Becky DeKeuster, M.Ed is co-founder and Director of Community & Education at Wellness Connection of Maine(mainewellness.org), the largest state-licensed medical cannabis dispensary in New England.
Becky has over a decade of experience in all aspects of the medical cannabis industry on both the West and East Coasts, with extensive focus on crafting successful policy and regulation at the local and state levels.
A former director of Berkeley Patients Group in California, Becky co-chaired the Measure JJ campaign which codified city dispensary regulations and created the nation’s first Medical Cannabis Commission in Berkeley.
She advised the Maine Governor’s Task Force as they drafted dispensary regulations in 2010. Becky has deep experience in operational best practices in both vertically-integrated and distributed cannabusiness models. A former high school teacher and administrator, she is an author and public speaker who uses her extensive knowledge of the industry to educate community leaders, health care professionals, legislators and others about medical cannabis.
Matthew: Hi, I'm Matthew Kind. Each week I'll take you behind the scenes and interview the insiders that are shaping the rapidly evolving legal marijuana industry. Learn more at CannaInsider.com. That's C-A-N-N-A Insider.com.
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Now here's your program.
Matthew: Becky DeKeuster is co-founder and director of community and education at Wellness Connection of Maine, the largest state licensed medical cannabis dispensary in New England. Becky has over a decade of experience in all aspects of the medical cannabis industry on both the west and the east coasts with extensive focus on crafting successful policy and regulation at the local and state levels. Welcome, Becky.
Becky: Thank you so much for having me, Matthew:.
Matthew: Becky, can you give listeners on yourself and how you got started in the cannabis industry?
Becky: I sure can. I guess I'll get this on the table first. I was a Catholic high school teacher for many years. And I mean as soon as I got past wanting to be a veterinarian, I wanted to be a teacher. And so, I was born in St. Louis, Missouri and was teaching around the turn of the century in California. I got a call from my family. My father was diagnosed with lung cancer, and I got a call from the family that said come home and buy a one- way ticket because we don't know, but this is it.
And I did not have very much personal experience with cannabis. And yet, I had met some folks in California who worked in dispensaries. And they said, Becky, when you go home to be with your dad, you should take him some tincture, just a little bottle of liquid, put it in your carry on and provide that to him. And given my background, and this was right after 911, and again I didn't really know much about cannabis; and so, I said, no, I was too afraid. I said no thank you, I'm fine. And so, I went home to be with him. And over the two weeks or so that it took for him to leave, there was not a day that went buy that I didn't kick myself for not having the guts to put that little bottle of tincture in in my carry-on.
That really stuck with me. It was something when I came back to California and was dealing with my grief and processing all of that, this was another piece of it. There was something very unjust about a society where my dad can't access this natural plant medicine because he lives in this box on a map and not this other box on a map. And so, I was sharing some of - I was venting, I guess, sharing some of these feelings with my dispensary friends. And they said that it would be a big career shift for you, but we're hiring, if you would be interested in working in the dispensary and seeing what this is all about.
I thought about it not very long at all. I thought I don't like this feeling of "what it I had" or "I should have." And so, I left my teaching career and started work at Berkley Patients Group, and that was, gosh, over 10 years ago now.
Matthew: Wow. I could imagine that frustration has got to be huge.
Becky: Oh, it was. You could still see it today in these families that are moving to Colorado and other states to access medicine for their children. As long as that is in place in this country, there's an injustice that we need to fix.
Matthew: You talk a little bit about transitioning from being a high school teacher to the cannabis industry, but can you turn back the clock to 2002, and the Berkeley Patients Group, and what exactly was going on there, and what you were doing?
Becky: Oh, yes. Actually, this is remarkable timing. Berkeley Patients Group is actually celebrating its 15th anniversary this Friday. So yeah, they started in 1999, and they grew out of - as did many of the older California dispensaries, they grew out of the patient collective that founded a commercial site. And they've certainly fought many battles along the way.
When I started there they didn't let me anywhere near the plants or the medicine because I didn't know enough about it. So I was working in the hemp store. So we had books and vaporizers and magazines and stuff. And it's important also to remember that at that point BPG had on onsite consumption lounge. So they were kind of grand-fathered in. Patients could come and use their medicine on site, which was just an amazing community building aspect of being there. And I think starting off in the front and helping patients, lending out a vaporizer kit to them or talking to them about what pipe might work better was really important informing how I approach this industry. I started with a very-patient focused experience, and I'm trying to maintain that.
