Transcript begins at the 16 minute 54 second mark. Original audio available here: https://www.iowapublicradio.org/post/defining-unborn-person-and-stronger-medical-marijuana#stream/0
Ben Kieffer: Let’s talk about medical marijuana. Now, when Iowa legalized medical marijuana just a few years ago, it allowed no manufacturing and was limited to epilepsy patients. Now it’s expanded to allow the manufacturing here in the state of oils, tablets, creams. Our current medical marijuana program that was launched in 2018 offers sales of these things containing up to three percent THC. This is to patients with qualified health problems. Now the potency of some here in Iowa could be increasing under a current bill. Tell us a little bit about it, Katarina Sostaric.
Katarina: Right, so the current medical marijuana law, it’s only – the current program has only been going for a few months. Dispensaries first opened on December 1st of last year. So there are some in the Legislature who have said, you know, we need to wait and see how this is going. That’s what they were saying last year at least. And this year the House of Representatives voted 96 to 3 for a slight expansion of the medical marijuana program. Under the current law there is a three percent cap on THC in medical marijuana products. That’s the chemical that makes people high.”
Ben Kieffer: Mmm-hmm.
Katarina: And some supporters of medical marijuana say that that’s not potent enough to relieve medical conditions, or maybe, a person has to take ten pills to get the amount they need rather than one pill if a more potent form of THC was allowed. So, this addresses that by removing the three percent cap and changing it to a limit per patient of 25 grams each month. And so – I’m sorry, 25 grams every 90 days. 25 grams of THC every 90 days. And, um, that would allow medical marijuana manufacturers to potentially make more potent products than what’s available right now. This bill also allows physician assistants and nurse practitioners to certify patients. It does a couple of other things as well.
Beh Kieffer: We have just a couple more minutes before we have to take a break. We’ll come back in the second half hour to discuss this further, but let’s hear some opening opinions from our lawmakers in the statehouse law library. Representative Jarad Klein is with us, a Republican from Keota. Representative John Forbes, a Democrat from Urbandale, a pharmacist, noteworthy there. Also Senator Thomas Greene, Republican of Burlington, a retired pharmacist. Welcome to you all.
Ah, let’s start with Jarad Klein. Representative Klein. Ah, what is your view on on, on what needs to be sort of ironed out on this advancement of medical marijuana laws here in Iowa?
Jarad Klein: Well, the bill’s had a lot of attention on the THC content, and so on and so forth, and I’m more than happy to talk about that but there’s some other important pieces of this bill. This came from conversations with members of the Board, with the public, with other legislators, to come out with some reasonable steps that we need to address. This isn’t an issue that will ever stop, that will ever go away. We need to continue to look at it, continue addressing it.
So, aspects of this bill include allowing pharmacists, allowing pharmacist’s techs to be in the dispensaries, to make sure that they’re getting professional advice and opinions. By allowing nurse practitioners and physicians assistants to recommend this product to their patients – because we have a real shortage in rural Iowa of doctors. These are some other aspects of the bill that I think continually get left out because all the focus is on this THC cap that we’ve addressed.
In conversations with the Board, we’ve definitely identified – and this is already happening – the challenge of trying to measure and make sure there’s compliance when you’re dealing with the percent THC level. Because there are products out there that now have 20 milligrams of THC in them and still are falling within that three percent limit. So that 20 milligrams is important because they tell us that is where the psychoactive effects start to take in. So what we tried to do is figure out a way to make sure that this couldn’t be abused because today, make no mistake under the current law, there is no cap. Because there is a product out there that can get you 20 milligrams of THC and be within three percent, but there’s no limit on how much of that you can buy. So today, there is no hard cap. What we did was put a hard cap of how many milligrams you can have —
Ben Kieffer: Mmm-hmm.
Jarad Klein: — which is done by weight and you can’t game the system. Because you can take, almost a 700 milligram capsule, filled with mostly inert material, and put in 20 percent, err, 20 milligrams of THC, to still get that out there. And that’s exactly what’s happening.
Ben Kieffer: Ok. Representative Klein. We’re coming up on a break, I wanted to give your colleague, Representative John Forbes, a chance to chime in with his initial thoughts, and then we’ll be back in the second half hour to go more in depth. John Forbes.
John Forbes: Ok. Thank you.
Ben Kieffer: We only have, we have less than a minute –
John Forbes: Ok.
Ben Kieffer: — you can expand on the ideas but, what points do you want to make.
