2025 annual report : annual Commission report to the Georgia General Assembly in accordance with O.C.G.A. §§ 16-12-203(9), 16-12-204(c)(2), 16-12-214(a) and (b).

2025ANNUALREPORT
ANNUALCOMMISSIONREPORTTOTHEGEORGIAGENERALASSEMBLY
INACCORDANCEWITHO.C.G.A.16-12-203(9),16-12-204(c)(2),16-12-214(a)and(b)
GeorgiaAccesstoMedicalCannabisCommission
254WashingtonStreet FourthFloorSuite420 Atlanta,GA30334 470-227-0331 www.gmcc.ga.gov

GeorgiaAc cesstoMe dicalCa nnabisCo mmission
254WashingtonStreet,FourthFloorSuite420,AtlantaGeorgia30334 www.gmcc.ga.gov

MEMORANDUM

TO

MEMBERSOFTHEGEORGIAGENERALASSEMBLY

FROM

GEORGIAACCESSTOMEDICALCANNABISCOMMISSION ANDREWL.TURNAGE,EXECUTIVEDIRECTOR

DATE

JANUARY15,2025

SUBJECT ANNUALCOMMISSIONREPORTS&SUPPLEMENTALINFORMATION

The Georgia Access to Medical Cannabis Commission ("GMCC" or the "Commission") had a highlysuccessfulyearworkinginpartnershipwithourproductionlicenseestocontinuebringing accesstopatients.ImplementingtherequirementsoftheHopeAct("theAct"),theCommission has established a newindustryinthestatefromthegroundup,bringingeconomicinvestment anddevelopmenttoTier1andTier2countiesinruralGeorgiaandmedicalcannabisaccessto registeredpatientsinkeylocationsaroundthestate.TheresultoftheCommission'sworkisthat safe, laboratory-testedmedicalcannabishasbeenlegallyaccessibletopatientsinGeorgiafor thepasteighteenconsecutivemonths.
This annual report includes highlights and milestones from FY24 and FY25 year-to-date ("YTD"). The reportfulfillstheCommission'sreportingobligationsunderGeorgia'sHopeActto includethestatutoryrequirementsfor:anyproposedlegislativechanges,low-THCoilproduction bydesignateduniversities,andminority-andwomen-ownedbusinessstudy.Alsoincludedisa program overview, the Commission's collection ofrevenue(actualandprojected),andagency milestones.

TABLEOFCONTENTS
ProgramOverview.......................................................................................................1 Milestones....................................................................................................................3 CollectionofRevenue&FY26Budget......................................................................7 ProposedLegislativeChanges..................................................................................7 DesignatedUniversityProductionReport...............................................................8 MinorityandWomenOwnedBusinessStudy.........................................................8 CommissionMembers...............................................................................................9 Staff,History&PurposeoftheCommission........................................................10
Exhibits Exhibit1:FY26BudgetRequest..............................................................................12 Exhibit2:FY24-FY26RevenueCollection..............................................................13 Exhibit3:LegislativeRecommendations...............................................................14 Exhibit4:PatientListeningTourReflectionsReport...........................................15

PROGRAMOVERVIEW
The Georgia Access to Medical Cannabis Commission conducted fifteen public meetings in 2023,andsixpublicmeetingsin2024,inaccordancewiththeOpenMeetingsAct("OMA").The CommissionhascontinuedworkingcloselywithgovernmentpartnersincludingtheDepartment of Public Health, the Georgia Board of Pharmacy, andtheUniversitySystemofGeorgiainits efforts to fully implement the HopeAct.FollowingisanoverviewoftheprogramforFY24and FY25year-to-date("YTD"):
FY2024
August 8, 2023 The Commission staff presented an introduction and overview of Georgia's medical cannabis program, laws, and regulations, with emphasis on local government involvementattheGeorgiaMunicipalAssociation'sCitiesConnectWebinar.
August23,2023 TheCommissionissuedthreedispensinglicensesfordispensarieslocatedin Chamblee,Stockbridge,andEvans.
September 20, 2023 TheCommissionrenewedbothClass1productionlicenseswhichwere initially issued on September 21, 2022. Production licenses are required to be renewed annually.
September 22, 2023 As required by the Administrative Procedures Act ("APA"), the Commission issued notices of intent to amend existing rules andregulationsthatwouldallow the Commission's licensees to work with pharmacies in making medical cannabis more accessibleforpatientsacrossthestate.
November1,2023 AsrequiredbytheAPAandOMA,theCommissionheldapublichearingto receivefeedbackonitsproposedruleamendments.
November8,2023 AsrequiredbytheAPAandOMA,theCommissionadoptedtheproposed rule amendments that were publicly noticed on September 22, 2023. The next day, the CommissionfileditsruleswiththeOfficeofSecretaryofState.
November15,2023 AsrequiredbytheOMA,theCommissionconductedapublicmeetingand awardedfourprovisionalcontractsforfourClass2productionlicenses.Therewerenopending lawsuits that prevented the Commission from issuing these provisional awards. Prior to the publicmeeting,alitigantfiledamotionforanemergencytemporaryrestrainingordertohaltthe Commission from making such contractawards,andtheFultonCountySuperiorCourtdenied the motion and made clear that the Commission could move forward with the provisional contracts.
November29,2023 TheCommission'samendedrulesbecameeffective.
December 5-6, 2023 At the CANNRA AnnualMemberConference,Commissionstaffserved aspanelistsontopicsincludingengaginglocallawenforcement,theinvolvementofpharmacies inthedispensingofmedicalcannabisinGeorgia,andlegaltrendsandissues.
GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 1

December11,2023 TheCommissionpartneredwiththeStateBarofGeorgia'sCannabisand HempLawSectiontopresentacontinuinglegaleducation(CLE)creditedprogram. January 10, 2024 The Commission issued the tenth dispensing license in the state for a dispensarylocatedinAugusta. April10,2024 TheCommissionrenewedtheregistrationforthestate'sindependentlaboratory for the testing of medical cannabis produced by GMCC licensed production facilities prior to distributiontodispensaries. June 4-5, 2024 Commission staff attended the CANNRA External Stakeholder Meeting and servedaspanelistsontopicsincludingupdatesonthecurrentlandscapeofregulatedcannabis.
June 12, 2024 The Commission issued three dispensing licenses for dispensaries located in Athens,Decatur,andSmyrna.
FY2025(Year-to-Date)
July 1, 2024 TheCommissionrenewedsixdispensinglicenseswhichwereinitiallyissuedon April26,2023.Dispensinglicensesarerequiredtoberenewedannually.
August20,2024CommissionstaffattendedtheUSPharmacopeia(USP)CannabisRegulatory ForumonHeavyMetalsinCannabis.
September 18, 2024 TheCommissionrenewedbothClass1productionlicenseswhichwere initially issued on September 21, 2022. Production licenses are required to be renewed annually.
October 1, 2024 The Commission renewed three dispensing licenses which were initially issuedonAugust23,2023.Dispensinglicensesarerequiredtoberenewedannually.
October24,2024 PatientListeningTour:ValdostaStateUniversity(SeeExhibit4pg.15)
October30,2024 PatientListeningTour:GeorgiaSouthernUniversity(SeeExhibit4pg.15)
November6,2024 PatientListeningTour:KennesawStateUniversity(SeeExhibit4pg.15)
November13,2024 TheCommissionrenewedallfourClass2productionlicenseswhichwere initiallyissuedonNovember15,2023.Productionlicensesarerequiredtoberenewedannually.
November14,2024 PatientListeningTour:MiddleGeorgiaStateUniversity(SeeExhibit4pg.15)
November21,2024 PatientListeningTour:LanierTechnicalCollege(SeeExhibit4pg.15)
December 2-4, 2024 At the CANNRA AnnualMemberConference,Commissionstaffserved as panelists on topics including federal cannabis policy updates, equity in state cannabis programs,andpatientandclinicianfeedback.
December11,2024 TheCommissionissuedthefourteenthdispensinglicenseforadispensary locatedinColumbus.
GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 2