Matthew: The club or organization aspect where people can consume cannabis together seems really important. I've talked to a lot of people recently in Europe, Spain and Amsterdam in particular, and they say wow, that's really a huge aspect that builds a sense of community around the cannabis and patients. So I hope that idea spreads more here.
Becky: I can't agree with you more. What came out of that experience, and I understand that now they moved, and they no longer allow that onsite consumption. But what we saw was people making friendships. We were able to provide services like acupuncture and other education and entertainment events, and it was a very tight knit-community.
There is the hospice program I was fortunate enough to assist in starting that. So that began when we noticed that one of our regulars had not been around for a while. And so, we started looking into it. It turned out that he was in hospital. And so, we were able to go out and visit him in (indiscernible 0:06:37) and help him medicate. So I mean just some real amazing things came out of that experience. And I understand that certainly for somebody who is maybe coming to this from a naive - cannabis naive standpoint, that might seem very threatening or scary or dangerous.
There's going to be all kinds of car accidents. The truth is that in all my time in BPG, I can remember maybe two fender benders happening. And surprisingly they were from people slowing down to pull into the parking lot and then getting rear-ended out on the street. So it was a remarkably friendly and safe environment. And we also could do a lot of education on responsible consumption. And if you tell me that you're not capable of driving, we'll either let you sit here and here are some free healthy snacks, or if you really need to go to an appointment or something we'll get you a taxi. So it was a beautiful thing.
Matthew: How have you seen the medical marijuana market evolve and grow since 2002?
It's like watching a child grow up. I mean there's these rapid advances in every aspect from patient care to the science to the regulatory environment. And it's pretty - I mean, to use a teaching phrase, you might call it mainstreaming. And I think that some negatives come with that. One example being that I don't see the U.S. moving towards embracing an onsite consumption policy or offering, not that it's impossible, but it's grown by leaps and bounds. It's a movement that is evolving into an industry, I think.
Matthew: Now you've helped to shape some cannabis public policies in both California and Maine. What are some of the key policies that you've helped shape?
Becky: Well, I want to preface this by saying it's super important to remember that any policy, any advances, are always the work of many, many dedicated people. And to recognize that we are just continuing work that was being begun by our ancestors in the movement and many of them haven't lived to see the flowering of the seeds that they planted. So it's important to keep that in mind. No one of us is responsible for any piece of this alone.
Going back to Berkeley, we worked very hard on self-regulation with city officials. It became apparent to us that statewide regulation for a number of reasons was not likely going to happen. And we were fortunate that Berkeley city officials were willing to listen and to work with us to create city-wide regulations and standards for dispensing. I'm very proud that I assisted in passing a citizens initiative that created the Berkeley Medical Cannabis Commission, which is in existence to this day. And so, that was a big piece of what we did there.
Here in Maine, regulators as they were building the dispensary program, now Maine also has had medical cannabis since ë99, but not dispensaries until 2009. And regulators were very interested in what had and had not worked in other medical states. And so, I think that being able to share the story of successful regulation in the City of Berkeley helped them see past a perception that all of California was just the wild west and there was no lesson to be learned from that state. And they created a good regulatory model, a stringent regulatory model for dispensaries, and we continue to work on legislation to refine those regulations today.
Matthew: I've heard that Maine is a little more functional and reasonable than California in it's regulation of medical marijuana. Would you say that's true.
Becky: I think that's going to depend on what you define as functional. It is definitely more stringent. We have a very - a fairly short list of qualifying conditions. We don't have any kind of a catch all, you know, "any other conditions which marijuana provides relief" clause. We are limited to only eight dispensaries around the state.
Also important to remember is that Maine's population is 1.3 million. So we're not a very big state, but there are only eight dispensaries. We are required to be vertically integrated. So I think that in the sense of being more stringent, yes, Maine is a little more stringent.
