Isolated CBD, full-spectrum oil, and even smokable hemp are all being diluted down by a draconian regulatory framework that needs to be changed to facilitate growth, innovation, and prosperity throughout the industry.

Hemp Regulations and the Restrictions on Innovation

This article outlines types of cooling equipment that contribute to sustainability and energy-efficiency; how to develop a customized cooling strategy that meets growers’ sustainability goals; and steps growers can take to improve operating costs and more.

Is Carbon-Neutral Cannabis Possible?

A systematic literature review to identify and compare analytical methods used for the determination of cannabinoids in different matrices using LC-based systems.

Analytical Techniques Used for Analysis of Cannabinoids

As globalization of demand for cannabis and its derivative products increase, new technology and artificial intelligence solutions can greatly boost the output of production and processing.

New Age Artificial Intelligence for Cannabis Production?

Cannabis Science and Technology June 2021

As the cannabis industry continues to grow across the US and globally, so too are multistate operators (MSOs). MSO’s are a sign that the cannabis industry is here to stay as investments and infrastructure for big players continue to come online. However, these larger companies face many challenges in setting up shop, often dealing with banking issues and the various state-by-state legal frameworks. Frank Knuettel, CEO of Terra Tech Corp. (now Unrivaled Brands Inc.), recently spoke with us about the various challenges his company faces, their plans to expand into the largest West Coast MSO, and more.

Can you tell us about your company, Terra Tech Corp. and the recent merger with Unrivaled?

: Terra Tech is an 11-year-old company that we believe was the first US plant-touching company that was listed on the US Stock Exchange. We have been publicly listed on the over-the-counter (OTC) Markets Group since 2012. We recently merged with Unrivaled, and pursuant to that, we rebranded the company as Unrivaled Brands Inc., with the intent of building the largest West Coast-based multistate operator (MSO). Currently, we have operations in California, Oregon, and Nevada, across all types of cannabis assets, whether it be cultivation, distribution, brands, delivery, or dispensaries. So, we are a vertically integrated West Coast-based cannabis MSO.

What is your vision for the future as the rebranded company Unrivaled Brands Inc.?

: I think we have a lot of great opportunities. The California, Oregon, and Nevada markets are in and of themselves approximately 30% of the national market, so we have an opportunity now to build a large, deep West Coast-based cannabis MSO. And I say opportunity now, but there are protective moats against the industry who are protecting the industry with the federal illegality. And to the same extent, there are protective moats around, especially California and Oregon, in that a lot of the large MSOs have tended to focus more on the limited licensed Midwest and East Coast states and have a small or nonexistent footprint in the California and Oregon markets at this time. So, we can use our platform and our asset base to really create a large enterprise and some of the largest cannabis markets in the country.

What challenges to do you face as a multi-state operator? How do the different state regulations impact your business?

: Well, that is a pretty significant question, in that, at the moment, we have federal illegality and fairly different regulatory regimes, depending on the states in which we or any cannabis company operate. So, we're basically creating individual subsidiaries in various states because the state regulatory environments each have fairly different operating processes. On top of that, because of the federal illegality, we also have significant headwinds with respect to commercial banking, insurance, and other things.

I would say commercial banking is probably the most complicating factor of our business and the lack of access to mainstream banks, cash management, credit cards, and that sort of thing. So, there's quite a few headwinds. But, frankly, it’s the headwinds that everyone in the industry experiences and it’s part of what gives us the opportunity and runway to create a larger competitive operating enterprise right now.

In your various cultivation sites, do you follow individual state guidelines, or do you implement the most stringent rules from one given state to all your locations? For example, California might require more testing for pesticides than say Nevada does.

: Yes, we strictly comply with all the regulatory requirements in a state in which we operate in. We do our best where possible to facilitate a standard process across all our operations—and that facilitates just a greater level of efficiency with respect to our operating team and our cultivation team. It allows them to move, from state to state, a little more easily and that we have a common process. So, we try to sort of raise, across the company, our processes and procedures to the stricter markets in which we operate, so we have that common platform.

Can you tell us a little bit about the manufacturing and processing operations? What is a typical turn-around to create products? How does automation fit in?

: The turnaround time varies depending upon the type of product. For example, flower, packaged flower, or pre-rolls are manufactured in-house because of the importance of freshness. Our turnaround time post-harvest and drying period is short, in a matter of days or weeks at most, whereas for edibles and vapes, there's a longer turnaround time because we use an outside processor for the distillate.

On the automation side, depending on the brand and price point in which we sell pre-rolls—and by that, I mean, we have several different brands leading from Korova, which is our high-end brand, down to Sticks, which is a little bit more of our budget brand or a price point brand and Cabana, which is more of a lifestyle brand—so it varies also a little bit depending on that. In that, for our Sticks brand, we have pre-roll machines and both the jarring and the pre-rolls are all automated, whereas with Korova, we do some mixture of either to a pre-roll machine or hand packing, just to ensure quality. I would say the automation in the industry has made considerable strides in the last few years and the quality of the systems has risen quite dramatically. And that's across the board, whether it's with respect to jarring and pre-rolling or edibles production. A lot of edibles production is still done at the kitchen level by hand, although that also, as I mentioned, is seeing great and significant strides forward on the automation side.

Do you use any software or technology to monitor your products from start to finish?

: We do. It varies depending on the system. We have an enterprise resource planning

(ERP) system, that is what we call seed-to-sale, and it manages the process in the grow environment through production and in the inventory into the dispensaries, the point-of-sale system and through the sale, down to the individual end user or customer. Our ERP system is end-to-end, through the entire manufacturing and growing, cultivation processing, and sale process.

Further to that, in cultivation facilities, for example, there's some pretty advanced fertigation systems, as they're called, which is a system that provides both water and nutrients. We have our own formula for the nutrient system or the fertigation system. That's all automated, depending on tests we receive back with respect to plant cycle and its development cycle.

So, the fertigation system changes the formula over the development cycle, and that's all automated out of central complex in our cultivation facilities. So, obviously, with those items, plus the automation of the backend processing, there's a fair number of systems that are either in place or going into place that are increasingly rapid clip in our industry.

Do you have any advice for newcomers to the field?

: I have spent much of my career is early stage, high growth, somewhat chaotic industries. And because of the incredibly high growth in our space, overlaid with the regulatory environment and the relatively early stage, it's an exciting industry right now to be part of and fits well with my experience in other industries or companies. I think, frankly, that the evolution in our society, with respect to cannabis, has been dramatic. We have further to go, but the number of states that have legalized, in one way or another, has been really impressive and supportive of the overall growth.

