Jaclyn Moore, Pharm.D., Lau Ola’s Chief Compliance Officer and a licensed pharmacist, hopes Hawai‘i will become a world-class destination for integrative cannabis treatment.
She would like Hawai‘i to be known for its progressive, quality, patient-centered approach to cannabis medicine, much like how people travel to the Mayo Clinic for traditional medical care.
Her desire to integrate medical cannabis into our healthcare system is a practical one. Currently, local hospitals and nursing facilities do not allow for patients to retain or consume medical cannabis while in those settings.
“I hope we are moving in the direction where hospitals in the State are willing to draft policies that address medical cannabis in a manner that doesn’t place it in the same category as an illicit drug of abuse,” she says. “If an individual is registered with the State as a patient, and is being treated in a healthcare setting like a hospital, a patient’s use of cannabis should be listed as a medicine during the medication reconciliation process and not part of a diagnosis of cannabis use disorder, which I fear is more often the case.”
How Hawai’i is unique
Other states that have legalized marijuana, she says, are finding ways to present it in ways that are a perfect fit for them. “Nevada just legalized recreational marijuana, and they’re talking about having smoking lounges now,” she says. “It’s perfectly in tune with how Nevada markets itself.”
As for Hawai‘i, the state is already known as a healing and wellness destination. It also has some of the nation’s highest quality testing standards for cannabis.
And the state is also unique in requiring an additional level of quality to lab testing called ISO 17025. All labs applying for permits to test cannabis are required to have ISO accreditation, which demonstrates a high level of technical competency to ensure data is accurate and precise.
“Because of this,” she says, “patients purchasing cannabis in this state know that what they intend to purchase is, in fact, what they are getting. That’s not the case in all states because in some places testing requirements are lax or missing completely.”
She says we can leverage this to create a medical cannabis model that is unique and valuable to residents and visitors alike. “It really lays the groundwork for us to have something very special here. The idea is to take what we have here and actualize it to its full potential.”
High level of accountability
One reason this is such an opportunity for Hawai‘i, she says, is that each of the eight medical cannabis licensees here is responsible for their products throughout the whole cycle of cultivation, manufacturing and dispensing cannabis as medicine.
Not all states do it that way, and she says it’s an opportunity to produce high-quality, research-ready cannabis medicine. “A vertical model enables a level of uniformity and standardization essential in the provision of reliable medicine.”
“When we have limited state resources allocated to regulating standards,” she says, “having one licensee responsible for the seed all the way to the delivery of the medication to the patient allows for a higher level of accountability.”
Education at medical and pharmacy schools
It all starts with education at medical schools, she says, which currently teach little or nothing about cannabis as a medicine or about the endocannabinoid system. That’s the system that includes receptors in the brain and throughout the central and peripheral nervous systems “recently recognized as an important modulatory system in the function of brain, endocrine and immune issues,” according to the National Institutes of Health.
“It’s certainly about educating healthcare professionals,” says Moore. “Healthcare providers that are well-versed in cannabis medicine seem to be a small, specialized group at the moment. Lau Ola is advocating for the integration of the endocannabinoid system into the medical curriculum here in the State, so we can begin to expand this group locally.”
And the education needs to be in pharmacy schools, too. Pharmacists are well-positioned to counsel patients who are using both pharmaceutical medications and medical cannabis. “We know about drug interactions and the CYP-450 system. There can be drug interactions between CBD, THC and pharmaceutical drugs. If we are going to treat it like a medicine, let’s begin to factor it into the equation for the sake of patient safety.”
Moore talks about the benefits of Hawai‘i setting up a “reciprocity” system. “That’s where non-resident visitors come from states where there is a medical cannabis program,” she explains, “and they're able to purchase cannabis from our dispensaries.”
It is written into law that Hawai‘i will have reciprocity, although the details of how it will work are not yet determined.
But she sees great promise in such a system. “Wouldn't it be great,” she says, “if we can provide such high quality cannabis treatment here that people come to Hawai‘i for it?”
Lau Ola Gives Away Tilapia
At Lau Ola, we feel it is critical to grow our medical cannabis completely without pesticides.
We know that pesticides subjected to high temperatures, such as on cannabis that is smoked, can convert to dangerous compounds. The Myclobutanil-based fungicide Eagle 20, for instance, breaks down to hydrogen cyanide.
