testing or laboratory support to begin with. But as far as inspections would go, I can probably tell you a little bit of where those costs get absorbed. We do have 2 inspectors, so they would be included with salaries and benefits for their time, and then they would also get a absorbed in the travel costs— gas, car maintenance and repair, that type of thing. And then the DPS inspections specifically from FY25 were called out at $6,203, but the program doesn't typically use those anymore.

Okay, I have one more question. I'm sorry, Mr. Brenner, but can you tell me the exact amount of monies that were left over in the year 2026 The exact number that you had to deal with for the new purchase of the software. What exactly are we talking about in the balance after all the expenses? Thank you.

Yes. So the remaining balance at the end of FY26 was $1,093,001 in that year's budget.

Thank you.

Senator Nelson.

State Senator Lauren Nelson, thank you for being here. Last, our last meeting, we were talking about the home cultivators, and one thing that— because after we had our meeting, last meeting, Kelliland, that was their head story about our meeting, was the number, the rise in home cultivators. I just, I mean, I would just want to ask, is that a concern for the department? Have you, you know, since our meeting looked into that at all? Or, you know, going forward, is there a need to kind of look at that and kind of make sure that that is not being abused, you know, somehow? Or, you know, what are your thoughts on that, on that number? Madam Chair, it is something of note, so much so that we did want to raise it to the committee at the last meeting, that that is a sharp increase that we're seeing. And as I talked about at the last meeting too. We just, we don't have a lot of information on our home cultivators. We collect photos of the space that they're going to home cultivate in, a photo of the lock on the door. We get a home diagram of the space they're going to cultivate in. So in absence of any additional information, you know, we don't ask questions like why, why are you signing up to be a home cultivator? What do you plan to use this for? In absence of that information, we can only speculate. There are complications with further regulating it. We're currently sitting at over 750, and we have 2 inspectors. We would also take safety considerations and legal considerations into into context there because we would have staff entering private residences alone. So yeah, it is something that is of note to us.

Senator Nelson, follow-up? Thank you.

Thank you, Madam Chair. When somebody applies to be a home cultivator for an individual, I'm assuming that they have to be a designated caregiver. What are the requirements to, to, to get that designation?

Can you answer that?

Thank you.

Yes, to be a caregiver home cultivator, they do have to go through the caregiver process, which includes submitting their basic demographic information. They must also pass a federal background check for that as well.

Madam Chair, just to follow up on the good senator's remark, could you also comment on just the— not the caregiver home cultivator, but the patient as a cultivator, what they need to do as a patient to cultivate?

Yes.

So they would submit all of the required information to be a patient. That includes basic demographic information, name, birthdate, address. We need a home address so we can mail a card. And then they would also pay their fee. They also submit a copy of their driver's license and a head-to-shoulders photo. And then in order to home In addition to that, they would send us a photo of the room in which they intend to home cultivate, a photo of the door or entrance to that room showing that there is a lock on the door, and then a diagram of the residence in which they intend to home cultivate. And then they would submit that additional $20 fee.

Senator Corley.

Thank you, Senator Carley. Thank you again, Mr. Brunner. I have a question on the Department of Health submitted— had a hearing and submitted some new rules recently for the Rules Committee, particularly to medical cannabis. Could you just summarize for us maybe the top 3 or 4 things that are contained in that rules package and just give us an overall summary of what those things were and what you're presenting to the Rules Committee?

Sure.

Yes, go ahead. Thank you.

Yes, I actually have the summary of all of them here. So these rules have undergone many iterations since they were originally posted. We took into effect LRC style and form review, and we also took public comment on this, of which we received quite a bit. So these have been slightly revised, but the overall goal of this rules package is just to clean up the language. We have done many rules packages in this program over the years. I think at least one a year since the program's inception. And there was a lot that just needed to be cleaned up as a result of that. There was some processes in here that were outdated. There was some things that the industry brought to our attention that said, hey, this is in here, but we can't feasibly do this. There were other things like statutory references, things like that. But to answer your question, Okay. As far as like patient cards, this was one of those areas we just cleaned up some of the language that we, we don't actually do, such as it said that patients have to return their cards to the office when they're done with them. Nobody returns cards to the office, and it would be very, very challenging for us to enforce that. So we just changed that to just immediately destroy it when you're done with it. There are things with registration certificates Let me see here. Some of these things have since been changed since we posted them. We corrected an OSHA reference that was incorrect. That's since been revised. That's since been taken out. A lot of this is just— I can just overall summarize it to say it was cleanup.

Okay.

Some of the main topics though, like I brought up last week, that have prevailed through all of the edits are we did make the seed-to-sale training requirements much simpler for establishments. That was a big issue before. It was difficult to interpret even for us sometimes, which was leading to inconsistent citations. And so we did get rid of that one, or we revised it. We also reduced the fines down to, with those lower 2 categories, just a cap for the first offense in those. Um, are there any rules in particular that you wanted me to address, Madam Chair?

Senator Carley, thank you. Uh, no, but you know, it's an interesting comment because we in the legislature, we also say, oh, this bill is just a cleanup bill, and, uh, I think that tries to minimize the effect of it. But there are significant bills that I've heard that in the legislature, and they have some significant changes. And so I just wanted to make sure we addressed for the public anything that would stand out for any supporters or opposers or anyone for that matter of anything significant. I heard you mention one with the seed-to-sale that sounded like maybe a more significant change, but any other highlights besides, you know, cleanup of language, which we appreciate that as well. That's, again, that's an important aspect. respect to reference to statutes and so forth. But anything else that stands out to you before that? And if not, no problem. I just wanted to ask you.

Madam Chair?

Go ahead.

Really, after all the revisions, I wouldn't say there's anything major. Other than those things that I highlighted, like I said, especially involving patients and the public, those were very minor changes that were made. Yeah, I just don't see anything else that I would say was major or significant that hasn't already been revised or taken out.

Madam Chair, Senator Carley.

Thank you, Senator Carley. One, one last question for you, Ms. Brunner. Uh, we heard Dr. Sabbat testify earlier. I know you saw some of those comments. Interestingly, he recommended some things the legislature can do, but he also actually recommended some things that sounded like the Department of Health could look at. I think he, he mentioned a couple different things, but I was just going to ask if your office could Sure and review that testimony. It was uploaded by LRC, and, and just take a look at them. One had to do with, I think, certification and a couple others. Would you be willing to look at that, review that, and see if any of those are impactful for your department?

Madam Chair, absolutely. And we have a couple individuals here taking notes, so absolutely.

I'm sorry, Mr. Brenner, I have 2 more questions for you. I keep going back I'd like to go back to the numbers in question number 1 and 2, the financial end of it. Do you have an itemized area there for the public education and safety of the cannabis at facilities or dispensaries? Is there any allocated area? I didn't see that itemized on there. And my second question is, I'm just intrigued by the cultivators, patients being cultivators, and the fee being $20.

Who sets that Madam Chair, I believe all of our fees are in statute, so that would be revised through legislation. But they're also in— I'm not sure if that one in particular is in statute or if it's just an administrative rule, but they're all in one place or the other. So we— that would be something, if it's in rule, that we could review. If it's in statute, of course, that would be brought by the legislature.

Thank you.

And then to your first question regarding— was it education in dispensaries?

Well, yeah, public, because that's been a big— that's one of our 7 items is the education to the public, the safety, the warnings. I just didn't see that in that question. Again, unless it was something I missed, it seems like it's all bunched in and not categorized the way I would like it. So if you could just answer that. Or if you don't know, that's fine. I'm just curious, is there money allocated for the public safety at the dispensaries or where they're purchasing the cannabis?

Yes, go ahead.

Okay.

I would say part of the public safety aspect happening in dispensaries would be happening through our inspections. That is one of their primary goals, is preventing diversion and making sure that everything is in order and all security protocols are in place. when they go there. Regarding the categories, like I said, our expenditures are managed by the agency's fiscal office, so we're, we're at the mercy of their coding and categorizing systems. But I wouldn't say that there is a separate budget outside of inspections for that. We do have the patient and practitioner education pieces on our website, but those are really no cost to us, so we don't have a budget line for those.

Maybe I'm sorry if I didn't ask it appropriately, but is there an area in the budget for patient education on these fees? That's just— is there an area you say on the— I get the platform has it and I get the inspectors go in, but actually, is there an allocated amount for the facilities to have like a poster or handouts or anything like that? That was one of our big issues.

Madam Chair? Yes, go ahead. There is not today, but as you say that, that's a great suggestion. One that we will take into consideration. Like I said, right now all fees just go back into the program and then they get allocated as needs arise. But that is a great suggestion.

Thank you. Sorry to ask all the questions to the committee, but anyone have any questions or—

okay.

Thank you very much. Appreciate it. Thank you, everybody. Mr. Jeremy— I'm sorry, I believe it's Dr. Jeremy Barthels, if you're present.

Greetings, everyone. I am present. Can you hear me okay?

Yes, thank you so much for waiting.

Oh, no worries on that. Uh, if I turn on my camera, will you be able to see me, or is that not an option?

Yeah, we can see you.

Okay, fantastic. And then I am going to share my screen and, and provide the presentation. From my understanding, I'm here to talk about the endocannabinoid system and connect it to cannabis. And I'll share my screen and just make sure— whoops— everyone can see my screen okay.

We can see it.

Fantastic, thank you for the confirmation. Now I also want to confirm, I was told I'd have about 30 minutes to like 12:30. I see that we're running over a little bit in time. What is my sort of time frame? Should I end— should I plan on ending around 12:30, or would I have Sir, you'll have the 30 minutes overall.

It's our fault on our end. Thank you so much.

No worries. I got that. Perfect. So let me introduce myself. I'm Dr. Jeremy Bartels. I am a department chair member and associate faculty member at Northwestern Health Sciences University here in the Twin Cities. I am a practicing chiropractor. I have been for a number of years, over 20 years. And I currently am working and teaching at the university here in the chiropractic program. Now, I want to just say right away that I do not have any sort of specific advanced degrees or direct research in this area of the endocannabinoid system or cannabis in general, but due to my sort of degree and the physiology content that I teach, it is a really sort of valuable and important area that I spend a lot of time personally researching and learning about. And along with the fact that I'm a chronic pain patient myself, I've gone through 2 cancers. I'm a survivor of Hodgkin's lymphoma and thyroid cancer that have led to multiple different sort of chronic pain conditions. And so utilizing cannabis to help with the pain, my chronic pain, intractable pain, has been something that I've been doing for 10+ years. I have a personal interest in the physiology aspect of it, but also then as a patient myself. So I want to clarify that I am a department chair and faculty member at Northwestern Health Sciences University, but I'm here participating today in my own individual capacity. The educational content and views expressed in this presentation are my own and do not necessarily reflect those of the university. So my participation does not imply university endorsement. So the first thing, and I don't know if this is gonna be a repeat or if you've been exposed to this at all before. So if this is something that you've seen before, you can just let me know. Otherwise, I'm just gonna progress through as you haven't been exposed to this sort of information, this content previously. So we have in our body a naturally occurring system called the endocannabinoid system, which is composed of endocannabinoids, molecules themselves, the receptors that they bind to, and the enzymes that create and break them down. The thing with the endocannabinoid system is it's not very well known, like the cardiovascular system, the digestive system, or the nervous system. Those are organ systems in our body that are very well known and researched, and most of the general public can sort of identify and talk about them in some sort of aspect. But the endocannabinoid system is something that's kind of under the radar, and I want to talk about that today because it plays an important role in maintaining homeostasis, this internal balance within our body, and influences all these other organ systems, including the nervous system, the endocrine system, along with the digestive system, the integument system, cardiovascular system. It has far-reaching effects on the body, but it doesn't really get the spotlight and the attention that it should. And the reason we're talking about this is because cannabis and the phytocannabinoids and the flavonoids And terpenes found in the plant itself will interact with the endocannabinoid system, giving these sort of therapeutic outputs and outcomes that we are seeking in certain patients. And so we truly have to understand the general premise and the basics of the endocannabinoid system to truly understand the effect that cannabis can have on individuals. So looking at the function overall, I'm not going to go through everything within these slides, but you can just see that the function of the endocannabinoid system is far-reaching, right? It influences, as I said, just about every organ system, but the main ones is like the immune system response and inflammation processes. It helps to sort of modulate the immune system and help to sort of decrease inflammation processes. It helps to sort of interpret and sort of manipulate the pain perception that people have. It can influence appetite and metabolism regulation. Mood, emotional, sensory awareness, right? All these different things, the wake-sleep cycle, memory, and learning. So a lot of the things that we can associate with cannabis and the use of cannabis, especially THC, we can sort of already sort of see this alignment to sort of changes, right? With THC commonly has this ability to increase appetite or change mood or change emotional awareness to sort of create a sense of of relaxation, time perception, right? These are all things that THC itself as a phytocannabinoid can influence the body. And it does that through this endocannabinoid system here. But outside of the phytocannabinoids, as I said, going forward here, part of the endocannabinoid system includes our naturally occurring endocannabinoids that our body makes to help sort of influence these different processes here. So overall, the endocannabinoid system The endocannabinoid system has really, you can break it down into 3 main functions, a regulation function, a response function, and a recovery function, right? So the endocannabinoid system is constantly regulating and fine-tuning all these physiological processes in our body. And so it helps to sort of maintain this idea of homeostasis, is internal balance within our body. And it's an important part of that process, but just kind of gets overlooked in general physiology.

Yeah.

because the nervous system is way more important, but the endocannabinoid system has an influence on the nervous system and its overall function. We'll see what that looks like here in a bit. The endocannabinoid system also then responds to any internal or external stressors or changes within the body, sort of modulating the nervous system function, modulating the immune system function, right? So we're trying to prevent this excitotoxicity, sort of this overstimulation.

Yeah.

Overincrease of activity of the nervous system as well too. And recovery, it's an important part of recovery adaptation. And as we sort of overachieve or go through these stresses and overcome these stresses, right, then we have to recover. And the endocannabinoid system is involved in that process as well too. So when you think of like the central nervous system, or you think of the nervous system in general, the digestive system, the cardiovascular system, right? They have their own specific roles and outcomes and sort of homeostatic variables that they're trying to maintain. But within their sort of ability to do that, the endocannabinoid system is playing a role to help them be able to do that kind of under the radar. And so this just gives us a little view of what the actual endocannabinoid system does for each organ system. This is a very general sort of overview. So we can see With the nervous system neurotransmitter release, the sort of basic premise of what the nervous system does, the endocrine system helps to sort of modulate and balance out hormonal release and the hypothalamus-pituitary axis, which really controls a number of different hormones being released from within the endocrine glands of the body. Immune system, right, helps to sort of regulate inflammation and the cytokine production. Which is really sort of the driving force for pro or anti-inflammatory processes to occur. So the other big one that is especially associated with me with my chronic pain is musculoskeletal complications with pain that I have from the chemotherapy and the radiation therapy that I've had with my cancers. So this is utilized to help modulate pain and the inflammation, not only maybe systemically, But in the local area too, and we'll get to how that happens as well. So emotionally, you can see mood, motivation, sensory, right, stress adaptation. All of these things are sort of these different organ systems and their overall sort of function that they have is influenced by the endocannabinoid system to some degree. And so when we have the use of cannabis or when we are sort of utilizing cannabis in a therapeutic method, right? We can influence these organ system functions through that sort of use of the cannabis due to the fact that those phytocannabinoids will interact with the endocannabinoid system. And so how does it do that? Well, first we have to understand that the endocannabinoids, again, a part of the endocannabinoid system with the enzymes and the receptors, but we naturally make these endocannabinoids like anandamide and 2-AG Right? And so what we're going to see is that they bind to specific receptors in the body, the CB1 receptors and the CB2 receptors. The endocannabinoid enzymes associated with this system are ones that actually produce the endocannabinoids and then break them down as well too. The big thing with the endocannabinoid system is the endocannabinoid receptors. So there's 2 classification receptors in the endocannabinoid system. We generally call them CB1 and CB2. CB1 receptors for the endocannabinoid system are primarily found in what we call the central nervous system, the brain and the spinal cord. And then the CB2 receptors are primarily found within the peripheral nervous system, so everywhere outside of the brain and spinal cord, so the systemic body typically that we think of. Now we do have CB1 receptors outside of the brain and spinal cord, and we have CB2 receptors within the brain and spinal cord, but primarily CB1 you want to think of. Within the brain, spinal cord, CB2 within the peripheral nervous system or outside of the brain and spinal cord. And this image here that you can see shows primarily where those receptors are located, but also kind of like if they're in the liver, if they're in the small intestine, or if they're in the joints, or if they're in the bones or the muscles, right? Kind of what they do and what they sort of modulate naturally. Again, this is naturally occurring within our system as we speak right now.