With that said, it's exciting. It's swiftly growing. There's a cool vibe and culture to it. But it is challenging. And unlike mainstream industries, because of the regulatory environment, there are more hurdles and barriers that need to be overcome to be able to put out a successful product or a good quality product. I guess the biggest thing I could say is not to underestimate the complexity of the industry, despite what is a relatively simple and straightforward concept.

Do you have any plans to expand your reach further, perhaps into the East coast eventually?

: I think it's certainly something we actively consider when the timing is appropriate. But I'll say it's not now. We have, as I mentioned earlier in our discussion, a very large market in which we operate that is still in its early stages. The number of dispensaries in California, for example, is approximately the same number that exist in Colorado, which is a state maybe approximately one fifth the size. So, the California market, despite having a long cultural history in cannabis, is still in fairly early stages in legal cannabis.

Since there's a highly fragmented market with relatively few or any national players, there's a long runway for us to build our operation out on the West Coast. So, our focus for the near, or medium term, is to really make, produce, and build a company that's the largest West Coast MSO out there. And then, from there, we'll see where we go, whether that's organic expansion by way of licensing, for example, in the tri-state area, which, all within the last year, all three states last year legalized for adult-use. So, it remains to be seen how we’ll tackle that, whether it be organic growth or merge with some other party. But really the focus right now for the near and medium term is out West because the opportunity is so significant.

If there is a change to the federal status, how would that impact you guys as an MSO?

: A lot of it depends on what that change looks like. There are discussions and bills currently in Congress or recently in Congress that provide anything from safe banking, called the Safe Act, which provides access to commercial banks, which, as I mentioned earlier, would be a significant value to the industry, all the way to full legalization. And along the way, there are all kinds of aspects and considerations with respect to whether it's managed at the state or federal level, what expungement or social equity issues are included, what tax items are addressed, whether interstate commerce is allowed. Frankly, I think right now, as it tends to be the case with legislation at the federal level and, especially in cannabis, it's very murky in my mind which way legislation is going to go and at what time.

There's an omnibus bill now that was introduced by Senator Schumer last week that would fully legalize cannabis. But by all accounts, there are not enough votes in the Senate to pass it. Some of the co-sponsors are refusing to do anything less and that calls into question the previously held belief that while the full legalization wouldn't have the votes that the Senate would tip it over to the Safe Act or some sort of banking act, that's in question now with some of the senators’ comments.

I wish I had a crystal ball to be able to figure out what the legislative environment looked like around the bend, because that would have a significant impact on our strategy and our processes and operations. But, at this point, I just don't have any clear insight into it, and trying to plan for it is therefore very difficult.

Do you guys do any in-house testing for your products or is it all third party?

: We have, before any of our products are shipped or hit the shelves, we are required to have third-party testing on various matters, whether pesticides or chemicals or anything else like that. We also do in-house testing with respect to developing new genotypes or strains in our laboratories. So, we have, I would say, two layers. We have a layer of R&D testing in-house, and then, a regulatory layer to ensure health and safety for the consumers.

Since you are multistate operators, but you obviously can't ship between states, how do you manage the product formulation? Does one group come up with product formulation and then you send a recipe out?

: Yes, with respect to edibles, that's correct. It's formula-based, or recipe-based, and we can obviously share the recipe across states. With respect to flower and similar products, we cannot ship across state lines. So, we have essentially separate genetics testing and development in any state in which we operate.

Is there anything else you'd like to add?

: I think it's an exciting time in our industry. My background was largely in early-stage tech across the last 20 or 25 years. I think it’s exciting to see the growth in the industry and the advancements in both operating procedures and process as well as technology and automation. In any industry, the value of technology and automation can significantly improve margins, operating profits, and operations. Our industry is one that is only recently legal in many states. The systems—whether they are ERP systems, pre-rolling machines, sorting, or any of the other aspects that are still in their earlier stages of development—it’s exciting to see the almost daily advancements in our industry, with respect to process and technology.

I think these developments are going to usher in an industry in the next five or 10 years that is really advanced, it will probably be the most advanced agriculture-based industry in the world, because some of the tech and processes coming online. Some of that's driven by the need for efficiency and profit and some of it is driven by regulatory environments. But I think if you look at some of the developments in the cannabis sector—whether they're on the medical, adult use, or pure pharma side—that there's just enormous upside potential and it's exciting to be part of and see it happening.

Articles

In this interview, Frank Knuettel, CEO of Terra Tech Corp. (now Unrivaled Brands Inc.), discusses the various challenges his company faces, their plans to expand into the largest West Coast multistate operator (MSO), and more.

An Insider’s Perspective: Challenges, Growth Plans, and Insight from a Multistate Operator

 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD; Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, NP, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours**

Can cannabis be used to get you off opioid addiction?

 There are numerous scientific articles that support the concept of cannabis as a substitute for opiates. In a 2017 survey of 2897 medical cannabis patients, 97% reported that they were able to decrease the amount of opiates they consumed when they used cannabis. Additionally, 81% reported that taking cannabis by itself was more effective for their pain than taking both opiates and cannabis together (1).

Another survey found that almost 15% of elderly patients were able to discontinue opioid use within 6 months of initiating medical cannabis (2). Additionally, cannabinoid-based medicines were associated with 17-fold higher odds of discontinuing opioid prescriptions within 21 months (3).

There is also some evidence that cannabinoids may help reduce opioid withdrawal. A 2020 report in the 

found that cannabis alleviated the opioid withdrawal symptoms of anxiety, tremors and trouble sleeping (4). Evidence is also mounting for the use of cannabidiol (CBD) for opioid addiction. In a double-blind, placebo-controlled randomized trial of 42 patients addicted to heroin who were experiencing withdrawal, CBD significantly reduced craving and anxiety compared to those who received placebo (5).

 Yes, if used in conjunction with a proper protocol, cannabis has been used successfully for weaning people from an opioid addiction. 

: C Lots of data prove yes in chronic pain: 

https://healer.com/category/cannabis-and-opioids/

. Less data suggests it’s helpful in opioid use disorder, but I have seen this work in my patients.