From Colorado Green Lab:
As noted on the Eagle 20 material safety data sheet (3), myclobutanil is stable at room temperature, but releases highly toxic gas if heated past its boiling point of 205°C (401°F) (3, 9). Disposable butane lighters, commonly used to ignite marijuana during consumption, produce temperatures in excess of 450°C.
“This may not be a problem for most healthy people, but we are going to be extremely cautious and not use any pesticides at all,” says Lau Ola CEO Richard Ha.
Different states have different regulations about whether there can be pesticides in medical cannabis and how much, he says.
It’s actually federal law that controls pesticide use. But since cannabis is illegal federally (except for some very benign products made from the plant) there are no pesticides at all cleared for use with cannabis.
Here in Hawai‘i, the state allows a very low level of "one part per million" of selected pesticides for use on medical cannabis crops; this way they can verify if illegal pesticides are used. It makes Hawai‘i one of the strictest states in the nation regarding pesticide usage.
But at Lau Ola, with our background as long-time farmers, we planned and built our facility to keep insects and pests from entering the grow facility in the first place.
“We have designed the building where we will grow the cannabis as a controlled environment,” he says. “We’re putting in the high technology that’s necessary to have a completely pesticide-free environment.
“There’s a lot of infrastructure you have to build to get to that place,” he says. “You have to have a controlled environment you can isolate if you get infected. You can clean out a whole room and isolate it and start it back up clean. It’s absolutely necessary.”
He knows pesticides and farming. His Hamakua Springs Country Farms and previous farming businesses produced tons of bananas and high-end, hydroponic tomatoes.
He says that although Hamakua Springs was successful during its 12 years of operations, he saw absolutely everything that could go wrong on a farm regarding insects and pests when you don’t have a controlled environment.
“Our facility was only partially controlled,” he says. “We couldn’t afford to have a completely controlled environment. In other words, we protected the plants from rain, but we didn’t control the humidity, the temperature or the access for bugs. This is why I have tremendous experience with what can go wrong.”
And still, Hamakua Springs was one of the first farms in the state to be food-safety certified. That’s an optional, detail-oriented and ongoing process that ensures safety.
Regarding rules about pesticides and medical cannabis, he worries about states that are “somewhat lax” with their laws, and that allow some pesticide use on plants.
“When it’s like that,” he says, “people cannot depend on the results. Because of customer demand, though, more and more states are becoming very strict about it. We are fortunate that Hawai‘i has some of the strictest lab testing rules in the nation.”
Especially since we live in the humid subtropics where there is no winter weather to kill off the bad pests, he says, he is pleased that Hawai‘i’s regulations on pesticide use are so tough.
“At Lau Ola, we are completely committed to not using any pesticides at all,” he says.
Jari Sugano knows about pesticides and their effects on plants – she works as an extension agent at the University of Hawai‘i’s College of Tropical Agriculture and Human Resources – and this background came in handy when she got involved with medical cannabis.
It wasn’t because of her work, though, that she taught herself about using cannabis as a medicine. It was because her baby was having severe, near-constant seizures and was diagnosed with Dravet Syndrome. Sugano learned that medical cannabis was helping other children with the same syndrome and when she tried it on her daughter MJ, her daughter’s quality of life improved dramatically.
But getting MJ, now eight years old, to this point wasn’t easy. Sugano has had to grow the cannabis, which MJ has taken medicinally since she was 4, in her backyard and then have it tested for purity and chemical make-up.
Now, she says, we are finally progressing from that trial-and-error system where people had to grow their own medicine from scratch and just hope they get it right. She says she is thrilled that dispensaries will be distributing medical cannabis in Hawai‘i. “Now you can actually buy something that’s already been tested and formulated,” she says. “I am excited about that.”
What she’s not excited about is that Hawai‘i State law allows a small amount of pesticides in medical cannabis.
“What I’m hearing is that the State has set an arbitrary limit of one part per million across the board for pesticides,” she says. “If it’s detected and it’s under this threshold, it can go through for sale, which is a concern for me. My concern is that we don’t want to see any non-approved chemicals in cannabis products because the patients coming into these dispensaries have illnesses, and their immune systems are something we worry about. I’m very concerned about insuring that the products coming out of dispensaries are of the highest quality.”
