Yes, We Cann | Cover Story | Salt Lake City Weekly

April 20, 2022 News » Cover Story

Yes, We Cann 

The smoke is starting to clear on Utah's experiment with medical marijuana.

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More than 47,000 Utahns are medical cannabis patients, according to the latest numbers from the Utah Department of Health. That means that out of every 100 people in Utah, at least one bothered to register with the state, pay a series of fees and obtain a prescription from an honest-to-God medical professional to cover the marijuana they use.

The actual number of regular marijuana users in the Beehive State is certainly larger. And according to the Utah Department of Health, cannabis sales in the state-sanctioned market exceeded $90 million in 2021, to say nothing of the un-sanctioned market.

It's true, dear reader. Weed—the Devil's Lettuce, the Jolly Green Ganja, Reefer!—is in your community. It's in your workplace. It's in your houses of worship. It may even be in your own home.

Tim Pickett - COURTESY PHOTO
  • Courtesy Photo
  • Tim Pickett

"Chances are, you know somebody who is using cannabis as a medicine," said Tim Pickett, founder of utahmarijuana.org. "Trying to tell people that it's not all Cheech & Chong and bong rips and joints is part of the challenge."

The growth of Utah's medical program has exceeded expectations, effectively tripling official projections in 2019, when it launched following a successful legalization initiative on the 2018 ballot. And while lawmakers—never keen to let others play with their toys—preempted the citizen legislation with a more restrictive cannabis program of their own making, observers say the ensuing policy tug-of-war has largely subsided, and that a relatively accessible system (for a red state, after all) is taking shape.

"We obviously live in a state that is not going to support, anytime soon, the full legalization of cannabis," said Libertas Institute President Connor Boyack, who co-wrote Proposition 2. "And so, living within the political realities that we have, we think the program is functional, healthy and accomplishing the goals that we had when set up to create it."

Connor Boyack - COURTESY PHOTO
  • Courtesy Photo
  • Connor Boyack

That's not to say Utah's program is flawless. Advocates are quick to point out that the list of qualifying conditions is incomplete, or unnecessary. Many traditional physicians are reluctant to issue cannabis prescriptions, diverting patients instead to out-of-pocket referral clinics. And limits on the number of cannabis prescriptions a single provider can issue—intended to prevent the apocryphal "card mills" despised by cannabis critics—has had the effect of churning patients through multiple clinicians.

"Because they established patient caps for providers in the beginning, it has created a system of patients jumping from one provider to another in order to maintain legal access," said Pickett, a physician assistant. "And that's bad for patient care, from a medical perspective."

Pot Docs
In addition to hosting informational resources online, Pickett's utahmarijuana.org also does business as Utah Therapeutic Health Center ("You can't bank with marijuana in your name," he says) and operates several cannabis referral clinics. There, prospective patients are connected with duly licensed medical providers, who explain the state's program and—if the qualifying condition list applies—can issue the legal equivalent of a prescription.

Pickett said UTHC has roughly 10,000 active patients, or one-fifth of the state's total cohort.

"I introduce myself from time to time as the person people love to hate, the notorious Pot Doc," Pickett said. "I don't mind being called that, although I do think it's disrespectful to the patients who see someone who considers themself a cannabis specialist."

Referral clinics are typically not covered by insurance, requiring patients to spend hundreds of dollars in upfront costs. Because of this, practitioners like Pickett can face a cash-for-hash resistance from both sides of the marijuana debate, with prohibitionists decrying a slippery slope to recreational use and patients' advocates criticizing the barriers to entry for low-income patients.

Boyack defended Utah's referral industry, saying its flaws are largely the byproduct of a system in which most physicians are unable or unwilling to participate in the medical cannabis program.

"It is fair to say that some practitioners hand out these cards more generously than you might otherwise think they should," Boyack said. "I don't think it's predatory. If you're a low-income patient, it's unfortunate that you have these impediments. But that's just the nature of this being a federally illegal product."

Pickett said his role is to introduce cannabis to a broader segment of the population who stand to benefit from legitimate medical use. He acknowledged that his clinics are "a hoop to jump through" for some Utahns. But he added that even for the most recreational-adjacent patients, his providers have an opportunity to work on effective dosing routines and healthier alternatives, like using a dry herb vaporizer (legal) instead of rolling a joint (not legal).

"The most important part to me is that, especially in Utah, there's a significant number of people who need permission and education," Pickett said. "They need a medical provider to guide them through the process, give them permission and help them access a scary, federally illegal substance, in order to be willing to try something new and take control of their own health care."