 Studies suggest that cannabis is effective for chronic pain in adults. With more research demonstrating the effectiveness of cannabinoids for chronic pain, many patients are seeking ways to use cannabis to reduce or eliminate their opioids. Clinical studies have demonstrated a synergistic effect with cannabinoids and opioids, thereby allowing patients to manage their pain without the need to increase the opioids. And while there is a need for more clinical trials to demonstrate the effectiveness of cannabinoids for opioid addiction, many cannabis clinicians have successfully helped their patients eliminate their opioids.

How does cannabis interact with other prescription medications?

 Cannabinoids are metabolized (broken down) for the most part by enzymes in the liver, where many other medications are also metabolized. There can be competition between cannabinoids and other drugs when they are metabolized by the same enzyme, resulting in what is called “drug-drug interactions.” These interactions can result in the blockage of metabolism, leading to accumulation of the drug in the body, which can cause an increase in unwanted side effects. Conversely, the drug-drug interaction may result in an increase in metabolism of a drug, meaning that more drug is broken down faster, causing a decrease in drug levels leading to less efficacy.

It is very hard to predict these drug interactions since there are many differences in the way that people metabolize medications. To avoid any undesirable consequences, the best approach for anyone taking pharmaceuticals who wants to use cannabinoid medicines is to speak with a physician, pharmacist, or other healthcare provider who is familiar with these types of drug interactions.

 While there are theoretical concerns of cannabis preparations negatively interacting with other drugs, clinicians are not observing drug-cannabis interactions. This is not unusual in that many of the theoretical drug-herb interactions have not been found to be of any clinical significance.

: Very few interactions except at high doses of cannabis. The blood thinner warfarin is a common one to watch out for—patients should have their blood checked after starting cannabis.

: Cannabis can either increase or decrease the effectiveness of other medications. In most cases, it is clinically insignificant and does not require patients to stop their cannabis treatment. Anyone using cannabis with other medications needs to be followed by a knowledgeable cannabis clinician who can adjust the medications accordingly and ensure that there are no contraindications.

Check back next month for part III of this series where our roundtable will discuss how cannabis is used to treat acute and chronic pain, anxiety, ADHD, and pediatric patients. To find out more about the

some of the clinical applications for medical cannabis and dosing information.

A. Reiman, M. Welty, and P. Solomon, “Cannabis as a substitute for opioid-based pain medication: patient self-report,” 

R. Abuhasira, L.B. Schleider, R. Mechoulam, and V. Novack, “Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly,” 

J.M. Vigil, S.S. Stith, I.M. Adams, and A.P. Reeve, “Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study,” 

C.L. Bergeria, A.S. Huhn, and K.E. Dunn. "The impact of naturalistic cannabis use on self-reported opioid withdrawal." 

Y.L. Hurd, et al. "Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: a double-blind randomized placebo-controlled trial." 

**CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attends can expect from the practicum. Here in part II, they discuss how cannabis can be used stop opioid addiction and possible ways cannabis might interact with other prescription medications.

Medical Cannabis Insights, Part II: How Cannabis Helps Opioid Addiction and A Discussion on Interactions with Other Medications

 a leading multimedia platform dedicated to advancing medical research, education, and treatment in the cannabis industry, and Americans for Safe Access (ASA), the largest national member-based organization of patients, medical professionals, scientists, and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research, are excited to announce a partnership to share educational content and patient stories.

 launched in November 2020 and has already made a big impression in the medical cannabis community due to the quality of its content and the important message behind each issue," said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of 

™. "We are thrilled to partner with Americans for Safe Access because we share their passion for education and for helping as many patients as we can."

As part of their agreement, ASA will by-line articles focused on patient and advocate experiences in upcoming issues of 

 will conduct interviews with various ASA chapters and highlight the work going on across the US to improve patient access and legalization efforts. All ASA members will receive a complimentary subscription to 

"As a patient-focused organization, we are honored to partner with 

™, a platform that focuses on the patient experience," said Debbie Churgai, executive director of Americans for Safe Access. "Through this partnership, we will be able to offer our members and supporters a trusted resource to learn about the latest medical cannabis research, benefits, and treatment options available for patients."

 magazine is an educational resource for patients, doctors, nurses, pharmacists, and caregivers on the latest research, benefits, and treatment options cannabis provides for a variety of illnesses. Its mission is to educate the medical community on the viable treatment options patients are experiencing with cannabis and the ongoing research into cannabis and cannabinoids worldwide. 

™, the largest privately held, independent, full-service medical media company in North America dedicated to delivering trusted health care news across multiple channels.

s mission is to ensure safe and legal access to cannabis for therapeutic use and research. ASA was founded in 2002 as a vehicle for patients to advocate for the acceptance of cannabis as medicine. With over 150,000 active supporters in all 50 states, ASA is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA works to overcome political, social and legal barriers by creating policies that improve access to medical cannabis for patients. For more information, please visit: 

The partnership will focus on sharing patient and advocate experiences and educating the public on the medical benefits of cannabis.

Cannabis Patient Care™ and Americans for Safe Access Form Partnership

THC testing whistleblower, Keegan Skeate, first detected the irregularities in cannabis laboratories during his time at Praxis Laboratory. This Washington state laboratory conducts consumer safety tests and THC potency analysis for legal cannabis products (1). During a shift in 2018, one of his fellow lab technicians approached him with the speculation that someone was manipulating her test results. Her spreadsheet numbers looked irregular and the recorded THC potency values were higher than she remembered measuring. Reexamining his own test results, Skeate witnessed a similar pattern.

Last year, the United States legal cannabis industry sold over $17 billion worth of cannabis. The industry’s infatuation with THC has spurred the creation of financial rewards for every marginal increase in THC potency. Consumers utilize THC percentages as nutritional labels, purchasing products based on their THC content. Laboratory systems entrusted with analysis are vulnerable to corruption. Across the country, numerous laboratories have been fined or suspended for manipulating potency results, having deficient procedures for detecting contaminants such as mold, or faking those contaminant tests altogether.

“THC inflation is pernicious, it’s easy to accomplish and there are strong financial incentives to do it,” said Don Land, a professor of chemistry and forensics at the University of California, Davis, and an adviser to the multistate cannabis laboratory company Steep Hill (1). “I believe that it is likely to happen at least infrequently in every market out there, and there’s very little chance that labs would get caught.”

