West Virginia
Medical Cannabis Advisory Board
Report and Recommendations

Rahul Gupta, MD, MPH, MBA, FACP
Commissioner and State Health Officer
Bureau for Public Health
West Virginia Department of Health and Human Resources
Medical Cannabis Advisory Board Chairman
February 21, 2018

 TABLE OF CONTENTS

Members of the Advisory Board...................................................................................3
Executive Summary of Board Recommendations........................................................4
Introduction ..................................................................................................................5
Advisory Board Recommendations..............................................................................5
Work Group 1 .........................................................................................................6
Work Group 2 .........................................................................................................7
Work Group 3 .........................................................................................................7

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 MEMBERS OF THE ADVISORY BOARD
• Rahul Gupta, MD, MPH, MBA, FACP, Chair
• Arvinder Bir, MD, Huntington
• Colonel Jan Cahill, Superintendent, West Virginia State Police, South Charleston
• Michael “Joe” Deegan, Social Worker, Cross Lanes
• Michelle R. Easton, PharmD, Charleston
• James Felsen, MD, Great Cacapon
• W. Jesse Forbes, Esquire, Charleston
• Joseph Hatton, Horticulturalist, West Virginia Department of Agriculture, Charleston
• Kimberly Knuckles, Pharmacist, Beaver
• Rudy Malayil, MD, Huntington
• D. Keith Randolph, Prosecuting Attorney, Madison
• Joseph Selby, MD, Morgantown
• Russell A. Williams, Patient Advocate, Nitro

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 EXECUTIVE SUMMARY OF BOARD RECOMMENDATIONS
The West Virginia Medical Cannabis Advisory Board met on Tuesday, February 20,
2018, and approved the following recommendations for consideration by the Governor
and West Virginia Legislature during its 2018 Legislative Session.
Recommendation 1.1
Amend the Act to clarify the requirements and responsibilities for physicians who issue
certifications to patients to include:
a) A determination by the practitioner that a patient has no past or current medical
condition(s) or medication use that would constitute a contraindication for the use
of cannabis.
b) A determination by the practitioner that a patient is experiencing serious
pathophysiological discomfort, disability or dysfunction that may be attributable to
a serious medical condition(s) and possibly benefit from cannabis treatment when
current medical research exhibits a moderate or higher probability of efficacy.
c) That the practitioner has educated the patient about cannabis and its safe use.
Also, to include a statement by the practitioner attesting that he/she has performed these
requirements on a form determined by the West Virginia Department of Health and
Human Resources, Bureau for Public Health.
Recommendation 1.2
Replace the phrase “Serious Medical Conditions” with the phrase “Medical Conditions
with Possible Serious Manifestations” throughout.
Recommendation 2.1
Include dry leaf or plant form of medical cannabis medically appropriate for administration
by vaporization or nebulization.
Recommendation 3.1
Remove limitations on the number of permits the Bureau for Public Health may issue for
growers, processors, and dispensaries.
Recommendation 3.2
Remove the limitation that a grower or processor may not also be a dispensary to permit
the vertical integration of growers, processors and dispensaries.
Recommendation 3.3
The Legislature should evaluate the need for the requirement that a physician or
pharmacist must be onsite at all times during the hours the dispensary is open to receive
patients and caregivers.
Recommendation 3.4
Authorize a pre-registration process for potential medical cannabis patients to more
clearly ascertain the market interest within West Virginia for medical cannabis.
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 INTRODUCTION
This report represents the first report of the West Virginia Medical Cannabis Advisory
Board after its establishment pursuant to the passage of Senate Bill No. 386, The Medical
Cannabis Act, (Act) in 2017. Under the Act, the board has the following duties:
1) Examine and analyze the statutory and regulatory law relating to medical cannabis
within this state.
2) Examine and analyze the law and events in other states and the nation with respect
to medical cannabis.
3) Accept and review written comments from individuals and organizations about
medical cannabis.
4) Issue a written report to the Governor, the Senate and the House of Delegates that
includes recommendations on:
a) Whether there should be changes to the types of medical professionals who
can issue certifications to patients.
b) Whether to change, add or reduce the types of medical conditions which
qualify as serious medical conditions.
c) Whether to change the form of medical cannabis permitted.
d) Whether to change, add or reduce the number of growers, processors or
dispensaries.
e) How to ensure affordable patient access to medical cannabis.
f) Whether to permit medical cannabis to be dispensed in dry leaf or plant
form, for administration by vaporization.
The first meeting of the board commenced on August 16, 2017. Four subsequent board
meetings were held, one taking place in Morgantown and the remainder in Charleston.
Public comment was accepted at all board meetings. The board established three work
groups to provide focused recommendations that may then be approved by the board for
submission to the West Virginia Legislature. The following recommendations represent
each work group and its charge.