John Forbes: Well, I think that in the bill that we passed, one of the things that we ran into is, access, patient access to healthcare providers that would make the recommendation to uh, allow them to receive medical cannabis. And so this bill also addresses physicians assistants, and also, nurse practitioners, so they can make the recommendation. As a practicing pharmacist I get confronted by patients on, they go to their physician and they won’t prescribe it for them, or they won’t recommend it. And so I think expanding it to nurse practitioners and physician assistants will allow more healthcare professionals the opportunity to bring this product to their patient.
Ben Kieffer: Ok. We’ll have to leave it there for now, we’ll come back after a short break with Representative John Forbes, Representative Jarad Klein, and Senator Thomas Greene. We’ll hear from the Senator in just a moment. Also, we’ll hear from some personal stories. We want to hear from you. Has medical marijuana helped you with a medical condition? Are you registered to buy medical marijuana here in Iowa for your condition? Has it been effective, or do you go elsewhere? We’re talking about many aspects of this new medical marijuana law. Be back in just a moment. I’m Ben Kieffer with Katarina Sostaric.
23 minute mark
Ben Kieffer: We’re back with more of River to River from Iowa Public Radio news. I’m Ben Kieffer with IPR’s state government reporter Katarina Sostaric at the statehouse law library, talking about a couple of things being debated in Des Moines at the Statehouse this half hour. Want to talk about medical marijuana laws, how they may be changing, with several lawmakers. Representatives Jarad Klein, John Forbes, along with Senator Tom Greene. We’d like to hear from you. Has medical marijuana helped you with a medical condition? Are you registered to buy medical marijuana for your condition in this state? Has it been effective? 1-866-780-9100. 1-866-780-9100. You can also email us. Rivertoriver@iowapublicradio.org
Katarina, remind us quickly for those who may have just joined us, what is being discussed in this bill, the facets of change?
Katarina Sostaric: So the Senate’s now considering a bill that was passed in the House, last week, 96 to 3, that makes some changes to Iowa’s medical marijuana program. It allows physician’s assistants and nurse practitioners to certify patients for the program. It removes a ban on some people with certain felony charges applying for the program. And it also addressed the 3 percent cap on THC by changing it to a limit per patient of 25 grams of THC every 90 days.
Ben Kieffer: We started to hear some of the opening opinions of our lawmakers. Let’s go back to the lawmaker we didn’t hear from, Senator Thomas Greene, a Republican from Burlington. Also a retired pharmacist I have in my notes. Senator Greene, give us your, your thoughts on the various changes here that you see as most important.
Thomas Greene: This is a positive step moving forward. There’s roughly 3.2 million Iowans. And I think through the program we’ve identified roughly 18 to 20,000 Iowans with debilitating medical conditions that have not been helped by traditional pharmacy. So, this is just an option to help those patients. I think these are, you know, way overdue, long needed, and it’s, it’s just positive steps for Iowans with, like I said, those debilitating conditions.
You know, Representative Forbes and I have been in the pharmacy business for oh I myself, 45 years. And, we’ve always been, patient advocates. We’ve always tried to do what is best for our patients to provide them relief, provide them options, with their varying medical conditions. This is just something that has come forward in the last few years, and I think it is well intended, it’s long overdue, and I think it offers very good promise for the future for these patients with debilitating medical conditions.
Ben Kieffer: Also joining us this half hour, Jason Karimi. He is Executive Director for Iowa Patients for Medical Marijuana. Welcome to you Jason.
Jason: Thank you, can you guys hear me?
Ben Kieffer: Absolutely, loud and clear. I want to mention too that you run something called WeedPress WordPress, which ah, describes itself as Iowa’s number one source for marijuana law reform efforts. Before we get to your opinion on it, tell us a little bit about your back story. You have a medical condition where you felt marijuana helped. Your backstory, a little bit about that, and why you’re so passionate about change on the medical marijuana front.
Jason: Sure, well I’m one of 14 patients that Iowans for Safe Access filmed for TV commercials a little over a year ago. So my story is well known. I try not to focus on it, because people will attack people with mental illness, but I am diagnosed with bipolar disorder. I’ve been attacked by other marijuana advocates this session, very harshly for that, and it’s made me realize we do need to talk about mental illness and have mental health advocates at the Statehouse more vocal about this issue for, for other Iowans.
