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story.lead_photo.caption Director of the Missouri Department of Health and Senior Services Randall Williams addresses concerns Thursday during a forum regarding vaping products in the Missouri Medical Marijuana Program at the Governor Office Building. Photo by Sally Ince / News Tribune.

The Missouri Department of Health and Senior Services hosted a forum Thursday night intended to allow the public to provide input into how the Missouri Medical Marijuana Program should regulate use of vaping products.

The DHSS wanted to let people know it is listening to their concerns, said Lyndall Fraker, director of the DHSS section for medical marijuana regulation.

"We wanted to make sure that you all had opportunity to give input to any rule-making process," Fraker said. "Vaping is (a product) that throws up a red flag. And we want to make sure that we listen to the folks and do what they expect us to do with the vaping part of that."

Missouri's medical marijuana amendment passed in 2018 with nearly 66 percent of voters' approval. It made marijuana use legal for treatment of cancer; epilepsy; glaucoma; intractable migraines (those persistent migraines that don't respond to other treatments); chronic medical conditions that cause severe, persistent pain or persistent muscle spasms including, but not limited to, psychiatric disorders (when diagnosed by a state licensed psychiatrist), including, but not limited to, post-traumatic stress disorder; human immunodeficiency virus or acquired dependence (if a physician determines cannabis would be effective and safer); any terminal illness; or (in the professional judgment of a physician) any other chronic debilitating medical condition.

The new law laid out in detail how the program should operate.

"We just need to make sure we get this piece the way the citizens would like to have it for the patients," Fraker said.

Listening has been an important part of the effort to roll out the program, DHSS Director Randall Williams told about a dozen people who showed up for the event at the Governor Office Building, 200 Madison St.

As organizers of the program listen, they understand people have concerns about vapes or e-cigarettes.

During the fall of 2019, people across the United States began coming down with life-threatening lung illnesses linked to vaping. Centers for Disease Control and Prevention showed a link between vapes that had been modified for use with marijuana (including use of vitamin E).

Williams said the latest numbers show the numbers have leveled off at about 2,500 cases nationwide. Of those, 55 have died. The cases occurred in every state of the country and in several territories.

"As we look at what could be causing that, it appears to be additives to tampered products, specifically around lipids like vitamin E," Williams said. "Which some people add to the vaping — particularly around marijuana — that cause a lipid-like injury in the lungs. It's like pouring oil in the lungs."

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Even though medical marijuana had very broad support, Missourians wanted it very regulated.

"They don't want a Wild West approach like other states," Williams said. "They thought it ought to be very, very regulated."

When there isn't oversight, you end up with these injuries, he said.

The state is committed to preventing those sorts of things, he added.

All medical marijuana products used in Missouri — including vapes — are to be manufactured in highly regulated Missouri facilities, Fraker said.

The amendment will not allow any products to be used in Missouri that aren't manufactured in the state, he said.

The state is scheduled to release the names of the 86 recipients of infused-products manufacturing facilities today.

It will release the licenses for 192 dispensaries Jan. 24.

"(The licensing process) will help insure the safety and regulation on these products," Fraker said.

Dan Viets, president of New Approach Missouri, the organization that forwarded the initiative, said evidence indicates vaporization of products like tobacco make them far less dangerous than smoking them directly.

"It would be a mistake, in my opinion for that reason, to ban or restrict the availability of vaporization as an option," Viets said. "I don't see that we're going to have problems with medical cannabis."

He added it pains him to admit the cases where people had lung illnesses stemmed from vaporization of marijuana. However, it was illegal marijuana.

The amendment provided for the establishment of a minimum of two testing facilities. Missouri went five times further and licensed 10, Viets said.

Those sites will test for potency and purity of the products.

"One of the best things you gentlemen and your department has done is to go far beyond the requirements of Article 14," he said. "(Only two testing centers) was clearly far too few."

The damage from vaporization is exclusively with illegal and unregulated products.

One of the greatest benefits of legalization is the ability for consumers to know what they are buying and using, he said.

Joy Sweeney, director of Central Missouri's Council for Drug-Free Youth, told listeners she has concerns about youth having access to medical marijuana.

Youth and vaping seem to go hand-in-hand, she said. A report from National Families in Actions had disturbing news.

"The number of teens vaping marijuana nearly tripled in two years — the last two years," Sweeney said. "That's a huge concern for me."

She acknowledged citizens have voted on the use of medical marijuana. She's simply concerned for youth.

"There is a vaping epidemic," she said. "And it is prevalent, primarily among the youth in our state, and that is a huge concern."

In early 2018, Jefferson City became the 12th city in the state to pass an ordinance that prevented people younger than 21 from buying tobacco products.

However, the medical marijuana amendment allows someone who is 18 to enter a dispensary and purchase medical marijuana, she said. Also, that person may take another person into the dispensary with them. That is a concern for her, Sweeney said.

And, should a community wonder if it has the option of passing an ordinance preventing someone from buying medical marijuana until they are 21, they can't, Fraker said. The constitution is clear that people 18 and older are eligible to buy the products, he said.

DHSS will continue to accept public comments regarding medical marijuana vaping products until Monday. Comments may be submitted electronically through a link at health.mo.gov/safety/medical-marijuana/rules.php

On the web:

More information about medical marijuana may be found at medicalmarijuana.mo.gov.

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