Right.

Within the endocannabinoids and the CB1, CB2 receptors. So we have this aspect here. And I don't want to get into too much of the physiology, but we can see that once these endocannabinoid receptors are activated through the endocannabinoids, or what we could call exogenistic cannabinoids, which are going to be commonly referred to as THC and CBD, the phytocannabinoids found in the cannabis plant. Once activated, these receptors will then change our pain perception, our inflammation process, muscle control, appetite, sleep, ocular pressure, emotional mood, right? All these different things are going to be influenced not only through our naturally occurring endocannabinoids, but then also through the phytocannabinoids found in the cannabis plant. So looking a little closer at the CB1 receptors, again, those are found primarily in the brain and the spinal cord, and you can see all the different sort of regions of the brain that are affected, or I shouldn't say affected, but have these CB1 receptors that can be influenced not only by our naturally occurring endocannabinoids, but also then by the phytocannabinoids found in cannabis. So you can kind of quickly see the sort of influence that it has. So when we think of THC use and just an isolate of THC, which is a phytocannabinoid, right, we can have time perception issues, maybe memory perception issues, associate changes with that because of the fact that they interact with these CB1 receptors. But we also can then have sort of pain reduction and the sensation of pain reduced as well through the use of THC and phytocannabinoids interacting with these CB1 receptors. And so physiologically, it's kind of a cool little process here. It's really interesting. It's a retrograde signaling. So, as you can see here, we have in this neuron here, the postsynaptic neuron, the naturally occurring. By our endocannabinoid system, it's a really, really interesting process here. But the key here, and I'll get to this in more detail in a moment, is that the phytocannabinoids specifically found in cannabis here, all of those phytocannabinoids and all the other sort of molecules can influence these CB1 receptors in the central nervous system. So they can modulate that effect. So they act as if they are our own endocannabinoids that our body makes naturally. If we can get the phytocannabinoids into the blood, they're going to influence the CB1 receptors, giving us these sort of effects, or maybe enhanced effects, what would naturally be occurring with the CB1 receptor activation here. So once these CB1 receptors are activated, you can see it has a whole array of sort of physiological changes that could occur, from anti-inflammatory to changes in appetite and nausea, to changes in mood and memory and pain, the gut-brain access to neuroprotection. It can help the neurons from actually being damaged and even being killed and dying from that sense from overactivity. Where in the CB2 receptors, then we have again outside of the central nervous system, outside of the You know, brain and spinal cord, we primarily find the CB2 receptors. So we can find these more in organs like the heart, in the liver, in the stomach, small intestine, right throughout the digestive system, in our bone and our muscles, right? So once we have activation of these CB2 receptors, we're going to see changes in the organs or, you know, muscles in this case, and more so within the immune system response with inflammation as well too. So we can see a reduction of inflammation. Again, this is naturally occurring with the the endocannabinoid system and the endocannabinoids that our body's naturally making. So all of this modulation, all these changes are occurring currently right now in our system. And again, with the use of cannabis, we can have then added modulation and specific outcomes. We can focus on those specific outcomes that we want. And so we'll get to that here in a moment. But the CB2 receptors, once they're activated, can lead to changes in inflammation and immune response, specifically more anti-inflammatory effects and immune modulation. So we're not having the immune system sort of go overboard and overreact to certain stresses and certain sort of internal, external stresses that the body's detecting. We can have it modulated so it provides the appropriate response. So these CB2 receptors, again, help to sort of allow that to happen. Also helps with analgesic aspects, reducing pain at sort of specific sites like in a joint or in a muscle or something like that, just in that sort of location. And again, it has more of this anti-inflammatory immune system response as well too. So these CB2 receptors are very powerful to reduce inflammation and reduce pain awareness in specific areas of the systemic body outside of the central nervous system and the spinal cord. So in general, we have CB1, CB2 receptors. The biggest thing, the biggest takeaway is that CB1, you think brain, spinal cord, CB2 in the body, and that CB2 really influences the immune system and inflammatory tone. So it reduces inflammation, and it sort of modulates the immune system to respond appropriately so it doesn't overreact or overrespond to some sort of stressor. Where the CB1 receptors are in the brain and the spinal cord, and they have more of a sort of effect on the nerves, the nervous system in the brain and spinal cord, and can have more of a systemic effect. So CB2, you want to think, oh, that's more local, like in a joint or in a particular organ. Where CB1, once they're activated, they can have more of a systemic effect throughout the entire body because they're found in the brain and that spinal cord. Now, I'm pretty sure you're well aware of this, but I just want to make sure we're on the same terms when we talk about endocannabinoid system and cannabis, because with that quick overview of the endocannabinoid system, the endocannabinoids, and the endocannabinoid receptors, I want to try to connect now for you the sort of connection that cannabis has. So we have these terms that I'm going to use. Cannabis is just the general plant itself, and it can be a couple different sort of varieties. The sativa or indica refers to the whole plant. Marijuana then is cannabis plants that are really kind of higher in THC concentration, so anywhere above 0.3 to 30%. And some of the strains, you know, are up around upper 20 to 30%, which is pretty high for the THC content. And that can then have those psychoactive effects depending upon how it's used. Hemp then is a term that we use for cannabis plants that are low in THC, federally under 0.3%. And so they're really high typically in a different phytocannabinoid called CBD. And that then doesn't necessarily produce those tremendous psychoactive effects. And when I say psychoactive, like sort of the mood, awareness, time perception, and hunger, that sort of those psychoactive This term that I've been using, phytocannabinoids, these are basically plant cannabinoids that we find in the cannabis plant. And there's well over 100 different cannabinoids or phytocannabinoids in cannabis, including some of the main ones that you're well aware of, THC, CBD, but then there's CBG, CBC, all sorts of different ones, well over 100 different ones that all interact to some degree in some sort of level.

Okay.

Within the endocannabinoid system that we have in our system. And so what we want to sort of understand then is that this plant, the cannabis plant, not only has phytocannabinoids, which again, what I just talked about is these sort of basic cannabinoids. They're not endocannabinoids because the endocannabinoids is what our body makes to influence the CB1, CB2 receptors, but the phytocannabinoids Or the cannabinoids in general found in cannabis also then interact with the CB1 and CB2 receptors to give the body its different output and outcomes, I should say. So we do have phytocannabinoids in the cannabis plants, well over 100 of them. Terpenes, we also have those in the cannabis plants. Those are sort of the— give the plant its aromatic smell. All, like, a lot of plants have terpenes and a lot of plants have flavonoids here that Then the flavonoids are more with the color, maybe a little even to the taste of the plant. So we have these three sort of categories of molecules in the cannabis plants, and this is really important to understand because it's these three compounds or three different categories of compounds that will then interact with the endocannabinoid system to give us the outcomes that we are seeking. So this is the big thing. The phytocannabinoids can kind of mimic or modulate our body's own endocannabinoids. So it interacts with those CB1 and CB2 receptors. So it can influence all the things that our naturally occurring endocannabinoids can do. So you can think of the phytocannabinoids as messages from plants or the cannabis plant that speak the language of our endocannabinoid system, which is really interesting because now what we can do is sort of use these phytocannabinoids And the influence that it has on the endocannabinoid system to directly sort of modulate and focus an outcome that we're seeking. So let's say the outcome is reduced pain or the outcome is reduced inflammation, right? We can use these phytocannabinoids to help sort of direct that outcome by ingesting the phytocannabinoids. And there's a few different ways we can do that, right? And we'll talk about that here in a moment. Okay. But this is just some of the phytocannabinoids and their sort of actions that they have within the body and the interactions that they have with the endocannabinoid system, and then the sort of outcomes that they produce. So there's well over 100 of them in the phytocannabinoids within the cannabis plant. The terpenes, again, are the aromatic compounds, and these are found in all plants. And what we have here is they actually sort of influence the body as well too. Specifically, some of them influence the CB1, CB2 receptors, and some of them sort of influence other physiological processes to sort of have different therapeutic effects. You can see, like, certain terpenes will have more of a sedating effect, muscle-relaxing effect, change maybe the mood, right? And so we have these compounds in the—

Yeah.

cannabis plant as well too. And so this is another sort of image of those here. The flavonoids then here, what we have with the flavonoids are these sort of another compound found in all plants, but also in the cannabis plant. And they again can have different effects, like cannabidiol A here has a very potent anti-inflammatory effect. And so it has each sort of flavonoid has its own of individual outcome and effect and influence on the body. The cool thing and the very sort of wild thing is, is that all of these sort of cannabinoids, the phytocannabinoids, the flavonoids, and terpenes will have a different sort of concentration in different strains. So we have a lot of different cannabis strains that are out there, and they can have some wild names like Pineapple Express, Genius Juice, Notorious THC, right? They have some really interesting names, but outside of that, what is important about the strains is that they have very specific concentrations of phytocannabinoids, flavonoids, and terpenes. And yeah, it will influence how it tastes and how it smells, but more importantly is that this concentration of flavonoids, terpenes, and more importantly phytocannabinoids will determine the therapeutic effects that it will have on So part of what I want to sort of express here is that it's very, very important to have regulation within any sort of recreational or medical marijuana sort of platforms within each state, because what we want to ensure is that if, you know, we want to ensure that if a patient or a customer is getting a certain strain of cannabis, we want to ensure that them to be able to sort of identify what is that strain like. And so we have a whole sort of classification system, which I'm sure you're aware of. The new classification system is Type 1, 2, and 3, where Type 1 is THC dominant, Type 2 is more of a hybrid where there's a balance of THC and CBD phytocannabinoids, and then Type 3 is CBD dominant, right? So we want to be able to have individual be able to understand what strain or what product that they're getting, and is it Type 1, Type 2, or Type 3? Because each one of these different sort of classifications is going to have a different effect outcome on the body. And so we want to be able to fine-tune that for each person here. So there is the idea of isolate, broad spectrum, and full spectrum. And I know I'm running low on time here, so I'm going to speed up a little bit.

Okay.

Bit, but the isolate is just CBD or THC, for example. A broad spectrum is the whole plant, all the phytocannabinoids, all of the terpenes, all the flavonoids except for THC. And a full spectrum then is everything— THC plus all the other phytocannabinoids and the flavonoids and terpenes. And the reason this is important, because it has this thing called the entourage effect. So depending upon the strain, depending upon the classification— Type 1, Type 2, and Type 3— and its overall concentration of flavonoids and terpenes, what we're gonna see is that that's gonna be able to fine-tune the patient's desired outcome. So you wanna be able to pick out the right strain, the right classification of cannabis plant for use if you're seeking more sort of assistance with sleep, or if you're seeking assistance with pain reduction. You have to be able to have the right sort of strain in the right classification classification to be able to get that specific therapeutic effectiveness. Otherwise, you may not get that sort of desired outcome that you're seeking. It's kind of like the whole food supplementation, right? You can get vitamin C in a supplement, or you can eat the whole plant itself, like an orange, and be able to get vitamin C plus all of the other compounds found in the orange that are going to interact with the body a little differently and a little more efficiently than just if you take vitamin C supplementation. So you can take an isolate of THC and isolate of CBD. Yeah, it's going to have an outcome, but it not— might not be the exact outcome that you're seeking. If you take a full spectrum where you have all the plant's compounds, including the— all the phytocannabinoids, the flavonoids, and terpenes in there, then you can sort of more fine-tune and dial in that specific outcome that you want, whether it's Pain reduction or relaxation, or, you know, improved sleep. And just as a few examples there. So with this entourage effect, it's important that you have the regulation so patients and customers can understand exactly what they're getting, and they can see what that concentration is of the phytocannabinoids versus flavonoids and terpenes to assist them in that sort of desired outcome. So first thing that you have to ask with the endocannabinoid system and the use of cannabis is like, what is your desired outcome or intention? Is it reduce inflammation? Is it pain? Is it to help modulate the immune system? Is it to help chill out, relax, or sleep better, right? That has to be the first sort of question that's answered with any sort of therapeutic or medical use of cannabis. With that, then, then you have to ask yourself, okay, is it to reduce inflammation? Is it to reduce pain? Figure out what administration route that you want, and then do you want an isolate, broad, full spectrum product, right? What strain or what chemovar, the entourage effect, and then you go into the doses and ratio and that sort of aspect. Again, this is important for regulation, association with regulation with any medical cannabis or any recreational cannabis use is what is your desired outcome. Now with anything, In that sense, you know, it can be abused just like alcohol can be used. You know, gambling can be used. Any sort of behavior, any sort of substance can be abused. But if you have the appropriate regulation around it, that limits the sort of opportunity for that abuse. And so when you have that sort of intention, whether it's reduce pain, right, you can then figure out these other options and utilize the best sort of cannabis plant and the sort of strain and the chemovar type 1, type 2, type 3, and the entourage effect that it can have to really achieve that outcome or that intention that you're trying to seek. Because if you don't have that, that can sometimes then lead to undesired outcomes, right? So if you're trying to sleep better, right, you don't want a strain or a type 2 or type 1 type of medical cannabis that will actually make you more awake and make you more sort of like kind of not give you energy in the sense, but it'll just keep you awake and keep your mind sort of busy in that sense compared to something that will make you more relaxed, right? So again, the desired outcome intention is important to identify. Then figuring out which direction you want to go in with it is just going to be just as is important because if you disrupt that, right, you're going to disrupt the sort of overall desired outcome. One other thing that I want to talk about therapeutic route is important is that if you use it topically, if you use any medical marijuana or cannabis topically, whether it's a cream, a roll-on, or something of that sort, that does not get into the bloodstream. So it only affects the CB2 receptors in that area. So if someone has knee pain, severe knee pain, and they use a topical cream, what is nice about that is it just helps to reduce pain and inflammation in that area of the knee that the cream is going to be applied, or the roll-on sort of medication. If you ingest it, then that means it gets into the bloodstream and then it's going to affect the CB1 and CB2 receptors. And so you get a systemic change. So all of the CB1 receptors in the brain will get influenced by that ingestion. And so again, this is the important part. So if you have a Type 3 Chemovar strain—

Dr. Bartholomew, we'll just give you kind of one 2-minute warning.

Sure, thank you very much. If you have a Type 3, that's a CBD dominant, that's not going to have as much of a— if you ingest that internally, you're not going to have as much of a psychoactive effect. So So again, the regulation is just as important with understanding these sort of different strains and classifications of cannabis. So with the few moments that I have left, is there any questions or concerns regarding this here?

Thank you, Dr. Bartels, for your presentation. We'll just ask the committee any questions. Senator Carley.

Hi, Senator Carley. Thank you, Dr. Bartels. Fascinating explanation of endocannabinoid system. That was very interesting. Just a quick question. So, you know, you mentioned earlier in your presentation, it said the cannabinoid system is— we have— the body produces some of those type of cannabinoid-like—

Yep.

Yeah, endocannabinoids. And, you know, our body also does produce some opioid-like products like endorphins and others. And so, you know, our body tends to have that internally, but then these are external sources. So in this case, we're bringing external endocannabinoids, and certainly there are external opioids that are brought, like fentanyl and morphine and that sort of thing.

Right.

With the opioid ones, oftentimes there's a limitation on either dose or frequency, potency, individual vulnerability. You mentioned one of your— one of the ones you mentioned to fine-tune using the strain type. Would you agree that there's some benefit also to the dose or frequency or potency or individual vulnerability with cannabinoids as well?

Yes, especially exogenous cannabinoids. There's a whole topic in research on endocannabinoid tone and how individuals have different concentration of receptors and naturally occurring endocannabinoids and the enzymes that make them and break them down. And so that can lead into sort of what 5 milligrams of THC for one individual can be a very mild effect, and 5 milligrams of THC for another individual can have a very sort of intense effect for those individuals, right? So we can see with the dosage that, you know, I didn't get to the slides on the dosage But that's an exact— that's exactly a very important part of this process too, is education and regulation, is understanding that 5 milligrams for one person can mean very little, and 5 milligrams for another individual can have a very intense effect. And so there's a different sensitivity within individuals. So dosage is always start low and slow to sort of figure out like what dosage level that you are comfortable with.

