Revision note:  In this post I discuss a proposal to institute a fine structure to address misconduct in the program. I failed to include the fact the the OMP proposal has two levels of fines for two categories of participants. The lesser fines are for home-based caregivers and the higher rate is for storefront and other industry participants.

I haven’t updated readers about LD 2099 since the Health and Human Services committee hosted a public hearing on February 26. The bill proposed several changes to the medical marijuana program, and I was especially concerned about a provision that would have defined the alcohol used to make Full Extract Cannabis Oil (FECO) as a hazardous substance. This change would have kept patients from being able to make their own FECO; and caregivers would have been required to get an additional license in order to do so.

Denny and I attended that hearing, and normally I don’t publicly testify at hearings I am covering as a blogger. However, that day I sat and listened to over twenty people testify, many of whom introduced themselves to the committee as “a patient AND a caregiver.” Not one of these caregivers talked about how the proposals in the bill would impact patients singularly and separately from potential impacts on their businesses.

In other words, these “patients and caregivers” only spoke about the impacts on patients as consumers of their caregiver products, not as freestanding individuals with rights and circumstances separate from the marketplace.

Because a committee member had asked an unanswered question about the impact the alcohol restriction would have on the 65,000 patients in Maine, I felt compelled to testify right as the hearing ended. I explained that many patients would not be able to afford to care for themselves if they were no longer able to make their own FECO. I reminded committee members that the choice to use medical marijuana can be a very expensive one, and while there are many fine caregivers out there, the reality is that not everyone can afford to buy all their medicine all the time.

Denny uses an essential oil extractor to make FECO. In this step the food-grade alcohol used to extract the medicine is being removed from the FECO that remains in the machine.

After I spoke, I was unexpectedly invited to participate in a stakeholder group tasked with finding consensus on the various provisions in the proposed language. I said, yes. Little did I know how much ethical and moral angst would be unleashed by that yes. The Office of Marijuana Policy (OMP) oversaw the stakeholder meetings, and OMP staff were charged with reporting back to the committee about the progress made by the stakeholder group.

In order to participate in the group, I promised to do so as a patient, not as a blogger – thus my lapse in covering what’s been happening with this bill. Further, I am not at liberty to disclose what happened during the stakeholder meetings. My experience, however, was such that I was compelled to attend the committee work session that followed to see how it all played out.

I’m happy to report that the disagreement about the definition of alcohol and ethanol used to make FECO was resolved by changes proposed by the department. The current proposal would allow for patients to continue to make their own FECO, and caregivers would simply check a box on their registration applications affirming that they do.

I’m unhappy to report that the issue of fines for misconduct within the problem ended up being an as-of-yet unresolved area of contention at the work session. At this time, the OMP doesn’t have the authority to impose fines but has been charged by the legislature with creating and enforcing a regulatory framework for the program.

The discussion about fines for misconduct in the program focused primarily on whether the fines were fair, necessary, and/or whether the proposed amounts were appropriate. The impact that provider misconduct has on the 65,000 patients fueling their businesses and the program itself didn’t come up. There was no talk about the actual misconduct itself or the folks on the receiving end of it. Seriously.

After the committee broke briefly prior to voting on the legislation, committee co-chair Rep. Patricia Hymanson called me up to testify. Sort of. Poor Denny had to disclose I was in the ladies room when she called for me. OMP staff had told me that she was likely to do so, which set off a panic attack. Since my bladder seized a bit as a result, I decided run to the ladies’ room while committee members were caucusing outside the hearing room.

Unfortunately, the caucus didn’t last as long as my trip to the bathroom, so I returned to a room full of people watching the door, waiting for me. Talk about awkward.

And, you’d think walking into a room to speak in front of roughly 40 people who all knew I had just gone pee would be as awkward as it gets, too, but it got worse. I think readers prone to anxiety can relate, the most awkward moment came when I sat down and couldn’t get a handle on my continuing anxiety attack.

I began by disclosing that I was a patient whose first medicinal use was for mental illness. At this point I’m sweating buckets and experiencing shortness of breath – I mean we’re talking full-fledged anxiety attack. So bad that a legislator asked if I was okay, calling attention to my symptoms. Given the prevalence of anxiety and the fact that I had just disclosed that I had mental illness, I was a bit surprised by the question.

How even more awkward to have to explain I was experiencing extreme nervousness about expressing an opinion that the majority of people in the room behind me would find contrary. The fear of having an uncontrollable anxiety attack in public and the separate fear that the symptoms will be negatively misinterpreted are part of what feeds out of control anxiety attacks and keep people with anxiety from public participation.

I guess I would’ve expected a higher level of mental health awareness from someone serving on the Health and Human Services committee.

Nonetheless, with weighted breath and through beads of sweat, I shared my concerns about the vulnerable populations making up the patient demographic:  the poor, the mentally ill, senior citizens, among others I missed, like veterans. I shared a story about Denny and I unknowingly buying weed that was tainted with powdery mildew from a local storefront caregiver who, like many caregivers, had a no returns policy. I went on to add that I’ve heard ample anecdotal evidence from other patients and caregivers to support my feeling that there should be fines for misconduct.

The work session ended with a majority of committee members voting to continue working on the bill, with three voting “ought not to pass.” Again, the OMP has been charged with gathering stakeholders to work on consensus around the issue of fines and any other outstanding areas of disagreement. Rep. Hymanson stressed that she was interested in hearing from more patients during the next stakeholder gathering, reminding attendees that the program was created “for the patients.”

Even allowing for the misunderstood anxiety attack, my experience with the committee and OMP has been incredibly positive, and I was honored by and grateful for the opportunity to participate in the discussion around this bill. I will try to continue honoring my role as a blogger as pertaining to this bill as it progresses, while trying to balance what I feel is an ethical and civic duty as a patient to see that our rights are honored, preserved and protected.

One of our rights is to safe medicine sold by businesses conducting themselves ethically. Since misconduct happens – OMP staff testified to this fact in addition to my testimony – fines are a necessary means to mitigate misconduct. In my experience, in Denny’s experience and in the experience of many others we’ve talked to, patients need protection.

Patients who know very little about medical marijuana, patients whose diagnoses make them vulnerable to unethical behavior, patients who are too poor to pay for medicine that may be toxic are all part of the medical marijuana demographic. To argue against disciplining participants in the program who can and do take advantage of these power imbalances isn’t an argument I can understand.