MILESTONES
PRODUCTIONLICENSES The Commission issued both of its Class 1 Production Licenses of the highest-scoring applicantsasauthorizedundertheActonSeptember21,2022.TheCommissionrenewedboth Class 1 Production Licenses on September 18, 2024. Production licenses are required to be renewedannually.
Class1ProductionLicenses BotanicalSciencesLLC-Glennville/TattnallCounty TrulieveGA,Inc.-Adel/CookCounty
The Commission issued all four of its Class 2 Production Licenses to the highest-scoring applicants as authorized under the Act on November 15, 2023. The Commissionrenewedall fourClass2ProductionLicensesonNovember13,2024.Productionlicensesarerequiredtobe renewedannually.
Class2ProductionLicenses FFDGAHoldingsLLC-Macon/BibbCounty TheraTrueGeorgia,LLC-Louisville/JeffersonCounty NaturesGALLC-Dublin/LaurensCounty TreevanaRemedyInc.-Milledgeville/BaldwinCounty
DISPENSINGLICENSES Georgia'sHopeActauthorizestheCommissiontoissuefiveinitialdispensinglicenseestoeach Class1productionlicenseeandeachClass2productionlicensee,foratotalof30,todispense low-THC oil and products to registered patients. The Commission has issued 14 dispensing licenses,sevenofthosedispensinglicenseswereissuedinFY24.
The Act also authorizes the Commission to issue one additional dispensing license to each production licensee when the Georgia Department of Public Health's Low-THC Oil Patient Registry reaches 25,000 patients and for every increase of 10,000 patients thereafter. The GeorgiaDepartmentofPublicHealthreportsthatthenumberofpatientswithan`Active'status ontheregistryis26,038asofDecember2024.
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DispensingLicenses Trulieve-Macon/BibbCounty Trulieve-Marietta/CobbCounty Trulieve-Pooler/ChathamCounty BotanicalSciences-Marietta/CobbCounty BotanicalSciences-Pooler/ChathamCounty Trulieve-Newnan/CowetaCounty BotanicalSciences-Chamblee/DeKalbCounty BotanicalSciences-Stockbridge/HenryCounty Trulieve-Evans/ColumbiaCounty BotanicalSciences-Augusta/RichmondCounty FineFettle-Smyrna/CobbCounty FineFettle-Athens/ClarkeCounty FineFettle-Decatur/DekalbCounty Trulieve-Columbus/MuscogeeCounty
INDEPENDENTLABORATORYREGISTRATION
Product safety testing is paramount to a successful medical cannabis program. To ensure patients have accurately labeled products, every manufacturing batch goes through product safetytestingatanaccreditedlaboratory.Productsaretestedinfinalpackagedformasitwillbe purchased by the patient. The Commission renewed the registration for an accredited independenttestinglaboratoryinApril2024.
IndependentLaboratoryRegistrants SJLabsandAnalytics,LLC-Macon/BibbCounty
RULES ANDREGULATIONS
The Commission promulgated rules and regulations for production licenses, dispensing licenses,independentlaboratoryregistrants,andseed-to-saletrackingsystems,whichbecame effective April 5, 2023. The Commission amended its rules, effective November 29, 2023, to allow the Commission's licensees to work with pharmacies in making medical cannabismore accessibleforpatientsacrossthestate.
TheCommission'sRulesChapter351isaccessibleathttps://rules.sos.state.ga.us/gac/351
GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 4

OPERATIONS
The Commission held 15 public meetings in 2023 (FY24), and six public meetings in 2024 (FY25), including the Special CalledCommissionmeetingtoannouncetheNoticeofAwardof Class2ProductionLicenses,torenewlicensesandregistrations,andtoissueeightdispensing licenses.
The Commission made 67 site visits to licensees (FY25 year-to-date), to conductoperational inspections, routine quarterly compliance inspections, as well as randomized compliance inspections, for all six production facilities, all 14 dispensaries, and one independent testing laboratory. The Commission received and processed 21 product packaging and labeling approvalrequestsfor184productsinFY25.TheCommissionmonitorsseed-to-saletrackingon adailybasisforallmanufacturing,production,transportation,anddispensing.TheCommission monitors certificates of analysis from independent testing laboratories to ensure safe and compliantproductsforpatientsonadailybasis.TheCommissionhasallstaffpositionsfunded forFY25filledwithtrainedandwell-qualifiedpersonnel.
OUTREACH
The Commission also conducted 28 outreach activities across the state to a variety of constituencies and partners to include five public hearings in FY24-FY25 YTD. The Commission has engaged in community outreach and education with an emphasis on the government partners that are an integral part of standing up a new industry inthestate.The Commissionfocusedontheimportanceofensuringcommunitypartnersreceivethemostupto date and factual information regardingtheproductionandregulationofmedicalcannabis.The Commissiondevelopedanaccreditedtrainingprogramtoprovidelawenforcementofficerswith Peace Officers Standards and Training ("P.O.S.T.") continuing education hours and partnered with the Governor's Office of Highway Safety ("GOHS"), the Georgia Sheriff's Association, Georgia Chiefs of Police, and local law enforcement agencies across the state to conduct fourteentrainingsessions.
The Commission also partnered with the State Bar of Georgia and the Georgia Municipal Association ("GMA") to provide training for local government officials and attorneys aboutthe important role local governments play in providing access to medical cannabis for patients withintheirjurisdictionsthroughthelocalzoningandpermittingprocess.TheCommissionalso participated at the national Cannabis Regulators Association ("CANNRA") Annual Member Conference,whereCommissionstaffservedaspanelistsontopicsincludingengaginglocallaw enforcement, the involvement of pharmacies in the dispensing ofmedicalcannabis,andlegal trendsandissues.TheCommissionwillcontinuetobuildpositiverelationshipswithcommunity partnersthatincludelawenforcementandlocalgovernment.
Finally,theCommissionheldastatewidePatientListeningTouratfivelocationsinOctoberand November across the state. These public listening sessions provided patients, caregivers, health professionals, and those with an interest inmedicalcannabisanopportunitytoprovide input on how the medical cannabis program is developing in Georgia. The Commission also provided the public information about the program, Georgia law, covered conditions, gaining
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access through the patient registryprocess,aswellasthetypesofproductsmanufacturedby licensees and regulated by the Commission. The Commission provided the public and attendeesinformationandpublicationsabouttheprogramtoincludetheGMA/GMCCguideand thebrochuresforFAQs,patients,andphysicians.

OutreachPresentations(FY2024throughFY2025year-to-date)

July5,2023 July24,2023 August8,2023 August9,2023 August15,2023 September12,2023 September13,2023 September14,2023 October11,2023 October16,2023 October26,2023 November17,2023 December4-6,2023 December14,2023 December11,2023 January18,2024 March28,2024 April25,2024 July11,2024 July22,2024 August15,2024 August16,2024 October24,2024 October30,2024 November6,2024 November14,2024 November21,2024 December2-4,2024

CherokeeCountyPhysiciansRoundtable NewnanPoliceDepartment GMACitiesConnect GOHSTrafficEnforcementNetworkConference SuwaneePoliceDepartment/9thDistrictGAChiefsofPolice OconeeCountySheriff'sOffice ColumbiaCountySheriff'sOffice OconeeCountySheriff'sOffice GeorgiaSheriffs'AssociationFallConference GMAPharmaciesandLocalGovernment HenryCountyPoliceDepartment StockbridgePoliceDepartment CannabisRegulatorsAssociation(CANNRA) GeorgiaPharmacies StateBarofGeorgia:CannabisandHempLawSection GAChief'sAssociation WinterConference GAChief'sRegionalMeeting GAChief'sAssociationRegional&Governor'sHwySafety GAGOHSTrafficEnforcementregionalmeeting(CentervillePD) U.S.DrugEnforcementAdministration GAGOHSSafetyTrafficEnforcement(Cohutta,GA) GADepartmentofPublicHealth ValdostaStateUniversity GeorgiaSouthernUniversity KennesawStateUniversity MiddleGeorgiaStateUniversity LanierTechnicalCollege CannabisRegulatorsAssociation(CANNRA)

Publications
(AvailabletodownloadandprintontheCommissionwebsite)
FrequentlyAskedQuestions-Pamphlet GuideforPatients-Pamphlet GuideforPhysicians-Pamphlet GuideforLocalGovernmentonMedicalCannabisinGeorgia

GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 6

REVENUECOLLECTION
TheCommissioncollected$920,000inapplication,registrationandlicensefeesforFY24.The Commission projects revenue collection of $ 985,000 forFY25throughthecollectionofthese fees. A projection ofrevenuecollectedforFY24-FY26maybefoundinExhibit2-FY24-FY26 RevenueCollectionofthisreport.

BUDGET

The Commission receives funding solely through appropriations. The Commission is not authorized to retain and utilize any fees it collects. All fees areremittedtotheTreasuryupon receipt; no funds are retained by the Commission as set forth in statute. For FY25, the Commissionreceivedfundingforstaffpositionsandvehiclestoregulateandoverseecannabis production and dispensing, to protectpublichealthandsafety,andtoensurethewell-beingof patients.FortheamendedbudgetAFY25,theCommissionwillrequestadditionalfundsforthe increase in cyber security and position assessments with the Department of Administrative Services forallstateemployees,aswellasincreasedrentwiththeGeorgiaBuildingAuthority. For FY26, the Commission projects a budget request of $2.4 million (See Exhibit 1 - FY26 Budget Request). Now in its sixth fiscal year, the Commission's funding history is outlined below:

FY19 FY20 FY21 FY22 FY23 FY24 FY25

$ 225,000 $ 211,000 $ 531,000 $ 847,327 $ 908,686 $1,560,000 $1,697,000

LEGISLATIVERECOMMENDATIONS
The Georgia's Hope Act (O.C.G.A. 16-12-203(9)) requires the Commission to recommend legislative changes annually, if necessary. The Commission has provided legislative recommendations in Exhibit 3 - Legislative Recommendations. These recommendations address the need for statutory authority to fingerprint applicants for dispensing licenses and other registrations. Additionally, proposedcleanuplanguagehasbeenincludedandamended toensureconsistencythroughouttheAct.