Pickett added that his clinics focus not only on treating patients with cannabis, but also on reducing a patient's reliance on more risky—yet legally and socially acceptable—drugs.

"We really focus on deprescribing opioids and benzos and Ambien," Pickett said. "Our track record is 79% of my patients are using less prescription medications, alcohol or other medications within six months of starting medical cannabis."

The clinics' providers work part-time, "moonlighting" (in Pickett's words) on top of their day jobs. Patient caps preclude cannabis care from being a full-time gig, Pickett said, while professional constraints like specialized malpractice insurance deter family physicians and traditional care centers from taking on cannabis clients. He described the dynamic as something of a Catch-22, with the state decreeing that cannabis is medically viable while tying the hands of the medical professionals who support its use.

"You're trying to force something into the medical system that the providers are just not ready for," Pickett said. "And yet, you're not really supportive of the specialist, who in all practicality is handling a significant amount of the patients in this system."

Rep. Ray Ward - COURTESY PHOTO
  • Courtesy Photo
  • Rep. Ray Ward

Rep. Ray Ward, R-Bountiful, is one of a handful of physicians who serve in the Utah Legislature. He disputed the suggestion that specialized insurance is required to issue cannabis recommendations, but agreed generally that health-care professionals face a headwind in adding cannabis to their practice.

Ward said he is philosophically opposed to any clinic—cannabis or otherwise—that specializes in a single type of medicine. But, he added, medical marijuana clearly works for some patients—as effectively as or better than other medications. And if they can't get it through their primary physician, referral clinics offer a path to treatment.

"That's better than not having access, for sure," Ward said. "But my wish would be that other primary-care clinics would come to offer it as readily as they offer narcotics."

Pickett said that over time, harmony among the various players around medical marijuana has improved. Physicians are increasingly comfortable sharing their patients with referral clinics, he said. And UTHC is partnering with pharmacies to subsidize costs for low-incomeUtahns.

"Now that the dust is kind of settling, we are learning how to work with each other better," Pickett said. "As medical providers, we have to be the ones to legitimize medical cannabis, or we're just never going to get anywhere."

Future Tense
State lawmakers approached cannabis cautiously after being effectively forced into the marijuana business by voters. It was a unique moment in Utah politics, as a surge of constituent unrest carried three ballot initiatives across the finish line, upsetting apple carts around health care and ethical government.

But it also coincided with a changing of the guard on Capitol Hill, with former House Speaker Greg Hughes passing the baton after cobbling together a hasty cannabis compromise and leaving his successor Brad Wilson, R-Kaysville, to oversee the decimation of voter-approved Medicaid expansion and independent redistricting. Meanwhile, in the Governor's Office, then-Lt. Gov. Spencer Cox was already measuring the drapes while Gary Herbert wound down the last months of his pre-announced final term. Then COVID-19 arrived.

Whether or not that confluence of distraction allowed the libertarian wing of the Legislature to shape a more-permissive program than their consverative colleagues would like—or fully understand?—is an open question. But whatever the case, the statutory walls initially erected to contain Prop 2 have largely fallen away and, this winter, it was the outlying voice on Capitol Hill raising objections to an alleged recreational marijuana bonanza facilitated by "fly-by-knight" cannabis clinicians, while the overwhelming majority of the Legislature moved decisively to bolster legal protections for patients and—checks notes ... checks them again ...—create a task force to study the decriminalization of so-called "magic mushrooms" for medical use.

"The tiny handful of legislators who just continue to oppose cannabis are sidelined and the majority is clearly OK with where we've landed," said Boyack. "Unlike other ballot initiatives, there is not this lingering desire to undermine or continue to chip away at what we've done."

Boyack estimated that 95% of the regulatory scheme envisioned by Prop 2 is now in state law. And the necessity of the remaining 5% is subjective, he said. Some qualifying conditions were cut from the Prop 2 list, but others—like "pain"—were broadened to allow greater flexibility. Prop 2 called for more dispensaries to ensure a broad service footprint, but Utah now allows cannabis delivery and for designated friends and family members to purchase cannabis on a patient's behalf.

"In some respects, we've improved the program beyond what we originally drafted when we sat around a table and wrote what would become Prop 2," Boyack said. "Whether now or—certainly in the years ahead—as the market continues to mature, no one really has difficulty accessing this if they need it."

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He said his lingering "quibbles" are minor, like wanting insomnia on the condition list or to repeal the list altogether and simply allow physicians the discretion to prescribe (something Boyack anticipates happening within the decade). He'd also like a greater variety of cannabis products allowed, like butters and THC-infused beverages.