I also think it's interesting to see that the signals that DOJ is giving us, they essentially very recently said, California, get your state-wide regs in order, or we're going to keep raiding. And I think that the willingness of DHHS here in Maine to create what some see as an overly restrictive regulatory system has actually helped. We are very well regulated here, and I hope that helps make us less interesting to any sort of Federal agency.
Matthew: Now is a doctor the only person that can help a patient get a medical marijuana card in Maine?
Becky: No. Actually, MDs and DOs can certify patients, and then just this year starting August 1st, nurse practitioners are now able to certify patients as well.
Matthew: Now what's a DO?
Becky: A doctor of osteopathy. So they are typically educated in both Western and more Eastern holistic forms of medicine.
Matthew: Do the doctors, Dos, and soon the nurse practitioners, are they pretty receptive to the message in benefits of medical marijuana?
Becky: Many of them are, and I think that as the program ages and we do more work on education specifically to help providers and also just the general public, I hope to see more acceptance. We still hear a lot of "there's not enough science backing it up." And of course, we know that is a frustrating thing to here because it's a Schedule 1 drug, and all of that. But there is a growing acceptance here in the state especially among oncologists. I think they've been very receptive to this as an option for their patients.
Matthew: So would you say it's difficult to get a medical marijuana card then given some of the MDs, the DOs?
Becky: It is. We do hear from patients who say I talked to my doctor about this and even though she personally thinks this is a worthwhile thing to try, the practice that she works for dissuades, frowns upon, or just completely disallows their physicians from certifying patients. So that's frustrating.
And again, there's also the fact that our list of qualifying conditions is a little more limited. So for example, Parkinson's is not listed as a standalone qualifying condition, but some of it's symptoms can fall into our list, for example, pain or muscle spasms. And so, we actually did a survey of our members this spring and found that many, many of them have comorbid conditions that benefit from marijuana but do not fall under our qualifying conditions list. So lots of folks suffer from depression. If you're seriously ill, depression is not an uncommon comorbidity with that. But depression is not a standalone diagnosis here. So if you are depressed because you have been diagnosed with cancer, you'll qualify with the cancer diagnosis. But if you are depressed, because you have that as a qualifying condition, you don't technically fit in the list.
Matthew: Unfortunately, there's still a stigma in many areas in communities about cannabis. For people that are having a hard time discussing their desire to become a medical marijuana patient, do you have any suggestions on how to broach that topic?
Becky: We often hear that not infrequently from our members too. And I think first we hear I want to bring this up to my doctor, but I don't know how to do it. And then we also hear I want to bring this up with my parents or my partner, my ex-wife who I share custody with, but I'm not sure how to do it. And I think the advice to any of those groups is the same, and the first step is to educate yourself. There's so much science out there. There are so many good resources. We direct a lot of folks to PubMed, which is a government sponsored clearing house of recent science. If you go to PubMed.com or gov and type in cannabis and Alzheimer's, you'll come up with a number of studies.
I think that going into a conversation armed with some facts is helpful. And we are certainly - WCM does our best to help by doing outreach in the community, doing public medical cannabis 101 events and talking to physician groups and patient support groups about the benefits.
Matthew: One of the things, I think - we recently had on a film maker, Adam Scorgie, who made the documentary, The Union - The Business Behind Getting High, and also a documentary just released this month called the culture high. And that is another excellent resource for people that aren't sure how to broach the topic with their family. They have Harvard MDs. They have Sir Richard Branson, and it really might help to open some minds a little bit. So that's a great one to suggest it.
Becky: Absolutely. I'm glad you thought to bring that up. Definitely. And again, there are just so many people doing so much good work. And also, another thing that we suggest is that if people are on Facebook, they look for - there's all kinds of groups. There's veterans cannabis support groups. There's cannabis for alcohol recovery. So making connections with people who are in a similar situation with you is also empowering.
Matthew: Now you're really good at the community outreach part, and they'll be people listening in different parts of the country where they feel like the community is not open to medical marijuana, or there might be some sort of elder tribes people that don't want to see that happen, let's say. Do you have any specific recommendations to try so they can make their community a little bit more open to the idea?
Becky: Yes. And we work on that all the time. I mean, it dose require - you can't do your community outreach at the end of the day after everything else is done. You need to be present in your communities. And I would recommend sorting the categories kind of in a bucket. So you definitely want to have a presence with your local government and local law enforcement. You want to look at charities in the community that are going to serve a similar population to you. And so, that might be a cancer research group. It might be the United Way. It might be HIV/AIDS resource groups, but do your homework. Look at who is active in your community and be present with them.
