The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. This week, Emma and Steve talk to Owen Parker, program manager for the Office of Medical Cannabidiol at the Iowa Department of Public Health. Owen is also a 2015 graduate of the University of Iowa College of Public Health, where he earned his MPH in occupational and environmental health. They discuss the issues surrounding medical cannabinoid use in Iowa, and policy and public health implications of its legalization.

Emma Meador:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Emma Meador and I am joined today by Steve Sonnier. And, if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today, I’m excited to welcome Owen Parker to our podcast. Owen is the current Program Manager for the Office of Medical Cannabidiol at the Iowa Department of Public Health. Owen is also a 2015 graduate from the college where he earned his MPH in occupational and environmental health. Welcome to the show Owen.

Owen Parker:

Thank you, Emma. Thank you, Steve, for having me. As an alumni of CPH, it’s an incredible opportunity to be here. I love what you all do with the podcast, and we’ve all been bearing as well as you’re able to this year.

Emma Meador:

So to start off, do you want to tell us a little bit about your background in this area? Was there a specific pathway that generated your interest in medical cannabidiol?

Owen Parker:

Certainly. So, I mean, anyone in this industry it’s not always a linear path, but it certainly did begin as a graduate student at the U of I. As you mentioned, I studied occupational and environmental health as kind of my subtrack, and I really liked the flexibility that that degree provided. Personally, I enjoyed a lot of the policy and toxicology courses that I was able to take, separate from the core curriculum obviously. In that degree there were certainly some issues that stood out to me, being where I’m at now. At that time, I’m sure a lot of it still is that way, there was a lot about social determinants of health, harm reduction, addiction was a big topic for us always. I certainly couldn’t help but realize there was obvious disparities in public health issues that were created by the war on drugs and mass incarceration at that time.

Owen Parker:

I had just kind of developed some questions, I just started to develop overall whether it was the [drug] scheduling regime which there’s really wasn’t a lot of science that was put into setting it up. Yet there’s a great deal of science that’s required to alter that scheduling at all. Is cannabis more of a mental health addiction, public health issue as compared to a criminal issue as it currently is. Also at that time, this was 2013, 2015, I was really interested in some of the data that was coming out from other states that were testing, tracking, regulating, and taxing cannabis. Whether it was a medical or adult use.

Owen Parker:

And that was really kind of… the industry has evolved quite a bit in that seven, eight year, time period. But that was really when a lot of states were implementing these programs through largely ballot initiatives and they were being regulated by the departments of health. So, I just thought that that was kind of interesting. I’m like, “Well, I have this public health background, this is how states are doing this.” And before you even had an opportunity to take part in the industry, I seriously certainly couldn’t help but see an obvious opportunity for public health professionals.

Steve Sonnier:

That’s a great overview into it too, and I’d love the tying in of your degree and saying this isn’t exactly the path that you come into within this field.

Owen Parker:

After graduation, I actually had the opportunity to be in LA, and actually with a couple other MPH grads. We founded a startup company at that time using some of that public health knowledge that provided, whether it was counseling and nicotine replacement for smoking cessation. And, that technology was ultimately acquired by UCLA in early 2016 that left me with a decision that I had to make–was I going to stay in Los Angeles? No way I was going to make my way back home and look for something else. And just to kind of talk about how some of those other states were implementing those programs. This was right at the time when Prop 64, which was a legalization initiative in California, was being heavily discussed. And, that considering the immaturity of the industry at that time and what was coming in terms of regulations, I just kind of continued to see that Venn diagram.

Owen Parker:

And it was about that time that I just thought, “Well, maybe the industry is looking for people and professionals that have this type of background.” And that’s what kind of led me to take a position in the private industry with a startup who was a multi-state operator. Now that’s kind of industry speak for private entity that’s has licenses in multiple states. So obviously those states have different ways that they do things. And while I started kind of in dispensary operations, with that company I worked in corporate for my last 18 months in different aspects. And then 2018, Iowa started their program, I wanted to come back and help out. And I suppose you can kind of see how a career in this kind of zigs and zags, but that’s really kind of how I ended up here.

Steve Sonnier:

With the career zigging and zagging, was there something that came out to you and said, “I really want to go back to Iowa and help them figure out this really new field that’s evolving”? Especially with your background from the public health side of things?