"Things are fine. There has been no horrible culture change—we're not Portland, Oregon, all of the sudden—and people are getting the help that they need," Boyack said. "That has put many minds at ease among those who initially had concerns and because of that, I think it has led to this willingness to consider psychedelics next for mental illness."

Ward said his colleagues in the Legislature understand that the question is no longer whether to have a medical cannabis program, but how to run the one they have. That means less contention, he said, and improvements over time that enhance patient access and safety.

"At least, slowly, things will get a little better and a little more smooth," he said. "And even that makes a difference."

Ward said he'd like to see the program be executed by primary physicians, through traditional health-care settings. He and other lawmakers have run legislation that aims to push things in that direction, like requiring hospice services to employ someone who is authorized to prescribe cannabis and requiring that pain management training include information on medical marijuana.

"If you are teaching other doctors how to manage pain, that should be a part of it," Ward said.

Hovering over any discussion of medical marijuana is the drug's federal status as a Schedule 1 substance, perpetually on the verge of declassification as more and more states opt to walk around an intransigent Congress.

Pickett said change at the federal level would undoubtedly reshape both his business specifically and the state's medical program generally. But he's confident that there will still be demand for his clinic's services.

"We would become a boutique, specialty service that really just focuses on the patients who need us, and there will always be patients who need more education and more hand-holding—like kids, or the elderly," Pickett said. "And in a state like Utah, there's going to be a significant portion of the population that has a moral requirement to have a medical card in order to continue their upstanding relationship with their religion."

By whatever time the remaining barriers around marijuana come down, Pickett said he hopes to have worked himself out of a job.

"At some point, cannabis becomes ubiquitous," Pickett said. "The ideal future for me is you've got ibuprofen in the cupboard for your headache, Tylenol for your fever and a tincture of cannabis oil for various things. It's just part of the medicine cabinet."

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Get ready for Utah's 2022 cannabis conference and exposition on May 13-14.
By Mikey Saltas

The cannabis industry in Utah is growing at a rapid pace, with the state's medical cannabis program now entering its third year of implementation. There's more access, users and products than ever before—and knowledge and learning opportunities are expanding, too.

The third Utah Cann Business Conference and Expo, presented by City Weekly, is slated to run May 13-14 at the Utah State Fairpark as an event for Utahns to learn more about hemp and cannabis.

Utah Cann had its beginnings in October 2018, ahead of Utah's vote for Proposition 2, the legalization initiative that opened the door for medical cannabis consumption in the state. The first conference was a success—with state representatives and senators meeting in a public forum with local business people and spokespersons for cannabis.

By May 2019, when Utah Cann rolled out its second conference, House Bill 3001 had recently passed to amend Proposition 2, easing the restrictions for patients and setting clearer parameters around cannabis consumption in Utah.

The second conference was a breakout event for Utah Cann. From a few hundred attendees and a handful of vendors just a few months prior, the event blossomed to a weekend gathering of more than 60 vendors and thousands of guests. Speakers at the event included some of the top minds in the cannabis sector in and outside of Utah, generating positive feedback from attendees.

While the COVID-19 pandemic derailed plans for scheduled events in 2020 and 2021, Utah Cann is now set to return and bring new ideas and opportunities to Utahns and businesses.

Pete Saltas—City Weekly publisher and organizer of Utah Cann Business Conference and Expo (and who is related to the author of this column)—expressed his excitement at bringing back Utah Cann: "It's a great event for the state," Saltas says. "Our first two conferences were designed to give people the resources they needed to learn about and understand cannabis. Now, as the industry has grown, we want our third conference to be the biggest and best yet for attendees."

Utah Cann tickets are $20/day or $30/weekend. More information can be found at UtahCann.com.

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“The goal is to be happy, present and productive—not to be impaired,” says health consultant Mindy Madeo
  • “The goal is to be happy, present and productive—not to be impaired,” says health consultant Mindy Madeo

Green Parenting
It's OK to be a mom who uses cannabis.
By Mindy Madeo

Being a mom is hard. We are overworked and constantly helping everyone around us. Moms are stressed and anxious and have little time to relax. I have had several patients who report that cannabis allows them to manage a number of medical conditions and better connect with their children and their partner.

Cannabis allows us to temporarily forget about our never ending to-do lists and live in the moment. It helps moms enjoy mundane tasks like playing dress-up with toddlers, watching episodes of My Little Pony or folding that mountain of laundry after the two-hour bedtime routine that must be performed just right every evening. You know you've been there.

And, as a bonus, studies show that women who use cannabis are found to exercise more and have more sex compared to those who don't. When it comes to socializing, there is currently a cultural shift from the "wine mom" to the "weed mom" and, for many, it can be a healthier option that comes without addiction risks or hangovers the next day. Many moms in Utah are happily trading in their Xanax and Prozac prescriptions for cannabis recommendations.