I say you have to be patiently, persistently, politely present because some of these folks are going to have kind of a knee jerk, "oh, I can't even meet with you" reaction. And you've just got to keep trying. You've got to send a letter of inquiry. You have to make a phone call and not take that, no, I can't fit you in my schedule as a final no. And we have found a lot of success especially in working with charities that support our patient base. So here in Maine, there is a group that's affiliated with a local hospital. It's called the Dempsey for Cancer Hope and Healing.
Matthew: I've heard that cannabis is available in hospice facilities. Can you tell us a little bit about that?
Becky: Yes. The rules around that have recently changed. So there are two categories. There are in-patient hospice and nursing facilities, which are affiliated with the hospital, and then there are private hospice facilities - home hospice. There's things like that.
The rules have just changed again this past year. We had a regulatory change through the legislature that made it more - it improved the access of patients who live in in-patient facilities to use their medicine. Previously they had to designate - a staff member had to be willing to be designated as a caregiver. And there were - two staff members had to be present at the administration of the product. And so, that has just opened up giving those facilities much more leeway to set their own policies on storage, dosing, things like that. And again, with the outreach, that happened. This is one little regulatory change that an in-patient facility is not necessarily even going to know about, right?
So we have been doing presentations to help staff and administrators understand, again, MMJ 101. The variety of products, the different strains, let's talk about what might be a reasonable policy around storage. If somebody is in a facility and they have a lockbox that will fit in their night stand, can they keep their medicine bedside? So we're definitely part of those conversations.
Private facilities again set their own policies. We just came back from tabling and presenting at the Maine Healthcare Association, which is kind of a trade association for these facilities. And there was a great deal of interest. And not so much from the administrators, but certainly from the staff and the nursing folks who work one on one with the patients. They see people come in who have been using before they enter the facility and are now very concerned that they can't bring their - the policy says I can't bring my stuff in. And I see people whose families are coming in and saying, hey, I would like to try this with my mom or my dad. So it's really encouraging to be engaged in those conversations.
Matthew: Can you give us an overview of some of the symptoms it helps some of the pain it alleviates for the people in the hospice?
Becky: Well, certainly with pain, just the general arthritic pain, things like that. We have also had anecdotal very positive results with sundowning, which is something that happens in patients with dementia or Alzheimer's where there tends to be more agitation towards the end of the day. A tincture especially seems to be very helpful for calming that agitation.
Another very interesting and we all know that one of the supposed negative side effects of cannabis is dry mouth. Nobody wants to get cotton mouth. Well, I'll tell you who does want to get cotton mouth, somebody who is living with Lou Gehrig's Disease because eventually they will get to a point where they can't control the production off their saliva. So we actually have a couple of members fairly young, in their 50s, with ALS, and they really appreciate that supposedly negative side effect. As one guy said I don't have to walk around with a wash cloth in my pocket anymore because I'm not drooling all the time.
So it's really - it's amazing. It's such an honor to see all the different ways that this one little plant can benefit so, so many people.
Matthew: Is there any specific strain that you see helping more than another for people with ALS and that excess saliva that actually causes the most cotton mouth?
Becky: Not that I am aware of. And that's the part that has just recently come to my attention, and we haven't dug into any sort of study or a survey on that. I'm trying to think of what these gentleman preferred. I think they both prefer (indiscernible 0:25:11). I think both of them mix it up with Sativa. It's not strain-specific for that specific symptom.
Now in terms of other ailments, we certainly just like everywhere else in the nation, there's tons of interest in high CBD strains for pain, and for seizures and tremors and things. Here in Maine, we've got Harlequin, Shark Shock. I think there's Chalice Tsunami (ph) is getting good reviews here. We have a strain called Chockalope (ph), which is a Sativa, which is fantastic for appetite stimulation, but also depression and sort of apathy. I actually had a member tell me, Becky, I have no idea how bathrooms ever got clean before I found Chockalope. That's a fact.