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DESIGNATEDUNIVERSITYPRODUCTIONREPORT
The Georgia's Hope Act (O.C.G.A. 16-12-204(c)(2)) requires the Commission to report low-THC oil production by Designated Universities to the SenateHealthandHumanServices Committee and the House Committee on Health and Human Services for the preceding calendar year. As of December 2024 (FY25 YTD), the Commission has not received any applications for a Designated University license. And, there are currently no Designated Universities licensed in the state of Georgia. Accordingly, there is no low-THC oil production activitytoreportforDesignatedUniversitiesinfiscalyear2025.
MINORITY-ANDWOMEN-OWNEDBUSINESSSTUDY
AsofFY24,fiveofsix(83%)productionlicensesissuedbytheCommissionareMBEcertifiedor MBEcertificationeligible,majorityminority-ownedbusinesses:
CLASS1PRODUCTION Of the two (2) Class 1 Production Licenses, which were issued on September 21, 2022, one of the two (50%) Class 1 Production Licenses issued was to a woman-ownedandminority-ownedbusiness.
CLASS2PRODUCTION Of the four (4) Class2ProductionLicenses,whichwereissuedprovisionalcontract license awards on November 15, 2023, all four(100%)Class2ProductionLicenses issuedaremajorityminority-ownedbusinesses.
Georgia's Hope Act (O.C.G.A. 16-12-214(c)(2)) requires the Commission to undertake a retrospective study of the participationofminorityandwomenownedbusinessesaslicensees issued under Part 2 of theActeveryfouryears:2022,2026,2030,2034,2038,2042,etc.No studyisrequiredforFY25.
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COMMISSIONCHAIR SIDJOHNSON Sidney "Sid" Johnson, III,M.G.A.,isaPublicServiceAssistantatTheUniversityofGeorgiaCarl Vinson Institute of Government. Sid is the formerCommissioneroftheGeorgiaDepartment of Administrative Services, Director of Stimulus Accountability, and Director of Implementation for the Commission for a New Georgia. Sid is appointed by GovernorBrian P.KemptoserveasChairoftheCommission.
VICECHAIR DANIELLEBENSON Danielle Benson is a small business owner and Vice President of Candid Construction Services,LLC.DanielleisappointedbyGovernorBrianP.Kemp.
MEMBER SHANEHUDSON Joseph "Shane" Hudson is an attorney with a litigation practice, HudsonInjuryFirm,in Tifton, and an owner-operator of a 4th generation pecan farming operation. Shane is appointedbyLt.GovernorBurtJones.
MEMBER BILLPRATHER William "Bill" Prather, RPh., is a licensed Pharmacist, the past PresidentoftheGeorgia BoardofPharmacy,andhasservedontheGeorgiaBoardofPharmacyfor19years.Bill isappointedbySpeakeroftheHouseofRepresentativesJonBurns.
MEMBER JASONSHEPHERD Jason M. Shepherd is a healthcare regulatory law attorney and Assistant Professor of PoliticalScienceatKennesawStateUniversitySchoolofGovernmentandInternalAffairs. JasonisappointedbyGovernorBrianP.Kemp.
MEMBER DR.JOHNSTEWART John G. Stewart, M.D. is a radiation oncologist and the medical director of radiation oncologyatDoctorsHospitalofAugustaandaClinicalAssistantProfessorattheMedical CollegeofGeorgia.JohnisappointedbyLt.GovernorBurtJones.
MEMBER CHUCKWELCH Charles"Chuck"Welch,Jr.isaContractor,formerbankdirector,andformerCouncilman in the City of Cumming, Georgia. Chuck is appointed by Speaker of the House of RepresentativesJonBurns.
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COMMISSIONSTAFF
AndrewL.Turnage,M.Ed,ExecutiveDirector JansenHead,GeneralCounsel PamJones,DirectorofInvestigations NicholeHill,LegalServicesManager RoseLawson,LaboratoryRegulatoryComplianceManager JasmineShannon,LegalComplianceAnalyst JoeSpell,SafetyandComplianceSpecialist PerryWalden,InspectionsRegulatoryComplianceManager AlexWood,LicensingRegulatoryComplianceManager CameronWood,ApplicationsandLicensingAnalyst
HISTORYANDPURPOSEOFTHECOMMISSION
The Georgia's Hope Act (O.C.G.A. 16-12-200 et seq., as amended), establishes the Georgia Access to MedicalCannabisCommission("GMCC"orthe"Commission")astheStateofGeorgiaregulatorycompliance agency to overseethesecure,indoorcultivationandmanufacturingofcannabisforthepurposeofproducing medical cannabis low-THC oil and products for patients registered on the Georgia Department of Public Health'sLow-THCOilPatientRegistry.SevenmembersareappointedtoserveontheCommission:TheChair and two members are appointed by the Governor, two members are appointedbytheLieutenantGovernor, andtwomembersareappointedbytheSpeakeroftheHouse.TheCommissionhasoneofficelocationat254 WashingtonStreet,FourthFloor,Suite420inAtlanta,Georgia30334. The Commission regulates the growing of cannabis, product manufacturing, quality assurance, laboratory testing, seed-to-sale tracking, transportation, and dispensing. The Commission oversees licensing and registrationofproductionfacilities,dispensaries,independenttestinglaboratories,designateduniversities,and research universities. GMCC is responsible for thefacilityinspections,compliance,complaintsinvestigations for its licenses and registrations. The Commission encourages active participation by minority, women, and veteranownedbusinessesandeconomicdevelopmentinTier1andTier2counties.
On April 28, 2023 safe,laboratory-testedmedicalcannabisbecamelegallyaccessibletopatientsforthefirst time in Georgiawhenthestate'sfirsttwolicenseddispensaries,locatedinMaconandMarietta,openedtheir doors for business. In addition to this historic milestone, the Commission registered the state'sfirstmedical cannabistestinglaboratory,promulgatedrules,issuedtendispensinglicenses,andhasissuedallfourClass2 productionlicenses.
GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 10

EXHIBITS
GeorgiaAccesstoMedicalCannabisCommission-2025ANNUALREPORT 11

EXHIBIT1 FY26BUDGETREQUEST

GMCC'sFY26budgetrequestbyaccountcategoryisprovidedbelow:

AcctName PERSONALSERVICES REGULAROP.EXP VEHICLEPURCHASES EQUIPMENT CPUCHARGES RENTS TELECOMM CAPITALOUTLAY CONTRACTS OTHER TOTAL

FY26 1,403,800 195,533 0 25,000 608,600 128,000 28,500 0 105,000 0 2,494,433

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EXHIBIT2 FY24-26REVENUECOLLECTION

GMCC'sFY24(actual)andFY25-FY26(projected)revenuecollectionisprovidedbelow:

FY24REVENUE(ACTUAL) APPLICATIONFEES LICENSEFEES RENEWALFEES REGISTRATIONFEES ADMINISTRATIVEFEES TOTAL

$25,000 $555,000 $340,000
$0 $0 $920,000

FY25REVENUE(PROJECTED) APPLICATIONFEES LICENSEFEES RENEWALFEES REGISTRATIONFEES ADMINISTRATIVEFEES TOTAL

$30,000 $140,000 $800,000
$4,000 $11,000 $985,000

FY26REVENUE(PROJECTED) APPLICATIONFEES LICENSEFEES RENEWALFEES REGISTRATIONFEES ADMINISTRATIVEFEES TOTAL

$120,000 $540,000 $1,080,000
$5,000 $0
$1,745,000

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EXHIBIT3 LEGISLATIVERECOMMENDATIONS
GMCC'slegislativerecommendationsforFY25areprovidedbelow:
16-12-203:Powers,dutiesandresponsibilities. 16-12-203(18)Torequireallinitialandrenewalapplicantsforalicense,registration,orpermitunderthisarticle tosubmitanapplicationorregistrationonaformestablishedbytheCommission,togetherwithatleastoneset of classifiable electronically recorded fingerprints submitted to the commission in accordance with the fingerprint systemofidentificationandestablishedbythedirectoroftheFederalBureauofInvestigation.The Commission shall transmit the fingerprints to the Georgia Crime Information Center, which shall submit the fingerprintstotheFederalBureauofInvestigationforasearchofbureaurecordsandanappropriatereportand shallpromptlyconductasearchofstaterecordsbaseduponthefingerprints.Afterreceivingthereportfromthe Georgia Crime Information Center and the Federal Bureau of Investigation,thecommissionshallreviewthe recordforallowners,officers,andemployeesoftheapplicantdemonstratingalackofconvictions,exceptfor felony connections that are greater than 10 years old, are not drug related, or have been expunged or pardoned;
16-12-215:Limitationonlocations;advertisingormarketingprohibited;informationavailableto physicians. 16-12-215(b)NolicenseeshalladvertiseormarketlowTHCoilorproductstoregisteredpatientsorthepublic; provided,however,thatalicenseeshallbeauthorizedtoprovideproductsafety,dosage,sideeffect,anddrug interaction information regarding its low THC oil and products directly to physicians andregisteredpatients, subjecttoanyrulesandregulationssetforthbytheCommission.
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EXHIBIT4 PATIENTLISTENINGTOUR
REFLECTIONSREPORT
TheGeorgiaAccesstoMedicalCannabisCommissionconvenedthestate'sfirstpatientlisteningtourholding five listening sessions between October 24, 2024 and November 21, 2024 across the state atthefollowing colleges and universities:ValdostaStateUniversity,GeorgiaSouthernUniversity,KennesawStateUniversity, MiddleGeorgiaStateUniversity,andLanierTechnicalCollege.Thepurposeofthepatientlisteningtourwasto learn from patients, caregivers,healthcareprofessionals,andthegeneralpublicabouttheirexperienceswith thestate'smedicalcannabisprogram,includingtheirfeedbackforimprovementstobetterservepatients.The patient listening tour engaged over 125 participants, including patients, physicians, nurses, pharmacists, advocates,licensees,andgovernmentemployees. The Commission deeply appreciates the patients, caregivers, healthcare and medical professionals, advocates, and the medical cannabis industry for participating in the listening tour and sharing their experiencesandrecommendations.TheCommissionwasmovedbythestoriesandlivedexperiencesshared by and about patients across the state whose lives have been significantly improved through the use of medicalcannabis. FollowingisareflectionsreporttosharehighlightsandinformationtheCommissionreceivedfromstoriesand testimonies:
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PATIENTLISTENINGTOURREFLECTIONSREPORT
TableofContents
Introduction..............................................................................................................................3 PatientsandPhysiciansNotAwareoftheMedicalCannabisProgram.............................4
EngageinOutreachforGeorgia'sMedicalCannabisProgram........................................................4 RenametheLowTHCOilPatientRegistrytoReflect"MedicalCannabis"......................................5 ImproveandIncreaseCommunicationsAbouttheLowTHCOilPatientRegistry...........................6 AllowLicensedEntitiestoEducatePublicAboutMedicalCannabisProducts.................................6 PatientsWantEquityintheQualifyingMedicalConditions................................................7 Remove"Severe"and"EndStage"fromtheListofQualifyingMedicalConditions.........................7 AddMoreQualifyingMedicalConditionstothePatientRegistryStatute.........................................8 AllowPhysicianstoDecideWhetherTheirPatients'ConditionsQualify..........................................9 PatientsNeedMoreProductTypeswithHigherTHC.........................................................10 IncreaseLevelofTHCforSevereandEndStageConditions........................................................10 ExpandTypesofProductsAllowed.................................................................................................11 PatientsStillFaceBarrierstoAccessingMedicalCannabis.............................................11 ProvideImmediateorQuickerDeliveryofRegistryCardstoPatients............................................12 AllowDeliveryofMedicalCannabistoPatients..............................................................................13 SupportPharmaciestoDispenseMedicalCannabis......................................................................14 PhysiciansNeedEducationandInformation......................................................................15 EducatePhysiciansAboutGeorgia'sLowTHCOilPatientRegistry..............................................15 EducatePhysiciansAboutCannabisandtheEndocannabinoidSystem.......................................16 PatientsWantLegalProtectionsForCertainBenefitsandRights...................................17 ProtectEmploymentStatus............................................................................................................17 ProtectSecondAmendmentRights................................................................................................18 ProtectBenefitsandRightsofMilitaryVeterans.............................................................................18 ProtectBenefitsandRightsofPatientsinHospiceCareorotherLong-TermCare.......................18 HighlightsofPatientTestimonials.......................................................................................19