Customers are being cheated out by corrupt facilities. With more states legalizing cannabis and regulations becoming increasingly dependent on measuring THC, laboratory fraud is unlikely to disappear. New York has plans to tax cannabis by THC content when commercial sales begin. There is also a nationwide movement growing in popularity to limit the THC content of legal products. It will be very difficult for consumers to trust a product’s THC potency listing because theywill not know how much THC is really there.

In the US, the cannabis industry is roaring to life. State governments delegate their regulatory eyes to private, for-profit cannabis laboratories. Cannabis farmers and processors must pay private, state-certified laboratories to perform batch-specific tests before any product can be sold to consumers. Samples from these laboratories must pass a quality assurance check, which ensures that they have not been contaminated by mold or other impurities. During these tests, products are also tested for their cannabinoid potency. Often this percentage is measured by cannabis’s two most common active compounds: THC and cannabidiol (CBD).

Laboratories throughout the country though have been accused of fraud. Such establishments have been caught inflating THC potency levels, passing moldy cannabis as safe, and falsifying results entirely. In a searing 2019 audit of Oregon’s testing system, the state’s testing program found that test results could not be ensured as reliable or that products were safe. The audit also revealed that the state regulatory program has limited authority, inadequate staffing, and inefficient processes.

Some experts believe that laboratory corruption is a widespread issue because the incentives to cheat the system are too high and enforcement is mostly ineffective. “The people paying for the tests are happier to get inaccurate tests that say [their products] are more potent than they really are,” Land said (1). Laboratory tests have excruciating financial impacts on the US multibillion-dollar legal cannabis market. If a sample fails its quality assurance test, a farmer may have to destroy an entire crop of cannabis. THC potencies have become a benchmark for both wholesale and retail cannabis prices for cured flower products, which is the common form of cannabis used for smoking.

Laboratory fraud allegations have existed since the very beginning of commercial cannabis sales, especially in Washington state, where recreational cannabis has been legally purchased since 2014. These claims are known due to laboratory data being public information in Washington, which has allowed data scientists to analyze test results of individual laboratories.

In late 2015, Jim MacRae, a private consultant to cannabis companies based in the Seattle suburbs, published research entailing that in a three-month period, four of Washington’s 14 certified laboratories had tested tens of thousands of samples without ever failing a sample for microbial contaminations. Other laboratories had failed as many as 45% of samples. Four months after MacRae’s investigation, the state suspended one of those four laboratories for six months. The state found that the laboratory had given the highest THC averages in the state, putting public health and safety at risk as well as exposing consumers to cannabis products that were not properly or accurately tested for microbial contamination and other hazards.

MacRae’s insight was again utilized in 2019 where he inspected the cannabis market in Nevada, which has publicly faced difficulty in regulating their industry. MacRae’s analysis showed that the average THC potency in the state had steadily increased from 19% to nearly 22% between 2018 and 2019. Multiple laboratories were releasing fraudulently inflated THC potencies and rarely failing samples for safety standards. In one five-month period, Nevada suspended the licenses of almost half of all of its certified laboratories. Days after MacRae had presented his data to the state, Nevada’s government warned the laboratory industry that they were actively investigating THC inflation. Within weeks, Nevada fined a laboratory for “unsound testing practices.”

A major issue in cannabis testing is that cannabis can have numerous natural variations between different samples taken from the same plant. Michigan is attempting to reduce the potential of sampling error by mandating that testing laboratories collect samples themselves with a standardized sampling process, rather than allowing farms to submit their own cherry-picked samples.

Remembering his coworkers’ allegations, Keegan Skeate created Praxis Laboratory’s information management system upon his promotion to software developer. Included in his software was a version control system. It had the ability to track every granular change to the company’s data workbooks. By the summer of 2020, their suspicions had been confirmed. The laboratory’s scientific director and owner, Dustin Newman, had been falsifying THC potency tests on a large scale.

“I saw that the first person signed off on one set of results and then Dustin signed off on a different set of results, and that was just crystal-clear proof,” Skeate said (1). “I tallied it all up and it was hundreds of samples.”

Skeate’s version control system revealed that over a three-month period in the summer of 2020, Newman had altered test results to boost the THC potencies for more than 1200 samples. The Washington State Liquor and Cannabis Board (WSLCB) officer reviewing Skeate’s whistleblower complaint wrote in his investigation file that the data showed “solid proof of tampering” because the weights showed inconsistent decimal points, varying between two, three, four, or five decimal points, even though the laboratory’s scales measured to four decimal points (1).

Two days after Skeate submitted his whistleblower evidence of widespread fraud, the WSLCB made an appearance at Praxis Laboratory. There, they were able to confirm the laboratory’s internal documents matched the information Skeate had secretly sent to the agency. Upon WSLCB’s confrontation with Newman, he denied inflating THC potencies but was unable to explain the irregularities. Five days after their visit, Newman emailed the state and said that he would no longer have any role in the operation or management of the company.

Seven months after Skeate first contacted the WSLCB, Washington issued a 180-day suspension of Praxis Laboratories and filed a complaint seeking to revoke its license due to evidence revealing the falsification of laboratory records.

According to Jim MacRae, there is a simple method to make sure cannabis laboratories are honest: Just look at their data. MacRae believes that state regulators should scan over laboratory data to spot fraudsters while also releasing it publicly so private firms can help report suspicious activity.

“Within three months of [Washington state] making the data available back in 2015 I had … informed the regulators that they had a problem. Those data should be available to journalists, to interested data scientists like myself, and social sciences the world over would be fascinated by this shit,” MacRae explained (1).

The public is still able to request Washington’s cannabis laboratory data but data firms across the state claim that it’s no longer usable due to a new state vendor who has muddled the system since 2018 (2). This has prevented MacRae from investigating laboratories for the past three years.

Cannabis’s federal prohibition also bans cannabis testing laboratories from having any federal business involvement, thus indebting them more to the cannabis industry. “That’s not an effective design of incentives for ensuring labs place priority on consumer protection (rather than industry protection)... Effective regulation means random compliance checks and secondary testing to ensure that the testing labs are in fact doing the job they are expected to do (and protect consumer’s safety, not industry profits),” said Rosalie Pacula, a professor of health policy, economics and law at the University of Southern California (1).

The state of Oklahoma has instated some of the strictest laboratory regulations in the country. Cannabis laboratories face regular proficiency tests and the state mandates laboratories to collect two samples from every test and then hold a reserve sample, which is used to investigate complaints. The second sample may be used as a calibration tool, with the state randomly retesting reserve samples. A laboratory must answer for any deviations between the first and second test.