Owen Parker:

At that point, it was… again, it’s just kind of one of those things where things kind of line up. And when I got into the industry, that was really when a lot of states started to proliferate their programs. It went from, I think it was 2016 that year there was five or eight states, they came online. And to be honest, I was shocked to see that Iowa passed the program. And just, I really thought being a hometown kid having some of this knowledge or “expertise” that I just kind of assumed a lot of people in Iowa weren’t likely to have… I kind of wanted to come back and see what I could do.

Owen Parker:

And I actually that session, I worked with a small lobby group and that was how I met some of the IDPH personnel and kind of it was like, “Hey, I have this background, you’re probably looking for FTEs to do this. I wonder if there’s any way that I could help.” And that’s kind of how I got here. Really, it’s just kind of, sometimes you have to go to a different place to get that expertise maybe applicable to somewhere else down the line. And that’s really kind of how I got here. Just wanting to bring that knowledge back to Iowa.

Steve Sonnier:

What does that translating that expertise look like in your day to day interactions at the office of medical cannabidiol? Does that look very comprehensive when you’re coming out from a public health standpoint? Is it coming with the startup side of things, the knowledge that you’ve gained there, what does that interplay look like?

Owen Parker:

Startup stuff, I like to think was very valuable when we were talking about starting an agency from zero, that’s really what we’re doing. You take a piece of paper that’s passed through the legislature and you have to turn it into a program. Whether that’s the rules, that’s your compliance and inspection processes, all those. Educating the public and the patients and all the stakeholders and industry stakeholders and the people and the groups that are affected by a program like this. The public health backgrounds kind of obviously allowed me to understand how those things needed to be implemented, but then I really think the startup background really came into play with just starting it from zero. Whether that’s staffing, that’s just how you go about thinking and developing the ways that you’re going to go about it. It really just kind of ended up being a great merger of both my background and some of the experience I’d gotten in the startup community.

Emma Meador:

So then with your work in our state, who have you found to be the primary users of medical cannabidiol? And, what are some reasons why they utilize this?

Owen Parker:

Sure. I mean, one of the things I think it’s really important to understand is that all of these are state-based medical cannabis programs. And, usually they are very different in how they operate depending on how the state is deciding to implement those. In a program like ours, we are fairly restrictive in terms of performs, knowing the potencies and who can gain access to those products. So, really it’s only accessible to those with those truly debilitating conditions and only allows downstream products manufactured from a cannabis concentrate. So, that would be vaporizers, capsules and tablets, tinctures, topicals. We don’t allow flower or anything or edibles, some of those things a lot of people associate with more of an adult use program. So, really the people that we’ve seen enrolling our program that have older individuals.

Owen Parker:

So our program, the average age of our… we have almost 5,000 patients at this point, the average age is 53 years old. We’ve seen in the industry and those in the know are aware that that’s really the [inaudible 00:08:42] expanding demographic of new cannabis users. And a lot of these people they’re not… And then I think a lot of people think that they’re old, they’re hippies that are coming back to cannabis and not the case either. These are people who have never tried cannabis and they’re really using it as an alternative to maybe some of the things that they’re on. So, in terms of a demographic that’s really what we’ve seen maybe the average age is 53, but we actually have had patients in our program ranging from ages two to 102.

Owen Parker:

So we have a pretty wide range with patients that partake. But then in terms of what patients take it for, we’ve seen right around 70% of our patient population is certified for a chronic pain condition. And, that might seem high, but it’s actually pretty right in line with a lot of the other medical cannabis programs and the percentages that they see in terms of people who are approved for what condition. We’re really hoping to conduct an observational study to understand more about the patient population what they’re using these products for, how they’re using them, are they finding a benefit? But really at this point we’re seeing patients kind of take medical cannabis to alleviate some of those symptoms even though they’re approved for a specific condition. But also in relation to chronic pain which is something that’s also discussed in the industry and we need to do a study to really figure it out.

Owen Parker:

But we have a lot of anecdotal reports, both from patients and our licensees that patients are using medical cannabis as a substitute for a lot of the other narcotics that they’re on, but ultimately, it’s largely anecdotal. And, then our other most certified conditions, which really are only around 5% to 6% of our population are post-traumatic stress disorder and seizures. So again, you’re talking more about not necessarily treating maybe the condition itself, but treating the symptoms that are associated with that condition.