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PATIENTLISTENINGTOURREFLECTIONSREPORT
Introduction
In creating the state's medical cannabis program, the Georgia General Assembly made clear that "thousands of Georgians have serious medical conditions that can be improved by the medically approveduseofcannabisandthatthelawshouldnotstandbetweenthemandtreatmentnecessary for life and health." (Preamble to Georgia's Hope Act). With that in mind, the Georgia Access to MedicalCannabisCommission("GMCC"or"Commission")convenedthestate'sfirstpatientlistening tour holding five listening sessions between October 24, 2024 and November 21, 2024 at the followingcollegesanduniversities:ValdostaStateUniversity,GeorgiaSouthernUniversity,Kennesaw StateUniversity,MiddleGeorgiaStateUniversity,andLanierTechnicalCollege.
The purpose of the patient listening tour was to learn from patients, caregivers, healthcare professionals, and the general public about their experiences with the state's medical cannabis program,includingtheirfeedbackforimprovementstobetterservepatients.TheCommissioninvited the following agencies to participate or attend the listening sessions:GeorgiaDepartmentofPublic Health, Georgia Composite Medical Board, Georgia Board of Pharmacy, and the Georgia Attorney General'sOffice.Theseagenciesplayacriticalroleinthestate'sprogram.AlthoughonlytheGeorgia AttorneyGeneral'sOfficeattendedthelisteningtour,theCommissioncontinuedtoinviteandlistento feedbackrelatedtotheotherstateagenciesandtheirrespectiverolesintheprogram.Throughoutthe listening tour, participants acknowledged that the majority of their feedback were about issues or challengesthatrequireachangeinstatelaw.
Each listening session began with a presentation bytheCommission'sgeneralcounselhighlighting thestate'smedicalcannabisprogram.TheCommissionanditsleadershipstaffservedonapanelto listen to participants who shared their experiences and feedback. Participants also engaged in discussions with the panel during the question and answer portion of each listening session. Participantswerenotrequiredtoregisterinadvancetoattendandnotlimitedintimetospeak.
The Commission expresses deep appreciation to the patients, caregivers, healthcare and medical professionals, and the medical cannabis industry for participating in the listening tour and sharing their experiences and recommendations. The patient listening tour engaged over 125 participants, including patients, physicians, nurses, pharmacists, advocates, licensees, and government employees. Participants were encouraged to be respectful and mindfulofthepersonalexperiences shared during each listening session. This created and fostered a comfortable, open, and safe environmentthatencouragedparticipantstospeakandsharetheirexperiences.
The Commission understands that the needs and voices of patients in Georgia are the foundation andcompassofthisprogram.Assuch,theCommissionanditsstaffpreparedthisreporttohighlight and summarize those voices as shared with the Commission throughout the patient listening tour. The summaries presented and other features in this report are based on the opinions and perspectivesoftheparticipantsandshouldnotbeconstruedasanexpression,perspective,practice, orviewpointoftheCommissionoritsstaff.

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PatientsandPhysiciansNotAwareoftheMedicalCannabisProgram
Participants strongly emphasized that the state needs to educatepatients,healthcareandmedical professionals, and the general public that Georgia has a legal medical cannabis program and the parametersoftheprogram.TheCommissionheardfromcountlesspatientsandphysiciansthatthey eitherdidnotknowthemedicalcannabisprogramexistedortheydidnotknowthatthepatientshad medicalconditionsthatcouldqualifythemtousemedicalcannabisforreliefandtreatment.
EngageinOutreachforGeorgia'sMedicalCannabisProgram Physicians, pharmacists, and registered nurses stronglyexpressedtheneedforthestatetoengage inoutreachandprovideeducationtohealthcareand medical professionals about the state's medical cannabis program, especially the state's Low THC Oil Patient Registry ("patient registry"). Participants repeatedly emphasized that patientscannotaccess medical cannabis products regulated by the Commission ("medical cannabis" or "medical cannabis products")iftheydonotknowaboutit.Theseparticipants,inadditiontopatientsandtheircaregivers, expressed the need and desire for a collaborative effort to come from the Commission, Georgia Department of Public Health ("DPH"), and Georgia Composite Medical Board ("GCMB")toeducate physiciansaboutthestate'sprogram.
Participants expressed that there is notenoughinformationavailableortargetedtotherightgroups aboutthefollowing:
ExistenceoftheLowTHCOilPatientRegistry
Requirementstoapplyforandobtainaregistrycard
Requirementsofphysiciansincertifyingpatientsforaregistrycard
Methodsofreliefandtreatmentusingmedicalcannabis
Typesofmedicalcannabisproductsavailable
Wheremedicalcannabisproductscanbepurchased
Explanationofdifferencesbetweenmedicalcannabisproductsandhempproducts
Participants expressed an overwhelming belief that medical cannabis is a safe alternative to prescription opioids and provides treatment and relief for many health conditions, but the stigma associated with marijuana negatively impacts the acceptance, understanding, and use of medical cannabis.Participantsfeltthatphysiciansrelytooheavilyonprescribingopioidsforpainmanagement

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despite the fact that opioids often lead to addiction and make it difficult for patients to function normally and productively. The Commission heard from several participants that described their misuse, abuse, and addiction to opioids and how medical cannabis helped them to stop taking or becoming dependent on opioids, and return to a more normal way of life. These participants repeatedlyexplainedthatifmedicalcannabisdidnothavesuchastigma,andifpeoplecouldseethe positives without thinking about all the negative things society has been told about cannabis, then physicians would be more likely to recommend cannabis as a form of relief or treatment for their patientsandpatientswouldhaveabetterunderstandingoftheirtreatmentoptions.
RenametheLowTHCOilPatientRegistrytoReflect"MedicalCannabis" Participants repeatedly expressed that the term "low THC oil" is confusinganddoesnotaccurately reflect the type of medical cannabis products allowed and currently available in Georgia. Patients explainedthatwhentheyhearorseetheterm"lowTHCoil",theythinkitreferstoa"lowerquality"or "cheaper" product, a hemp product (that contains no more than 0.3%THC),orsomeotherproduct thatwouldnotprovidetheformofrelieftheyneedfortheirmedicalconditions.Theysharedthatthey wouldoftensayorhearfromothersthattheywant"therealstuff"andnot"thatlowTHCoilstuff."
Several patients shared that they thoughttheonlytypeofproductallowedandavailablewerelarge bottles containing 20 fluid ounces of oil. Patients explained that "oil" is the only referenced formof medical cannabis product in the statute for the patient registry in O.C.G.A. 31-2A-18 ("patient registrystatute"),inthenameofthepatientregistry,andinthetitleonthefrontsideofaregistrycard. TheyalsoexplainedthattheDPHwebsiteonlyrefersto"lowTHCoil."
Patientsfurthersharedthatthismisunderstandingiswidespreadacrossthestate,includingwithlocal and state law enforcement officers. They explained that the DPH website specifically for law enforcement states that the "law does not legalize the possession of any types of marijuana in Georgia except 20 fluid ounces of Low THC Oil for personswithavalid[registrycard]."Oneofthe patients explained that DPH noted the reason for this is thepatientregistrystatutewhichmentions "oil"astheonlyallowabletypeofmedicalcannabisproduct.
Participants expressed confusion astowhythepatientregistrystatuteonlyusestheterm"lowTHC oil"whileGeorgia'sHopeActrefersto"medicalcannabis"andotherformsofproductsotherthanoil. Participants also pointed out that theterm"medicalcannabis"isusedintheCommission'sfulllegal name ("Georgia Access to Medical CannabisCommission")butisnotusedinthefulllegalnameof the patient registry ("Low THC Oil Patient Registry"). To address these concerns, participants recommendedthattheterm"lowTHCoil"beremovedandreplacedwiththeterm"medicalcannabis" inthepatientregistrystatuteandGeorgia'sHopeAct(O.C.G.A.16-12-190etseq).