Okay.

Should be utilizing for your therapeutic outcome that you're seeking.

Thank you.

Madam Chair?

Yes, Ms. Entwisle.

Kasey Entwisle, patient representative. Thank you, Dr. Barthos, for your time today.

I appreciate it.

Just a note on your PowerPoint, would you be able to share that with the committee for our review?

Yeah, I can, um, I can give you this one and the full— I, I usually do a like a 2-hour presentation for continuing education. So I can send both to you. So if you want more detail on that, I, I can send you both of those sort of presentations that you can share with the committee then.

Madam Chair?

Yes, go ahead.

Yeah, that would be fantastic. We love both. The more education we can get on this God-given plant for our system and the wonders it does will benefit this committee. I appreciate you, and I'm going to one-up the soon, Mr. Entwisle, and say I attended an endocannabinoid session with you. Thank you for your time.

Absolutely. Thank you for having me. All the best to everyone.

Any questions from the committee? Dr. Barthos, thank you so much, but also congratulations on your remission and best of health for you. Yes, tremendous. Thank you. Have a great day. Yes, you too.

Thank you.

Okay, going forward, we have a Dr. Kenneth Finn coming up or presenting online He'll be our next presenter, and then I'm going to just ask that we take a 5-minute break after his presentation, and we'll resume with the public comments. So thank you, Dr. Finn, for waiting. I'm sorry we're behind, but we appreciate your time. That's okay.

Can you hear me okay?

Yes, we can. Thank you.

Awesome. Can I share my screen?

Okay.

Yeah, top right, you should be able to hit the share button on the far Yeah, but it's asking me to choose what to share.

Let me see.

Then you can pick your PowerPoint screen or your full screen or whatever you'd like.

Oh boy. Chrome tab window, open system settings.

There we go.

I'm having a hard time. Let me see if I can pull up my presentation here.

Yeah, if you open your presentation first, have that up, then when you—

Can you see that?

Nope, not yet.

All right. I'm usually on— not on Chrome or Teams. I'm usually doing Zoom, which is easier. And so I'll be able to see the contents of your screen. Open system settings. And let's see, Chrome. Google Chrome. There we go. That probably should work.

Allow.

So, Dr. Finn, we lost you. We'll wait a moment to see if you can rejoin.

There we go.

We have you back. We can see your video, hear your audio. So yeah, just try that share again and share the screen you want to share.

That probably works. Let's share that. Can you see that?

It looks like it's loading. Give it a second.

You bet.

There's always a wrinkle, isn't there?

Yep, we had some wrinkles today on our end too, so no worries. We're working through them though.

Yep.

So we have a gray screen from you. It looked like it tried to share. I wonder if— are you running PowerPoint?

I'm running— oh, you know what? Let me convert it to a PowerPoint and that'll probably be the answer. Give me one sec. I'm running a Keynote. That's probably the answer.

Document.

Let me see if I can find the PowerPoint.

Move to documents.

That's Keynote, and let me export to PowerPoint again. All right. Well, my apologies. It's always something.

No problem.

Put this in my documents. Export. That probably should be the answer. Let me stop sharing that. And then I'm going to open that up. And get back to this share window. Let's see if that works.

Not that one.

Is that working?

It said loading content, then we've got a gray window, unfortunately. You could try share the screen. That might be another option rather than just the program itself. You could try sharing the screen.

All right, I'm going to stop sharing again. Share entire screen. Share versus share. Let's try that again.

For some reason, we still see a gray.

Let me make sure this is.

One alternative option is you can also email that to. Ben on our staff, and he can put it on the screen while you're presenting as another option.

Well, that, that might work. Let me make sure this is on a— maybe a PDF. Well, let me, let me just do the PowerPoint again. Export. All right, what's the email?

He's been emailing me.

Okay, you can just email Ben back and his email, you should—

Oh, there it is, I got it.

Yeah, I think you have his email.

Yep, let me send that. Send anyway. Let's give it a shot and I'll keep working on my end. So this is the PowerPoint, should be there. Let me try sharing that one again. It's opening. Okay, let me go back to Chrome. It says stop sharing, so I don't— it should be sharing somehow.

It does definitely look like something's trying to be shown because it takes your video away and it puts a, puts a new screen up for us. So we see your computer doing that, but it puts up gray and the— The only technical thing I can think is there's some sort of permission or something that has to be given, or it's something with the software that's not actually showing the screen.

So—

Okay, so while I send it to Ben, Ben, just confirm that you received it, and then we can start playing it. In the meantime, I'm just going to give you a little background on myself. Thank you again for allowing me to present. I think this is the second time I presented to this South Dakota legislators. As a background on myself, I practiced pain medicine in Colorado Springs between 1994 and 2024, and I recently moved to Prescott, Arizona in '25 to continue practicing comprehensive pain medicine. I'm board certified in physical medicine and rehabilitation, board certified in pain medicine, board certified in pain management, certified in cannabis science through the University of Colorado, I was an associate professor for the University of Colorado Medical School, Colorado Springs branch, between 2018 and 2024. I'm the former president of the American Board of Pain Medicine, and I've served on their exam council for over 25 years. I served on Colorado's Governor's Task Force for Amendment 64, legalizing marijuana for recreational use, consumer safety and social issues workgroup. And I served 4 years on Colorado's Medical Marijuana Scientific Advisory Council. I've been an invited speaker to the United Nations Commission on Narcotic Drugs in Vienna a few years ago. I've testified in the Canadian Senate on their marijuana bill in 2018. I've testified to the New York General Assembly in 2019, and I speak internationally on the health impacts of marijuana, including being an invited speaker to Mayo Clinic Jacksonville, the Royal College of Surgeons in Ireland, the VA UCLA VA Medical Center, MD Anderson Cancer Center. New Zealand Pain Society, Texas Medical and Pain Societies, among many others. I work nationally with other state legislators considering legalizing marijuana for both medical and recreational purposes. I was selected to testify to the Department of Justice on rescheduling of marijuana in 2024 and in 2026. I'm the editor of Cannabis and Medicine: An Evidence-Based Approach, and currently the co-vice president of the International Academy on the Science and Impacts of Cannabis, which is now a member of the Vienna NGO Committee on Drugs. So we help with the UN on international drug policy. So it looks like you have my slides. I don't know if I can advance them or not.

We can see your slides now. We received a copy. So if you just tell us what slide you're on as you advance, we will stay right in sync with you.

Awesome.

Well, again, thank you for the time to allow to present. I'm not going to belabor some of the prior testimony from Dr. Madras and Dr. Sabet on the recent hearings on rescheduling. I was one of the few physicians that testified in Arlington on the rescheduling issue in opposition for a variety of reasons that both Dr. Sabet and Dr. Madras covered. So I'm gonna kind of, this is a very Very abbreviated presentation. I'll try to be efficient. There's so much ground to cover and not enough time in 30 minutes. I speak. I'm speaking to a primary care group in Canada recently and coming up next month, and I have four hours of talks that still barely scratch the surface. And for example, my my cardiology talk is over one hour. So there's a lot of things. That we can talk about, and please consider me a resource moving forward down the road. These are some of the key points that I looked at in South Dakota. They can only use marijuana for medical purposes. Patients that are registered must be 18 years or older to possess legal amounts. Minors up to 18 can choose a caregiver to help them purchasing. There's a possession limit. Not more than three ounces of weed for 14 days. I find it interesting because I always get land blasted for calling it marijuana, despite the fact that multiple states have medical marijuana programs. And I think South Dakota is the first state that I saw the term weed used in their their information that's available on the website. They allow qualifying patients growing up to four cannabis plants for medical use, etc. So next slide.

Okay, we're following just great.

So if you look at, you know, if you look at 3 ounces of cannabis, you can roll about between 84 to 160 joints. So on average in the state of South Dakota, that's up to 12 joints a day, so 1 joint every 2 hours. And we know that the effects of 1 joint can last between 4 to 6 hours. 6 hours. So I think the amount is way over any limit that a person can actually consume on a daily basis. So next slide. So these are the conditions in the state of South Dakota that are allowed to be recommendations for the use of cannabis. You're looking at the vast majority is severe pain, And then you have PTSD and muscle spasms, and then other diagnoses at a much lower percentage. So clearly severe pain is the most common recommendation for the use of cannabis, and that's very consistent with other states. Next slide, please. Next slide.

Yep. When you say advance, we're going to— so if you just give the title, like we're on number of patients Okay, number of patients.