The show started with a couple of very controversial issues. I want to speak to Representative Shipley’s point during discussion on this House File. This isn’t a very controversial issue anymore. It’s kind of changing, and people, even our, it looks like some of our legislators are even ahead of the curve on this, because there was a nearly unanimous vote at the House. So, it seems like everyone is on the same page, we are going to be moving forward and taking this seriously, and as someone with bipolar disorder, all I can do is advocate. I’m not a doctor, I don’t have those credentials, I can’t tell people whether or not they should use marijuana, but I have found for myself that every time I go see doctors they volunteer on their own, that for someone – multiple times they’ve volunteered on their own – that someone like me is not gonna work well with normal pharmaceuticals. I’m a referee, I’m a top – well, I was a top level referee – I refereed Des Moines Menace, NCAA soccer. I couldn’t do that when I was taking pharmaceuticals, which for my disorder, have side effects like weight gain, or an inability to function and focus. I need to function and focus at the highest possible level in the professional circuit. Smoked marijuana is the cheapest and most effective form for myself to medically benefit from the entire components of this plant, and, while we feel frustrated as advocates that we’re not being listened to or even ignored at the Statehouse – that seems to have changed quite drastically this year, so I’m very grateful for that, and also very nervous about where the discussion is gonna go because of all the miscommunications, misreportings by media and everyone, because the complexity of this issue is not easily summarized.
Ben Kieffer: Ok. Jason Karimi. Let’s go back to our lawmakers. Representative Forbes. There you hear, an advocate wanting, by his words to go far beyond what is being suggested as changes here in Iowa. What’s your view on, on that, on that view?
Representative Forbes: Well uh, I know there’s a bill in the Senate, Senator Joe Bolkcom has a bill that would bring in the full plant. At this time I don’t think there’s enough support in either chamber to get it on the floor for a vote in either the House or Senate. Personally I don’t think, I don’t, personally as a lawmaker I don’t think Iowa is ready right now to move to a more recreational type use of cannabis. Some states do allow, a few do allow the smoked version, and we’ve had discussions about that in our committees and our caucus. But right now I don’t think we’re there to be able to pass legislation that would allow for people to access medical marijuana through the smoked version.
Katrina: Representative Klein, I do want to ask you, when you spoke on this, spoke about this on the House floor, you said that this was part of working with the advisory board that was put into place to handle decisions about medical marijuana, to make recommendations to the lawmakers. You said these recommendations came from them and that you want to continue working with the board and follow their advice. A member of that board quit, this news came out on late Friday, saying that the board’s decision to not raise the 3 percent THC cap was misrepresented. Um, can you explain why then that you said that this was following the Board’s recommendations?
Representative Klein: I’ve always been very clear. This is based on discussions with members of the Board, not the Board as a whole. Some of this stuff was dealt with as a Board, that when you talked about the, PA’s, the nurse practitioners, that was I believe that was something they did vote on. What they voted was to maintain the cap. The three percent cap. But in discussions with them, and I believe they, even those that were there were acknowledging this, we recognized the challenge of meeting compliance when we’re basing it on a percentage basis and not a weight basis. So, we had that discussion, by – at the end of that meeting we had not landed on an exact gram amount. So what we did was, we went, the Department of Public Health was there as well. They went to get language drafted. They are the liaison or the overseer of the Board. Department of Public Health came to us with a much higher proposal then where we ended at 20 grams. I believe there was a 90 gram level, and they came back to 45, and finally we ended up comfortable at the 20 gram level, uh, and that was to make sure that people aren’t abusing this, but that there’s enough available to, to provide treatment. At the end, we compromised to the 25 gram level. Again, through the whole process, this went through subcommittee, through committee, sat on the calendar. All I heard from was from people who wanted to increase above 20 grams. (31:20 minute mark) There was plenty of ample opportunity for members to reach out in the medical community – not just board members – but members of the medical community to reach out and say, we think this is going too far, this is going beyond. Instead, we never heard that, we only – from the medical community. We only heard those, from outside, that only wanted to go up, but we held to what we thought was a reasonable and responsible approach, taking input from members of the board, the public, other folks in the medical profession such as pharmacists who are sitting on either side of me here today, to come out with a good piece of legislation that in the end, had I think the most votes any bill like this has ever had to pass, out of the House.
So I think it just shows that we worked together. I think that there’s a lot of misinformation in that article that was printed. I’ve been very clear. This was a conversation with members of the board. What were their concerns, what are things we need to be doing, looking at, because we have to try to stay ahead of this. So that percentage, switching to grams, we were trying to get a like for like change so that we weren’t allowing it to be abused, because there is no cap today. You can get an unlimited amount of THC. What we did was put a hard cap based on weight.
Ben Kieffer: Jason Karimi, can I hear from you? We have concerns there, about possible abuse, I believe you believe that the THC should not be capped legally whatsoever. How do you answer the concerns that the lawmakers have about abuse, and wanting the cap?