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ImproveandIncreaseCommunicationsAbouttheLowTHCOilPatientRegistry Participants expressed great appreciation to the Commission for conducting the listening tour throughout the state, and recommended more listening sessions to reach more communities and geographic areas. Participants expressed that a concerted effort by the various state agencies involvedintheprogramwouldbeevengreaterandmoreefficientinprovidingclearinformationabout theprogram,thebenefitsofmedicalcannabis,andthestepsinvolvedtogetapatientcertifiedwhich wouldnotonlybenefitthepatient,butalsotheprogramasawhole.
Physicians, patients and their caregivers, and patient advocates shared that DPH does not communicatewiththemregardingchangesorupdatestothepatientregistry,suchastheprocessto certifypatientsandtheformsrequiredtocompletesuchcertification.Theyexplainedthatthislackof communication can create delays for patients in obtaining a registry card, accessing medical cannabis,orboth.
Several participants shared that DPH changed the certification page without providing information about the updates to physicians, which resulted in several physicians completing the wrong certification form. They explained that the physicians did not know they completed the wrong form until days or weeks later after their patients' appointments with them. This would cause not only confusionbetweenthephysicianandpatient,butwouldcauseadelayinaccesstomedicalcannabis.
Participants also shared that DPH recently changed the payment process for registry cards. They explained that DPH sends patients an email with a hyperlink that expires after a few days. ParticipantsexplainedthatthischangewasnotcommunicatedonDPH'swebsiteorinanyotherform ofcommunicationtopatientsorphysicians,causingconfusion,frustration,anddelay.
To address these concerns and challenges, participants recommended that DPH provide more information in a timely manner on their website and create an email listserv or notification list for those interested in updates to the patient registry and the process. In addition, patients expressed that a public list of physicians who are able and willing to certify patients to use medical cannabis wouldbehelpfulandremovebarrierstothestate'sprogram.
AllowLicensedEntitiestoEducatePublicAboutMedicalCannabisProducts ParticipantsexpressedthatGeorgiashouldallowcompanieslicensedbytheCommissiontoadvertise and markettheirmedicalcannabisproductssothatthepublicunderstandswhichproductsarelegal and where to find them. They explained that the companies are knowledgeable and have the resourcestoprovideeducationaboutthetypesofmedicalcannabisproductsallowedandavailablein Georgia, the benefits and side effectsofsuchproducts,andthepackagingandlabelinginformation providedwitheachoftheirproducts(e.g.ingredients,instructions,expiration,etc).

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PatientsWantEquityintheQualifyingMedicalConditions
Physicians, registered nurses, hospice care facilities, and patients and their caregivers strongly emphasizedtheimportanceoftrustingphysicianstodeterminewhethertheirpatients'symptomsfrom anymedicalcondition--evenifnotlistedinthepatientregistrystatute--canberelievedbyortreated withmedicalcannabis.Theyfurtheremphasizedthateachpatientisunique,wherethesymptomsof thesamemedicalconditionorsame"stages"ofsuchconditioncanimpactpatientsdifferentlybased onthepatient'soverallhealthcondition,healthhistory,allergiesorsensitivities,andotherfactorsthat areuniquetothepatient.
Remove"Severe"and"EndStage"fromtheListofQualifyingMedicalConditions
The most commonly expressed concern throughout the listening tour is therequirementin the patient registry statute (O.C.G.A. 31-2A-18) for medical conditions to be diagnosed by a physician as "severe" or "end stage" before the physician can recommend the use of medical cannabis to their patients. Physicians, registered nurses, and patients pointed out that the terms "severe" and "end stage" in the patient registry statute are subjective qualifiers forhalfofthelisted medical conditions not defined.Physiciansexpressedconfusionabouttheuseofthesetermsinthe statutewhensuchconditionsareinherentlysevereorattheendstage.
Physicians and registered nurses expressed that the "severe"or"endstage"qualifiersoftheirpatients'medical conditions are unique to each patient, even among patients who have been diagnosed with the same or similar medical conditions. For example, they commonly referred to the patient registry statute requiring cancer (without regard to the typeofcancerorthepatient'spre-existinghealthconditions)tobediagnosed as"endstage"andemphasizedthatapatientwithastage1cancerdiagnosiscanexperiencecancer symptomsandcancertreatmenteffectstobejustasdebilitatingorpainfulasthoseexperiencedbya patient with astage3cancerdiagnosis.Theyalsoemphasizedthatonepatientwithstage3cancer mayhaveadiagnosisdetailedasan"advancedstage"butnotdiagnosedas"endstage."
Physicians and patients pointed out that other qualifying medical conditions in the patient registry statutearenotrequiredtobediagnosedas"severe"or "end stage" such as Crohn's disease and seizure disorders,eventhoughthoseconditionscanbejustas debilitatingasothersrequiredtobediagnosedassuch. Participants expressed frustration and confusion as to why the statute requires some of the listed

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medical conditions to be "end stage" when many are chronic or lifelong conditions, not end stage conditions. For example, a patient with multiple sclerosis shared that in their experience and knowledgeoftheircondition,multiplesclerosisisnottypicallyassociatedwithbeing"endstage"asit isnottypicallyacauseofdeathformostwiththiscondition.

Physicians, hospice care facilities, and registered nurses stronglyemphasizedthatthestateshould not makeapatientwaituntiltheirmedicalconditionprogressestoanadvancedstageinordertobe certified to use medical cannabis. They were concerned this can lead to situations where medical
conditions quickly progress to where patients succumb to their medical conditions before going through all the steps to apply for a registry card, waitfortheregistrycardtobedelivered,andtravel to a dispensary (if thepatientisphysicallyableto and has the means to travel) to have access to medicalcannabis.

AddMoreQualifyingMedicalConditionstothePatientRegistryStatute
Physiciansandpatientsstronglyexpressedaneedtoincludemoremedicalconditionsinthepatient registry statute that would allow more patients to use medical cannabis for medical relief and treatment. Physicians,registerednurses,patientsandtheircaregivers,andpatientadvocatesasked forthefollowingmedicalconditionstobeaddedtothelistinthestatute:

Anxiety Arthritis Attention-Deficit/HyperactivityDisorder ChronicPain Depression Dysmenorrhea Endometriosis Fibromyalgia Glaucoma

Insomnia InflammatoryBowelDisease Lupus Menopause Migraines NeurodegenerativeDisorders OpioidAddiction Osteoarthritis PolycysticOvarySyndrome

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AllowPhysicianstoDecideWhetherTheirPatients'ConditionsQualify Physicians, patients, and patient advocates expressed concerns that those who recommend or make changes to the patient registry statutes do not understand the medical conditions, personally or professionally, and were concerned that such individuals are making decisions that can significantly impactandlimitpatients' medicaloptions,treatmentplans,andqualityoflife.They strongly emphasized that unlike many of those individuals who are not healthcare or medical professionals, physicians have the expertise with treatingconditionsandthephysician-patientrelationshipstoprovidethe"qualityofcare"thatpatients requireforthereliefandtreatmentofvariousmedicalconditions.
Participants emphasized that physicians have the expertise, knowledge, and patient records to determine--foreachoftheirpatients--whethermedicalcannabiscouldbepartofthetreatmentplan formanagingsymptomsandlong-termeffectsofvariousmedicalconditions.Theyfeltthatthepatient registry statute restricts physicians in a way that could negatively impact or burden the physician-patient relationship. To address this, they recommended the following changes to the patientregistrystatute:
Removethelistofsixteenqualifyingmedicalconditionsandreplacethelistwithlanguagethat allows physicians to determine whether a patient has a medical condition that could be alleviatedortreatedbytheuseofmedicalcannabis.
If keeping the list of sixteen qualifying medical conditions in the patientregistrystatute,then addlanguagethatallowsphysicianstomakeadeterminationastowhetherapatient'smedical condition(notlistedinthestatute)maybealleviatedortreatedbytheuseofmedicalcannabis.
Physicians, patients, and patient advocates shared that several states with medical cannabis programs have one of the two recommendations listed above in their respective statutes. They expressed that physicians are trusted to understand how medical conditions impact each of their patients, andthatphysicianshavetheexpertisetodeterminewhethermedicalcannabiscanbepart oftheirpatients'treatmentplanstomanagesymptomsoftheirmedicalconditions.Theyemphasized that physicians are trusted andabletorecommendandprescribeoverthecountermedicationsand prescription medications (including opioids) for their patients, and that they should have the same trustandabilityinrecommendingmedicalcannabisfortheirpatients.

