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Editor’s Note: SB1182, the Compassionate Use of Cannabis Act, has been placed in the hands of the Senate Law & Justice Committee. There will be a hearing for the bill on Tuesday, January 28th, where legislators will consider commentary from doctors, researchers, patients, and other experts on the subject. The following is one Pennsylvania resident’s testimony, which can serve as a template for advocates preparing to testify about the laws in their home states.
TESTIMONY OF KATHLEEN DUNKELBERGER RN, BC, CLNC
REGARDING LEGALIZATION OF CANNABIS AND SB 1182
SENATE LAW AND JUSTICE COMMITTEE
STATE OF PENNSYLVANIA
This is to testify in support of legalization of cannabis in the state of Pa. As a medical professional and a business owner in Pa. (LLC and a nonprofit), a mother of a child who would benefit from cannabis treatment, and a potential patient myself, I am in support of SB 1182 only with the added changes I offer within this letter. Although SB 1182 is a great bill, some clarification is required and I would like to see the concerns addressed with appropriate additions, deletions or changes.
My name is Kathleen Dunkelberger and I am a registered nurse certified nationally in psychiatric and mental health nursing as well as legal nurse consulting. I am a member of the PSNA, ANA, and have been involved in a variety of committees in Pennsylvania and nationwide including the Pa. Autism Task force, Pennsylvania Governor’s Cabinet and Advisory Committee for People with Disabilities, Jones Center for Special Education Excellence at Bloomsburg State University, and more. I have also been a reviewer for the National Institute of Justice.
I began my in-depth research into medical cannabis several years ago when I saw Mieko Perez on television speaking about cannabis use for her son with autism and how it saved his life. I have since befriended Ms. Perez and have consulted with her and others regarding use of cannabis for people with autism and other conditions. I have researched medical benefits of this plant through the internet (studies, research papers, articles, YouTube, etc) at length and also spoke to people who are using cannabis for medical reasons. Cannabis successes are claimed and/or documented for a number of conditions including but not limited to diabetes, post-traumatic stress disorder, migraine, autism, seizures, OCD, Tourette’s, anxiety, depression, cancer, and more. It is my professional and personal opinion that the benefits are great and by far outweigh the extremely limited potential risks associated with cannabis use.
I have 27 years of experience in all phases of health care with patients across the lifespan including working with people with addictions. I have never had a patient that was addicted to marijuana and when I worked inpatient psych, if marijuana use was in the patient history it was not even addressed. I have never had a patient overdose, die, or voice any side effects from marijuana use.
In fact, when I worked in a private hospital in Florida we actually used Marinol for elderly depressed patients in the early 90’s with moderate effect. Please note, as a wellness nurse focused on naturopathic healing, I do not support use of Marinol or any other synthetic form of THC/CBD/cannabis but rather the organic plant substance. In my view from my professional experience with Marinol and from what I have read, the synthetic form is not as safe (has more potential side effects), loses effectiveness over time, and most definitely would be more expensive to manufacture.
As a business owner, farmer, and RN, I am greatly interested in becoming a grower and owning and operating a compassionate care center when cannabis is legalized in Pa. I currently own and operate a nursing consulting business as an LLC in Pa. as well as a nonprofit business providing services to people with autism.
I also have a son with autism who experiences symptoms such as OCD, anxiety, self- injury, and apraxia. After much research, I strongly believe these symptoms would be relieved by cannabis as well. It is my opinion that psychiatric medications for these conditions cause more behavioral and medical problems, have serious side effects, and have proven over and over to have little efficacy. Cannabis could be a first choice, safe option for people with autism for the variety of complex symptoms associated with this medical condition.
I also suffer from an occasional migraine and have spoken to people in legal states who claim migraines are completely relieved with cannabis use. Frova, a migraine medication, costs $399.99 for 9 pills and in my experience, caused more frequent and severe migraines with potential risks of serious and life threatening side effects. Migraines also cause loss of wages, work time, and increased hospital stays for those who are not receiving appropriate relief from traditional medications. Cannabis, with a secure safety record, would be a reasonable first choice option for migraine sufferers.
By refusing to legalize cannabis, we are forcing patients to be victims of geography. It is very difficult to read and listen to the success stories of others in legal states while we, our own children, and our patients suffer needlessly in Pennsylvania. The only people you are harming by refusing to legalize quickly are the people who are really trying to do the right thing LEGALLY. It is my belief that there are probably many who are already using marijuana for medical and recreational purposes anyway in our state and sadly, those people too are victims of the judicial system and charged criminally without performing any real crime. These people in fact, are being forced to choose health for themselves and risk potential legal situations or continue to suffer with symptoms that in many cases are debilitating.
