August 2023

Cannabis Clinicians Colorado

Sunset Review of Marijuana Laws Draft of Proposed Corrections / Improvements

Hi friends –

In preparation for the 2024 five-year sunset review of Colorado marijuana laws, Cannabis Clinicians Colorado respectfully submits these ideas for corrections and improvements to the code for your consideration:

  1. Combine medical and recreational dispensary rules into one unified code so that medical patients can shop at any dispensary – medical or recreational – without the burden of taxes and at medical potencies and quantities. Yes, that’s a long sentence. But it makes sense. HB21-1317 added an onerous level of compliance to medical sales. So onerous, that scores of medical dispensaries have closed, and product manufacturers have abandoned medical. Patient access to medical marijuana hasn’t been this low since the pre-dispensary Caregiver days.  List of anticipated changes:
    1. -End 7pm sales restriction on medical
    1. -Allow stores to stock 200mg to 1K+mg edibles in a separate case for sale to medical patients
    1. -Allow 18-20 yr olds to shop medical in rec stores (this will take some hard thinking, due to constitutional ban on 18-20 year olds in recreational dispensaries.)
    1. -Allow Homebound patients to shop with or without Caregiver. (Currently, Homebound patients are not allowed to go to a dispo alone. Why?! We very much want our Homebound patients to go outside and do stuff.)
    1. -Allow 10% of product transferred from OPC’s to be excise and transfer tax free for medical patients. Medical patients will still pay the 4% State tax as always but will be exempt from retail sales and local sales taxes. Reconcile excise taxes at end of month as % of medical sales across entire business, not by individual sale, for ease of adjusting.
    1. Calculate savings to MED and State by having just one license type. This single license type will continue serving medical-only patients in medical only counties such as El Paso, but greatly increase access for medical patients in recreational-only counties such as Gunnison.
  2. Allow sales at dispensaries for CBD products grown under CO Dept of Agriculture licenses.

Did you know cannabis dispensaries cannot sell CBD products? They can’t and it’s stupid.  If the dispensary can sell products from METRC grown plants, they should also be allowed to sell products from Colorado Dept or Agriculture grown plants. Under current rules, if we want a  patient to titrate CBD and THC separately to figure out their optimal ratio, they have to buy the CBD part at a different store or online. Which subjects them to unscrupulous CBD stores selling “hemp derived” delta-9 THC and delta-8 THC – an abomination of toxic sludge created to circumvent current dispensary rules.

  • Bring Controlled Substances Act in line with MJ & natural medicine laws so licensed professionals such as Realtors, plumbers, doctors, car salespeople, and nail technicians can use cannabis or shrooms while holding DORA occupational license. This is an easy fix: add the words “with the exception of substances separately regulated by the State of Colorado” after the line “shall not use DEA Schedule 1 drugs” in the Colorado Controlled Substances Act.
  • Non-discrimination of cannabis clinicians and patients -see draft
  • Caregivers wishing to get dispensary licenses able to keep genetics / introducing new genetics in METRC
  • METRC Stupidities needing correction.
    • Make METRC comply with CDPHE forms and allow splitting plants. Right now, “6 plants or All plants” are the ONLY options METRC supports, despite the CDPHE MMRS application clearly allowing splits between patients and dispensaries and patients and caregivers. Often, the dispensary refuses to allow patients with EPCs / UCFs to shop to their limit if they don’t surrender all their plants. Even if they live many miles away and therefore have a home grow.
    • Allow 100% of EPC / UCF use. METRC currently only allows patients to purchase ½ of their concentrate limit; or a max of 4oz concentrate per patient. (Who is the Department of Revenue to overrule what the doctor allows??) Many dispensaries refuse to honor Uniform Certification Forms at all, saying “it’s just too risky based on our last MED inspection”. This is harming our rural and disabled patients and pushing them back to the black market.
    • Allow 18-20 year old patients to use a Uniform Certification Form. Many dispensaries are too afraid of HB21-1317 to let 18-20 year old patients buy more than 2 vape pens, despite having a UCF. No matter how many hours they have to drive to find a dispensary that even accepts 18-20 year olds.
    • Disabled adults with Legal Guardian or Medical Power of Attorney should not be required to present a CO ID to get a medical card. The Legal Guardian / Medical POA persons ID is enough. Under Gov. Hickenlooper, only the Legal Guardian or POA person needed a Colorado ID. Under Gov. Polis, patients in hospice, with dementia, or who are physically nor mentally unable to go to DMV lose the ability to join MJ Registry when their Colorado ID expires or when they turn 18.
    • By-mail patients STILL cannot shop with paperwork in many of the METRC POS systems, despite MED work-around in March 2022.  Renewals by mail also need to be allowed to shop with paperwork.
    • Caregiver Registry by mail STILL not available even after DORA ordered them to return this option in 2019. CDPHE and MED in constant battle to force other agency to take responsibility for Caregivers. It’s discouraging.
  • HB21-1317 Issues to correct:
    • HIPAA violations –
      • Forcing patients to carry around their diagnosis printout in order to shop is a HUGE HIPAA violation. There is NO REASON a 21-year old minimum wage budtender needs to know you have AIDS, ankylosing spondylosis, oral cancer, etc. Budtenders are NOT pharmacy techs.
      • I have patients who know people now classified as “drug deaths” for testing positive for cannabis in unrelated accidents. (How is getting struck by lightning a “violent drug death”?) Unauthorized by next of kin drug testing on corpses is a HIPAA violation.
    • Restore practice autonomy to cannabis clinicians by again allowing them to diagnose their own patients. Colorado Board of Health declared the requirement a doctor review a previous diagnosis before writing a cannabis recommendation to be WRONG in Dec 2021. But the DA over-ruled, resulting in the loss of many cannabis doctors, and loss of care to over 20,000 patients and climbing. Easy fix – change the word “must” to “may” in the “review previous diagnoses” line of HB21-1317
    • Restore practice autonomy for cannabis clinicians by removing prescription requirements on recommendation. Despite over 40,000 clinical studies on cannabis there remains no known correlation between any given dose of cannabis and any blood-level or effect in a person. Period. Cannabis is highly individual medicine. Each patient must use trial-and-error to find the appropriate routes of administration and dosages for them. This does not mean we don’t counsel our patients on use – we do. But with the loss of medical dispensaries and products (not to mention the Controlled Substances Act and Medical Practices Act forbidding doctors to ever try cannabis themselves), having the cannabis recommendation include prescriptive information on potency, products, amount dispensed, and usage is so impossible as to be a joke. For the past 20 months we have instead used a disclaimer that says “In compliance with Colorado Constitution Article XVIII, this is a recommendation and not a prescription. Therefore, if and how the patient uses cannabis is up to them, and at their own risk. Provider assumes no liability for patient’s decision to use cannabis under this certification.” And having the patient mailing address on the Provider Certification is beyond pointless as 1/3 of our state lacks home delivery of mail and uses Post Office boxes.
    • Restore telemedicine for disabled and rural patients. Thanks to HB21-1317, there are now fewer than 150 cannabis practitioners in Colorado. Down from a high of over 800 in 2015; we lost 50% with the switch to online certifications in 2016, and another 50% since 2021. Patients who have seen the same doctor multiple times, patients who are Homebound, and those without a doctor within 30 miles should be allowed to use telemedicine to establish and/or continue a bonafide physician-patient relationship. We can keep the in-person only requirement for non-Homebound patients between the ages of 18-20 to appease the Mad Mothers.

That’s my list for now! I have some of this already written up and am starting on a Track Changes version of the medical code.  Keep in touch –

Martha Montemayor CNC

Director, Cannabis Clinicians Colorado