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PatientsNeedMoreProductTypeswithHigherTHC
Physicians,registerednurses,patientsandtheircaregivers,andpatientadvocatesfeltthatGeorgia's HopeActdoesnotallowtheamountofTHCinmedicalcannabisnecessarytoprovidemedicalrelief for several patients with qualifyingmedicalconditions.Theyexplainedthecurrentallowableamount inmedicalcannabisproductscannotcontainmorethan5%THC,andalthoughitprovidessomerelief for conditions that are less severe or debilitating, it is not enough for over half of the medical conditionslistedinthepatientregistrystatute.Physiciansandpatientsexpressedthateachpatient's body,overallhealthcondition,anddiagnosedmedicalconditionisunique,andthatsimilartooverthe counter and prescription medications, their individual reactions and responses to medical cannabis products in Georgia will vary based on the level of THC in the products and the types of administration route. Participants also expressed thatthelimitedproducttypesallowedinGeorgia's HopeActdonotprovideimmediateorquickonsetreliefwhichisnecessaryforpatientssufferingfrom medical conditions that are associated with acute or sudden symptoms (e.g. seizures, periodic episodesofextremepain,severeanxiety).
IncreaseLevelofTHCforSevereandEndStageConditions Patientsexpressedappreciationfortheavailabilityofmedicalcannabisproducts,butalsoexpressed theirneedsformoreTHCintheproductssoastofeelthereliefneededfromtheirmedicalconditions. Patients shared their experiences using prescription medications including opioids, and explained how their physicians would treat the side effects to those by prescribing additional prescription medications. Patients expressed concerns about taking too many prescription medications and the possibleimpactsontheirbodyastheycontinuetoageandastheirconditionscontinuetoprogress.
Patients shared that they suffer from extreme pain and have built up a pain-tolerance level that requiresahigherdoseofTHCthancurrentlyallowedbyGeorgia'sHopeActtobeeffectiveattreating thepain.Patientsexplainedthatifapatient'sconditionis"severe"orat"endstage,"thenthe5%THC allowed is "like giving baby aspirin to someone with end stage cancer." A patient with Parkinson's disease shared that the medical cannabis products do not help them much, and even thoughthey have a registry card, they purchase illegal products in and out of state to get products with higher THCtolessenorrelievetheirtremors,mobilityissues,andotherphysicalsymptoms.
Patients and physicians explained that having access to products with more than 5% THC would mean less use of legal and illegal products, less costs to the patients from purchasing several medical cannabis products, and less likelihood of patients self-medicating beyond a physician's recommendationandtreatmentplan.PatientssharedthatuntilGeorgia'sHopeActchangestoallow morethan5%THCinmedicalcannabisproducts,theymustcontinuetousemultipleproducts(legal andillegal)atatimetoalleviatepainandseekrelieffromtheirmedicalconditions.

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ExpandTypesofProductsAllowed Physicians, registered nurses, hospice care facilities, patients, and patient advocates shared that patients are often told to "start low andgoslow",butifapatientisincrisis,theydonothave30-60 minutes to wait and see if the first doseofthemedicalcannabisproductwasenoughtorelievethe painorsymptomsoftheirmedicalcondition.Fortincturesandingestibles,theparticipantsexplained thatthetypicalonsetis30-60minutes,whichistoolongtowaitforwhenapatientisexperiencinga severesymptomoftheirmedicalconditionthatcouldleadtoapaincrisisormedicalemergency.
Participantssharedthatotherproducttypes,suchasvapesandotherinhalationproducts,providea rapidonsetofrelief.PhysiciansexplainedthattheirpatientswithseizuresandPTSDhaveonlyafew seconds to a few minutes to seek relief before their symptoms become progressively worse or becomeamedicalemergency,andthatthisisassumingthereisanytimetorealizeorrecognizethe occurrenceofanacuteorsuddensymptomofthemedicalcondition.
Patients and patient advocates expressed that the best form of relief depends on the medical condition, and that patients should have options to access different types of medical cannabis products to obtain the relief they need. For example, a patient with Crohn's disease shared that because of their condition, they are not able to obtain relief using any ingestible products such as tinctures,capsules,ortroches.TheyexplainedthatCrohn'sdiseasemakesitdifficultfortheirbodyto absorb vitamins and minerals. They further explainedthatothermedicalconditionsanddiseasesof thegallbladder,liver,andkidneyscanalsocausethisissue.
Asanotherexample,apatientwithcancerexplainedthattheycannotuseproductscontainingsugar because it accelerates cancer and worsens their symptoms. Thepatientfurtherexplainedthatthey cannot use medical cannabis products that are oil based (i.e. all products currently allowed in Georgia) because the oil feeds the type of cancer they have. The patient shared that they have a registry card, but they travel across statelinestopurchaseflowerwhichtheyfindisbesttoprovide relieffromtheirpainandsymptomsassociatedwithcancer.
PatientsStillFaceBarrierstoAccessingMedicalCannabis
Physicians,pharmacists,patientsandtheircaregivers,andpatientadvocatesexpressedthatpatients cannot access medical cannabis if their registry cards are not being delivered to them in a timely manner. Participants pointed out that the patient registry statute was changed during the 2024 legislative session to allow DPH to deliver registry cards electronically to patients, but shared that DPH's rules and policies indicate that DPH is notcurrentlyutilizingthisdeliveryoption.Participants alsoexpressedconcernsandsharedexperienceswherepatientsarenotabletotravelfardistances, ifatall,fromtheirresidencetooneofafewlicenseddispensariesinGeorgiaoncetheyreceivetheir registry cards. In addition to recommending direct delivery of medical cannabis to patients, participants expressed great appreciation for the state in allowing patients to purchase medical cannabis at their local pharmacies, emphasizing the convenience of driving justashortdistanceto receivemedicalcannabis.

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ProvideImmediateorQuickerDeliveryofRegistryCardstoPatients Participants expressed appreciation for the change in the patient registry statute during the 2024 legislative session, which allows patients to request DPH to deliver their registry cards to them directly "either via certified mail or by secure electronic means, including email." However, they sharedthatDPHiscurrentlynotallowingforthedeliveryofregistrycardselectronically.Theyshared that DPH is mailing registry cards once a week to patients via UPS which requires the recipient's signatureupondelivery.Theyexplainedthatthesignatureuponreceiptappearstoberequiredinthe patientregistrystatutewhenreferringto"certifiedmail."
Patients shared their experiences in waiting fortheregistrycardstobedelivered.Theyexplainedit canstilltakeupto10daysormoreforapatienttoreceivetheirregistrycardafterthepatientpaysfor the card online. Participants emphasized that this is too long for patients suffering from such significant health diagnoses and for some, they have and will pass away waiting for their registry cardstobedeliveredtothemormadeavailableatalocalhealthoffice.
Healthcare professionals involved in hospice care programs explained and shared the impact this delay has on their patients who are either in-patient or out-patientsoftheirhospicecareprograms. Theyexplainedthatforin-patients,thoseindividualsareusuallyincriticalconditionandneartheend oflife,rarelyreceivingrelieftheyneedbecausetheneedisimmediate.Theyfurtherexplainedthatfor out-patient, morphine is more quickly available before the registry card has been issued,andeven then,theout-patientisnotinaconditiontodrivetoalocalhealthofficetopickuptheirregistrycardto thendrivetooneofthefewlicenseddispensariestopickuptheirmedicalcannabisproducts.
Participants pointed out that other state agencies in Georgia, and other states, have utilized more efficient means to deliver state-issued cards, including identification cards that are temporary or permanent, digital or printed, and are accessible through a mobile application or electronic mail. Participantssuggestedthefollowingformoretimelyissuanceandreceiptoftheregistrycards:
Upon the state's approval of an application for a registry card,thestatecouldissueadigital registrycardviaelectronicmailoramobileapplicationthatcanbeprintedorscanned(e.g.QR codeorbarcode)andusedatlicenseddispensaries.Participantspointedoutthatinstitutions of the University System of Georgia, the Georgia Department of Driver Services, and other governmententitiesinGeorgiahavesimilarsystemstoissueanddeliverstatecards.
Patients should have both adigitalandphysicalregistrycard,sincestateregulationsalready require state-licensed dispensaries and pharmacies to check both the patient's registry card andanotherformofidentification.
Similar to other jurisdictions (e.g. District of Columbia, Florida, Texas), patients should have immediate access to their registry card (e.g. digital or downloadable card) upon payment of

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such card, so that the patients can access medical cannabis on the same daythatthecard becomeseffective.
Physicians, registered nurses,andpatientsemphasizedthatwhenaphysicianwritesaprescription, the patient does not have to wait a week or two to pick up their prescription. In contrast, when a physiciansubmitsanapplicationforaregistrycardandrecommendsmedicalcannabisforapatient, thepatienthastowaitweekstoreceivetheirregistrycard,andthenwaittofindthemeanstotravelto a dispensary to pick up the medical cannabis as recommended by their physician. Participants expressed that if Georgia truly seesmedicalcannabisasaformofmedicalreliefortreatment,then thereshouldbenounduedelaytoallowpatientstoaccesstherelieftheydesperatelyneed.
AllowDeliveryofMedicalCannabistoPatients Participants strongly emphasized the need for dispensaries licensed by the Commission to be allowedtodelivermedicalcannabisdirectlytothepatients,ratherthanrequiringpatientswithsevere medical conditions to find their own transportation or be forced to travel far distances. Participants recommended that, like states with medical cannabis programs, Georgia should allow delivery of medicalcannabistothepatients'homesorplaceofresidence,includinglong-termcarefacilities.