Though one part per million is low, she says, there should not be any pesticides at all in medical cannabis. “It should be zero tolerance for these illegal chemicals,” she says. “I would never buy anything with any pesticides in my daughter’s tincture, oil, or whatever it is. It’s also important there’s disclosure, so people understand what they’re buying and what’s in it.”
“When we talk about patient safety we want to make sure that not only is the medicine tested,” she says, “and we know the THC content of it, we also make sure it doesn’t have E. coli, salmonella. And we want to make sure there’s zero tolerance of illegal chemicals.”
She just wants to be able, finally, to buy safe medicine for MJ, she says, instead of having to grow and test her own. “I can’t keep up with raising my child and raising all these products and trying to make medicine. I would really like to buy it.”
Her daughter MJ, which is short for Maile Jen, was six months old when she was diagnosed with Dravet Syndrome.
“She would have little twitches here and there, and then it would roll into one of the grand mals, or a status type of seizure where she would have to be admitted to the hospital,” says Sugano. “And as soon as we got out of the hospital, we would be back in there again.”
MJ was having five different types of seizures. “We could control one type of seizure,” says Sugano, “but then there would be a different type that required a different medication. At one time she was on about five different types of seizure medications.”
MJ has been physician-certified as eligible for medical cannabis for four years now, and these days her life is better. She’s only on one medication for seizures now, which they are working on getting her off, instead of five different ones.
“She does still have this one persistent seizure type, the grand mal type of seizure, maybe once every couple of days during nap type,” says Sugano. “But it’s a dramatic decrease from what she’s had in the past, and she’s able to function right after. She doesn’t go into status and end up in the hospital anymore. She can bounce right back; right after she wakes up from her seizures, she’s literally off and running.”
This change has come since MJ started on medical cannabis, says Sugano, but getting MJ to this point hasn’t been easy. “It took me many years to figure out how to find a plant with cannabinoidal, the CBD,” she says.
Though she is not affiliated with any of the dispensaries, she does sit on the State’s Act 230 Medical Marijuana Legislative Oversight Working Group. She considers herself an advocate for her daughter and for other families that rely on medical cannabis.
“I don’t believe anybody’s spraying anything intentionally, but let’s just set the bar and say zero tolerance on things like malathion and others,” she says. “Let’s be very sure we’re not going to tolerate that in this industry.”
She says she just wants to be certain that medicines coming out of dispensaries are free of pesticides.
“Pesticides do have a role in agriculture,” she says, “but not in this case.”
Hilo physician Stefan Harmeling is one of the few Hawai‘i Island doctors licensed by the State Department of Health to certify that a patient has a condition eligible for medical cannabis use.
He says the first thing he tells any patient is that the most important “medicines” out there are what he calls the five pillars of health:
• Regular exercise
• Drinking adequate water
• Good, healthy, organic or non-toxic food
• A positive attitude
• Adequate sleep every single night
He prescribes traditional medications, he says, only if these lifestyle changes don’t fix the problem. And he’s cautious about it, prescribing the fewest number of medicines at the lowest dosage and for the least amount of time possible.
As for medical cannabis, he strongly believes in its use because it’s a natural, non-toxic alternative to traditional medications, he says, and one with numerous benefits.
“I think it’s very, very effective for a lot of different medical conditions,” he says. “And it’s a wonderful alternative to the more addictive medications that are prescribed or even non-addictive medications that have all these terrible side effects.”
People who use cannabis medicinally find positive effects beyond only pain relief, he says. “It also relaxes the muscles. And there’s a decrease in the anxiety and the stress that always goes along with chronic pain. It has multiple effects.”
And he says it works very well on severe pain.
“If you look at different studies you'll get mixed results,” he says, “just like with any study that you look at. But what I'm paying attention to are the individual clients who see me, the ones who have been on chronic pain medication for a long period of time."
“They're concerned about the potential health side effects because all we see now are issues of overdoses,” he says, “particularly in middle America, that's killing entire generations of young people.
“And I have other clients who are just starting to have pain from some issue that just continues to worsen, and they don't want to start taking narcotic pain medication. They've seen what happens to family members.”