Steve Sonnier:

When you’re talking about the research and the funding and everything along those lines. I know the anecdotal evidence, right it’s out there, you see a lot of folks say, “I take this for my back pain. It’s really helped. I can sleep better at night.” All those things come up, but you talked earlier about how that scientific backing is really necessary to change the current policies that are at play. One of the major pieces of legislation that was just passed in Iowa was House File 2589 and part of that looks into research funding. Has that seen any progression or anything along those lines coming out of it at this point?

Owen Parker:

Sure. I mean, and that’s kind of one of those other aspects that makes all of these programs a little bit different. So you’ll see in a lot of big programs where they receive specific appropriations, whether to run their program which subsidizes the cost of the licensees to run it, or to the patients to enroll in it. Iowa’s a little bit different in that the legislature in our statute mandates that our program is solely a fee-based. That means that we receive no taxpayer dollars to implement our program and basically everything in the program is funded by patient and caregiver registration fees and then the fees that our licensees pay each year. We do intend to absolutely to conduct an observational study, which would require some money. And really we plan to do that once we’re able to refill some of these budget holes that have been created, unfortunately by losing two dispensary and a manufacturer earlier this year. The industry is in dire need of science and real effectiveness data.

Steve Sonnier:

When you’re looking into that local experience and examining specifically the loss of those two dispensaries too as well, that you’re commenting on. How is the office of medical cannabidiol responding to the health needs of Iowans right now during the pandemic, you mentioned the budget caps and these other situations going on. Again, we’ve also seen with that recent House File that was passed that there’s a change in the cap and the THC. There’s contention around those areas and how it can fill the needs for individuals who need this assistance with predominantly chronic care conditions. Where do you think this is headed towards?

Owen Parker:

I mean, I initially I can kind of speak to what we’ve done since the pandemic started, because I think that’s that’s really forced a lot of public health professionals to get pretty creative. Across the board, I don’t think it really matters what your specialty is in but we did see certainly a pretty steep drop off in registration at the beginning of the pandemic. Whether it’s people not being able to renew their certification or people having trouble getting in to see a physician. That really caused a pretty steep drop-off on our patient population largely due to factors like not being able to see your practitioner, being compromised and not being able to be comfortable going out in public or going to a dispensary.

Owen Parker:

But we certainly did identify some of those issues and provided dispensers with a waiver to allow for curbside delivery. That was a pretty consistent theme across the industry a lot of different businesses did that. We were no exception. That really helped a lot to get patients out, but also at that time, the DOT was involved in our process. So, we always were aware that was a pretty significant barrier that patients actually had to visit the DOT to get their card made. More so, most of the programs it’s the department ourselves who would review that information and approve them. So, we worked with the DOT to schedule specific appointments with our patients to allow for the manufacturer of those physical cards. Then also for patients who were renewing, we worked with the DOT to actually mail the cards directly to the patient.

Owen Parker:

So, we were able to both through allowing for socially distance transactions allow for socially distance and safer ways for patients to get their cards made but then also facilitating telemedicine. Both with our patients and our providers there’s nothing in our rules that forbid a patient to have that consultation through telemedicine. So, those are some things that really allowed our patient population since then to rebound. But then also, you’ve mentioned a house file 89 that allowed for the department to manufacture those cards. That’s a light that really came right at a great time in the pandemic where we removed that DOT, we got those cards out to patients and we’ve really seen quite a bit of improvements in the patient population from that aspect. We’re pretty proud of what we did in response to the pandemic. To answer some of your other questions, in regards to how the bill is actually going to help patients?

Owen Parker:

That’s really going to be one of those things that it’s ultimately going to be better served by an observational study that would be conducted by the U of I or just in general to look at. I mean, I can say that one of the things that potency, the removal of the 3% cap and going to more of a gram limit over 90 days, it did allow for the manufacturer of higher THC vaporizer cartridges. And those who might know that vaporizers do allow for much easier titration, more fast on fast off relief of some of those acute symptoms. We haven’t received anecdotal reports that those have been very beneficial to patients, especially where 70% of them are certified for chronic pain. But really it’s going to take an observational study and tracking this data over time with this new program to really see how it’s going to benefit people.

Owen Parker:

Because we’re really only four or five months in. We have data on our website that you can kind of see the month to month tracking of sales and patients’ adoption and physician adoption. And, all those things that kind of showed me help with the program. It’s really going to take public health data gathering and studies to really know how this program is benefitting people all the time.