And there is also a Maine grown strain called MOB, and depending on who you ask, MOB either means mother of berries or Maine's own berries, but it is an absolute champ. It is fantastic certainly for pain and insomnia.
Matthew: Now in Maine, a caregiver can be selected by a patient to grow on the patient's behalf. What are the rules around that? What does that look like?
Becky: So a patient in Maine has three options. You can grow your own up to six plants flowering. You can choose a dispensary to grow those plants for you, or you can designate an individual that here in Maine we call caregivers, again to grow up six plants for you. And that is a very - that side is not state regulated. For example, if I was sick and I know that you have a really good green thumb, I could say, hey, Matthew:, I would like to designate you as my caregiver, and do a little bit of paperwork and you can grow for me. Caregivers are allowed to serve up to five individual patients. So if they them selves are a patient that adds up to a total of 36 flowering plants at any one time. And then patients, no matter where they're sourcing their medicine, patients are allowed to 2.5 ounces of finished product every 15 days.
Matthew: Can you tell us a little bit about your main wellness facilities? How big they are? Where they are? What they do? How patients access there? I know it's a big question, but I just want to give people an overview.
Becky: It would help if we could do a radio version of a map of Maine, but - so we operate four of the eight dispensaries. So we're in Portland, which is Maine's largest city with about 60, 000 residents. We are in Hallowell, which is a small town just outside of our capital, Augusta, in the middle of the state. We have one in Thomaston, which is along the mid- coast. And we have one in Brewer, which is right outside of Bangor. And then there are four others around the state. Our facilities range from about 2,000 to about 6,000 square feet.
Matthew: You said they're vertically integrated. So you grow everything that patients consume?
Becky: We do. Yes, we do. We have a separate cultivation facility that supplies all four of the dispensaries. So we don't actually grow in any of the dispensing facilities.
Matthew: So for infused products like if someone wanted some chocolate or something infused, do you have to make that then? You can't have anybody that's not an employee of Maine Wellness help you with that at all?
Becky: That's correct.
Matthew: Do you see that being liberated, a little bit at anytime in the future or not talk of that?
Becky: Okay. So currently we do have one tiny little way around that. Recently there was again a legislative regulatory change that allowed these individual unlicensed caregivers to sell up to two pounds per year to dispensaries. So if you had excess as a caregiver, you could come to one of us and say, hey, I've got this. There are two hurdles to that. One is that we have - one of the things that we want to do is provide a consistent supply to our patients. I mean, it's pretty rewarding to help a patient find the strain that really works for them and then continue to be able to provide them that to them.
And so with a limit of two pounds, if you're the caregiver, and we purchase two pounds of really fantastic high CBD meds, that two pounds is going to come to an end at some point, and I can't purchase another two pounds from you for a year, which is extremely frustrating.
And then the other hurdle is with regulation. Again, there is not sort of middle tier where a caregiver could be regulated and inspected by the state. And so, the state does not inspect anything the caregiver grows. The dispensaries don't have the man width to do that. And so, it's a door that I don't know that a whole lot of people are able to use right now.
In terms of whether that's going to change in the future, I know that when the initial bill was put forth, the quantity was not two pounds, but I want to say 12 maybe that we started with or ten. And that quantity just kept getting whittled down by legislators. And so I don't know if that's something that's going to be fixed in the near term. I would hope that as Maine looks at ways to legalize for the responsible adult use market that we would look at that piece of the medical regulations and see that it was not ideal.
Matthew: Is there any trends or technologies that you see having a real impact in the cannabis industry in Maine, but also elsewhere that you're excited about?
Becky: I think the move towards concentrates is very interesting. Maine is a little late coming to the game on the regulated side with the concentrates. This is not to say that they don't exist, but I think that the things that you can do with some of these extractions and the ways that you can sort of create a very potent medicine to order almost with your ratios of the different cannabinoids, I think that's very promising certainly for the medical side. It's interesting. It's very different. Here in Maine the medical culture is very different. Again, we just clarified with our regulators that, yes, we can sell concentrates. We can create those and provide them to our patients. So in that way, we are little behind.
Another thing that I think is very important, very necessary, should probably have gotten more attention earlier than it did in this industry is the need for the lab testing. Whether you're a patient or an adult use consumer, I think that's a really significant piece of the puzzle. You deserve to know that first there's no contaminants in your product, and second, you pick up a beer, you know what the alcohol content is. You deserve to know the cannabinoid profile of what's working for you.