This is the Colorado data over time, and Colorado is very well known to be a very healthy state. We've got mountain biking and hiking and skiing and whitewater rafting and climbing 14,000-foot peaks, et cetera. And, you know, over time, and we voted to legalize in Colorado in 2000 and implemented in 2001, and around 2009, after the Ogden memo, we went from what appears to be a very healthy state to what appears to be a very unhealthy state when the number of medical marijuana patients skyrocketed to over 100,000. And you can see over time the number of medical marijuana patients is on a slow decline over time despite more people moving to the state. I don't know why that may be. I mean, I have my own personal thoughts that people may have been medicinalizing their recreational use, and then once we got retail marijuana patients moved from medical to recreational marijuana. But, you know, unfortunately, due to the tax structure, it's more cost-effective to be a medical marijuana patient. And as a personal note, I was a former registered patient in the state of Colorado, just based out of my curiosity, what my patients were telling me. I applied for a marijuana recommendation, and full disclosure, I don't use, but In, you know, the visit was 15 minutes. It lasted about 60 seconds. And so within a minute, I was approved for severe pain, the most common recommendation in the state of Colorado, despite the fact that my recommending physician never asked me what my level of pain is or was, which on a day-to-day basis is 0 to 2 on a 10 scale, which is minimal to mild pain. But I was approved for severe pain in 1 minute. I was renewed for my medical marijuana card a year later with the same— no fanfare. It was a couple clicks on the computer, about 2 or 3 questions, and I was approved for a renewal. I was never asked about previously tried and failed treatments, what medications I always used, potential drug interactions, and my recommending physician, when I asked her pointedly if I had an adverse event, who should I call since she was recommending the use of marijuana. She told me to follow up with my primary care provider if I had an adverse event. So my medical records do not exist. I do not feel I had a bona fide doctor-patient relationship with my recommending physician. And like my other patients were telling me, I don't even remember the name of my recommending physician. So it kind of underscores part of the ruse of these medical marijuana programs, that it's very easy to obtain something Without any real rigor in terms of physical examination or questioning, et cetera. And I'm always curious, because I've never gotten an answer from any state I've spoken to, how many patients have been denied a medical marijuana card? I've never been able to get that answer. Next slide, please. So here you can see in the state of Colorado, as of a few months ago, severe pain is leading the pack in by age group in terms of the most commonly recommended diagnosis. Next slide. And in the January 2026 legislative report, 3 providers made 20% of all the recommendations. So that's 1 patient every 20 minutes. I mean, this is somewhat reminiscent of the pill mills of yesteryear, where the only reason people are doing this is for money. There's really no a bona fide doctor-patient relationship when you have a small number of providers making the vast majority of recommendations. And it's not isolated to Colorado. Next slide, please. Pennsylvania, you can see there was 3 doctors made over 11,000 recommendations, 9 doctors made between 6,000 and 11,000 recommendations, and 18 doctors made between 3,000 and 6,000 recommendations. So again, in the state of Pennsylvania, The vast majority of recommendations were coming from a very select few providers. Next slide. And it's not isolated to the US. I mean, 10 doctors prescribe half of all cannabis drugs in the UK. And the Royal College of Psychiatrists in the UK say there's insufficient evidence to support treating mental health conditions such as PTSD, depression, etc., or anxiety With cannabis, and it may exacerbate these disorders such as depression and psychosis. So there were fewer than 400 cannabis medications dispensed every month in 2020, and by the first 5 months of last year, that increased to 85,000 per month. Next slide. So if you look at the Colorado overdose data, again, in 2001, we implemented medical marijuana, and And the program was dormant for several years, and I think it was kind of multifactorial. Doctors were fearful recommending for fear of losing their license. There were no dispensaries, there was no infrastructure, so it was kind of flat. And then in 2009, the dispensaries opened across the state. We're currently not only Colorado but other states, there's more marijuana dispensaries than Starbucks and McDonald's combined. So it's easier to get marijuana. That is a Big Mac or a latte. And you can see what happened to our drug overdose data. It kind of skyrocketed. That was somewhat driven by the fentanyl crisis, but you can see cocaine, methamphetamine were slowly on the rise as well. Heroin is readily available and cheap as it is, was on the decline. Next slide. And these are some of the South Dakota data. When you're looking at unintentional and undetermined overdose They were somewhat flat between 2020 and 2024, and this is the most recent data that I was able to obtain from South Dakota. Next slide. So it doesn't appear that cannabis is impacting the state's overdose data. Methamphetamine is up, and these are the substance use history in people that are overdosed: history of meth use, unspecified substance, opioid, cannabis, and 10%. Of the people that have overdosed in the state of South Dakota had a history of problems using marijuana. And all these drugs seem to play very well in the sandbox. And if you go back to slide 10, if you don't mind, you can see at the very bottom of the graph, there's a, what I call cannabis creep, the identification of the presence of cannabis in Colorado's overdose death data is slowly on the rise. And I, we don't know what to make of this. I do a lot of work with CDPHE, and I've asked, you know, the coroners and medical examiners, they're not teasing it apart. I don't think people are overdosing on cannabis. I suspect it's more likely a companion drug, or it could be a synthetic. But the coroners are not looking at that critically, and that's one talking point I think the state of South Dakota should do, is look at the presence of cannabis and clarify, are these synthetic cannabinoids or are they companion drugs? It's very uncommon for people to die from the use of cannabis, although cannabis, and I'll talk about this later, is known to cause sudden death, arrhythmia, and stroke and heart attack. Go back to slide 12, or the next slide, please. So the potency is on the rise, and we know that there's a gap between the the amount of THC and CBD. And we know that CBD is non-psychoactive like THC is, but the potencies are on the rise. And I think somebody had mentioned, you know, the average flower in Colorado is now about 20%. Products, smoked flower and bud, is about 30-35%, which they never thought they'd be able to engineer a product that strong. And then you get into the concentrates that are pushing 40 to 60% THC, and then the world of dabs, waxes, and shatter that are more than 85, 90, some claiming 100% THC. And those are still considered medical products in the state of Colorado, and they are very strong and they're very dangerous. Next slide. So if you look at high-potency THC products and mental health outcomes, this came from the Annals of Internal Medicine, and you're talking about high concentration is defined as products that are more than 5 milligrams edible, or more than 10% THC per serving. Things like shatter, dabs, again, way above that. And the high THC products are associated with unfavorable mental health outcomes, particularly psychosis, schizophrenia, or cannabis use disorder. Next slide. And you look at the psychosis-related emergency department hospitalizations after we legalized in Colorado. This came out last year in the Journal of Drug and Alcohol Dependence. Psychosis-related hospitalizations rose in Colorado after cannabis legalization among all age groups. So the psychosis encounters with cannabis diagnosis increased significantly after legalization, and this is again something that the state should monitor and be able to be readily available to the public. One of my colleagues from the emergency department in Pueblo, Colorado, the youngest person she saw with cannabis psychosis was a 7-year-old boy who got into their parents' or grandparents' edible products and was floridly psychotic, and there was only one substance in his drug testing, and that was THC. Next slide. If you look at the age-dependent association of cannabis with psychosis in the adolescent You know, which is the period of critical brain development, those people have an 11-fold increased risk of developing psychosis. And kids that are with psychotic symptoms, 5 out of 6 teens that had psychotic symptoms had been using cannabis. So the association during adolescence was greater than previous studies, probably reflecting the rise in potency. Next slide. This came out from JAMA Open last year, looking at the incident schizophrenia diagnoses with cannabis use disorder after legalization in Canada. So the proportion of incident cases of schizophrenia associated with use disorder tripled during a period of substantial liberalization of cannabis policy. Next slide. So this is medicine in the state of Colorado. There's really no There's no dosing guidelines. There's no commonly accepted medical use. You know, the products are highly variable. If there's any way to get it into the body, they've created it. This is an apple bong from several years ago. Next slide. You know, an ounce is an ounce is an ounce. 1 ounce of THC oil is equivalent of 2,800 servings of a 10-milligram gummy bear. Next slide. You know, people talk about CBD as less psychoactive, but it does have its own baggage. This is kind of a dated slide from about 2 months ago. I've checked more recently. Now there's 725 drug interactions between commonly prescribed or over-the-counter medications with CBD. And if you go to the Epidiolex website, if anybody's not heard of Epidiolex, it's an FDA-approved CBD. Yeah. CBD that is not contaminated, very regulated and controlled, and approved for a very narrow spectrum of pediatric seizures. You're talking about Lennox-Gastaut, Dravet syndrome, and tuberous sclerosis. And that is FDA-approved CBD. The stuff people are buying in the dispensaries are frequently contaminated, not very well regulated or controlled. And I can tell you, having spoken to places like UCLA, Mayo Clinic, MD Anderson Cancer Center, among many other medical groups. Doctors don't know this. So if the doctors don't know this, the patients are not going to know this. So when I have a patient coming into me, a little old lady with arthritis that's taking ibuprofen and wants to use her CBD tablets, I go to drugs.com, I look up CBD, I look at interactions, and there's a moderate interaction between ibuprofen and CBD for liver damage. And if you go to the Epidiolex website that things you're going to see on warnings and precautions are liver damage, suicidality, and sedation. So it can make you tired, so I caution patients not to drive if they're using CBD because they don't associate CBD with things like sedation. Next slide. Next slide. Talk about kids. A lot of states are not tracking this. This is the Colorado data of pediatric poisonings and marijuana exposures between 2000 and 2019. And you can see the younger age group, 0 to 5 years, significant spike in the number of kids getting marijuana poisonings and going to the emergency room. And I can talk probably about 30, 40 minutes on pediatrics alone. Other states have looked at this. The state of Canada has looked at this. And interestingly, the province of Quebec had a very flat incidence of pediatric exposures and poisonings because they banned edibles. In the province of Quebec. So their pediatric poisoning data is much better than the other provinces. Next slide. I use the state of Oklahoma as an example because they are more recent in expanding their marijuana programs. And I found this very interesting. I tried to— this came from the Oklahoma State Department of Health. And I found it interesting because this is the number of non-fatal cannabis Poisonings, so I reached out to them and I asked them, "Well, if you have a non-fatal fatal cannabis poisonings, have you had any fatal cannabis poisonings?" I never heard back from them. But you can see once they expanded their program, the number of pediatric poisonings skyrocketed. Next slide. Same thing happened in Texas. THC poisonings have tripled since hemp legalization. There was a 300% increase in five years. They went from 923 in 2019 to nearly 2,600 in 2024. Calls involving children 5 and under rose by nearly 500% over several years. So this is something that is going to happen in South Dakota and is something that needs to be monitored and published in terms of monitoring public health and safety data, because in every single state that's gone down this road, marijuana has failed every single metric of public health and safety. Next slide. These are edible poison edibles, 0 to 12 years of age, coming from the DEA. And you can see that over time, with other states going down this road, the number of exposures to poison control centers significantly rose. And this data came out over, over 2 years ago, and I haven't been able to get more recent data from them. But I think it's very important that states are tracking and monitoring this data because kids do not metabolize cannabis as well as an adult, and some of these kids do end up on a ventilator, a significant amount. Next slide. In the state of Texas, the marijuana presence of a child abuse or neglect fatality by a perpetrator or parent, you can see the presence or use of marijuana, either past use or active use, marijuana leads the pack, followed by nothing, and then followed by the usual suspects. And I can tell you the state of Texas, the state of Arizona are the only 2 states that are continuing to monitor this data. The state of Florida used to monitor it, but for some reason they took it out of their annual report. In terms of kids that are dying by neglect or abuse, what is the circumstances surrounding that death? And you can see that the use of marijuana by the perpetrator or parent, marijuana leads the way. Next slide. I think this is the Arizona data. Marijuana is much higher than alcohol, opiates, or methamphetamine when there's an abuse neglect fatality in the state of Arizona. And I don't know why Florida took it out of their their report because it used to be the same data, same facts that marijuana was the most common. Substance found in the perpetrator in terms of use or active use, past use, but they removed it from their annual report. I think South Dakota should put that in report and track it. Next slide. Next slide. We're going to talk about adolescents. In the state of Colorado, marijuana is the most prevalent substance found in completed teen suicide. Never used to be that way. I've been tracking this data for probably 15 years or so. It used to be alcohol, was the number one substance, and then around 2012 when we legalized, coincidentally, the data flipped. And you can see the presence of marijuana was not a close first place, it was a far first place with a distant second place of alcohol, when it used to be alcohol was the number one substance in completed teen suicide. And kids aren't overdosing, they're not dying from their marijuana use. I think it's multifactorial. It's probably a bidirectional relationship. Are they using because they're depressed? Are they depressed because they're using? We don't know the answer. It's probably a little bit of both. And you can see based on CDPHE website data, there's always a mental health issue: suicide note, depressed mood, current diagnosed mental health problem, etc., crisis. Next slide. The positive toxicology results in suicide deaths in South Dakota. Alcohol leads the way in overall, followed by marijuana. But when you're looking at the adolescents, South Dakota, I could not tease that data out. I emailed the department, the state department, health department, and I couldn't get an answer as to separating it by age group. And the nice thing about the CDPHE website, it's very user-friendly. You can pick and choose which age group you want to look at. Next slide. So if you're looking at the state of Colorado, these are the toxicology results among non-natural, non-homicidal Colorado residents under the age of 25. So these are not just teenagers or adolescents. And you can see the most common finding is no substance present in those 25 years and younger. But again, similar to the adolescent suicide data, THC is greater than alcohol in the presence of a non-homicidal, non-natural death of Colorado residents under the age of 25. So these are adults too. Next slide. So what are the rules for advertising in South Dakota? I went to your website. Here's kind of a screenshot, limitations on where they can be displayed near schools, parks, etc. I'm not going to— I'm sure you're very well aware of these restrictions. Next slide. But in these states, you know, they they talk about they're very attractive to children. The nerd ropes, these trips ahoy, the stoner patch, the Cheetos, those sorts of things are being seen by your kids on the internet. It's very easily to access these things online. You could just click yes, I am over the age of twenty-one. There's no verification, and I think those things need to be addressed by every state going down this. Next slide. If you look at the exposure to cannabis advertising associated with use, this came out earlier this year in the Journal of Addiction. General cannabis advertising exposure was significantly associated with cannabis use, and internet social media advertising as well showed an association between use. Next slide. So how advertising, if you look at this, came out a few months ago, exposure to any advertising was associated with initiation of cannabis use. So when they're measured by number of advertising channels, exposure through 1 channel and 3 or more channels were significantly associated with higher initiation. So I think advertising needs to be stopped. You need to have limitations, restrictions on what kids can see on the internet. Next, next slide. So looking at advertising across the U.S., came out a couple years ago. So tactics may be appealing to you, youth, mislead consumers, the unsubstantiated health claims. It's marketed in a variety of ways, including, you know, including increase in the use of other commercial products like vapes and tobacco. So several studies show those associations between exposure to cannabis marketing and initiation and use of cannabis. Next slide. This is a very important slide to understand. I mean, we talk a lot, and I'm not going to get into the weeds on cannabis use disorder, which I think affects, you know, anywhere between 10% in the adults to up to 30%. I mean, if you look at NIDA and NIH data, the number of people that have problems with cannabis use is up to 30%, and I think part of this is related to potency. But what about the kids that don't have use disorder, non-disordered cannabis use? It's much more prevalent than those that have cannabis use disorder, but this paper really outlined that those kids that aren't having a problem with their use are still having 2 to 4 times higher odds of all adverse psychosocial events, including depression, suicidal ideation, thoughts, difficulty concentrating, lower GPA, fighting, truancy, violence, aggression, etc. And this, this is a population that is not very well monitored because they're not having trouble with their use. But I think it's a very important scientific paper to understand and the slide to recall. Next slide. So where do the kids get their marijuana from? Clearly they're getting it from the parents. So I think not only should kids be educated, I think parents need to be educated that this is not good for the developing brain. And I think that's part of the difficulty in this world is educating parents and educating kids on these, that it's not necessarily safe, it's not necessarily medicinal, there are harms associated with it. And I think we did a good job with tobacco with education. And in general, we've done a terrible job with the legal drugs we already have. We've done a terrible job with alcohol, tobacco, and opioids. I mean, Alcohol and tobacco kill hundreds of thousands of people a year. Despite ships have left the harbor, the marijuana boat is still in the harbor, and I think we have the opportunity to rein it in, put the guardrails up to keep your communities safe. Next slide. Again, this is a non-fatal poisonings inpatient discharges. And you can see this is out of Oklahoma. Again, the number of poisonings is gradually increasing across the state of Oklahoma when they went down this road. Next slide.

Just give you a little 5-minute warning.

You bet.

Next slide. Thank you. Inpatient discharges, 1 to 4 years of age in Oklahoma. Again, once they implemented a program, more kids having trouble. Trouble and end up in the hospital related to their use. Next slide. Inpatient discharges between the early adolescent group still on the rise. Again, it's not making this get better. Again, I think marijuana has failed every single metric of public health and safety, but you need to put these guardrails and caps on to keep your community safe. Next slide. We're talking about driving fatalities. The top 5 results in investigations in 2023 out of Oklahoma, in the traffic deaths after no drugs, cannabis is higher than the other substances. Next slide. These are percent of all cases that tested positive for cannabis, 50%. Next slide. The total number of cases testing positive for cannabinoids, a 327% increase in the number of cases testing positive for cannabis cannabis between 2019 and 2023. So again, that's a very significant increase. Next slide. Looking at past month marijuana use national compared to California, 12 years and older, you can see there's a gradual increase. You can see it was flat in 2020, 2021 during COVID They didn't have the data. Next slide. California emergency department visits and admissions for any related marijuana Abuse between '08 and 2022. Significant rise after legalization. Kind of was flat around COVID. My suspicion—I haven't been able to get more recent data—that it's probably on the rise. I know in California there was an over 1,800% increase in older people getting hospitalized in the state of California. Next slide. Next slide. If you look at homicide deaths. You know, marijuana is up there in the top three when there's a homicide. And you know, I do a lot of requests for FOIA and getting toxicology results. I think you need to have them public and accessible. There are a lot of states that just will not get the toxicology reports when there's a crime. And for example, the the LA County coroner had a conversation with her, the toxicologist, and I asked her why they would not test for cannabis in a. Violent crime? And they— the answer was, because everybody's using it, was the answer I got. And I got an email from the, uh, the, the second largest city in the country saying they will not test for cannabis for a violent crime unless mandated by the court or the law changes. When I asked her if they test for alcohol that everybody uses, she said yes, and opioids, yes, other illicits, yes. But cannabis got a free pass in Second largest state in the country. Next slide. Tax revenue. This is not going to fix your tax problems. We all know what's happening in California. We know what's happening in Colorado. I think the honeymoon is over, and it's not going to fix your budgetary woes. Next slide. There was a nice paper that came out last year. Kevin Hill and Michael Su from Harvard published this. You know, we know there's FDA approved. Approved drugs for cannabinoids for HIV/AIDS-related anorexia, chemotherapy-associated nausea, vomiting, certain pediatric seizure disorders. You know, the FDA has not approved a single medical condition for the use of raw cannabis, and that was part of my testimony to the DEA. You know, there's no dosing guidelines, not commonly accepted medical use. Next slide. Looking at high potency and psychosis. There's no evidence it's going to treat anxiety disorder or any mental health issues. Next slide. Evidence from randomized trials do not support the use of cannabis or cannabinoids for most conditions for which it's promoted, which includes pain and insomnia. And we know there's a cardiovascular risk with heart disease, MI, stroke, arrhythmia, etc. Next slide. So I had— I published a paper in the Journal of Legal Medicine having these conversations with patients. We know there's a lot of drug interactions. We know it impacts the liver. We know it impacts the heart, and the brain is the primary target organ. Next slide. We got 1 minute left. So the action plan, I'm wrapping it up here. You got to monitor public health impacts and publish those results to the public, including healthcare utilization and costs. I think that the dispensaries need to have consumer name, number, and email. You know, that's the problem that you you have a contaminated product at the shelf that's contaminated, and the recalls predate purchase. So those products are already consumed, and we found things in in Colorado like arsenic, cadmium, mold, fungus, antifungal agents, pesticides, rodenticides—all these things that are on the products. People are consuming because they don't get a recall. So you need to have some mechanism in place to contact— well, number one, the product shouldn't hit the shelf if it's contaminated, but they do. Things can slip through the cracks. And in the event of a slip through the cracks, those consumers need to be notified. I mean, you get the baby formula all over the news, the Ritz crackers, romaine lettuce, but there's never a recall on the news of a contaminated marijuana product. You need to have very structured PDMP like program to monitor patient providers to avoid the pill mill scenario like other states have done. And those doctors need to be penalized. I mean, this is, this is not, um, this is not grandma's weed. This is, this can be very dangerous products in the wrong hands and the wrong consumer. Massive educational campaign starting sadly in elementary school and including parents, um, you know, delay onset of use until 25 or later because of the developing brain And restrict potency. You know, I can talk for a long time on the risks of high potency products, more than 10% THC flower and more than 5 milligram edible. Next slide. Track the child fatality neglect data and publish it. Monitor driving fatality data. I didn't have time to get into the in utero substance exposure data. There's only one state I found that's looking at that critically, and that was. The state of Connecticut. They had about 6.6 babies a day with substance exposures, and the number one substance found in the state of Connecticut for kids that were exposed was marijuana. It was about 80%. 20% were opioids and 3% was alcohol. So in the state of Connecticut, marijuana led the pack on that one as well. There should be drug test mandates on violent crime, including blood, urine, and hair. Restrict advertising to use. To youth, eliminate home grows. I mean, number one, there's no state revenue. Number two, no one's tracking or monitoring it, and it's a breeding ground for illegal activity. Next slide. Discourage use during pregnancy and lactation following the American Academy of Obstetrics and Gynecology, the American Academy of Pediatrics. I remind people we're in the middle of a vaping epidemic before COVID hit. Drug test mandates on all suicides, particularly in youth. Youth. You need more money for our men and women in blue, who I support 1,000%. You need to have very clear warning labels and dosing guidelines. The warning labels on a lot of products are a font of like 3; you can barely read it. There need to be a package insert with products that are going out of a medical dispensary, although we don't know what a package insert really would look like. And you need to have these bona fide doctor-patient relationships and maintain medical records. My records do not exist despite the fact by Constitution in Colorado they should exist, and by Constitution in Colorado I should have a bona fide doctor-patient relationship with— I do not have. So I think those are the things that I think the state of South Dakota should keep in mind when you're going down this road.

Last slide.

This is what I prefer to do during— before I go to work. It's kind of my place I can center, and South Dakota is a beautiful state. For things like this, so I'm going to stop here. I apologize for going over. I'm open to a few questions before I get back to my clinic.

Thank you, Dr. Finn. We appreciate your expertise. We'll just ask the committee: Does anyone have any questions for Dr. Finn? Madam Chair, yes.

Thank you, Dr. Finn. I appreciate your testimony today. I'm Kasey Entwisle, patient representative. Well, we have this mess going on in South Dakota with the hemp market. Our last Last year, our superintendent of one of the largest schools testified that our children are getting these flavored vapes. It's a huge public safety concern, and we need guidance in South Dakota on how to help that. Clearly, we're here for the Medical Marijuana Oversight Committee, the safe regulated program under the Department of Health, but we have a mess in our state where our children are actively getting these products from these bad actors because it's unregulated and unsafe. Any suggestions, maybe an opinion that you have? And I thank you for your time.