ADVISORY BOARD RECOMMENDATIONS
The board has been charged by the Act with making recommendations related to five
specific areas concerning medical cannabis. Recommendations are submitted within

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 this report to the Legislature in order to achieve the tasks set out through passage of the
Act.
Since its original appointment in 2017, the Commission has met on five occasions; three
times in 2017 and twice in 2018. The work groups created in 2017 continue to meet in
2018 to take on the tasks as outlined in the Act.
The following is a compilation of the recommendations organized by the respective work
groups and their assigned task. The recommendations have been approved by the full
board and are being advanced as recommendations of the full Medical Cannabis
Advisory Board.
Work Group 1
Charge: Assess and make recommendations to change, add, or reduce the types of
medical conditions that qualify as serious medical conditions under the Act and the types
of medical professionals that can issue certifications to patients.
Membership: James Felsen, MD – Chair; Arvinder Bir, MD; Rudy Malayil, MD; and
Kimberly Knuckles.
Recommendations:
Recommendation 1.1
Amend the Act to clarify the requirements and responsibilities for physicians who issue
certifications to patients to include:
a) A determination by the practitioner that a patient has no past or current medical
condition(s) or medication use that would constitute a contraindication for the use
of cannabis.
b) A determination by the practitioner that a patient is experiencing serious
pathophysiological discomfort, disability or dysfunction that may be attributable
to a serious medical condition(s) and possibly benefit from cannabis treatment
when current medical research exhibits a moderate or higher probability of
efficacy.
c) That the practitioner has educated the patient about cannabis and its safe use.
And to include a statement by the practitioner attesting that he/she has performed these
requirements on a form determined by the Bureau for Public Health.
Recommendation 1.2
Replace the phrase “Serious Medical Conditions” with the phrase “Medical Conditions
with Possible Serious Manifestations” throughout.

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 Work Group 2
Charge: Assess and make recommendations as to the forms of medical cannabis that
can be permitted under this Act, including whether dry leaf or the plant form of cannabis
should be dispensed for administration by vaporization.
Membership: Michelle Easton, PharmD – Chair; Joseph Selby, MD; D. Keith Randolph,
Esq.; and Russell Williams.
Recommendations:
Recommendation 2.1
Include dry leaf or plant form of medical cannabis medically appropriate for administration
by vaporization or nebulization.
Work Group 3
Charge: Assess and develop recommendations as to how to ensure affordable patient
access to medical cannabis and whether to change, add or reduce the number of growers,
processors, or dispensaries.
Membership: W. Jesse Forbes, Esq. – Chair; Col. Jan Cahill; Joseph Hatton; and Joe
Deegan.
Recommendations:
Recommendation 3.1
Remove limitations on the number of permits the Bureau for Public Health may issue for
growers, processors and dispensaries.
Narrative
The Advisory Board and work group continue to examine other states’ experiences and
gather information. The work group is not currently in a position to recommend a specific
number for the increase but work group members believe the current numbers are likely
too low to provide for adequate patient access and market viability in light of the survey
results and interest level that has been indicated thus far in the Advisory Board’s
tenure. Further, by increasing the number of permits available, a broader cross-section
of interested businesses would be able to take part in the process allowing for an increase
in affordable patient access to medical cannabis.
Recommendation 3.2
Remove the limitation that a grower or processor may not also be a dispensary to permit
the vertical integration of growers, processors and dispensaries.
Narrative
In researching this issue, it appears West Virginia is an outlier in prohibiting vertical
integration among the 29 states that have approved medical cannabis laws. In

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 presentations to the full Advisory Board, as well as reviews of applicable tax codes, it
seems that the three-tiered system currently provided in the law would make it less
economically viable for entities to enter into this market and to provide an affordable
product for patients.
Recommendation 3.3
The Legislature evaluate the requirement that a physician or pharmacist must be onsite
at all times during the hours the dispensary is open to receive patients and caregivers.
Narrative
In reviewing the current law, it is unclear what role a physician or pharmacist would bring
to the dispensary process. The current law states that physicians and pharmacists
cannot prescribe medical cannabis. Further, the code specifically states that physicians
and pharmacists cannot “otherwise treat” patients at the dispensaries. Having a
physician or pharmacist onsite at each dispensary during operations would dramatically
increase the dispensary’s operating costs, increasing the costs to patients for the
product. However, if physicians and pharmacists are not present to treat patients at the
dispensaries, it is unclear what service their required presence would provide. In fact, if
not providing treatment, it may not be possible for a physician or pharmacist to even
access any patient data during the dispensing process. Therefore, the work group
recommends that the role of physicians or pharmacists being required at a dispensary be
reevaluated and that their involvement in that process be more clearly defined to ensure
the necessity to increase costs by requiring their presence be justified. This
recommendation is made to ensure affordable patient access to medical cannabis.
Recommendation 3.4
Authorize a pre-registration process for potential medical cannabis patients to more
clearly ascertain the market interest within West Virginia for medical cannabis.
Narrative
The work group believes that such a process would allow for a better and more exact
figure of the potential market so that this board and the Office of Medical Cannabis are
able to determine what numbers and geographic regions of license holders would best
serve the patients. Further, such a process would allow for a better understanding of the
potential market for anyone wishing to open businesses to support this industry. The
work group recommends that a nominal fee be established for potential patients to preregister with the revenue from such fees going to the Office of Medical Cannabis to
support the pre-registration process and otherwise to fund the start-up costs associated
with implementing the medical cannabis laws in West Virginia. By ascertaining more
specific numbers and data regarding patients willing to sign up and pre-register, there will
be a better understanding of the potential market in West Virginia which will be beneficial
in establishing standards for affordable patient access and the number of permits
necessary.

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