It’s these legal pain medications that people are overdosing on, he says.
“And that's a wonderful thing about marijuana,” he says. “There are pretty much no reported overdoses of marijuana at all.
“Yet the number one killer out there in regard to drugs now is overdosing on narcotic pain prescriptions,” he says.
Interestingly, this is changing with the legalization of marijuana in some U.S. states.
A 2017 Reuters Health article, referring to a study of 27 states’ hospitalization records from 1997 through 2014, says, “Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.”
Harmeling says he’s very happy about, and wants to support, this reduction in opioid addiction in states with legalized medical cannabis.
In Hawai‘i, the medical conditions that make someone eligible for medical cannabis are limited. From the State of Hawaii Department of Health website:
Harmeling says it’s unfortunate that insomnia or anxiety are not currently eligible conditions. The state does occasionally expand its list, though. It just added lupus, epilepsy, multiple sclerosis and rheumatoid arthritis in June of this year.
And Harmeling is glad the list includes cancer. “Studies from the National Institute of Health show that the cannabinoids, or CBDs, in the cannabis plant are carcinogenic in lab mice,” he says, “meaning that they kill cancer cells, so that's fantastic.”
He doesn’t recommend his clients smoke marijuana cigarettes. “Inhaling anything burning is bad for your lungs,” he says. “I like medical cannabis for its low side-effects potential. But if you're inhaling hot smoke into your lungs, the side effect is going to be a lot of lung irritation, and perhaps in the future COPD or emphysema.”
“I always tell my clients, don't do it that way,” he says. “I tell them to make a smoothie out of it, or juice it if you can. If you have a vaporizer, do that. If you can get your hands on a tincture, that's the best way to do it.
He explains why becoming licensed as a medical cannabis-certifying physician was important to him.
“Medical cannabis isn't this magic plant,” he says. “There's no such thing. But it can be a very important partner in helping a client improve their health and wellness over the long term.
“I truly, truly back that up and can support it with my own evidence from the clinic I work in with my clients.”
If you are older and feel it’s time to get out and make a difference in your community, Kaui Paleka-Kama can almost certainly set you up.
Paleka-Kama currently has more than 1,200 people, ages 55 and older (including, currently, a 92-year-old), doing volunteer work at more than 180 of the island’s nonprofit agencies.
She is the island-wide program director for Hawai‘i County’s Retired and Senior Volunteer Program (RSVP) and works out of Nani O Hilo, also known as the Kamanā Senior Center. She can, she says, find almost anyone a place they will enjoy helping at – from preschools and hospitals to nutrition sites, public/private nonprofit agencies and more.
There are volunteer opportunities, she says, that would surprise you.
“I work with people who nurse marine mammals back to life,” she says, “and with those up in Kohala that are helping our native Hawaiian birds, and with the Dress-a-Girl program. I just helped Dress-a-Girl get a grant from the Hawai‘i Women's League Foundation. Last year, I think they sewed and gave out 400 dresses to marginalized and impoverished children.”
One of her target projects every year is tax preparation for kupuna (seniors). Last year, volunteers helped Hawai‘i Island’s kupuna retrieve more than $350,000 worth of tax refunds. That’s more than at the similar tax preparation center in Honolulu.
The volunteer program she directs also helps ensure the island’s blood supply by sponsoring, promoting and recruiting for the Blood Bank of Hawai‘i. “We play a big and, I think, a nice role in ensuring the blood supply for our Hawai‘i Island residents. We potentially saved 1,200 lives last year by providing that much blood product.”
Her volunteers also have a strong impact on food distribution. “We work with the County nutrition program at their congregate meal sites and their home delivery meals,” she says. In 2016, volunteers helped distribute more than $350,000 worth of food to seniors at 16 Food Basket sites around the island.
And it’s ongoing, she says. “It's not just that we're going to give you food this one day and then we're not going to see you for the next six months,” she says. “This is consistent, and when you do something consistently, it tends to have more of an impact than your one-shot. By the end of it, I surveyed, and over 92 percent reported increased food security.”
Other volunteers work in a STEM program for 5th graders at the old Armory building in Hilo and at hospices and museums. Some provide information and directions at the County building.