Thank you so much for that question. I think the simple answer is ban all hemp products. A lot of states are already going down this road. A lot of these products have a lot of isomers and analogs that people are not aware can be very dangerous. For example, in the state of California, and even online, you can find this on more happy to send you a link. Uh, there are products that contain a product, a cannabinoid called THCP, uh, which is about 30 times stronger than Delta-9 THC. Uh, they contain products like THCO that was weaponized by the US government in the 1940s as a chemical warfare agent because it eroded dogs' muscle coordination 3 times stronger than traditional Delta-9. I can send you the link to that. Uh, you have these Delta-10s, Delta-H, HHC, All these other analogs and isomers that are flooding the market that are accessible to kids. I think the simple answer is ban the hemp products completely. Close the farm bill loophole, and I think that's my simple answer. Madam Chair, hi, I'm Andrew.

I'm a geriatrician. I appreciate your talk.

Would you share that with us? Could you please, because you did briefly mention increased rates of something in the elderly, I believe it was in California, could you restate that for me? Yes, and I'm more than happy to send you— I can send you a copy of my slides. Well, you have them, so you're free to share them. In the state of California, there was a paper that came out that there was a 1,800% increase in the number of people over the age of 65 ending up at the emergency department with a cannabis as poisoning. And as you know, as a gerontologist, the older population is underrepresented in the medical literature. And as we age, we tend to be on more drugs, and there could be a significant number of drug interactions, particularly things like blood thinners. For example, warfarin, which is a blood thinner. I had a patient that had a coughing episode because he had a familial bleeding disorder and was stable on his warfarin. His INR, the internationalized normalized ratio, Of how thin your blood is. It should be between 2.8 and 3.0 on average. And, he had a coughing episode after gobbling up a bunch of CBD products and ended up with a condition called a retroperitoneal hematoma and a lumbar plexus injury. So, he had a very terrible nerve injury. His INR was 7.8. His blood was extremely thin because of the interaction between CBD and his blood thinner. And, when you get into the older population, they may be at risk of a subdural hematoma, GI bleed, all these other things. But yes, I'm more than happy to send you information on the older population, which are at risk. And I think older people are using more because they think it's safe and it's what they grew up with in the '60s. These products are very, very different than the 1960s and '70s.

Thank you, sir.

I've actually seen an increase in use as middle-aged people like myself have provided it to their their elderly parents who reside in facilities?

Thanks, that's it.

Yeah, they end up in the emergency department catatonic and they get the million-dollar workup, and basically they— if there's no concerning adverse event like a heart attack or a stroke, they have to ride it out. And then, you know, what are the healthcare costs? I published a paper that one hospital in Colorado lost $20 million between 2009 and 2014 just from marijuana-related ER visits. I had CFO of the hospital signed an attestation agreeing with that number in our data, and if you take that hypothetically across the state of Colorado, that was a half a billion dollar price tag in 6 years. That's $83 million a year. That's stuff a lot of states are not looking at critically and they're not publishing that data. So I think the healthcare utilization needs to be looked at critically in the state of South Dakota because it is creating a public health and safety concern.

Any further questions for Dr. Finn? Thank you, Dr. Finn. It was excellent. Appreciate your time.

Thank you. Consider me a resource, and thank you for the efforts.

Thank you. I'm going to adjourn the meeting for 5 minutes. Okay, we're now reconvening, and we're up for the public comment. So please, if you haven't signed in, please sign in. When you're coming up for the public comments, please sign in and identify yourself. Thank you very much. Just be clear, we'll do the in-person comments first and then we'll get all of you waiting online. Thank you very much.

All right, thank you, Madam Chair, council members.

My name is Rob Krogstad. I'm here for Bad River Cannabis across the river, and I'm also a cannabis patient cardholder. I'd like to start with some of the things I've heard some of these outside state folks say. One thing, Georgia tried the pharmacy route and they stopped it right away, but I believe that was before Schedule 3. So just to know that there have been states that looked into using the pharmacy route. Cannabis use disorder, I don't think that's a medical term. I think they use that because they can't use cannabis addiction because there is no such thing as physical cannabis addiction.

That's a medical fact.

So I think they use the word cannabis use disorder because they can't use the word addiction like they can with alcohol or any Amphetamines or opiates. Every study I've read about shows that alcohol, opiates, and amphetamine use goes down when there's access to legal adult-use cannabis. That's every study I've ever read about. I've never read a study where those addictive substances go up when there's legal access to adult-use cannabis. And Dr. Dr. Madras, I don't know why whenever she put FDA standards up there she had them in quotes. I don't know why she said that. She also said that all these patients say it works and then went through why they are wrong. That was very contradictory, I felt. There was a new study and there was no noticeable driving deaths or effects from cannabis in states where it has have legalized it for adult use. That was just a new study that came out. I'd like everyone to see that. The schizophrenia argument was debunked in the '80s.

It doesn't cause schizophrenia.

They've been trying for 40 years to say that if you have schizophrenia and you smoke, it will give you an episode, which they can keep studying that.

I hope they do.

Dr. Sabbat, what I mostly heard from was hyperbole. He really didn't have any facts. Like the potency cap, they've tried that in multiple states and it's never worked.

That's failed in every state they've tried it in. He said the evidence doesn't matter and then went into a lot of hyperbole.

Cannabis is still the same as it was in the '60s, '70s, '80s, '90s. It's still the same. It's still the same plant. I don't understand where he got that. He said there was a loss of IQ, and that study was the monkey study where they put face masks on monkeys and fed them smoke for 8 minutes, and they lost brain cells because of low oxygen. That's a fact. You can look that one up. The gateway theory has been disproven since I think the '90s or the '80s. Like the potency cap, like I mentioned, if I have something that's 13% or something that's 20%, I'll have to take 2 tokes of 13% to get the same effect as something with 20%. So again, that's just— I don't understand where they're coming with that, but they all want more More big government in our lives, it seems. Now, Dr. Finn, or the next one was Dr. Barthels, and I'll get into what he talked about in just a second. Dr. Finn was pretty much all hyperbole with a few out-of-state stats. We're not Colorado. We're not Pennsylvania. We're South Dakota. He said he talked a lot about overdose deaths. The DEA just came out under oath and said there have been zero overdose deaths ever in the United States. The DEA just came out under oath and said that medical marijuana poisoning—I've never—that's never happened. No one's ever died from poisoning of marijuana. That's They talked about that, and I don't know where he got that. Just hyperbole, and it's not true. Cannabis lasts 10 times longer or more in your system than a lot of other drugs.

So let's say you get into an accident.

2 days later, you're tested.

You were hammered at the accident.

Well, 2 days later, you're sober. You have no alcohol in your system, but you still have cannabis in your system. It can last up to 2 months in your system. That's why cannabis is always where amphetamine is 3 days, opiates are like 3 days. THC is already illegal in South Dakota. We just we do have a problem and we need to get get that. The not good for developing brains—that was a UK study. It was done on 12 kids and it was National Enquirer type magazine. Now I'll go over my prepared statement here. There's zero deaths from overdose. There is a 7,000-year history of cannabis being used as a medicine, not 4,000 or whatever Madras said. There's a 7,000-year history of it in China. It is a medical fact every, every human has an endocannabinoid system, which is a complex cell signaling network that helps regulate and balance many critical bodily functions, and the cannabinoids in cannabis mimic our system perfectly. Both the DEA and Smart Approaches to Marijuana, Kevin Sabet, had to admit under oath this summer that medical cannabis has— cannabis has medical properties. Both the DEA and Kevin Sabet both had to say under oath that cannabis has medical properties. The DEA also had to admit there have been zero overdoses ever in the U.S. That's—

this is under oath.

They had to admit this. There's also never been anyone homeless due to their physical cannabis addiction ever. Cannabis doesn't cause homelessness. Alcohol, amphetamines, opioids— they're rife with physical addiction, homelessness, and death. Cannabis never. If everyone on this committee could write this name down and look into his team's 40 years of medical cannabis research, I would appreciate it. His name is Dr. Raphael Mechoulam, and I'll spell it. It's R-A-P-H-A-E-L M-E-C-H-O-U-L-A-M. Him and his team have cannabis for over 40 years and they're still conducting research. Please look into his work as it contradicts our out-of-state paid agitators' lies and misinformation. South Dakota patriots do not need out-of-state paid agitation on a voter-initiated and voter-passed bill. We South Dakotans have a safe, effective, science-backed medical program that is running smoothly under under our free market capital system by South Dakota patriots, and I resent the outside-paid agitators trying to take safe, effective medicine from sick and dying South Dakota patients, including myself, a combat veteran. Any questions?

Any questions for Mr. Rudd? No. Thank you, sir. Appreciate it.

I appreciate it.

Thank you.

Going forward, it will be a six-minute time frame, and if needed, we will extend it if it is necessary. Thank you.

Thank you. Can you guys hear me okay?

Madam Chair, members of the committee, my name is Kittrick Jeffries.

I represent Dakota Cannabis Consulting out of Rapid City.

I'm also the president of the Cannabis Industry Association here in South Dakota.

First off, I want to like to thank the department for all their hard work and their presentation they put forward today.

I thought that was really good concluding.

Fact-based evidence that they brought forward, so I'm appreciative to have them in the room. At the end of the day, the Cannabis Industry Association of South Dakota opposes what we would consider anti-marijuana propaganda. There's no there's no need for it.

There was a lot of dialogue that was not fact-based, and so at the end of the day, what we're looking for is more presenters like. Dr. Barthels, who spoke to the endocannabinoid system.

He was very articulate.

He spoke well.

And he was on point.

That being said, it's just hard to express some of that frustration. But at the end of the day, the Cannabis Industry Association is thankful to work with the Department of Health and to continue moving with the process of regulation. With South Dakota state law, the rules, and the DEA.

Thank you.

Thank you. Any questions?

Good afternoon. My name is Kasey Entwisle and I serve as your patient representative. Sitting with me today are my parents Barbara and Randy Knutson. I'm asking this committee to support a dedicated task force to examine patient access, product safety, and practical improvements to the South Dakota medical cannabis program. I want to begin by explaining why this work matters to me. For more than 25 years, I've served as a deaf and hard of hearing I've served the deaf and hard of hearing community as a nationally certified interpreter for the deaf. I own a South Dakota interpreter referral agency. My work involves helping people communicate, be understood, and participate in decisions that affect and impact their lives. These same principles guide my service as a patient representative. I'm also a 5th generation South Dakotan and a mother of 2 young amazing adults. I believe in hard work, personal responsibility, and looking out for our neighbors. In 2022, my husband received a cannabis cultivation license. His work with the South Dakota— South Dakota's regulated medical cannabis program introduced our family to a treatment option we had not previously understood. I share that connection openly because it's part of our— my perspective. My responsibility on this committee is to represent patients and bring their experiences into our decisions. My father served 2 tours as a recon Marine in Vietnam in '68 and '69, where he was exposed to Agent Orange. Over the years, he's faced diabetes, heart attacks, bypass surgery, congestive heart failure, strokes, numerous eye surgeries, blind advanced kidney disease, neuropathy, and loss of several toes because of the gangrene. At one point, his daily regimen included 16 prescribed drugs, 4 insulin shots, and frequent medical appointments and frequent hospital stays. Our family watched someone we love struggle with pain, declining health, and the long-lasting effects of PTSD. Through my husband's work, we learned about Rick Simpson Oil, RSO, a concentrated cannabis oil. Since my father began using it, we have witnessed meaningful improvements in comfort, sleep, blood work, and quality of life. I can speak to what our family has experienced. My father still has serious medical conditions, but he is finally able to sleep better. Feel better, live a better quality of life, and our family has found renewed hope because of the safe regulated program we are here to talk about. That experience is why protecting access matters to me so deeply. Since my appointment, I've worked diligently on behalf of the patients of South Dakota in an effort to ensure I have an informed decision and can make informed decisions. I have provided each committee member with a book on the endocannabinoid system. That's the first thing I did in hopes that it would encourage a deeper understanding of the science behind this medical cannabis. I reviewed more than 20 hours of committee meetings, visited licensed dispensaries, cultivation, manufacturing, and testing facilities under the Department of Health. I attended the Department of Health meetings meetings, public hearings. I spoke directly with patients. We spoke directly with patients. Traveled— I traveled to Washington, D.C. for an Americans for Safe Access event and talked to our national leaders on how we can do better for the patients of South Dakota. I have attended in person and actively participated in every community meeting. These experiences have reinforced the importance of testing accountability and clear rules. They have also shown me why we need to listen carefully to the patients who face obstacles in obtaining this care. I understand the committee members have different views about cannabis. Questions about medical evidence, certification practices, and public safety deserve careful consideration. Patients' experience deserve that same consideration. Patients of South Dakota and their experiences deserve that same consideration. When concerns arise about someone obtaining a card inaccurate— with inaccurate information, our response should be to examine certified certification safeguards and recommend improvements. Patients with legitimate medical needs should not buy Bear the consequences of someone else's misrepresentation. We also need to examine illegal products sold outside of this regulated medical cannabis program. We have heard concerns from law enforcement, school officials about youth access to these dangerous, unsafe, unregulated products. Those concerns also deserve serious attention at our state level. A regulated med medical cannabis program provides a framework for testing, for oversight, and for accountability. Our policies should strengthen those protections while making it possible for eligible patients to obtain care. Veterans, rural residents, and other underserved patients deserve this particular attention. Distance costs and difficulties navigating certification can create real barriers. We should identify these barriers. We should work together and address them. South Dakotans voted very loudly to establish this program. Honoring that decision means doing the work required to make it function responsibly. This committee has an opportunity to turn concerns and competing viewpoints into practical recommendations. For that reason, I recommend a dedicated Task force that includes patients, veterans, medical professionals with knowledge of safe cannabis use, the Department of Health, law enforcement, licensed medical establishment, and the Attorney General's Office. Its work should focus on improving access for our veterans, our rural patients, reviewing certification processes, costs, and delays, strengthening product safety and testing, addressing what law enforcement concerns involving. These illegal, unsafe products outside of this medical program. The task force should have a defined timeline and deliver specific recommendations for legislative and administrative actions. My faith calls me to approach this work with compassion. My professional experience calls me to listen, and my family experience reminds me that these decisions affect South Dakotans who are already carrying difficult barriers. My father sits beside me today as a Vietnam veteran. For him, for the patients, the 19,000 patients I represent, this discussion is deeply personal. They deserve a program that listens to their needs, protects their safety, and allows them to pursue the relief. Thank you to the executive board for appointing me, and thank you to the committee.

Thank you, Ms. Entwisle. Any questions for Madam Chair. Yes, please go ahead.

Ned Horsted representing 605 Cannabis. We're an operator out of Worthing, South Dakota. Statute calls for 2 medical marijuana oversight committees per year. This is meeting number 4.

How many tax dollars were spent for legislators, department staff, law enforcement officials, etc.?

With the exception of one presenter today, the chair and vice chair, who are both individuals who sponsored legislation to eliminate South Dakota's medical cannabis program.

Yes, I'm sorry, you said four. This is just the second one for this year. It's two per session. So this is our just our second one, not a fourth one. We have two. It was three last year. You're correct, and you're thinking about that. But there's only been this is the second one.

Okay.

I yeah.

When I pulled up, so we're not wasting taxpayers' dollars. We're doing what is our due diligence.

Got it.

Just one one more of those.

Okay.

Just want to clarify for the record.

That's good.

Thank you.

You bet. I guess either way, with the exception of one presenter today, you know, the chair and vice chair. Are both individuals who were sponsors of legislation to eliminate South Dakota's medical cannabis program. You've done quite the job once again in stacking the committee with anti-cannabis individuals from out of state. The agendas produced by this committee show evidence of a 2-year war on patients, industry, and at times the Department of Health. Therefore, I do not think it would be appropriate to provide recommendations to the legislature in which more than half of the legislators on this committee will not be a part. Over the recess a few minutes ago, we asked if the order of the agenda could be changed so that the public could speak to any recommendations the committee will likely discuss next.

We were told that a vote was taken to deny that request.

I'm curious if the chair and vice chair will make that vote public. I suspect public comment is taken before the final agenda.

Once again, I'm sorry, Mr. Ned, would you tell me what are you talking about as far as what, what Yeah, I'm getting there.

It was—

Could you be specific?

Yes, over— you came and talked to us during recess.

You mean when I was approached in the hallway if I would switch up the agenda today?

Yeah.