ParticipantspointedoutthatGeorgia'sHopeActlimitsthenumberoflicenseddispensariesregulated bytheCommission,andthatconsequently,therearenotenoughlicenseddispensariestoadequately cover the various geographic areas of the state. Participants further explained that the number of licensed dispensaries, under currentlaw,dependsonthenumberofpatientsonthepatientregistry, whichpreventsadditionaldispensariesfrombeingallowedtoopenandreachmoreruralareasofthe state. Even if the lawchanged,participantsexpressedconcernsonwhetherthecurrentdemandfor medicalcannabiswouldsupporttheopeningandoperationsofmoredispensaries.
Patients emphasized the need for meaningful and realistic access to medical cannabis forpatients whohavesevereorendstagemedicalconditions.Severalpatientssharedthatengaginginphysical movements or travel canbedifficult,ifnotalmostimpossible,withtheirmedicalconditions.Patients emphasized that senior citizens, some living in senior living centers, often have mobility issues, transportation barriers, or are otherwise not able to leave their residence and travel such long distances. Some expressed that they have even struggled to get out of their vehicles after a long driveoncetheyarriveatalicenseddispensary.
An employee of a licensed dispensary shared that their employees assisted a patient who drove hourstotheirdispensaries,andhaddifficultystandingandwalkingafterdrivingalmost3hourstothe

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dispensary.Participantsareconcernedthatthistypeofhardshipisnotjustthetimeittakesgettingto and from the dispensary, but the additional costs and stress of the travel for the patients who are alreadyexperiencinghardshiprelatedtotheirmedicalconditions.
Participants shared data showing that patients in Georgia are driving more than 2 hours--one way--to alicenseddispensarytoobtainmedicalcannabis.Participantsexpressedthatpatientswho are hours away from the closest dispensary should have the ability to have medical cannabis delivered to them directly, and that the current rules of the Commission already provide for secure andtrackedtransportationofmedicalcannabisbetweenproductionfacilitiesanddispensaries.
SupportPharmaciestoDispenseMedicalCannabis Physicians,registerednurses,pharmacists,andpatientsfeltstronglythatGeorgiashouldcontinueto allowpharmaciestodispensemedicalcannabisandcontinuetosupportthosepharmaciesevenifthe U.S.DrugEnforcementAdministration("DEA")continuestotrytointerferewiththestate'sprogramas participantsfelttheydidin2023.Patientssharedthattheystronglysupporttheavailabilityofmedical cannabis through theirlocalpharmacies.Manyexplainedthattheywanttopickuptheirprescription medications and their medical cannabis at one place, and be able to speak with their pharmacists whotheyknowandtrust.
Pharmacists who participated in the listening sessionssharedthatshortlyaftertheGeorgia BoardofPharmacyauthorizedpharmaciesto dispensemedicalcannabis,theDEAsentout communications to pharmacies that they are not authorized to do so under federal law. They explained that in late 2023, the DEA issued written communication via electronic mail and physical mailwarningthatpharmaciescannot lawfully possess, handle, or dispense medical cannabis. They furthersharedthatDEAagentsfrom division offices in Georgia also made unannounced, in-person visits to Georgia pharmacies asking questionsaboutthepharmacies'involvementinthestate'smedicalcannabisprogramandlookingfor medicalcannabisproductsintheirpossession.
Pharmacists shared that the DEA warned them and several other pharmaciesthatiftheydispense medical cannabis in Georgia,thentheywillbeinviolationoftheFederalControlledSubstancesAct and could face penalties including the loss of their DEA permit to dispense other controlled substances, closure oftheirpharmacy,facejailtime,beissuedsignificantfines,oracombinationof suchconsequences.PharmacistsemphasizedthatduetotheDEA'sefforts,pharmacieslicensedby the state to dispense medicalcannabis,includingpharmaciesinterestedindoingso,areconcerned aboutfurtherinterferenceandthreatsfromtheDEA.Pharmacistsexplainedthattheirlocalbusiness is their livelihood, and that many communities rely on their locations for local access to medicine. PharmacistsexpressedthattheyfeelintimidatedbytheDEAandneedsupportfromthestate.

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PhysiciansNeedEducationandInformation
Participants expressed that medical cannabis should be treated thesameasanyothermedication. When a physician prescribes traditional medications, the doctor is specific about the type of medication (oral, inhaled, topical) as well as how much a patient should take andwhen.Whenthe samephysicianrecommendscannabis,thephysicianusuallydoesnotprovideanyguidance,soitis leftuptothedispensarytoeducateandhelpthepatientchoosetheproducttypeandamount.Along the same lines, physicians felt the treating physician should track the patient's cannabis use and effectivenessofthetreatment,justasheorshewouldtrackothermedicationsprescribed.

EducatePhysiciansAboutGeorgia'sLowTHCOilPatientRegistry Several physicians expressed a need for a better understanding about the patient registry and the processtocertifyapatienttousemedicalcannabisformedicalreliefandtreatment.Physiciansand patients noted that the certificationprocessiscomplexandtimeconsumingandifastepismissed, thenitbecomesevenmoredifficult.
Physicians,patientsandtheircaregivers,andpatientadvocatessharedthefollowingchallengesand issuestheyhaveexperiencedwiththepatientregistry:
DPH requires a "wet signature" on the forms which requires either multiple trips to the physician with signed and notarized forms or regular postal mail, both of which delay the process.
Oncethecertificationiscompleteandprocessed,DPHsendsatimesensitivelinkviaemailto patientsforpaymentoftheirregistrycard.Ifthepatientmissestheemail(ordoesnotreceive it) and the link expires, then the patient has to start over and request a new linkfromDPH, againaddingdelay.
Physicians and patients have difficulty updating information in the patient registry, especially whenapatientchangesphysicians.Participantsexplainedthatthenewphysicianisnotableto update the patient's records in the patient registry. For example, if a patient did not have a caregiver associated with their profile in the patient registry, physicians are not able or find difficulty in adding or changing the caregiver information after the patient has beenissueda registrycard.
Physicians are uncertain on what forms are required, if any, by the state in follow-ups with patientswhilethepatientisusingmedicalcannabisforreliefandtreatment.

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These participants also expressed difficulty in adding, removing, or updating information about patients'caregiversinthepatientregistry.
Physicians explained they have difficulty changing caregivers in the patient registry once a registrycardisissued.Theyexplainedthattherearetimeswhenapatientneedsanimmediate changetotheircaregiverwhichisnotpossiblewhenthepatienthasanewphysicianandonly theoriginatingphysiciancanmakethosechangesinthepatientregistry.
Physiciansalsoexplainedthatpatientsmaynothavehadacaregiveratthetimetheyreceived their registry card, and when the patients are admitted to longtermcarefacilitiesorhospice programs, the patient is not able to rely on the facility to pick up their medical cannabis products for them or isotherwisenotabletohavesomeonedosowhenacaregiverwasnot listedwiththeirprofileinthepatientregistry.
Patientsandphysiciansexpressedtheneedforpatientstobeabletoupdatetheirinformation inthepatientregistryabouttheircaregiversatthelicenseddispensaries.
Participants expressed that the definition of caregiver needs to be expanded and that the numberofcaregiversshouldnotbelimitedtotwocaregivers:
Participantsexpressedconcernsthatthecurrentdefinitionof"caregiver"inDPH'srules regardingthepatientregistryislimitinganddoesnotallowforadultpatientstoselecta caregiver unless the caregiver is the parent, legal guardian, or legal custodian of the patient. They explained that there are instances where an adult patient may want or needacaregiver(orcaregivers)astheyarenotable(financiallyorphysically)totravel to a dispensary themselves for any number of reasons. For example, some adult patientssharedthattheirsiblings,adultchildren,spouse,orpartneraretheiremergency medical contact person or otherwise permitted to receive medical information about them. Patients expressed confusion as to why those individuals cannot also be their caregiverslistedinthepatientregistry.
Participants alsoexpressedthatcaregiversarenotalwaysbloodrelatives,spouses,or partners. They explained that caregivers may be a representative at a longtermcare facility, a representative of a hospice care program, or a close friend.Becausenotall patients have living family members who can serve a caregiver role, participantsalso sharedtheirneedtohavemorethanjustoneortwocaregivers.
EducatePhysiciansAboutCannabisandtheEndocannabinoidSystem Physicians,registerednurses,andpatientsfeltthathealthcareandmedicalprofessionalsneedmore educationaboutmedicalcannabis,includingitsbenefits,risks,andpossibledruginteractions. There wasaconsensusacrossthesessionsthathealthcareprofessionalsneedacomprehensiveresource guideaboutmedicalcannabisandhowthemedicalcannabisprograminGeorgiaworks.Participants strongly felt that physicians should be educated and have the resources to guide their patients on