Matthew: Yeah. We see lot of the dosage issues here in Colorado with people eating whole candy bars not realizing that 10 milligrams is all they probably want to start with.
Becky: Right. Actually, I have a question for you. Do you see Colorado moving towards individual dose edibles only? I know that you were on the brink of let's pull them all off of the shelves. Do you see a time when you will only be able to buy and individual serving of the chocolate rather than a chocolate bar?
Matthew: You know, it's funny you mention that. Just this week - or was it last week, there was kind of a - there was some politicians that said we've got to change this whole edible thing. And there was immediately an overwhelming backlash that seemed to be bigger than what the politicians and bureaucrats brought - their suggestions. So I think the dust has not settled on that. But in the end everybody is seeing such a positive impact from legalization and allowing businesses to help patients and adult users that I think we're going to have a really - perhaps the largest spectrum of available options that I can see anywhere maybe excluding Washington. So I'm really optimistic and excited about that.
Becky: Good. Well, all eyes are on you guys, and you know that. We're way over here taking notes furiously.
Matthew: So you have four wellness centers. There are a lot of people that are listening that have either applied for a license or at some point may consider that. What kind of, if you were their mentor for day, what would you tell them to steer away from or to focus on?
Becky: Oh, my heavens. That was a big question. I have friend who would say run away. Don't do t that. We wouldn't get far if that was the case.
I would say be sure that - one of the things that's amazing about this industry and probably would surprise people who aren't very familiar with it is how tediously normal it is when you get right down to it. I mean this is just like any other business in terms of a whole lot of stuff. But be ready for the complex, every shifting layers of regulation that you're going to need to deal with. Be ready. This is not like making widgets. You're producing a product, if you're in a medical state, that people are going to be using therapeutically.
If you're in an adult use state, you're going to be creating products that adults want to rely on that need to be consistent. And really the eyes the U.S. and the world are on us here as we move forward. So better - be 10 times better than you think you need to be in terms of ethics, in terms of transparency with your communities. We don't have room to make mistakes here.
I think that if you've got a good business plan, if you've got investors who you can trust, the next step is to hire wisely. And I think - really I'm thinking of cultivation here because I've seen and heard from a lot of folks, who have run into trouble with getting their groves up and running. And I think on the cultivation side, you don't want to hire a full staff of people who have been farming cannabis for the last 10 - 20 years because they each have their own methodology. They each are - you know, my way is the - I've done this, and I do it well, and this is how we should do it.
I think in some instances, and again, this is based on experiences that I and some colleagues have had. It's best to start with one or two master growers who see eye to eye. And then hire just plenty of smart eager people who like plants. I don't care if you've ever tended or cultivated a cannabis plant. If you like plants and you care about helping people, those are two good things for me to see in an interview.
And I think also - this actually goes back to something I think I said at the beginning - respect your elders. You may be fresh on this new idea and sure that you have the answers and you're going to come into this industry and blaze a new trail. And that is as maybe and please do and do it well, but also remember that you wouldn't be here.
I wouldn't be here without the work of thousands of activists who came before us. People who lived through raids, who lost their homes, who went to jail, whose families broke up over their fight to increase access to this plant. People have died without ever seeing the final fruition of what they have been fighting for. I think that level of respect and understanding. Again, it's a movement that's moving into an industry. We can't forget our movement roots. We can't forget the people who got us where we are today because we wouldn't be here without them.
Matthew: Becky, as we close how can listeners follow your work and your dispensaries?
Becky: Wow. Well, you can find us online. We have a website at www.mainewellness.org. And that's Maine all spelled out M-A-I-N-E Wellness.org. We're on Twitter at @wellconnectme. We have a Facebook page. Just type in wellness connection of Maine and you'll see us there. We also publish a couple of times a month. We have a blog that appears in the Bangor Daily News, which is the largest newspaper here in Maine, and you can find that by just Googling Cannabis today or Bangor Daily News cannabis today. That's it.
Matthew: Thanks so much to Becky DeKeuster, Co-founder and Director of Community and Education at Wellness Connection of Maine.
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