Which I went back and spoke to, I think it was Mr. Kittrick Jeffries who represents, and that no, we took a vote yes here. I asked, went around and asked because the public also has to be informed. So it's a matter of keeping with what we have published 5 days— we have rules we have to publish. So yes, at the discretion of the chair, I could change, but that's not what I decided to do. So I'm questioning what my—

that's the vote I was referring to.

Yeah. So what's the point? I'm not understanding where you're going with that.

Um, I, I'm getting there, if you'd allow me.

Sure. Yes, go ahead.

Okay.

Thank you. I suspect That that request was denied, and public comment is taken before the final agenda item. So you don't have to hear from patients or stakeholders after you come up with recommendations, which seems very counter to the vast majority of 3420G93—the statutory responsibilities of the committee—which you started the meeting with. So I'm asking for no recommendations, and if that is your intent, here's one to consider: We talked about the financials. The department did a very good job of stepping through the financials. One thing that I've noticed as an operator that may be helpful in painting the full financial picture of the medical cannabis program is to have Department of Revenue track the medical marijuana sales tax separately from all other sales tax. To get that data, it is very, very difficult. You got to call the Department of Revenue, sort through it, figure all that stuff out. Stuff out. And I think, I mean, it's an expensive program for patients, for operators, and that number is just pretty important. But again, I'll rewind just a little bit. I'd rather see no recommendations coming out of this committee given, you know, I've asked, I think after every meeting, I've invited the chair, the vice chair of the committee to tour our facilities. Ms. Entwisle shared that, you know, other resources are available that have been offered to you by the public. That's been ignored every time.

Thank you.

Thank you. Any questions from the committee for Mr. Ned? No.

Chair Garcia, members of the committee, my name is Mitch Richter and I represent Genesis Farms. The committee's job under SDCL 3426-20G92 is to evaluate the program South Dakota voters approved with 70% of the vote and to recommend how to make it work. Today you spent roughly 2.5 hours on presentations. All 4 presenters were from out of state, 3 of them Dr. Medeiros, Sabet, and Finn have spent years opposing medical cannabis nationally. All 3 fought federal rescheduling, and Dr. Sabet's organization is suing to overturn it. Not one South Dakota patient, certifying practitioner, or operator was invited to present. Look at what their evidence actually was actually about. Dr. Finn showed you Colorado, Oklahoma, Texas, California, Pennsylvania, the UK, and Canada. Those are recreational markets, a program with no qualifying condition list, and Texas's unregulated hemp market. He described getting a Colorado card in 60 seconds. South Dakota requires an in-person exam and genuine practitioner-patient relationship, and Dr. Sabet credited this state for that this morning. When Dr. Finn finally showed South Dakota data, it was overdose deaths and they were flat from 2020 to 2024. In his own words, it doesn't appear cannabis is affecting this state's overdose numbers. That was the only South Dakota outcome data presented all day. Dr. Medeiros told you the program fails FDA standards. Voters didn't create an FDA program. She also testified against the rescheduling that would make research easier and then faulted the research for being thin. Even so, her own slides show that cannabis reduced chronic pain and improved sleep, and chronic pain is what 70% of patients here qualify for. The one presenter who is a patient was Dr. Barthels, a 2-time cancer survivor who has managed intractable pain with cannabis for over 10 years. His message was that regulation, labeling, and dosing guidance are what keeps patients safe. That is what a regulated program provides and is what the gas station hemp products don't. When Ms. Entwisle asked about the hemp, Dr. Finn's answer made the real problem clear. Children are getting unregulated hemp vapes, not products from licensed dispensaries. Here's what the state's officials told you. The Attorney General's opinion says federal rescheduling will have a negligible impact and the program may continue as it has. The program is self— the department says it has received no complaints about access to safe cannabis. The program is self-funded— $2.5 million in fees, $1.5 million in costs, and a million-dollar balance. So here's a constructive ask. The department said today it has no budget line for patient and public education. Patients already funded a million-dollar reserve, so use part of it for education at dispensaries. And before the department acts on Dr. Sabet's list, it should hear from the patients and who live under these rules. Proposals like a 10% potency cap, a pills-only rule, eliminating home grows would not oversee the program voters approved. They would repeal it. Changes that large belong to the incoming legislature with South Dakota voices at the table. Thank you. Any questions?

Sorry about that. I don't know what happened. In there with the IT, Madam Chair.

May I ask?

Go ahead, Representative Shock.

I can't even remember what you said. You said it all so fast, but that's okay. It was it was towards the end. You talked a little bit about how there was maybe nothing that we had recommended. We had recommended nothing for warning labels or warnings. You talked about gas station vapes and you were definitely against that.

Like, that would be a recommendation that you would suggest.

I think that made some sense. And then you would like us to come forth with a recommendation on how to—

So what's your question?

I'm getting to that. How do we fund— like, you want us to make a recommendation on a certain amount of funding for warning labels on packages? Is that where you were going with that?

Funding for education with the dispensaries. But we'd also like— it's not part of this committee's oversight, but the real problem is the unregulated vape that is being sold at smoke shops around the state. I mean, that is the crux of the whole problem that a lot of what you heard this morning, that has nothing to do with the medical cannabis facilities. So if you want to attack the problem, attack the vape shops.

Sir, I have a statement. Actually, not even a question. I just want to have you repeat your recommendation. Because I agree, I know you're upset with the presenters, as everyone has been upset with the presenters, but it is our objective of number 5, 6, and 7 to go through that. That is, we have a job here to do. But I agree, the vapes, but we discussed that the last year. Vapes, we don't have any control over the vapes. We— this committee is not in charge of the vapes. The bigger issue is, yes, that and the children's mortality or whatever we might be seeing coming down the Yes. But I had said, even with the AG asking about the pharmacists being involved, because it is in codified law, the pharmacists should be involved. But education is one of the top priorities of this committee, of getting it out to the public. It's a safety issue. So you're saying, if I heard you correctly, the dispensaries allocate money for the dispensaries to educate the people when they go in?

Is that what Well, the health department can create an education program. I'm not saying each dispensary should come up with their program.

Okay.

But the health department should be able to do that.

Okay.

And why did you not have presenters from South Dakota today? Why was there nobody here talking about the South Dakota program?

We have asked many, but some did not—

Who were they?

Because we'll certainly ask I'm not saying we didn't ask them to come, but nobody that I know of, and I'm in the industry, was asked to come and present.

Well, perhaps you have people that would agree that we didn't have agree, and we can ask them. Well, we can— I'm sure we can give you some names of who we asked and they would not come forward.

Okay.

But going back to your suggestion, which I agree is imperative, is the dispensary education, but also it's at the school levels. Where do you recommend? We had the superintendent last session. We talked about that, how they're not getting educated at the school sites from all levels— elementary, middle school, high school. What are your thoughts on that? How do we get over that obstacle? Because that's where it starts, from the home to the school and then the teachers and going forward.

Well, that superintendent talked about that it was a vape issue, and again, this is not Not this committee's part of an oversight, but there are four legislators here that could have brought vape legislation last legislative session to to deal with that, to to to take care of the unregulated chemicals that are coming into the state.

Sir, you're absolutely right, but there were some bills that came, but they got killed. They didn't get any further.

Well, you didn't work hard enough on them.

Well, we just didn't know the right people to pull it through. So perhaps maybe people didn't support it. I can't answer that, but I do agree that education is a huge component and we have to come up with that. And thank you. I understand your frustration, but that would be great to know who you could have come speak on behalf of South Dakotans.

So that would be great.

Thank you.

Madam Chair?

Yes, Senator Carley?

Just to correct the record a little bit. The previous testifier mentioned Section 3420 as the duties. It's actually 93, and that's what you read at the very beginning. And it does speak to any research studies regarding health effects of medical cannabis for patients. And actually, we heard that from 4 of the presenters. Secondly, just to correct a little bit, we give public testimony. So actually, anyone Anyone can come during this period. So if you have, you mentioned you have people in your industry, you are welcome to have them here to come and testify during this time.

Thirdly, we—

someone's checking. We hear you. We hear the check. All right. Thirdly, we did have people from South Dakota testify today, both the Department of Health and And we've had members testify. So just to kind of correct a few of those things and make sure that you're aware that we do make it quite open.

Well, there's a big difference between a 45-minute presentation from somebody sitting in an office with a 50-slide PowerPoint versus giving somebody 3 minutes to sit down here and advocate for the program. I mean, check. The public can show up, but you know you tried to cut off one of the own committee members. So why not give them you know twenty thirty minutes like you gave the the folks that are anti cannabis? That's my point, and I don't want to get in a back and forth with you on the on the regulation in ninety two versus ninety three. But you know exactly what I was talking about, Madam Chair.

Madam Chair, you both came at the same time.

So Just to correct the record again, I recall hearing the chair giving 6 minutes, and she also mentioned at her discretion she would extend it, which she did in a couple circumstances. The first speaker got 9 minutes, and the second— third speaker got more than that. So I think that did take place, and that's why we have it open for the public.

Kasey Entwisle, patient advocate. Representative, I just wanted to clarify on the miscommunication and probably maybe some misinterpretation of our 32-something whatever law we're talking about for the rules that guide this committee. You talk about health effects from medical cannabis patients. These health effects that these people are talking about come from a hemp product that are not associated with this program, and this is where you're confusing yourself, sir. Thank you.

Madam Chair, Representative, uh, Representative Travis Ismay. District 28B. You know, I've heard a lot of good information today, both sides. But I'm a legislator. I'm still a legislator. And I took a little time here the past few days and I read through 34-20G. And there are some of the sections in that law that are just absolutely ludicrous. And here are 4 of them. Section 59, local government prohibition of dispensaries not permitted. No county or municipality may prohibit a dispensary either expressly or through the enactment of an ordinance that makes the operation of the dispensary impracticable. Impracticable. How do you pronounce that?

Impracticable. Come on, guys.

Help me out.

Impracticable.

Okay.

Anyway, in the county or a municipality, we have no local control of a municipality if we cannot prohibit a marijuana facility if they deem it necessary. Who determines what is impracticable?

Whatever.

Not.

I don't understand how you can have dry counties, you can have all kinds of things like that, but if my community sees that there is a problem with a marijuana facility in it, that's a loss of local control. Everybody in the legislature touts how, oh, we want local control, we want local control. Well, my county didn't want that. They didn't want anything to do with marijuana. But we were forced to allow that. That's not fair.

Okay.

Section 53, registry identification card not required to raise defense. This is where I'm going to take a lot of I'm going to fire back a little bit at the marijuana industry because I brought this bill last year and it would have actually helped their business because they would have required a medical identity or medical marijuana identification card. All of you fought me every step of the way. So what's it about? If it's not about getting a registry identification card, what are you doing? Section 34G72.11— boy, they buried this one— the department may accept donations from private sources to reduce application and renewal fees. The department should not be accepting any donations from private sources. That is ridiculous. Anyway, Section 95. This is the one that I've heard a lot of talk about today too. Section 95: Administration of medical cannabis to students. The department. Department of Education, the department shall establish policy to allow students who are medical cannabis cardholders to have their medication administered in school in accordance with their physical recommendation or physician's recommendation. This policy shall be implemented the first day of new school year following the passage of this chapter. The departments shall implement identical provisions. To the Colorado Revised Statute 22-1-119.3 as of January 1st, 2019. We're not Colorado, but we're using their law. Exactly their law. So what makes you think that that's going to be any different than Colorado? We're still humans.

We're still people.

It's pretty much the same kind of reason. I've heard it said that South Dakota is not Colorado. We're doing it better. This section of law says we're doing exactly like Colorado. If we as legislators are determined what is medical marijuana and what is recreational marijuana, we have to actually regulate what matters, such as the quantity that we are producing in these medical marijuana grow farms and how much is sold in the dispensaries? Do we know? I've asked before. I've never got a definitive answer. They said they don't know. So how are we supposed to get a true definition or keep track of our medical marijuana if we don't even know how much is being produced or sold? Any questions?

Madam Chair. I just maybe have an answer to your question that you asked of the committee. And what's that about? I think it's about silly felony charges. As I talked to the Attorney General's Office earlier, I asked if they would maybe present new laws in the cannabis world to protect our citizens of South Dakota from receiving felony charges for a plant given to us for our system. So I think what's— and it talks to the integrity of this industry. The South Dakota born and raised people in this industry don't want people going to jail for felony charges. I don't think anybody does.

Madam Chair, Representative, I, I don't know of anybody that has gone to jail in a felony charge for marijuana. I guess I've asked the Attorney General myself. He said nobody goes to jail for a felony charge on marijuana. That's just what I've— that's what the Attorney General told me. And he made it very public. It was in a meeting that I was in, in public. He said we don't do that.

So— Thank you for the clarification. Any further questions? Thank you. Now we're going to go to the public online. Steph Scherer, are you online? We're ready for you.

Yes, I am. Although I can't— I'm trying to find out how to share my screen, and I don't, I don't see an option here.

One moment, please. The IT, we're looking at it.

Oh, it just popped up.

You should be able to now.

Great, thank you. Thank you all for having me. I want you to know that every state has— is having very similar conversations.

I'm sorry to interrupt you there, but your screen is not being shared. You want to just double-check, please? Thank you.

Yes, I was just talking while I was doing it. I'm multitasking and I'm a medical cannabis patient. But I think, you know, the whole time I was listening, you know, I definitely wanted to jump in and answer some of the questions that you were having, especially the legislator that just spoke.

Thank you.

It's asking for permission. Sorry. Can you see it now?

Yep.

Okay, fantastic. So I'm going to keep this as short as As possible, but you know right now, I know you guys were very focused on what's happening within the state, but there have been two very significant federal developments: one around the hemp laws and one around actually moving the state medical cannabis programs. Into Schedule 3 that are gonna have major impacts on every medical cannabis program. And I just, you know, I was with you guys for most of the day and was hearing sort of these, especially the last speaker, sort of the everything anti-cannabis. But, you know, I am a medical cannabis patient. I founded Americans for Safe Access. 24 years ago, and I became a medical cannabis patient because my neurologist brought up cannabis as an option. And I'm so thankful that he did, but that was after I had tried every anti-inflammatory and was having issues with my kidneys. And so one of the reasons that there are so many people in so many different conditions is that we have a pain crisis in this country, and it turns out That cannabis is a very effective and safe treatment for pain, and I'll share this presentation. I'll upload it so you guys have it. But I just wanted to kind of ground you back in in the fact that we're talking about medical cannabis, and you know, for every statistic that you can talk about the negative components, which I I definitely think communities need to have those conversations. You know, that we need to really look at the facts of the health of Americans and why cannabis has become such an effective treatment and such a sought-out treatment for so many patients. And so the DEA actually estimates that there's about 6 million medical cannabis patients. About 22% of veterans are currently using medical cannabis. About two-thirds of medical professionals recognize that cannabis has medical value, but a very small percentage of them are recommending cannabis. And this is something that your committee could do to help. But what we do know is that when people do have access to cannabis, that they're actually using fewer prescription drugs, that they're actually replacing some of the more dangerous prescriptions with cannabis, and that cannabis is actually treating pain factors like neuropathic pain and other conditions that there is no known treatment. And, you know, when we talk about these conditions, where they came from, actually starting in 2015, states started actually going through a process of looking at research to add these conditions. And I just wanted to let you guys know that there are, you know, quite a few health organizations and doctors involved. Yes, in every state there are a few doctors that write most of the prescriptions, but that's actually true of opioids now. That's true of a lot of specialty diseases. That's not unusual. And there are, in fact, guidelines for recommending cannabis that have been available that doctors use. Um, there, you know, the CDC actually back in 2016 recognized that cannabis, um, was a positive treatment. I hear people talk about the gateway theory. Actually, the DEA, um, actually took down this information about the gateway theory. It was disproved in 2017, right? Even NIH says that there's no such thing. And so I just think it's easy to kind of go back to, you know, the 50 years of propaganda. And I'm not saying that there aren't challenges, but I think we just need to kind of move past that and really look at the health of our, of our communities. And yes, we need, you know, there's a million-dollar surplus. Look at some of the other states that are educating kids in elementary school, in junior high about cannabis. But all of that education, everything needs to evolve so it really meets where we are today. Our organization, we actually worked to change the scheduling of cannabis in the UN drug treaties that happened December 2020, and that actually opened the door for what we experienced with the AG changing the scheduling of cannabis. Um, but there's been, you know, a lot of sort of unusual characters, I would say. Some of the most anti-cannabis people in the legislature actually passed legislation for a research act. This actually— I don't know if you've notified all of the doctors in Sandy— I mean, South Dakota.