Jason Karimi: I currently don’t seem able to answer, because it seems like we’re being blatantly ignored. I just said that I as a patient advocate, and other patient advocates, need smoked marijuana for the purpose of cost effectiveness, and then, with respect, it seemed that it was interpreted that I was advocating for recreational use. I’m personally opposed to recreational use. I think it’s against Biblical beliefs, I don’t think there’s any benefit to that. Smoked and psychoactive marijuana helps mental illness. So, putting caps on THC doesn’t help me. It’s not potent enough for what I need. You can give me Adderall, which just makes me feel like I’m on methamphetamine, because it is, that’s not too dangerous, but I want a less harmful version and it’s equated with heroin. So, I don’t like being ignored. And I think lots of patient advocates in the state feel like, what we are asking for is absolutely ignored. I understand the political reality –
Ben Kieffer: Jason, I’m asking you with respect, in other words, to tell us how you would craft legislation, uh, uh, with a person, to meet the various conditions to help.
Jason Karimi: I think it’s impossible. I think the legislators have an impossible task. No legislation you craft will be perfect. All of this legislation seems to be violating basic principles of limited government. I don’t think you can craft a controlled mechanism for something that is holistic at it’s nature. It’s not like our western medical model. We normally don’t use cocaine. We normally don’t use opium. This is a very unique thing, and and – I, it’s almost a translation issue. I don’t think it can be translated easily, so. I think it’s going to be a matter of a cultural and value change, which is that we accept what people are telling us. Which is that they find alternative relief with this alternative substance. It’s definitely alternative medicine. There is no legislation you can craft on a pharmaceutical model that’s going to satisfy every single patient, and my main concern is, is while the limitations and concern about abuse is very much on point, I’m afraid doctors are going to be advocating to patients quietly to break the law in their extreme circumstances. That 25 milligram limit, let’s say you have cancer and excessive amounts of pain, and you need 26 grams, you’re putting doctors in the position where, what’s the lesser harm. And with that Hippocratic oath and all that kind of stuff that you guys are experts on, I don’t know what to do. I genuinely have to, have to tip my hat to you guys on the work you’re doing here, because of the impossibility of designing a program in this manner. I, I, don’t know the answer to that question.
Katrina: Jason, I do – Jason had mentioned earlier um, an amendment that was brought up on the House floor by Republican Representative Jeff Shipley. He later, he then withdrew the amendment. But it would have added many more qualifying conditions to the medical marijuana program, allowed basically any form of marijuana for use by patients in the state program under supervision of their doctor. Um, Representative Forbes, I’m curious what you thought of that from a pharmacist’s perspective. I know you’ve advocated for lifting the cap that’s in this bill even higher. Do you think going in that direction would be a good thing? Would you have voted for something like that?
John Forbes: Well, I, uh, when we had our discussions with Representative Klein, I was advocating for a 30 gram per 90 day cap, and we compromised down to 25. And that’s doable for most Iowans. That’s equivalent to 277 milligrams per day of THC. Which covers the vast majority of patients. But there are patients that fall outside those parameters. And we wanted to make sure that we could take care of patients in all different types of medical conditions that are in the current bill. Now, from the medical conditions side, I would like to see us expand the number of conditions that are covered. And the Senate does a much better job I think of allowing physicians to make the determination on which patient gets the best medication. Many medications today aren’t effective. And in the case of opioids, we’re seeing opioids being prescribed, although we’re seeing lower numbers today where patients could benefit when they could use in combination opioid with a medical cannabis product, reduce their opioid dose.
Katrina: Senator Greene, can you talk a bit about, I know the Senate has been much more open to expanding the medical marijuana program than the House has. Last year you expressed frustration on the Senate floor that the House wasn’t coming along with the Senate on this issue. Um, where do you stand on that now?
Tom Greene: My first year here was 2017, and we passed the Compassionate Use of Medical Cannabis 45 to 5 on the Senate side. The previous year, when it was first implemented with the 3 percent cap, etcetera, it was 26 24. So, I appreciated the rest of the Senate moving along the lines of public sentiment, and medical need, and medical demand for this. So, I am a little bit frustrated. Sometimes, when we send over to the House, with good intentions, and vice versa, it goes both ways believe me. You know, I do get a little frustrated with that. But that’s how the process works up here. It is a compromise. It is a working together. And it’s finding that common ground that will benefit those 20,000 Iowans who need, and could use, and could benefit, from medical cannabis. If this was your daughter, or your son, or your sister, or your brother, or your mother, who had one of these debilitating conditions, we’d do everything possibly to help them. And that’s what we’re really trying to do, is to help those people who truly need another option for their help.