Lastly, I was told by an employee of the state at a senator’s office that Pennsylvania is so conservative that it will be the last state to legalize in the nation. My response to that ridiculous statement is we Pennsylvanians deserve better than that. We voted for leaders, not followers.
In summary, I completely support legalization of cannabis in Pennsylvania with an appropriate bill. SB 1182 is a great bill and it is very obvious much effort went into completing it however I do have questions and concerns. Please see the attached three pages with concerns and suggestions for SB 1182.
Editor’s note: Kathleen Dunkelberger’s attached notes to follow:
Testimony from Kathleen Dunkelberger
Senate Law and Justice Committee
Concerns and suggestions for SB 1182
1. Liability: As an RN, working in the legal field, I quickly noted there is no liability protection for the RN’s owning and operating/working at the compassionate care centers. Liability is provided for prescribers only such as the nurse practitioners, dentists, MD’s, etc. Liability protection for the RN’s at the compassionate care centers should also be required. Expanding some liability protection to growers and transporters would be ideal.
2. Appeal Process: There is no appeal process for a potential patient if the board denies their need/card and again, this is not going to be well received and will cause many problems. ALL government systems need an appeal process. Having been an advocate for patients and students with disabilities in Pa., I can assure you, mediation, due process, and an appeal process is necessary and in many cases, changes the outcome.
3. List of Illnesses: The list of illnesses is not all inclusive and I am really advocating that you add autism, migraines, anxiety, depression, Tourette’s, OCD, self-injury, pain. This is not only about seizure disorders. Autism needs to be added because this is a disability that is always complex, and if not on the list the practitioners will not be prescribing to assist these patients. Pain, such as with a migraine, is not always chronic but comes and goes. For some patients cannabis will be used long-term and for others as needed only. The way the illnesses are described is very limiting and I suspect, only people requiring long-term treatment will be able to access cannabis therapy.
4. Page 4 Line 3: 6) “any medical condition or its treatment that is recognized by licensed medical authorities attending to a patient as being treatable with cannabis in a manner that is superior to treatment without cannabis.” I am asking that “in a manner that is superior to treatment without cannabis” be removed. THIS IS NOT just about seizure disorders or SEVERE or chronic conditions. “Debilitating or chronic” and “treatable with cannabis in a manner that is superior to treatment without cannabis” is too strict. It needs to be simple and allow prescribers and patients to treat any condition not mentioned or listed in the bill in a way determined appropriate by the medical provider/prescriber and patient. In my view, the way it is written will be misinterpreted by many and will force patients to use other more dangerous meds first, as if medical marijuana is a last resort, and it is not.
5. Board has ability to override a prescriber and deny a patient access for any reason: Clarification is needed on page 12 #14 board duties: “limitations in the public interest on a debilitating medical condition…” The board should not be allowed to deny a prescriber and a patient. This is most important because there is absolutely no appeal process within this bill. This definitely needs to be clarified and if it is stating that the board can deny a patient and doctor it definitely needs to be removed.
6. Fees: Patient fees: Patients taking other prescribed medications or supplements do not have to pay a fee. This is discriminatory. I am glad a cap of 100 dollars was added, but this again is too high. The sliding scale may help some, but leaves those like myself and other single moms of one child who CHOOSE to work in a difficult position because we never are assisted by sliding scales with anything. NO OTHER patient has to pay a fee for a medicine. I am asking that this be completely removed OR at least lowered to a one time only application fee with a 25 dollar cap.
Please remember that the way this is written, patients will have to pay this high fee every year, pay for the medical cannabis on a REGULAR basis, pay to travel to see a doctor, perhaps have to doctor shop to find a doctor who has knowledge and is willing to prescribe, and as mentioned in the bill cannabis treatment is not covered by insurance. Thus, patients will be paying for insurance as per the new Obamacare law, in addition to these fees and for the cannabis treatment. And if a chronic condition, the price of the cannabis is going to be a regular expense. REMOVE the fee please. It is really discriminatory and I realize other states are doing this but I voted for leaders, not followers.
Grower fees: No mention of grower licensing fees that I saw yet. How much for a grower, transporter or a compassionate care license fee? And again, we need to keep this as a low, one-time fee to promote healthy competition and business in Pa.
7. ONLY nonprofit status cannabis business: I also disagree with the nonprofit only status for businesses. I understand the hope is people will “donate” but this is limiting potential business in Pa. and causing much more paperwork. The nonprofit status is a paperwork nightmare. I would suggest allowing other business types such as LLC, or even sole proprietors to the list. We have good people in Pa. interested in performing these duties but might not if the business has to be nonprofit only. It is also very costly to start a nonprofit 501c3 and not all nonprofits are 501c3 status by the way. I am asking that all growers, compassionate care centers, transporters, etc have the freedom to choose what type of business they wish to initiate. Nonprofit status will not decrease the cost of cannabis. Our local hospital is nonprofit and an article in the daily paper stated the CEO made millions per year and the hospital profited fifteen million in one year. Healthcare costs at this facility are over inflated and people are paying 75 thousand for less than a two day stay. There is no proof that a nonprofit would lower costs of a product and in fact, experience indicates the contrary.