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how medical cannabis products can be used to treat their medical conditions, rather than leaving patientstofigureitoutontheirown.
Physicians and registered nurses shared that they, along with their colleagues, did not learn about the endocannabinoidsystemandcannabinoidsinschool, andfurthersharedthatitisnotcurrentlytaught.They alsoexpressedthatphysiciansshouldberequiredby the GCMB to complete continuing medical education ("CME") courses or otherwise obtain CME creditsrelatedtomedicalcannabisinordertocertifypatients.Participantsfeltthathavingphysicians whoareknowledgeableaboutmedicalcannabiscertifyingpatientsonthepatientregistrystrengthens theprogram.
PatientsWantLegalProtectionsForCertainBenefitsandRights
Several participants were hesitant to speak during the listening session due tofearofjudgment,of beingreportedtolawenforcementforsharingtheirexperienceswithmedicalcannabis,oflosingtheir job,orofhurtingtheirreputation.Thoseparticipantswhodidspeakexplainedthatsuchfearsandthe stigma of talking about medical cannabis would fade over time if Georgia fostered more public discussions and outreach about its medical cannabis program. In some listening sessions, participants who felt such fears waited until the room or building cleared out to share their experiences with GMCC. The majority of these participants were active military members, military veterans,employeesofeducationinstitutions,andemployeesoflocalgovernment.
ProtectEmploymentStatus Patients expressed concerns and fears about losing their jobs or not getting hired for being known as a registry card holder or for testing positive for cannabis as a result of their lawful use of medical cannabis as recommended by their physicians. They explained that unlike other states, Georgia does not provide any protections in the statutes prohibiting employers from discriminating against employees who have a registry card or who test positive for cannabis when theirlawfuluseofmedicalcannabisisdoneathomeandwithoutimpactingtheirworkperformanceor safety. Several participants shared that their place of employment has a "drug free policy" suchas local andstategovernment,schoolsystems,andprivateemployers.Participantsrecommendedthat Georgia look at other states that haveprovidedsuchlegalprotectionsintheirstatestatutes,andto work withtheGeorgiaDepartmentofLaborandotherstateagenciestocreatepoliciesandpropose legislationthatprotectspatientsintheworkplacefromdiscrimination,discipline,orterminationbased ontheirstatusasapatientonthepatientregistryandbasedoninformationrelatedtotheirlegaluse ofmedicalcannabissolongassuchusedoesnotinterferewithworkperformanceorsafety.

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ProtectSecondAmendmentRights
Patients,especiallymilitaryveterans,expressedconcernsregardingtheirsecondamendmentrights. They shared that gun permit applications in Georgia require disclosure of past or current use of marijuana without any regard to that use being lawful under the state's medicalcannabisprogram. Theyfurtherexplainedthattheirapplicationswillbedeniedifthey,aspatientsinthestate'sprogram, disclose their use of medical cannabis. Because of this, these patients felt they had to choose betweentheirrighttobeararmsandtheirrighttomedicalrelief.
ProtectBenefitsandRightsofMilitaryVeterans
Veteransandpatientadvocatessharedthatif a patient with aregistrycardadmitstousing medical cannabis totheirhealthandmedical providers through the U.S. Department of VeteranAffairs("VA"),thenthepatientwillbe subject to routine drug screening, will lose their benefits with the VA, and face other consequences. Participants shared that the VA actively pushes back against cannabis use by veterans duetothefederalillegalityofmarijuanaandthattheVAexpressesthatmarijuanaisillegal eveniflegalizedbythestates.Participantsemphasizedthatveteransfoughtforourcountryandput their life on the line so that Georgians and everyone else in the country could live a good life and have a chance to live with decency and respect. A veteran participant, whoisalsoapatientanda directorofaveteranadvocacygroup,sharedthatveteransinGeorgia"donotevenknowwhototalk to, where to go, or where to start" to learn about or access medical cannabis. Theyexplainedthat PTSDwasaddedasaqualifyingmedicalconditioninthepatientregistrystatutetohelpveterans,but emphasizedthatmoreneedstobedonetohelpveteranstoaccessmedicalcannabis.
ProtectBenefitsandRightsofPatientsinHospiceCareorotherLong-TermCare
An owner of a hospice carefacilityexpressedfrustrationwiththeconflictbetweenstateandfederal statutes as it relates to comfort care for patients and the useofmedicalcannabis.Theynotedthat because hospice is federally funded through the Centers for Medicare and Medicaid Services ("CMS"),theycannotlegallytelltheirpatientshowtousemedicalcannabisorevenrecommenditas analternativetoopioidsandmorphine.Theycanadministermedicalcannabisintheirfacilitiesifthe patientisalreadyonthepatientregistry.Howeverthereareissueswithobtainingthemedicationsfor thepatientsasthefacilityisnotthe"caregiver."Therewerealsoconcernsthatonceapatientoptsfor morphine as the comfort medication, the patient cannot change the treatment plan to include cannabis. So if a patient entershospicecareandisnotonthepatientregistry,thepatientlikelywill begin morphine before being certified. Additionally,itwasnotedthatthehospicefacilitycouldcover thecostsofmedicalcannabisasacomfortmedicationiftherestrictionsetbyCMSwerelifted.

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HighlightsofPatientTestimonials
Whileparticipantssharedseveralcommentsandsuggestionsforimprovementinthestate'sprogram, participants also shared countless experiences about how medical cannabischangedtheirlivesfor the better. Patients shared their lived experiences with various medical conditions, with previous prescription medications and the negative side effects, and with finding less harmful forms ofrelief through medical cannabis that prescription medications could not otherwiseprovide.Somepatients even shared how they misused and became addicted to the prescription medications (e.g.forpain management)andexplainedhowtheywereabletoovercometheiraddictionandstopallopioidswith theuseofmedicalcannabis.
The Commission was deeply moved by the stories and lived experiences shared by and about patients across the state whose lives have been significantly improved with the use of medical cannabis.Belowaredetailedhighlightsofafewstorieswiththepatients'permission:
A patient with neuropathy shared they face daily challenges withtremors,pain,andinabilitytosleep.In2019,theybegan having difficulty walking. By the endof2020,thepatienthad tousetwocanesbutstillsufferedmultiplefalls.Theyarenow dependent on a wheeled walker. The patient began using cannabis for medicinal purposes and saw significant improvement in their symptoms.Fromonlybeingabletosleep2-3hoursanight,thepatientisnow abletosleep7-8everynight.Becauseoftheirabilitytorest,theirabilitytofunctionduringthedayhas greatlyimprovedsuchthattheyareabletoworkduringthedayandbeabletospendtimewiththeir family.Theirspouseexpressedgreatappreciationformedicalcannabisgivingthemhopetocontinue livinglifetogetherandwithintegrity.
A patient with intractable pain shared that they had atotal hip replacement three weeks before the listening session they attended. They were prescribed four days worth of oxycodone to take every four hours. They took a total of threeoxycodonepillsinlessthan24hours,andthenbegan taking a full spectrum troche (i.e. a form of medical cannabis allowed andavailableinGeorgia)for pain management. The patient has not taken oxycodone since then. They explained that taking a 20mg troche twice a day manages their pain better than the oxycodone, and that they are able to functionwithintheirnormallifewhileusingmedicalcannabis.
Amothersharedthattheirchildwasdiagnosedwithaveryrareformofepilepsyatonlyonemonthof age.Thechildwasplacedonsevendifferentmedications,butnoneofthemcontrolledtheseizures. The mother was able to apply for and receive a registry card for her child, but at that time, the Commission did not exist and medicalcannabiswasnotavailablelegallyinGeorgia.Untilthen,the mother had to cross state lines to obtain medical cannabis, in the form of flower, from states that

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accepted her child's registry card to make the medicine in her home in Georgia. She shared that becauseGeorgiadoesnotallowflower,shecontinuestotraveloutofstatetoobtainwhatisneeded toprovidemedicineforherchild.Thechildisnowsevenyearsoldanddoesnottakeanyprescription medicationsforseizuresbecausethosearenowcontrolledandmanagedwithmedicalcannabis.She alsospokeasadoulaandstudentmid-wifeaboutpatientswhosufferfrommiscarriages,stillbirths,or other birth-related trauma. She explained that cannabis allows those patients to grieve and work through the trauma without masking the emotional pain with prescription medications, emphasizing that those medications cause side effects that worsen depression, anxiety, emotionalpain,andphysicalpain.
A patient'scaregiverspokeaboutcaringfortheirrelativewhowasdiagnosedwithstage3cancerin 2016thatprogressedveryquickly.MedicalcannabiswasnotavailableinGeorgiaatthattimesothe familytraveledacrossstatelinestoobtainmedicalcannabis.Thecaregiverexplainedthatwhiletheir relative eventually succumbed to cancer, medical cannabis improved the quality of life--including extendingtheremainingtimeleftoftheirlife--byhelpingtherelativetohaveanappetiteandenergy toeatanddrinkwhileunderhospicecare.Theyemphasizedthatalthoughthoselastfewdayswere difficult, their relative was able to be mentally aware, speak with loved ones, and create last memories before they passed away. They explained that using medical cannabis, instead of morphine,allowedtheirrelativetopassawaywithintegrityandtolivelifeasmuchaspossible.
Another patient's caregiver shared that their parent was diagnosed with stage 4 cancer and entered hospice care in 2022. They explained that the use of medicalcannabisextendedtheirparent'slifebyfourto sixmonthslongerthanexpected.Duringthattime,the parent was able to avoid using opioids for pain relief whichallowedthemtobemoreawakeandpresentwiththeirfamilyinthoselastmonthsandweeks. In using medical cannabis,theparentwasabletoeatandobtainnutrition,allowingtheirbodytobe fedratherthanstarvedwhileinhospicecare.Theysharedthatthecostofmedicalcannabiswasless expensive than the cost of medications traditionally offered to patients with later stages of cancer. Theyemphasizedthattheirparentwasawakeandcomfortableastheynearedtheendoftheirlife.

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