“If by some chance they are outside the [testing accuracy] window, the lab director must do some evaluation to figure out how that happened,” said Lee Rhoades, the laboratory oversight manager for the Oklahoma Medical Marijuana Authority (OMMA) (1). “If it becomes a chronic situation where people simply cannot achieve the target value, there are provisions in our rules that allow us to take more action.”

With such rigorous testing framework, Oklahoma could become a good place to start for the government to standardize the cannabis testing industry and help protect consumers from cannabis testing fraud.

https://fivethirtyeight.com/features/americas-pot-labs-have-a-thc-problem/

https://mjbizdaily.com/lack-cannabis-tracking-data-washington-state/

A recent article published by FiveThirtyEight (1) was highlighted on major news networks across the US, bringing attention to a very important issue facing the cannabis industry: how much tetrahydrocannabinol (THC) is actually in products. Here, we highlight some of the findings from the FiveThirtyEight report and what it means for the cannabis industry.

The Serious THC Problem in the US

 conference—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practicum organized by Bonni Goldstein, MD, (the practicum’s originator); Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, RN, MSN, AGPCNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid therapeutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeutic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours.**

In this roundtable interview series, we speak to each of the organizers to learn more about them and what attendees can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information.

What are some of the clinical applications for medical cannabis?

 Medical cannabis can be useful for numerous conditions, including managing symptoms of neurodegenerative disorders, inflammatory gastrointestinal conditions, symptoms from cancer and cancer treatment, chronic pain, sleep disorders, and some psychiatric disorders. Because of the widespread distribution of the cannabinoid receptor, we know that the endocannabinoid system plays a role in almost every physiologic process and therefore can be utilized as a target for treatment.

 Anxiety, seizure disorders, pain, mood disorders, sleep issues, and autoimmune disorders.

: Chronic pain, insomnia, PTSD, nausea, and vomiting are certainly the most common, but a typical cannabis practice is full of refractory conditions from every other field in medicine, for example, psychiatry, gastroenterology, oncology, neurology, rheumatology, and so forth. Overall, cannabis is often an effective treatment when everything else has failed.

 According to the National Academies of Sciences, Engineering and Medicine report on the health effects of cannabis and cannabiniods, there is moderate to substantial evidence to support the use of cannabis for chronic pain in adults, sleep disorders, chemotherapy induced nausea and vomiting, and muscle spasms in multiple sclerosis. Additionally, we are seeing more clinical data to support the use of cannabinoids for anxiety, depression, and PTSD.

How is medical cannabis dosed and what methods are being used by patients?

 Medical cannabis is different than most pharmaceutical medications, meaning there are no specific dosing recommendations for the vast majority of conditions being treated. Patients are advised to “start low and go slow” to customize their dosing regimen. The reasons for this include a wide inter-individual variation in absorption, metabolism, and excretion of the cannabinoids and other compounds in the plant. However, a clinician knowledgeable in cannabis dosing can help a patient negotiate dosing for the many products on the market, helping to personalize the patient’s dosing regimen. Methods of use include inhalation, ingestion, sublingual, topical and transdermal applications. Each of these has advantages and disadvantages that can help patients choose their preferred method, although many patients use multiple methods of use depending on symptoms, time of day and cost.

 Dosing has a high interindividual variability. Best to start at very low doses and work up so the optimal "physiological" dose can be found (versus a "pharmacological" dose)

: Cannabis is highly versatile and allows for individualized treatments that can often be fine-tuned to allow for all benefit and no adverse side effects. This fine-tuning includes delivery methods (oral, oromucosal, inhaled, topical), numerous varieties of cannabis with distinct properties. You can find more info at: 

https://healer.com/using-medical-cannabis-delivery-systems/

: Cannabis is best when it is individualized to the patient's condition and goals of care. It is important to take a thorough health history and discuss the plan of care with the patient. Some patients may need low doses to achieve relief and others may need higher doses and that usually cannot be determined without considering many factors like age, gender, other health conditions, medications and previous or current cannabis experience. In some cases, patients may need multiple methods of administration to effectively treat their condition.

Check back next month for part II of this series where our roundtable will discuss the role medical cannabis can play in stopping opioid addiction and how it might interact with other medications. To find out more about the CannMed Medical Practicum, please visit:

, a medical practice devoted to educating patients about the use of cannabis for serious and chronic medical conditions. Dr. Goldstein was a Clinical Instructor in Pediatrics at USC School of Medicine in Los Angeles, Emergency Transport Attending Physician at Childrens Hospital Los Angeles, and Emergency Medicine Attending Physician in the Pediatric Emergency Department at Los Angeles County-USC Medical Center. A frequent speaker nationally and internationally, Dr. Goldstein was awarded “2017 Healthcare Professional of the Year” by Americans for Safe Access, a non-profit that promotes safe and legal access to cannabis throughout the nation. She is on the board of the International Association for Cannabis as Medicine and is also on the Medical Advisory board of Whole Plant Access for Autism, a non-profit that provides education and resources to families of individuals with autism. Dr. Goldstein’s first book, 

, was awarded “2017 Semifinalist Book of the Year” by the American Botanical Council. Her latest book, 

, was published by Little, Brown Spark in September 2020. She is the medical advisor to 

 is a researcher, clinician, educator and industry consultant that has advised the White House and the Department of Defense on natural products for regulatory guidelines and research on effective battlefield hemostatics, respectively. Dr. Spelman studied brain cancer, as well as CB1 and CB2 receptor binding as a Postdoctoral Fellow at National Institutes of Health and was the first researcher to elucidate cannabinoid ligands in Zanthoxylum spp. He has also carried out malaria and natural products research as a Marie Curie Research Fellow in the European Union and has focused on molecular techniques to elucidate the pharmacology of phytochemicals on human physiology and has 27 peer reviewed publications on medicinal plants. He has also been a senior R&D executive for multiple companies over the last decade. Dr. Spelman has considerable experience in medicinal plant, nutraceutical and cannabinoid research and has coordinated new product development, analytical and QC guidelines, research activity and educational curriculums for industry and universities over the last 30 years. 