8. Monitoring: I am asking that monthly monitoring for businesses be changed to quarterly for the first year then yearly thereafter. Quarterly monitoring will be sufficient initially to assist the business owners with compliance. Monthly monitoring is not necessary and will also create increased hours and expense for the businesses and the state board responsible for the monitoring.
9. Transportation: Clarification is needed. Can farmers/growers and compassionate care centers transport under their own license or do they have to buy a different license to also transport? Or does this have to be yet another new business? This is not clear under the bill.
10. Nothing is included about allowing patients to grow their own plants: I would like to see an addition to clarify that patients can grow and manufacturer their own plants and edibles/ oils. This would be considered different than a farmer/grower as no license would be required and generally a lower number of plants would be needed. I suggest this be done without fees to the patient. No monitoring would be required unless (and only if) proof of wrongdoing is evident, in order to prevent patients from being harassed. Most people will never be able to understand the government forms. If the bill as-is will be allowing patients to pay for a grower’s license as well, then that should be specified and perhaps if there must be a fee, determine the fee by the plant count not to exceed 300 dollars per year for a larger grower and cap the patient fee to grow or maintain six plants at 25 dollars per year.
11. Oils/edibles/manufacturers: I think the requirement of needing an organic chemistry degree is definitely going to limit this needed service and as you know, we will then have a law but nobody to make the oils. My suggestion would be for providers of this service to have some type of approved training rather than limiting it to only people with an organic chemistry degree. I am sure the many people in Oregon, Washington and Colorado winning the oil awards are not all degreed people but perhaps could assist with a training guide. There is no mention of the legality of patients making their own oils or edibles and this should be added as well.
12. I didn’t see anything about labs to test for mold, pesticides, THC, CBD levels etc? This is another type of business to promote the economy in our state. Again, this should not be limited to nonprofit and should not have high fees which will deter business growth. (Also, this is exactly why as a potential patient I would want to grow my own to be sure it is organic, or vegan grown in ground without pesticides in the past five years and free from mold, etc.) In other states, independent labs are available for testing for growers but also for those patients who wish to have testing done. We need to make a reasonable system for labs to function in the state so the fees for patients and growers are fair and reasonable.
13. This is clearly just medical cannabis and no mention of hemp. Currently, the way I understand the law, hemp cannot be grown in the US, but can be imported and used in all fifty states (hemp shirts, hemp oils, hemp cooking materials, hemp makeup, etc.). Should hemp be added to this bill since hemp is also high in CBD and can be made into oils? Allowing hemp to be grown will also increase the farming industry in our state for industrial purposes too. Some states including Colorado have already done this.
14. Caregivers: Not sure why it is limited to one patient. Perhaps this should be left open. What if someone has a child and a grandparent they are assisting with medical cannabis? What if someone with much knowledge on this topic wishes to start a caregiver business even as a sole proprietor or as a volunteer and chooses to assist to help more than one person?
15. No mention of sales tax or other tax so are we to assume the state is not taxing this product? Will it be a cash only business like in Colorado? Is this the reason for nonprofit status only and if so, please note not all nonprofits are tax exempt and although any business can take donations, only people/businesses that donate to a 501c3 can claim donations for tax purposes.
16. Board Questions: (1) Where is the grant money coming from for the board to issue for study, research or testing? (2) What is the process for determining who and what organizations receive these grants and will it be a public process or just three people appointed by the Governor making these very important decisions? (3) What conflicts of interest clauses will be in place for the board members in this regards? (4) Clarification is needed for page 12 #14 where it states the board duties: “limitations in the public interest on a debilitating medical condition…” does this mean the board can over-ride a prescriber? If so, I am asking this to be removed too. (5) I would like to see an addition that the board member cannot work for any facility within two years after leaving the board that he or she might have had influence. For example, if the board gives a hospital or university a million dollar grant for research, then a board member that was a part of that decision leaves and works in a high paying position for that same facility; that is not ethical and is very questionable and we see this all the time with drug companies, hospitals and government employees. So, guidelines are also required for the board and monitoring of them as well. Monitoring is not just for patients and growers. (6) Also, could the board members be volunteer only? What is the process for residents of Pa. and people in the business to monitor the board and process as well?
Thank you for considering the above 16 issues with SB 1182.
Kathleen Dunkelberger RN,BC,CLNC