Yes.

Um, but, um, so, you know, But in this research bill, they actually codified that doctors have an explicit right to recommend cannabis. Several states actually have dosing guidelines. So this information is out there. There are over 60 countries that have federal cannabis programs. The International Narcotics Control Board has created guidance for how member states can create these programs, and that's what we're starting to move into. So, you know, as much as people have personal bias, right, even FDA said that looking at all of the evidence that nothing— they didn't see any sort of safety issues that would merit keeping cannabis from people right now. Actually, last month, September, was Cannabis Safety Month. We're actually giving out awards this month. For programs and individuals that are working on cannabis safety, I invite you to look at these awards. And you know we're highlighting you know state programs and individuals that are addressing a lot of the issues that that you showed concern for earlier this year. We put out a this report for states guidance document for governors and for state legislators. On actually the, the change in the hemp bill, we actually want to see all of those products regulated. And so we're not trying to, to stop that loophole from being closed, but we are, you know, educating states that there will be thousands of patients in your state that couldn't, for whatever reason, use the medical cannabis program. That are going to be without access, and so this is just a guidance document to think about maybe how you can incorporate some of those products into your existing regulated program. So that was sort of crisis number one, and then in April we all woke up to a notification from the Attorney General that said they were going to move the. Existing rescheduling process forward, but also that the AG used his authority under USC 811 to move all of the medical cannabis programs into a regular DEA-regulated program under Schedule 3. So that means like right now, sure, the businesses in South Dakota applied for the DEA license, but they're all actually federally legal businesses now. And so, you know, this came out of a request from the president, an executive order.

I'm sorry to interrupt, Miss Stephanie. We're at 9 minutes and 30 seconds, so I'm going to have to ask you to wrap it up.

Okay, I think you just— I'm just going to ask for like 3 more minutes because there's some things I think that you guys really need to hear, and so I'm So I'll push through it really quickly.

I'll give you 2 because there's 4 other people waiting, so I only can give you 2 minutes.

Okay, I've been sitting here for 8 hours. Just kidding. So the— again, I'll send this to you, but what this means for patients is that if you have a state ID, if you're a part of the legal program, you now have federal rights. Your ID card is equivalent to a prescription. And that means that you have rights under the Americans with Disabilities Act, the Fair Housing Act, and Section 504 of the Rehabilitation Act, which means, you know, hospitals, hospices, they actually have to accommodate medical cannabis patients. And so we are actually educating patients about what this means. Unfortunately, the AG order only gave instructions to The to Treasury and to the IRS, and so all these other agencies need to catch up, which we are working on from there. But within the state, I think what you should be looking at is that actually employers—you guys already have in your state law—that employers. Uh, landlords, you know, can't discriminate, but this actually now moves into hospitals. You know, the patients have the same rights as anyone with a prescription. And so some of the things that you should be looking at is whether or not cannabis can be taxed in your state. If you don't tax medicine that is Schedule 3, you So, what you may— if you want to tax our medicine, you may have to change your tax code. But anyway, these changes— your program is now federally legal, and the patients that are participating in it have federal protections. And so we have a lot of resources for states to educate patients, to educate hospitals, employers, landlords, About what this means, but this should also mean that patients, as long as they're following the state law, you know that they cannot be discriminated in any setting because of their medical cannabis use. And so this means teaching patients how to ask for reasonable accommodations, and we've created resources for patients, resources for doctors, resources for elected officials as well. So we're here to help you guys through this process, but it's pretty exciting. And, you know, as someone who worked on the South Dakota law and worked— meaning that we helped patients on the ground there, you know, I think it's pretty exciting to see where this is evolving and the work that you guys have done in South Dakota. Helped make this happen, helped make a pathway for the federal government, for HHS, FDA to recognize cannabis medical use. I'm stopping there, but if I can answer any questions, and again, we have a lot of resources.

Thank you for your thorough explanation and understanding the time. I see, anybody here have any questions?

Madam Chair, Kasey Entwisle, patient representative. I just wanted to go on the record and state my frustration as you cut her off at 6 minutes when this is something you just testified to that you wanted to hear from these people.

I'm not going to get into it. It was 9 minutes and 30 seconds, and I have the discretion as the chair to do that. I'm not answering your question. We're not going there on that.

Thank you very much. I have a question for her, Stephanie, and on August 6th—

And I'm not allowing the question. I'm not allowing the question.

On August what? I'm sorry?

Thank you very much for your testimony. We are moving forward. Appreciate it.

I'm sorry. Do you not want me to answer questions from people?

We are right now not going to get into dispute with one of the members on the board, and I am actually going on to the next testifier. She can email you the question and we can pull it up on our website, the LRC website. Thank you very much.

Madam Chair, LRC question procedurally.

Madam Chair. I suggest we move on. You've given double the time to that public testimony, so I suggest we move on.

Maybe we should take a vote of the whole people here sitting. Do we move on? Do we continue? What are we doing? Because I believe in team efforts here.

Madam Chair, I would allow a question from someone on the committee.

A question.

Is everyone in agreement, Madam Chair?

I would allow a question as long as it pertains to what the person presented.

Senator Nelson, I agree.

I was asking for LRC question.

LRC question. I'm going to go ahead and. I'll allow the question to the LRC. Go ahead, Ms. Entwisle.

Can I provide documentation, emails related to the speaker from Co-Chair Carley to the LRC to publish? Thank you.

Okay, online, I think we have a Mr. Aaron Cooper. You're good to go.

Can you hear me?

We hear you very faint, so if you can get closer and we'll try and turn the volume up here.

All right, fantastic. All right, let's see here. I had a thing prepared. Chair Garcia, Vice Chair Clary, I think I'm saying that right. Members of the committee, thank you for your time. My name is Aaron Cooper. I live in Mitchell, South Dakota. I'm a father, a I'm a husband, a stay-at-home dad who cooks, does laundry, and keeps the house running while my wife takes care of the show. I also run a small media company called Ben of Production. I'm a recovering addict. I've been clean since January 20th, 2020, and cannabis is the reason that date means anything. When I was 14, an adult put meth in my hand. I did not choose that life. That life chose me, and it ran for nearly 30 years. I buried friends. I watched mothers cry over caskets. I sat in rooms at 4 a.m. while the walls breathed and my heart tried to beat out of its chest. Locking me up did not fix me. Shaming me did not fix me. The other medications that the system pushed on me, trying to tell me they would fix me, never fixed me. I watched doctors like everyone you just had on this panel. Pushed pills on me my entire life that did nothing but make me crazier. I spent my entire life fighting to use this plant. I've been laughed out of doctor offices. I've been told I'm stupid. I've been called an idiot. I've been raided over this plant. I've had my life taken away. Travis, You said you've never met anybody that's been a felon or been in prison for this plant. Well, now you have, because I have. Today, this committee heard from people who spent years telling this country cannabis is dangerous and should stay tightly controlled. Some of them don't even live here, which I just frankly don't understand. They do not look at a South Dakota patient in the eye and explain why the plant Can keep me off meth. I was forced pills for years, pain pills, antipsychotics. Nothing worked. I was put through the system religiously. Nothing worked. I've got eight or nine felonies. Nothing worked. The only thing that has kept me clean, sober, functioning, and a business-running South Dakota adult is cannabis. If it wasn't for cannabis, I would be dead. That's not something you can put in a medical journal. That's not something anybody wants to write about. My entire life I have been called crazy because I believed in this plant. The only reason I made it through the 30 years of pills, meth, and every other drug the street and doctors fed me was because of cannabis. It was the small, brief window of light in my life that didn't make me want to jump off a bridge because I knew what I was. Being an addict's not a choice somebody makes willingly. I didn't wake up one day and say, hey, I'm going to go smoke meth with a 45-year-old man and see how life turns out. I can tell you it didn't turn out real fucking grand. Pardon for the language. I've watched this program from the beginning. I've been a part of it from the beginning. I had that fancy card from the Indians too. Nobody has taken me seriously in any doctor's appointment ever, except for the cannabis doctor. I walked into a normal doctor to try to get a cannabis card and got laughed out of the office. I recorded it and am filing a lawsuit against that doctor. My entire life has been nothing but shame and misery because people tell me that this plant is going to make me stupid, make me a degenerate, make me a worthless pile of shit when it's done nothing but the exact opposite. The things that turned me into every one of the things that you people say this plant is going to turn me into was the pills that the doctors gave me, the bad advice that the schools gave me, the shitty education that I received in South Dakota.

I'm sorry, but we cannot have profanity. We were being recorded and there are other people. We just cannot have that, so please refrain from the profanity.

Oh, I don't have the freedom of speech?

You do have freedom of speech, sir. We just ask that you use—

it's—

you're right, I should, I should.

No profanity, please.

I'll try to conduct myself better in this setting.

It's not that you're conducting yourself any poorly. We just can't have profanity.

I honestly believed that something would change when this all happened. The only thing that has changed is that I don't have the police kicking in my door and trying to put me in prison. Other than that, I'm still looked down upon. I'm still regarded as lesser in society. It doesn't matter that my business pays taxes. It doesn't matter that I take care of my family. You people sit here, aside from a few of you, and laugh at people like me. You think it's a joke, and it's not. It's not because without this program, I would be dead.

Yeah.

And there is many, many, many more people like me that unfortunately don't have the pain and PTSD that I have that allows me to have this card that unwillingly showed me the side effect of getting me off of meth and all the other fantastic drugs that are out there in this world. And just so you're aware, as someone that's lived in that world my entire life, No kids are getting drugs from the medical cannabis program in South Dakota. They're getting drugs from the internet. They're getting drugs from California where it's simple and easy to just type on a website and have it shipped to your door. The medical cannabis program is one of the most regulated things that I've ever been a part of. So So that's my 2 cents, and that's what I came here to say. Thank you for your time.

Thank you, sir.

Madam Chair, I have a question for you.

Is that okay?

Thank you, Representative Andera. Sir, you mentioned— and first of all, congratulations on getting off of meth.

That is amazing. Amazing.

So my hat is off to you. I need some clarification for the record. Did you get your felony because of the ingestion, possession of marijuana only, or could you just clarify that for me? I just, just for the record, thank you so much.

Yeah, actually my, my first felony that I ever received was for Marinol. Marinol, which is a controlled substance. It's a pill that I received from a family member when I was 16 years old. She got it from California, gave it to me. It was in my car and I was pulled over with it. And that's what I was given a felony for, was possession by ingestion of Marinol.

Okay.

Thank you so much. Follow-up real quick. But that was before we had the medical marijuana program here in South Dakota, correct?

Yes, ma'am.

Thank you, sir.

Thank you, sir. We have no further questions. Appreciate your— all your information. Thank you. And just to reassure I just want to reassure you, the program is not going anywhere. This committee is just an oversight.

We are—

we have 6 or 7 duties here, and that's all we're doing. The program is established. That's already been established by the voters. We're not here taking away the program. So I just want to reassure you on that. I keep hearing you say this is the program. The program is not going anywhere. We're just trying to get people educated, make sure that the dispensaries are available to people, warnings It's all in the 34.20, the oversight committee duties that I had read earlier today. So I just want to reassure you the program is not going anywhere. Thank you. I believe our last online is Elizabeth Tiger. If you're still there, thank you very much for waiting, and you are up. I'm sorry, Ms. Tiger, did you mute yourself? If you could just unmute yourself. Thank you. We can't hear you.

Ma'am, can you select your microphone as the input device? And then just make sure it doesn't have a little cross through it. Not yet. We can see your video, but that little microphone in the top right corner. If you could click the little triangle below it, you might be able to select a different microphone.

Okay.

Okay, she dropped off. We're waiting for her to potentially join back on any moment.

Okay.

We're going to take a 5-minute recess to see if our last remote person can get connected. Thank you. Meeting back to order. Thank you, Elizabeth Tiger, for your patience in re-signing And we're ready for you if you are.

I'm ready if you can hear me all right now.

Yes, perfect. Thank you.

All right, thank you.

And thank you, Madam Chair and members of the committee, for allowing me to testify and working with me while I worked out my tech. My name is Liz Tiger. I am a medical cannabis patient and a former patient representative on this committee, and I live in Spearfish. Before I proceed with my comment, I do want to just clarify something that was stated earlier by Representative I looked up the vote for Butte County, which is where he resides, and on IM 26, which is the medical cannabis law, it was approved by roughly 60% of the voters in that county. So if I may continue with my comments now.

Go right ahead.

2 years ago, I testified before this committee and I asked you to remember the patients that you were appointed to serve.

Today I'm here asking you the same thing.

I live with autoimmune diseases that are rooted in inflammation. Medical cannabis doesn't cure my diseases, but it does help me manage the pain and inflammation associated with them so I can maintain a decent quality of life. Today we heard from Dr. Jeremy Barthels, who explained how the endocannabinoid system—

sorry—

works, particularly CB2 receptors, and how they play a major role in regulating Inflammation, immune responses, and pain.

This is exactly how medical cannabis helps me, and how I understand it to work based on my conversations with my rheumatologist. This kind of science matters to patients like me, and I would like to take a minute to thank Kasey Entwisle for working to bring that perspective before the committee. Over the last two years, we've watched Casey steadfastly advocate for patients, often with resistant. And deserves some recognition for continuing to hold the line as the committee's only patient representative. I am deeply troubled by the direction this committee has taken over the past two years. Rather than evaluating how effectively our voter-approved program serves patients, we continue to spend considerable time hearing from nationally recognized opponents of cannabis. Meanwhile, Casey and others have repeatedly struggled to get patients. Concerns placed on the agenda.

I believe this committee has become far more interested in talking about patients rather than listening to patients.

As has been brought up several times today, your statutory responsibility is to evaluate patient access, safety, affordability, and the effectiveness of this program. It's not to relitigate whether South Dakotans should have medical cannabis. With new appointments approaching, I do hope this committee returns to a patient-centered mission, one that feels has been incredibly lost. We deserve oversight focused on whether patients across South Dakota have timely access to high-quality medical cannabis, whether dispensaries and cultivation facilities are meeting our needs, whether prices are reasonable, whether testing and regulatory safeguards are effective. We deserve accountability. And most importantly, we deserve a meaningful voice in these decisions. I, I am available for any questions you may have.

Thank you for your time.

Thank you. Any questions for—

no.

Thank you very much. Now that all the public comments online and present have been heard, we'll go to committee discussion and directives.

Madam Chair, Kasey Entwisle, patient representative. I would recommend, like I had stated in my public testimony, that a task force be created for the good of the South Dakotans in the medical cannabis program.

Any questions for the comment? Anybody have comments on that recommendation?

Madam Chair, Senator Carley, don't we have that now with this committee? I see Good discussion in there. How do you see that different than the current committee and all the statutes that we read through earlier?

Madam Chair.

Yes, go ahead, Ms. Entwisle.

I think with the rescheduling, we got a hot mess here in South Dakota, and this committee doesn't do that justice. And I think that a committee with strong state leaders that are brave enough to approach all these tough, tough subjects is what we need. We need our leaders. We need the governor, we need the Attorney General's Office, we need the Secretary of the Department of Health and her team involved, we need industry involved, and we need patients involved. We need a lot more people involved to go forth and do good for this program.

Follow-up. So I think you named a few. AG, we had the AG involved in this task force. We had patients come and testify, part of this task force. We did. We actually last session and this session brought people to testify on the rescheduling. We brought the AG office. So again, I guess I'm just everything you mentioned. Great. We got that part of this task force.

Any other comments?

Madam Chair, just discussion.

Sure, go ahead, Representative.

Yeah, thank you. Statement, actually. Well, if none of you know this, I am a proponent of medical marijuana. I have seen medical marijuana help people. But I am also a proponent of the law. And since we have had this program in place, there have been some ways to get around the law. Our job is to make sure sure we protect this program, we protect the people using the program, and we do not break the law. Further, I would echo what Ms. Entwisle was saying as far as we got to start looking outside a little bit to the whole vape thing. That may be where we need to expand this committee a little That is a big, big problem. So I want to thank everybody on both sides because this being my first committee and being somebody who is a medical marijuana proponent, it helps to know both sides. That is what a democracy is. Because guys, we are in a paradigm shift. You know what that paradigm shift is? There are people out there that are opening up these shops. They're not regulated. They're not safe. Even scientists are coming up with new versions of O and S and G and 13 and 18. We have got to look at safety now. And I think it was Dr. Finn, he said this is not the medical— or this is not the marijuana of the '70s. This stuff is getting dangerous if it's not appropriately administered. And I also agree, I think it was— I can't remember which speaker it was, but talking about give the authority to the Department of Health regarding dosage.