Emma Meador:

Our state has recently joined a novel Cannabis Regulators Association that is formed from 19 states. Comparing Iowa’s medical marijuana program to the other participants. What is the aim of joining?

Owen Parker:

I kind of spoken to how we really in the U.S. without any federal guiding framework and that federal illegality, what we really ended up with is this patchwork fragmented regulatory schemes on a state by state basis. And so, CANNRA we’ve been kind of working with the informal aspect of the group for about the last year. But I would say that we’re incredibly excited for this opportunity to be a founding and full voting member of CANNRA and really can’t understate it’s importance. Some of that fragmentation that I kind of spoke to is specifically due to the lack of existence of a group like this. So, the goal of joining us to understand those lessons learned from other more experienced programs how they go about implementing those new policies. And so hopefully, the goal would be to never being reinventing the wheel.

Owen Parker:

And I think, it seems in this industry as people who have lost shit for the last handful of years or even the last decade is incremental change. And we’ve discussed how I was no different. We just had a bill passed that made pretty structural changes to our program. So, the goal of this group is to create harmonization and standardization of policies between states. So, we can mitigate those variances in the patchwork and just kind of speak to the specifics whether this be product standards. Obviously very important, how do we label things? How are things tested? How do we regulate industry advertising? What is the correct actual structure of a market? This is all licensed based what’s the best licensing scheme and structure to vet and stand up those responsible operators. But also one of the other things is I did kind of mention the war on drugs and some of those issues that have been caused by prohibition.

Owen Parker:

So, we also want to make sure that programs foster social and economic equality and justice. So really in general, this is kind of the group that would generally be in charge of regulating on a federal type of landscape. But without that, it’s really left to state leaders and experienced regulators to come together to share about how we can come to some level of consistency. So, we’re really just trying to promote regulatory certainty for the industry and all the industry participants. So it’s really valuable. People that maybe outside the industry may not quite understand that value, but previously there was nothing but reinventing the wheel or just inventing the wheel because there was no rule book for how to do this. So, this group kind of as this industry continues to gain traction and evolve. A group like this just becomes more powerful.

Steve Sonnier:

That’s really exciting to hear and to be part of it, it makes me think also back to your startup concepts and everything along those lines that experience of you’re really building from the ground up. And I’m thinking, is there something in particular that since you have been a part of this organization that you’ve gained?

Owen Parker:

As opposed to anything really specific, I would say really over the last year whether it’s writing our rules that we had to write, once the legislature changed our statute one of the first things we did was talk to that group. It’s like, “Okay. Hey, we got this thrown to us. How did you write rules around it when you did it?” As opposed to coming up with on your own. A big thing that’s always evolving, you’re familiar with E-Valley and some of the issues around Canvas product testing. So, really we want to talk to those other states that say, “Hey, what do you look for in terms of contaminants? How do you test this given product for them?

Owen Parker:

Hey, do you have a validated method for how you go about testing this?” In advertising is another big one, you really kind of have to find that fine line. There’s obviously the parallels between the alcohol and tobacco industries and how they went about regulating those, but states are coming up with their own ways and lessons learned and licensees trying to skirt around them and maybe do some things that bend those rules. And so it’s really across the board, like I said kind of being a younger professional that’s been put in charge of standing something from the ground up, I’ve really leaned on those experienced through the years for just about everything. You really think about some of these programs California’s initial medical cannabis program was started in 1996.

Owen Parker:

We have multiple medical programs that were started in the early ’00s in 2000 through 2005. And so there’s regulators out there that have a lot of experience in what’s been done. And even though maybe I got a little bit of that experience in California and being on the private side of the industry, it’s really you have to lean on those people just as always that have that actual experience. And especially our program is really we just had our third birthday we’re basically brand new, we’re still a baby. So we’re still setting up just about everything in the program and improving it and constantly doing quality improvement type of processes. That group and those experienced regulators I’m very grateful to them, because that’s really what allows us to make things efficient and work well for the patients and people it’s designed to work for.

Steve Sonnier:

That’s great to hear that you get to tap into that [inaudible 00:22:56] component, and that’s still there and a really excellent breadth of knowledge. When you’re looking at this situation, as it presents itself, right. Coming into this new role and getting to explore these opportunities as a whole. Is there an issue that you’re specifically interested in solving through your work?