Dr. Dustin Sulak is an osteopathic general practitioner whose clinical practice focuses on treating refractory conditions in adults and children with an individualized, health-centered approach. Dr. Sulak received undergraduate degrees in nutrition science and biology from Indiana University, a doctorate of osteopathy from the Arizona College of Osteopathic Medicine, and completed an osteopathic rotating internship at Maine-Dartmouth Family Medicine Residency. Dr. Sulak is a founder of Integr8 Health, a medical practice in Maine that follows over 8,000 patients using medical cannabis, a cofounder of 

, a medical cannabis education resource, and serves on the board of directors of two non-profits, the Society of Cannabis Clinicians and Patients Out of Time.


Eloise Theisen is a board certified Adult Geriatric Nurse Practitioner who specializes in cannabis therapy. For over 20 years, Eloise has worked primarily with cancer, dementia and chronic pain patients. In the last 6 years, Eloise has focused her efforts on cannabinoid therapies. Since then she has worked with over 6000 patients to help them effectively treat age-related and chronic illness with cannabis. Eloise is a co-founder and the Chief Executive Officer of 

 and Radicle Health Clinician Network. She is the current president of the American Cannabis Nurses Association (2020-2021) with over 1350 members nationally. Eloise also serves on the editorial board of the 

American Journal of Endocannabinoid Medicine

, a journal dedicated to educating healthcare professionals on the subject of medical cannabis through research, independent medical studies and evidence based data. In 2019, Eloise co-wrote 

Pain Free with CBD: Everything you need to know to safely and effectively use cannabidiol

. She is currently teaching the accredited medical cannabis certificate program at Pacific College of Health Sciences.

In this roundtable interview series, we speak to each of the organizers of the CannMed Medical Practicum to learn more about them and what attends can expect from the practicum. Here in part I, they share some of the clinical applications for medical cannabis and dosing information.

Medical Cannabis Insights, Part I: CannMed Medical Practicum Organizers Discuss Clinical Applications and Dosing

One of the most common statements people hear about medical cannabis use in the United States is that there needs to be more research, clinical trials, and studies on the plant’s long-term effects. What people don’t often hear is that research in the US has been substantially limited and restricted due to the Federal government’s stance that cannabis is a schedule I drug making it illegal. Despite this, there has been research both in the US and in other countries. While we still have a long way to go to understand this plant medicine and how it can best serve people, one public health doctor is taking the initiative to gather as much information as possible now. Dr. Marion McNabb has been conducting surveys related to medical cannabis for about five years and her most recent endeavor is to gauge the knowledge, interest, and understanding of medical cannabis in healthcare professionals. Here, she shares her plans for this latest study as well as her background and key insights into the medical cannabis industry. 

Can you tell us a little bit about your medical background and how you became interested in the cannabis industry?

 Yes, I am a public health doctor by training. I have about a 20-year career in global public health. My background is working in HIV/AIDS, family planning, and maternal child health, mainly in low-income countries such as in Africa and Haiti. I worked on training healthcare providers in a new clinical area. I worked with doctors and nurses around HIV in a country where that was a new disease area and new treatment that clinicians needed to learn. I developed continuing medical education courses and different job aides for doctors and nurses to deal with HIV in clinical care settings and do research and using digital technologies to help. For example, using mobile applications, SMS technology, and clinical decision support tools for doctors, nurses, pharmacists, lab techs, and so on.

About five years ago, when it became legal for adult use cannabis in Massachusetts, I left my global public health career to basically transfer a lot of the skills and tools from global public health to the cannabis industry. Because cannabis is still federally illegal, it's been restricted and difficult to research the plant and research the plant in human and clinical populations. I set out to advocate at the design of the industry in Massachusetts for the research license that is now operational here and integrating cannabis education into institutions of higher education and conducting research studies.

A couple of years ago, I partnered with the University of Massachusetts-Dartmouth (UMass Dartmouth), and we have now conducted five different research studies together related to cannabis from a medical cannabis use perspective, as well as an adult use perspective. I've also been involved in developing a number of cannabis education programs, together with Holyoke Community College and Boston University as well as other universities such as UMass Dartmouth.

Now, I’m excited to be leading to research studies together with UMass Dartmouth and about 15 different colleagues. One study is around COVID-19 in medical cannabis and adult use cannabis consumers and the impact of COVID-19. And the second is called the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study” that we are doing together with Medicinal Genomics (1,2).

I think what's exciting about medical cannabis and adult use cannabis is that there's more opportunity for not only research, but implementation. We know that medical cannabis is providing relief for a number of health conditions and symptoms. Not only should we continue to study the plant, but I think we should also design clinical implementation protocols and dosing protocols to help healthcare providers integrate this into their simpler regular practice.

Can you tell us more about the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study”? What inspired you to form this informative research entity? How can healthcare professionals take part in the study?

 Yes, it started as a result of the launch of the 

 magazine and the webinar event that we did online on Veterans Day (3). Actually, because of that event, one of the attendees was from Medicinal Genomics—who are leaders in cannabis science and research from the genomic plant side of the category and have been colleagues and friends of the Cannabis Center of Excellence, the nonprofit I founded, which has been running research studies for quite a while. So, they attended that webinar, which was part of the launch of the 

 magazine and shared some valuable information from the Veterans Study that I conducted. Medicinal Genomics reached out to me afterwards. They organize and run the annual CannMed conference, which brings together researchers, clinicians, and experts from the medical cannabis and adult use fields every year. They also offer continuing medical education credits and different educational courses throughout the year as well as podcasts related to the science around cannabis. They reached out with an interest in understanding more about healthcare providers’ current knowledge and training related to medical cannabis and what they would be interested in learning in the future.

My nonprofit, the Cannabis Center of Excellence (COE), is very much interested in medical cannabis and advancing the field of not only using data that we collect to provide advocacy and move it forward, but also to really provide evidence-based background for training and educational purposes. So, Medicinal Genomics reached out to run a research study. We put together this anonymous survey, which basically asks any kind of healthcare provider what their knowledge and training and current practices are related to medical cannabis. What they are interested in learning about in the future and how they're interested in learning that. The study launched in May 2021 and will be running through August 2022. We'll be presenting the preliminary results this year at the CannMed conference in early October. We will also share results in the spring of 2022 at the 15th annual clinical conference on cannabis therapeutics run by Patients Out of Time. Final results will be presented at CannMed 2022. Sign up and stay tuned.

If you're a healthcare provider, you can take the survey. It’s about 10 minutes to take and you'll be entered to win a free pass to the 

, including the CME portion of it, which is an $820 value. And you'll also be entered to win an Amazon gift card for participating. Check out the COE website for regular updates on data collected through the study.