Let them look into it.

We've got a much, much bigger issue on our hands now simply because of the rate at which this thing is expanding. It's getting out of control. So we've got to wrap our hands around it and I agree, we've got to get appropriate people in place to help us come up with something that protects the program but also protects the law. Thank you.

Madam Chair, comment?

Go ahead, Ms. Entwisle.

Thank you, Representative Andera. I'm just going to echo that we have to move forward with this rescheduling. Senator Ishmael or Representative Ismay spoke to the fact that this law has a lot of flaws. The Department of Health, when I went to their ruling, they said their robust rule package was so intense because there's so many changes that need to be done. We just need. We're— I think we're failing on this committee to do what's necessary for the state of South Dakota, for the people of South Dakota, to protect them from the bad actors here and have access to the good, safe product. And I think a task force is needed for that purpose, to move forward, to do better for South Dakota.

Senator Carley.

Yeah, I definitely resonate with the discussion. I think we have heard that today from those that testify. We have heard that from the industry regularly, that that is actually harming their businesses. And we have heard that from the Attorney General's Office, who I believe mentioned this morning that they had to use law enforcement to deal with some issues last year. I will just point out we did have a bill this year, SB 61, that specifically addressed that vape issue. And we, you know, and we were attempting actually to help deal with that issue. Unfortunately, the legislature, or at least that committee I should say, determined not to move that forward. And that actually recommendation came from this committee, and I was glad to hear that. I think maybe you even suggested it. So we need to continue to tell that story and get that out there and potentially Maybe have some from industry speak in support of that, because certainly we had vape shops that were opposing that bill. But, you know, or come up or work with industry to find out what would be favorable for them to reduce that, because I think we're hearing that from a lot of people that that's an issue that needs to be addressed. So we need to continue on this task force to address that and bring that up.

Thank you. Senator Nelson.

Yeah, just a few comments here that I have scratched all over the place. You know, when we when I sat here with all of you, you know, last year our first our first meeting, I'll be honest, I walked away because what I was hearing that first meeting was recreational, recreational, recreational. I was shocked because I'm like I thought. Was about medical. And, you know, Minnesota is going to legalize, so we've got to, you know, and I was really shocked. And I think what has happened over the last couple of meetings is with the speakers that we have had, yeah, have they been on the verge of being kind of not what this committee is about? But I think it swung that pendulum back to what we're really here about. And that is medical cannabis or medical marijuana. The you know, the effects are there. You know, we have to be reminded, and I know some of the presenters today people were not happy with. But the thing about is we still need to be reminded of the effects of marijuana. This is not this is not something that's you know some people look at you know will show it and they'll. Say, oh, this is great, this is wonderful, it's wonder— you know, magic. And, you know, for, for some people, yeah, but not for everybody. And that's the thing, is that it is dangerous, it has harm. And, um, the idea that it's the same plant that we had in the '60s is a bunch of hooey. It's like saying that our corn is the same corn we plant that we planted in the '60s. Tell you what, I was at White River, South Dakota, I was in South Dakota this summer and I saw some good-looking corn, even in the drought. It's not the same corn we had back. The genetics is different. And same thing with marijuana. I think education is important. A couple other things that I want to talk about is when they say marijuana is not a gateway drug. You can tell me all the studies you want. I have real-life people who have told me, and that's the thing. It is again going back to its its dangers, and and especially with with adolescents. And I and again not wanting to go down that recreational avenue. You know you look at Massachusetts; they're voting on it November.

3rd.

Massachusetts is voting to take back recreational marijuana. And we'll see how that vote goes. I've been to Boston. I don't want that in South Dakota at all. I do not want that in my South Dakota at all. So with that being said, a couple things. Vape, these vape stores, we have got to get a handle. And we did last, we tried last year and then we were told that was outside our of you are outside our realm. We do need to get a handle on that. And there was bills, and they were killed mainly by our chamber lobby because they'll hurt sales tax. We won't bring in as much revenue. And so we're going to need a coalition of people, especially our medical marijuana lobby and our medical marijuana proponents, to come on board with us. Because I've met with my state's attorney, and I met with my Sheriff here in the last two weeks. Number one thing they tell me is that right there, above everything else, they say that is a is an issue. So we've got to get a handle on that, and we're going to need help because it's a strong lobby that's that's fighting against that. Also too is is is we need help from the patients. Everybody testifying here saying how you know these these You know, presenters today were not really you know on on the subject that we're supposed to be on. We need help from you to keep medical marijuana medical because if it goes out to the recreational side, the people going to be hurt is our medical people. The people are using it for medical reasons because your whole stories will get lost in that mess. And so I want to keep. You know, if you're using medical marijuana, I want to hear you. We want to hear your stories. We want to hear the stories of how it's being used and used for good. And that all that gets lost when we go down that road of recreational. So, couple things that coming out of this discussion today that are still concern to me. And again, you know, Casey talks about here about we want. We want it safe and we want it regulated. And that's— I definitely, I want it safe and regulated. Number one, again, is these pop-up shops. One was in Yankton this summer. Come to the Fairfield Inn and we'll give you your card after talking to you for maybe a minute, like whoever that testified did. You know, it's supposed to be a bona fide relationship. And I think that's something for safety reasons is to have that a good relationship and and being able to say what that is again the home cultivators yeah I think I'd like to know look more into that and how how that comes about and just seems like twenty dollars just to be able to do that at home seems a little bit odd and then again just the the hemp products. And I know that's out of our preview or out of our jurisdiction, but again, getting a handle on those hemp products.

So that's my—

what would you say—

my speech for now.

So thank you, Senator Nelson.

Anyone else?

Madam Chair, Julie Bostic.

Go ahead, Ms.

One thing I was struck by too is, and we talked about this last year, was the marketing.

We can't market with colorful, pretty packages that look like gummy worms or whatever because children are affected, and we saw that today, how many children are in the ER.

And so I think we have to look at that too.

Madam Chair?

Yes.

Just a follow-up on a clarification on that. Those products are all coming from the hemp world. Just another reason why we need a task force to figure this out. Those aren't coming from the Department of Health's program.

Anybody else? So as the chair, I want to conclude. I want to thank everybody for the last 2 years of what we've gone through because Because no one wants to be in this seat, I can guarantee you that. It's a hot seat. But just to bring back, because I'm meticulous and also a businessperson, our job, the 34, 20G, 93, the 7 points, I think we've done a very good job as a committee addressing all of those every time. Have people liked what was said or heard? Absolutely not. Well, what I take home and when I think about in summarizing what we've done in this committee. Back in October of 2025, we discussed several things that keep coming up: K-12 education. I took notes here. The counselors, the D.A.R.E. program. Dr. Arneson talked about the dispensary, the smoke shops. Here we are again revisiting it again. So I do, and I had asked the Department of Health, Mr. Brenner, thank you very much, but I did ask you like, where is the money allocated for education? This is a public safety issue. It's not that the program is going away. We can be better. South Dakota can do better for the people of South Dakota and those that need the medicinal marijuana. I too agree with medicinal marijuana. I have several patients. I don't write for it, but I definitely invite it if that's what it is. I'd rather have them have that than an opioid addiction or IV drug addiction or something else. But the disappointing thing is, though, in one of our objectives, we are to work together with school boards, pharmacists, municipalities, state legislators, Department of Health, Criminal Investigation, departments that— we have to beg people to come to the meetings instead of attacking the chair, the co-chair, or any member. We should be transparent. We should be collaborating. We should make it better, make it a better program. And this program should move on to the next and extrapolate to the hemp, to the alcohol beverages now with all the cannabis in it that we haven't even touched on. We haven't done that. We failed the people of South Dakota in that aspect. We did not do a good job. All we did was bring out what we should have done 5 years ago, which is the dangers of medicinal marijuana, no matter what the elements are, and there's hundreds of them, and then make sure that people are safe when they use. The problem people continue to forget is there's no therapeutic index for medicinal marijuana. It's not like you can draw a digoxin level and you have a level. You don't know what works for, say, myself or for you or for Senator Nelson. You have no idea. It's called pleomorphism. It works differently for everybody. That's not addressed, but it's constantly mentioned. The other thing is digital cards with Secretary Magstadt. We talked about the digital cards. I don't have an update on that. I surely would like that. That was a compromise on a I would have liked to have known, yes, they're implementing January of 2027. That was for the police officers. They asked us to do that. That was something that Senator Nelson also perfected with the gender and date of birth and everything, so we can keep track, be meticulous, and save lives so no one dies. That's the point of this program, so we don't have a high mortality rate. The cultivators, it's too free-for-all in my opinion. A patient is a cultivator. $20. We don't monitor that. That was mentioned today. That's something that was new to me. I didn't know. So I did not know about that, how easy it was to be a cultivator. That's just fair market. That hurts the industry. The industry should have prevented that from happening, in my opinion, because that takes away from the industry. But I keep going back to the monies, the amount of money. I'm surprised we don't have more money in the state of South Dakota, which is with the amount of dispensaries, the amount of people that I know that treat, that have dispensaries, and the amount of millions they're making, how we don't have enough for software for the people of South Dakota with all the taxpayers' dollars. I just, I just, I'm blown away today. So I do want to say, Mr. Norsted, you're right. You're angry. I get it. But you had a good point. Department of Revenue. Yes. Accountability in the Department of Revenue. I agree. They should be here at the table with us. This should not be just a committee having people come in and talk ad nauseam about the good and the bad and the ugly, but to make it work, because that's what the people voted on 5 years ago. I'm not here to change what was— what's in play. The Trojan horse is out. We— I don't— it's— we're to protect the people of South Dakota. That's our job as legislators. We do our civic duty. That's why I'm here. Like me or not, I don't care, but I am going to protect that person that wants this Medicinal marijuana to make sure they don't overdose, they don't get the bad laced stuff that's out there. That's the job. That is what it takes. So, so be it. But you have a great point, the Department of Revenue. I would like the, the Division of Criminal Investigations to be here too. I'd like to know what the charges are. I'd like to have more information on that. We all would like that as part of this whole oversight committee that was developed way before I got here. Then on Mr. Mitch, you mentioned a good point also. You brought up the education and dispensaries. I'd take that one step further. That's got to start in schools. I mentioned superintendents, any recreational area. We talk about the gas stations, these pop-up shots. There's nothing. There's no brochures, no pamphlets, there's no billboards, nothing.

Why?

Why don't we have money allocated for that? That education, seeing it repetitively The mind absorbs it. They know it's bad. It starts at two years of age. I don't get it. Parents, the gummies readily accessible. We saw that last year. We see it again this year. It comes up. The gummies are available. They're on tables. Maybe the parent just doesn't know. Maybe they don't think the child's going to taste it. I don't know, but it's education. Toxicology reports they discussed. The pharmacist being involved. I mean, why don't we have all these stakeholders at the table? Why are we here going back and forth what we can do or being afraid of what would legislation bring? Who cares? Work together and bring something that the people of South Dakota want. That is the job of this committee and of you, the people that dispense it, make money from it, the Department of Health that is responsible for the patient's safety, the public's safety. We should all be on the same board. And that's what's disappointing. So the recommendations can be whatever they may, but people do need it, and we need to do better. And we have all failed in that. I do think that I'm hoping that the Department of Health, with the new rollout of this actual computer digital program, which I know you have geniuses in that department that can figure this out. That maybe we can have some statistics. That's where research comes in. That's where you get grants. That's where you generate more revenue. I mean, it just takes outside thinking, but you have to work together. So despite what it may be— and maybe I didn't stop the profanity when it was happening during today's meeting, and that I apologize for, but the man was frustrated, and I hear him— but he has changed his life around. We're not here to judge. We're just here to do the job, and sometimes it's ugly. I do would hope I would hope that you're right. Who was it? I think it was just to bring it out on record, Mr. Horsted. You said a lot of us won't be here. You're absolutely right. We won't be here, and that's a shame for the people of South Dakota because a lot of us are here for the right reasons, and that is going to be a disappointment for the people of South Dakota. But I hope that you will carry it on and make sure that these things that we. Have exemplified here in this meeting this year and last year and make it better for the people of South Dakota so that maybe one of your loved ones is not affected like one of mine or somebody else on this committee. Because everyone has a right, and I think that is the point of this whole meeting here. So going on to another task force, you know, being in legislation for 2 years now, all we do is talk, talk, talk, talk, talk, and nothing gets done. I can't stand that. So I feel like Like you know, come together. It's it's important if you collaborate and you can reduce it and get rid of it. You want to get rid of the meeting? You want to try to do that again next session? Go for it. But you know what? Not on my watch. Not when people are not getting what they need, whether that's from us or from you. The bottom line is the people of South Dakota want it, and we need to make it right where it's safe. It's always about the patient's life and safety. So. So I won't keep going on because I know you've been here long enough, but I do think out of the 7 points, we have done a very good job as a committee and as the people have attended, whether they be here or not. We learn from our other states. We learn how to not make the same mistake, which is what we are about to do if it goes recreational. We will have. And the bigger issue today that came out was the young children. We don't want a young child overdosing on a gummy and dying. We don't want that. We don't want that on our time. We don't want that on our watch. So if we're not checking children out, we're not doing that, then shame on us. So I do believe that going forward, whoever takes it forward, whether it be another task force, whatever, I don't suggest that. I'm not going to suggest that. But we still are not educating. We're not putting warnings on these actual items and all the other things that were mentioned today. So I would say my take-home is some of you are very right on what has been going on, but this is not about ending the program. This is about making it the best program for South Dakotans. If no one else has any other comments, Want to say anything, Madam Chair?

Over here.

Yes, Andrew. Representative Schrock.

Not yet. As a medical provider whose job is to be a patient advocate, you know we keep calling Casey the patient advocate, but I'm a patient advocate. If a patient comes to me and And they get put on some medication. There's always a therapeutic dose that once you max it out, if we go past that, we just end up with more side effects. And so as a scientist, a medical provider, a patient advocate, one thing I— we got to make sure we get the science right.

What do we—

we've heard about caps.

Yeah.

On the percentage, and there should be caps for safety reasons. We're talking about patient advocacy. Interesting that the gentleman from Fort Pierre brought up a—I can't even know how to say the guy's name—the Israeli researcher who's passed. That's the guy. He said, "If you—it's not science if you can't measure it," right? And so it's certainly not best medical practice. Practice. So let's do really good medical practice. If it's medicine, let's make sure we are doing the right research, that we're making the right recommendations scientifically speaking. That would include a legit medical provider-patient relationship. And I think everybody would be on board with that. And then the prescription medication drug monitoring program I don't know how they say it, PDMP. I would love that rolled out too so that we can see who is— where they're getting their medication from, when they got it, are they filling it too quickly, are they even filling it at all, is it working for them, is it not, we can follow up. And then lastly, I don't want to hear people say, well, your committee is trying to overturn the will of the people. I don't think anybody is out to end this. You'll hear some voices periodically. It's not going to happen. I think that's just kind of inflammatory rhetoric for the most part. And so I think that's kind of silliness. So let's stick, as the medical provider scientist, let's stick as closely to the best science practices we can.

Just to your point, the PDMP, that was something we stumbled upon last session, and that was corrected. The department did take care of that, and that is now working. So we had before a different program, but it's, it's definitely been improved. I also can say in my office, I am getting the actual reports that people are on, have a medicinal marijuana card, which I was never receiving before. So there are a lot of things that this committee has done well. Those might have been small, isolated things, but it does have accountability and a tracking method, and then we have some— maybe some statistics behind it for the science. So just to let you know, I think that was last session. If there's no other comments, then I'm going to adjourn. I would like to adjourn the meeting. Thank you all very much. And we need a vote first, so I'll take votes. Who would entertain that?

Second.

Okay, medicinal marijuana meeting is now adjourned.

Thank you.