Owen Parker:

Oh, really? I’ve always thought that people in public health and with the public health degree, in some ways you have to be willing to be creative. And, I really do think that I kind of recognize that early on and that was one of the reasons that I found this industry a brand new emerging industry. That’s very public health focused, presents a lot of public health issues and it is brand new. There is no rule book. And I thought it was really just the perfect application of that background, but really to keep it relevant to this conversation. And in some ways segue from that conversation about Canada is that I really feel like I am truly interested in solving the issues facing the cannabis industry and the public health issues that it presents as we’ve talked about, continues to gain traction.

Owen Parker:

It proliferates, it evolves at light speed we kind of always talk how this industry works in dog years. It’s really surprising how quickly it changes from year to year and really each state’s different, right? Each state and their legislatures have different opinions of this and how they want to handle it. In terms of public opinion we have now 36 states that have medical cannabis in one form or another and we have 15 allow adult use and that would tell you that in some ways the genie is out of the bottle, so to speak. So, I really see my role and something I’d like to accomplish in this industry was being an active participant in ensuring that the industry is safe, it’s responsible, it’s equitable and it makes an effort to do some of the wrongs that it’s been creating by the long drugs and prohibition. And I really feel like five years into different versions of this career that I do take that seriously. I think that’s an issue I’d like to solve.

Emma Meador:

Definitely. That sounds like a very important issue to work on and really exciting that you get to be able to work on that. And then just to ask a final question that we ask to everyone we interview, what is one thing you thought you knew, but were later wrong about?

Owen Parker:

Yeah, that’s a tough one. And maybe as opposed to something that I’m wrong about, I’ll think of it as something that I always try to keep in mind. Especially being in this industry and especially in today’s times it’s very easy to be cynical and think that people have that fixed mindset, are incapable of evolving their opinion or worldview. I really think my five-year experience in the industry and three years in this role, tells me that people and perceptions really do always evolve. I like to believe that people will tend to respond to objective dialogue and information when it’s presented to them properly. And again, it’s objective and which that’s always on us as individuals to figure out how to do that and change their mindset. Because I know it’s always easy to be cynical and I’m the same way, but I think that’s kind of something it’s easy to be wrong about. Always try to improve.

Steve Sonnier:

I think that’s a really good point too, because you need that optimism in founding something new and then starting something new you’re saying this is the third birthday. This is all just incoming. And I can imagine too that it can seem very difficult when you’ve got situations like the pandemic going on, some industry components leaving or other things happening along the way, but then you get to see the other buoyed amounts of legislation being passed nationwide. We were talking about this in a prior email, but there really is, I think, this big push for change that is around the corner. And, having that optimism and recognizing to the right that folks can change their minds. That legislation is reflective of that, that constituents are reflective of that and attitudes too. So I think that’s an excellent takeaway.

Owen Parker:

When I got in this you really don’t know where it’s going to go. I think it’s been fascinating to see the industry change and to be where I’m at now and ultimately my role is just to implement the statute and the rules as they’re written. But it certainly it’s been fascinating to watch that perception change because I know you mentioned something I think that is important to mention about this and it’s very relevant to the conversation. Even before last year there wasn’t even a standalone cannabis bill that had even been introduced in the US Congress. And then just last week we had the More Act which would reschedule and decriminalize cannabis and look to quell some of those some of those social justice components passed the US House of Representatives. I think that stuff like that it’s fascinating to watch. It’s fairly exciting to be a part.

Steve Sonnier:

We want to thank you for your time today, Owen, and really glad that we could have you on and chat with us further about this exciting opportunity that you’re a part of, and wishing you well throughout the duration of the holiday season and onwards into 2021.

Owen Parker:

Steve and Emma, I truly appreciate the opportunity. It’s been great to talk to you, love what you do with the podcast and happy to be an alumni of U of I, go Hawks. And have a good holiday.

Steve Sonnier:

That’s it for this week’s episode of From the Front Row, big thanks to our guest Owen Parker for coming on today. This episode was hosted and written by Emma Meador and Steve Sonnier. This episode was edited and produced by Steve Sonnier. You can find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple podcasts, and SoundCloud as the University of Iowa College of Public Health. If you enjoyed this episode, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Keep on keeping on out there.