Ben Kieffer: About five minutes left of our conversation on medical marijuana. Possible changes coming to Iowa law. I wonder if this aspect of marijuana, we have 50 US states with a patchwork of different laws concerning marijuana. Of course, several states have legalized it for recreational use, and many more states are dealing with it in terms of medical marijuana as Iowa is. I wanna ask our lawmakers, and perhaps also Jason Karimi, how does that complicate the picture, when, marijuana is not legal in a federal sense? What do you have to think of in terms of making law, or do you have to accommodate, ah, that at all? Jarad Klein?
Jarad Klein: Well, I think that the reason we’re doing this is because quite frankly the federal government has been failing in their duty for a number of years on this and it’s left it to the states. And those of us that face these patients on a regular basis. We work with the patients, we work with the medical community. I know from the House side, that my caucus always wants to have as much data as they can before making a decision, and a lot of times they want to hear from the medical community. But in actuality this has been a complete failure under our federal government. Both parties have dropped the ball on this. Uh, I’m disgusted that we have people that go to other states, Mayo clinic for example, that cannot work with that state very well on this program because quite frankly the federal government has been derelict in their duty.
Ben Kieffer: John Forbes, do you see a time when the federal government anytime soon, any indications that the federal government will put this all under one umbrella and not leave this up to the states?
John Forbes: Well, that would be the best case scenario. Um. Right now, marijuana is considered a class 1, or schedule 1 type drug, which is in the same class as heroin, which is considered illegal substances. And that’s the big barrier right now. We are basically violating federal law when we passed medical cannabis laws here in the state of Iowa. I think the federal government needs to sit down. I’ve had, a couple times, discussions with Senator Charles Grassley about rescheduling marijuana here in our country. I think that they are starting to open their eyes a little bit more now. And ah, hopefully in the next one to five years, we’ll see something moving that then makes it accessible to patients across our country. And, if that would happen, then drug companies would be able to then start manufacturing and producing medical cannabis products, and probably under a, under a more stringent type of processing which would go under the FDA.
Katrina: Representative Forbes to follow up on that. The Iowa Peace Officers Association is registered against this legislation. They were saying today that they are concerned about the 25 gram cap, that they think it’s too high and would allow marijuana products that they consider to be too potent. What’s your response to that?
John Forbes: Well like I said before, it gives patients more dosing options. When people start out on these products, they start out on low doses, but as they use the product they’re going to need higher doses because they’ve built up a tolerance. And so this bill gives more dosing options and allows patients and physicians to make those best choices.
Ben Kieffer: Just a couple minutes left of our conversation. We would like to wrap up by having our lawmakers tell us, what is your forecast for the changed laws here? It sounds like there’s a number of wrinkles that need to be ironed out, but there’s some bipartisan consensus here. Jarad Klein, do you see a bill coming out of here for sure?
Jarad Klein: Well, we’re going to have conversations with the Senate. The House has done it’s job. We’ll see what the Senate comes back with with new developments that have happened in the last few days. And I’m hopeful that we can find a compromise and get a good piece of legislation out for the people of Iowa.
Ben Kieffer: To make this second funnel week, we have a funnel at the end of the week, is that right?
Jarad Klein: Correct.
Ben Kieffer: Jason Karimi, I don’t know, are you registered to receive medical marijuana through Iowa at this point, or does that not serve your purposes?
Jason Karimi: Not currently, because the current restrictions, the arbitrary restrictions on the program, um, are too expensive for me to afford. It’s not cost effective. Patients, many patients I’ve had reported to us at Iowa Patients, say they can’t afford the program even though they have a medical card. So, the program simply is not cost effective. For that reason I haven’t bothered to sign up and spend the fee.
Ben Kieffer: Final words from either the Senator, Greene? Your forecast for this issue in the Statehouse?
Tom Greene: I think it’ll move this year. I feel positive. You know, like I said, the House has sent us a bill to work with. It will — I haven’t seen it yet, but I will review it. I think it’s good legislation when we have a pharmacist in the House and a pharmacist in the Senate. John and I have worked together on many of issues over the last three years. And this is another one that will benefit, like I said, up to 20,000 Iowans, who are really hampered and hindered in their quality of life, so, we’re going to move forward on this.
Ben Kieffer: Ok. Representative Forbes, you feel, as well?
John Forbes: Well I’m hopeful that before we adjourn here in the next 30 to 45 days, we’ll have a bill out of here that will be meaningful for people here in the state of Iowa, and help these very debilitating conditions that people aren’t being treated well now with conventional medications.
Ben Kieffer: Well thank you for the conversation. Before we go, Katarina, remind our listeners who might not know, what is this second funnel week all about?
WeedPress: The Paper Trail 
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