In addition to presenting at the CannMed conference, we’ll also over time be sharing the results back out with the clinical community just to encourage awareness about the importance of topics such as the endocannabinoid system or medical cannabis in pre-service, healthcare provider education as well as nursing, pharmacy, clinician, doctor, and dentist educational programs.

What do you hope will come out of the “Healthcare Provider Knowledge, Attitudes, Practices Related to Medical Cannabis Research Study”?

 What I hope will come out of the study—what we're really trying to do this year—is not only engage healthcare providers and respondents to the research study, but also to carry the idea and the information forward to their colleagues.

What I'm hoping is that by taking the research study, it will raise awareness among healthcare providers about the topic and encourage them to reach out and share the research study with their fellow clinicians, one to help get more opinions and ideas. But also, to start a behavior change campaign.

. We have T-shirts and hats and different swag that really works, that has fun slogans on it that aim to destigmatize medical cannabis and cannabis research. We've developed a specific line for healthcare providers and raising the awareness of this alternative medicine of medical cannabis. If folks take the research study, they can also continue to support the research by buying one of the pieces of swag, which helps fund our work and continues to raise awareness.

What I hope, again, what I will get out of this is information from healthcare providers about what their knowledge is, about what they want to learn, and how they want to learn it so that we can move the field of medicine forward in an innovative way by including medical cannabis as an alternative.

I would like to also really thank our study sponsor, Supercritical Labs and Chris McElvany. Without his financial support, we couldn't make this study possible. And we're also looking for additional study sponsors and partners. Please feel free to reach out (contact 

). We really appreciate the support. Couldn't do this kind of work without our partners.

Again, to circle around what I'm what I'm hoping for is continued awareness raising among the healthcare provider community that patients are using medical cannabis. It’s available and becoming more increasingly available in states. And I feel the healthcare providers can learn more about the topic.

Do you think there should be more research into the medicinal properties of the cannabis plant and its interactions with the endocannabinoid system?

 Yes, I think there's enough research to integrate cannabis as a first-line or second- or third-line therapy for several symptoms right now. But I also believe that we can continue to do more research around the medical benefits.

Specifically, around different combinations of cannabinoids and terpenes and how those impact specific conditions and demographics, people profile, so to speak. I also think there's really a good opportunity to understand more of the endocannabinoid system, as you mentioned, within our own bodies.

What endogenous cannabinoids are in play? Cannabis can have a positive impact, but also understanding what the risks are associated with integrating medical cannabis, particularly with a patient who is taking several medications. There are polypharmacy patients. It's important to understand drug–drug interactions and the side effects that may happen by introducing cannabis and certain cannabinoid profiles. Particularly, in those patients with a pharmacy cocktail, such as opioid or fentanyl.

There is evidence that cannabis can be a good treatment alternative to help people reduce the use of opioids or other harmful substances such as alcohol and tobacco. But I think those need to be done under clinical supervision and there's opportunity to continue to research in those areas.

Have you encountered hesitancy or judgment in the medical community to viewing cannabis as a potential medical treatment?

 Yes, lots. And I think that stems from the fact that the medical community and in all types of education from physician, nursing, and pharmacy, the endocannabinoid system and the value of medical cannabis is removed from education. Also, it’s worthy of noting that medical cannabis was included in the 

Our medical education in the last several decades has been squarely focused on pharmaceutical and chemical-based interventions as primary care treatment options. So, the understanding of the medical community around medical cannabis is limited right now.

I think, additionally, in the last 50 years or so, there was a “Reefer Madness” campaign which was a structured, engineered public awareness campaign that really looked to demonize cannabis. And that alongside a war on drugs that targeted people of color and arrested folks for cannabis has jaded, so to speak, the medical community.

So, I think there's room to continue to educate the medical community around where the current research efforts are and where the evidence stands and work to break the stigma that was created through the the war on drugs and the “Reefer Madness” campaigns.

When cannabis was taken off the USP back in the early 19th century, was there an outrage from medical professionals? Is there any documentation of that, that people that were using it were upset that it was taken off?

 Yeah, that's a good question, I'm going to open this book that my friend gave me here. Yes, the American Medical Association (AMA) reached out at the time. I'm looking at this book, 

There was outrage. There was outrage by the American Medical Association that was upset by the removal of this from the US Pharmacopeia and the tax on cannabis. To quote the book from the section titled “Did Anyone Consult the AMA?” (4): “The AMA doctors had just realized ‘two days before’ these spring 1937 hearings, that the plant Congress intended to outlaw was known medically as cannabis, the benign substance used in America with perfect safety in scores of illnesses for over one hundred years.”

The AMA was brought in at the end and they did not accept really their testimony and moved on. There was a lot of political pressure associated with the removal of this. The AMA and drug companies testified against the 1937 Marijuana Tax Act because cannabis is known to have so much medical potential and never caused any observable addictions or death by overdose.

Twenty-nine years passed, however, before American scientists could begin to even look at the cannabis medicine again. And that's when Dr. Raphael Mechoulam in Israel discovered and isolated THC delta-9 in 1964. And it's worthy of noting marijuana was America's number one analgesic for 60 years before the rediscovery of aspirin, around 1900. From 1842 to 1900, cannabis made up half of all medicines sold with virtually no fear of its high.

Clearly, cannabis has been used as medicine in the United States and then removed from the pharmacopeia. But it's also been used as medicine around the world for thousands of years.

Do you recommend any educational resources for healthcare professionals seeking to learn more about the benefits of medical cannabis?

 Yes. I would say if you're interested in learning some of the research results we have from our observational self-report studies over the last couple of years around how cannabis patients, consumers and veterans are reporting using medical cannabis you can go to www.cannabiscenterofexcellence.org and check out some of our research results. We’ll be having more educational videos and resources for download soon.

And then additionally, Medicinal Genomics, as I mentioned, runs CannMed and it's an excellent conference. It's going to be held September 29–October 1 this year in Pasadena, California, with speakers from around the world as well as clinicians and researchers in the cannabis industry. They will also offer continuing medical education credits and we'll be presenting the preliminary results from this research study. CannMed will be a great place to learn more about the latest and greatest clinical and research in cannabis.

There's also another group called Patients Out of Time that's very worthy of following. They just had their 14th annual clinical conference on cannabis therapeutics last month. I was honored to be a part of it as well. They offer of continuing medical education credits every year too and offer great educational opportunities.