“We also do adult literacy in Kona. The literacy curriculum is to bring them at least to the point where they can comfortably navigate or negotiate job applications, rental applications and read lease agreements.”
Paleka-Kama, who has degrees in both sociology and accounting, says some of her satisfaction comes from keeping good data that she can then analyze and interpret. “I can really gauge whether or not we truly made an impact on the community,” she says. “It is rewarding to really see, through actual data and feedback from others, that what we're doing is having either a financial, emotional or social impact on the target population. It’s very rewarding.”
She surveyed the groups they work with last year and says more than 90 percent reported feeling more than satisfactory with the services they received from her programs.
For the volunteers themselves, she says, it can be life-changing. “I get to see the quality of life shift for people,” she says, “which they report too. They report that they feel better. We knew that this kind of programming would help people socialize more, get out more, and the feedback I get validates that and shows that it actually improves health.”
She talks about universal principles, such as that of cause and effect. “What we put out there is what's going to come back to us; so we, as the service deliverers, start the loop, right? And we provide access or actual resources for individuals and they turn around and give back into the community. The community then shares with us – in our reports – the benefits and how it's helped.
“Then I take that emotional reward I've gotten from their sharing their wonderful stories, and I take it and loop it back into the service delivery.”
“It’s cause and effect on steroids,” she says.
If you’re 55 or older and would like to volunteer, call the Hawai‘i County Retired and Senior Volunteer Program and a program assistant will help you find an outlet that fits your interests. 961-8730 in Hilo or 323-4333 in Kona.
Meeting People that Medical Cannabis Can Help (at Relay For Life)
There was a sudden downpour while Lau Ola Administrator Jenea Respicio was manning the Lau Ola tent at the American Cancer Society’s Relay for Life event in Hilo this summer. So she called out to a man walking nearby and invited him in to take cover.
They chatted over watermelon, and she learned he was walking for cancer despite having painful, injured legs that resulted from a hit-and-run car accident.
Respicio asked if he took opioids for pain, and he said no. Before the accident, he told her, he’d had a drug addiction problem.
“He said he was afraid to take opioids,” she says, “so he didn’t take anything at all.”
She asked if he would ever consider medical cannabis for the pain. Lau Ola’s dispensary, she explained, will be offering a variety of dosage forms for various CBD:THC ratios including CDB dominant medicine. There are medical cannabis products that are non-psychoactive, and have anti-inflammatory properties.
He told Respicio he was interested in that, and in getting a medical cannabis card from a doctor. They talked about how to do that.
He was only one of many people who stopped at the Lau Ola tent that day to learn about the medical cannabis dispensary and what it will offer Hawai‘i Island’s residents.
In fact, says Lau Ola CEO Richard Ha, the reason Lau Ola set up at Relay for Life is because the company will be working with cancer patients and caregivers.
“When you talk about medical cannabis,” he says, “cancer patients are one of the first groups that come to mind. It’s a natural place where we can help.”
The rain during the Cancer Society’s event at Wong Stadium didn’t stop thousands from participating.
Relay for Life is a team fundraising event where team members take turns walking for hours. It goes late into the night, and the American Cancer Society explains why: “Each team is asked to have a member on the track at all times to signify that cancer never sleeps. Cancer patients don't stop because they're tired, and for one night, neither do we.”
Another walker who stopped by the Lau Ola tent was a man with muscular dystrophy who has extensive problems with his leg muscles. He told Respicio he uses CBD oil but can tell it still has THC in it. He didn’t like that feeling, he said.
Respicio told him, that Lau Ola will offer medicine that is lab tested and labeled according to State law, so that patients can be better informed, and have confidence in what they are actually getting.
“We at Lau Ola felt strongly that we needed to be at Relay for Life, as a team, in order to let the community know we are here and to support the American Cancer Society,” she says. “We want to let community know we’re working hard to create the best production facility possible to create the safest medical cannabis for them.”
Relay for Life ran until midnight, and as darkness fell, the stadium’s lights switched off. The darkness symbolizes the fear a patient feels when diagnosed, according to the American Cancer Society.
Luminarias lit up the stands in honor of loved ones lost to cancer.
“After sunset, we light Luminarias to remember those we have lost,” explains the American Cancer Society, “to celebrate cancer survivors, and to show those affected by cancer that they are not alone.”