And then out of the study, the healthcare provider knowledge, attitudes, and awareness study, we will be developing good, targeted content for healthcare providers based on what they report they want to know. Stay tuned. And if folks are interested in being a content contributor, writer, or being part of this effort in a deeper way, we welcome that. Please definitely feel free to reach out to me directly, 

With the growing interest and increased legalization in cannabis, do you believe it will become a more sought out treatment option by healthcare professionals?

 Yes, I do. I think when legalization happens cannabis will be more sought out if it is reimbursed by health insurance. And as part of the mainstream medical system. In terms of the health insurance, what we're finding in the research studies that I've run is that more than 70% of people report using medical cannabis to reduce the use of prescription or over-the-counter medications. Often those prescription or over-the-counter medications have side effects that are unwanted by these respondents. By shifting to medical cannabis, it relieves some of the side effects of those medications. Therefore, improving the quality of life, ability to return to work, improves family relationships, and so forth.

All those factors come into play when you want to reimburse a treatment option. Health insurance should look more towards reimbursing medical cannabis because of the benefits of return quality of life, and therefore a reduction on the cost of the insurance company to keep covering medications or one medication that covers the side effects of another medication. If you think about somebody who's on a cocktail of 10 or 12 medications, the cost to the insurance company for long term chronic care is a lot. But if somebody is introducing medical cannabis to reduce that, you could see the cost savings and improve quality of life.

Anyway, I think that is something that would be attractive to healthcare providers. I think also, we have done a disservice to our healthcare providers by not including this education around the endocannabinoid system, which is a fundamental system in our body that interacts with every other system—the endocrine system, the nervous system, the immune system. It’s unethical to not include this, especially when you're talking about medicine and research. I think our healthcare providers deserve to know about this. And once they start to learn about it and start to feel more comfortable that they know as much or more about medical cannabis than their patients, then they'll want to see it as an option.

The other barrier that exists, I think, for medical providers is the lack of guidance around dosing and types of cannabis for different types of health conditions. Really drilling down into those nuances of dosing by health condition, by age, and understanding what drugs may interact by dose and what titrations you should do and what tolerance levels exist in certain patients, what delivery mechanisms are best, all of those. I think providing some clinical tools around that for healthcare providers will help them feel more comfortable in the future, integrating medical cannabis as an option.

Do you think healthcare professionals would feel more comfortable if there was more of a pharmacy model where their patients have a real prescription and then they go and get it filled rather than going to a budtender? Do you think something like that would ever come to the US?

 Yes, I think it already has in some ways. Some states are tending towards the pharmacy model. Georgia, as an example, will be licensing pharmacies to dispense low THC oil and products. I think there is. Canada has the purchase from that model. I think there are going to be examples of where physicians are going to feel more comfortable.

That is their status quo. They write a prescription then you go to a pharmacy and pick it up. I mean, I think that that should be available and would help the clinician. I just want to make sure that wouldn’t box out anybody from having access to cannabis. I'm a proponent of making sure that the community can have access to it. So having dispensaries that are medical dispensaries that are available and accessible to patients that have discounts that ensure that cost isn't a barrier, all those things are very important to me. I think having a clinical model of going to a pharmacy is important, but then also ensuring that that doesn't limit access.

People should also be able to grow their own medicine at home, which is something that I promote. But back to what would help healthcare providers feel more comfortable. I think what's interesting and a real opportunity in medical cannabis is that it is personalized medicine. So, compounding and formulations for particular conditions become very important.

Think about, in advanced cancer, say, one type of breast cancer. Dr.Dedi Meiri who's a professor in Israel who I greatly admire, has been doing quite some significant research and trying to understand different cannabinoid formulations and profiles on different cancers and different types of cancers. What he's found is that there are unique circumstances in cannabinoid combinations, in terpene combinations that affect particular cancers. One strain may affect one breast cancer type, but may not affect another breast cancer type. It's that personalized.

When you walk into a dispensary now that has only 10 different options or types of cannabis, it's limiting because you may not have that particular profile that may impact your particular health condition. It goes back to how can we get into this personalized medicine? Is that through a pharmacy route? Hey, pharmacy, can you create this formulation where we have a CBN, CDC, and THC at a 3:2:1 ratio, that's a tincture. Because that’s the personalized medicine that we need for that patient? Or are we trying to, like, step back up and create sort of generic broad-spectrum types of medical cannabis? If this makes sense, that may impact a variety of conditions and have great opportunities for all different types of formulations.

I think in the cannabis industry, not limiting the farmer and not limiting the cultivator or the processor will be your best bet because there’s so many ways that you can cultivate or formulate or manufacture processed cannabis. If we move only to high level multi-state operators (MSO), mass-produced quality and mass-produced mid-level quality, we're really missing out on the natural benefits of the plant and sacrificing that for profit. It'll be interesting to see how the pharmacy model plays out in Georgia and other states versus a dispensary model with the budtender.

That is primarily the delivery in some states. The last thing I would say is the delivery with the budtender—there are opportunities to educate that budtender and that patient advocate. Not everybody needs to be a healthcare professional necessarily in medical cannabis to deliver counseling. We have lots of experiences in healthcare that you have lay counselors in HIV, for example. Those are the primary first frontline workers for an HIV patient, and they are not actually healthcare providers. I think let's not shame the patient advocates or the budtenders because they do know a lot about cannabis. I think they could also learn more about medical cannabis, especially in states where adult use is legal and not lose the focus of medical. But stay tuned. The Cannabis Centre of Excellence will be coming out with some materials around that.

What do you hope will change in the cannabis industry? Where do you find the most difficulties and how do you deal with them?

 I guess the change I would like to see is in two places, social justice and the race for money. Right now, in the cannabis industry, I think there is some push in Massachusetts and in other states to really work towards restorative justice, to right the wrongs of the failed drug war. And I think that's very important. It's something that's been a cornerstone of my work for the last five years—advocating and working towards the area of social justice in the industry. And what that means is, I believe, big industry and small business participating together. Providing opportunities for those who've been negatively impacted to have priority access to the cannabis industry and fair and transparent business deals to happen for industry grow and success for both small and big business.

Dr. Marion McNabb has been conducting surveys related to medical cannabis for about five years and her most recent endeavor is to gauge the knowledge, interest, and understanding of medical cannabis in healthcare professionals. In this interview, she discusses her latest study as well as her background and key insights into the medical cannabis industry.

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