April Miera, founder and creative director of The Kush Ladies and Terra Health and Wellness and mother to two young children, says: "As a mom, I found so much of my life was in the concept of others' standards in parenting and image. As I learned to use my plant medicine to find my inner self, I found myself becoming a better mom and feeling less responsible for others' misconceptions of what it means to be a 'kush lady.'"

Miera continued: "Our education in plant medicine is key to shaping our response, and I hope every mom knows she is worth the investment. Self-care is not optional for kush ladies. It's an investment in our future and our families."

Medicating Responsibly
I recommend always using the smallest dose possible, which we often refer to as "microdosing."

Tinctures and inhalation routes are the easiest dosage forms to microdose. Inhalation routes are nice because their effects wear off in a couple hours, so you can be medicated for just small portions of your day.

During the day, use products that are lower in THC and higher in other cannabinoids such as CBD and CBG. Use the lowest amount of THC possible. The goal is to be happy, present and productive—not to be impaired.

The right dose can deliver a calm focus that allows moms to tackle their days gracefully. I recommend combining your medication with activities like yoga, meditation, being in nature and creative endeavors.

Child Safety
The question of how open a parent should be toward their children using cannabis is a personal preference that depends on many factors, such as the age and maturity level of your child, the culture where you live and your partner or co-parenting situation. If appropriate, I believe it's best to always err on the side of truthfulness and harm reduction.

Normalizing cannabis use does not mean we should ever allow or condone early or excessive consumption by our teenagers. It's important to educate your tweens and teens about the harmful effects of cannabis use in brains that are still developing.

Make sure all of your cannabis products are kept in their original, child-resistant container and locked up in a safe. This protects your children (and pets) from accidental consumption.

Use common sense. Never be overmedicated when you are the only adult caring for a newborn, driving a vehicle or watching children in dangerous situations like at a swimming pool or near rivers. Moms already know this, but it's important to remember we need to be running on all cylinders while actively parenting.

And I do not recommend cannabis while pregnant or breastfeeding. We still don't know enough about the risks.

Too often we judge moms more harshly than other members of society. It's time we give moms a break and normalize medicating with cannabis. The most important part of using cannabis as a mom is doing so responsibly—in a way that positively enriches our life and allows us to take good care of ourselves and our loved ones.

Mindy Madeo is a cannabis pharmacist and health care consultant. This piece originally appeared in Salt Baked City, a Utah cannabis news and wellness magazine, and is reprinted here with permission.

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To the inexperienced, casual conversation about cannabis can sound like a foreign lanuguage, Salt Baked City publisher Cole Fullmer says.
  • To the inexperienced, casual conversation about cannabis can sound like a foreign lanuguage, Salt Baked City publisher Cole Fullmer says.

How to Talk With Your Budtender
Getting the most out of your Utah pharmacy experience.
By Cole Fullmer

Navigating through a Utah medical cannabis pharmacy is significantly easier when you know how to communicate with your budtender. For the many first-time visitors in Utah, one look at the menu board can make the head spin. Even having a casual conversation with a cannabis-savvy friend can feel like speaking a foreign language to the inexperienced.

A budtender (we call them "pharmacy associates" in Utah, but some habits are hard to break at Salt Baked City) is a sales associate responsible for helping you select the best cannabis-related products to suit your medical needs. Most Utah pharmacy employees are highly trained professionals who can help with product information and consumption recommendations. Their goal is to help you become a loyal customer by matching you with products that meet your needs, and the best way for them to help make that match is through meaningful conversation.

Here are some things to know—and to ask your budtender about—for your next pharmacy visit.

Personalize Your Visit
Medical cannabis consumers in Utah come from all walks of life and visit their local pharmacies for a variety of reasons. Some are patients undergoing chemotherapy and looking for specific relief, while others are simply looking for rest and relaxation. Whatever spurred your visit to one of the state's new cannabis shops, going in with purpose can help you and your budtender select the most effective products.

If you're not visiting with a product already in mind, planning your search and questions before visiting can help significantly. Is there a consumption method you prefer? Are you looking to vaporize, eat or apply medical cannabis topically? Are you a seasoned consumer searching the dankest of the dank, or a novice looking for a low dose? Do you want speedy and strong effects, or a lasting impact that creeps up on you? There's a lot to think about, so read on, Green Scene.

Tell the Budtender It's Your First Time
It's always smart to let your budtender know if you're a greenhorn to cannabis—you're not alone in Utah. Once informed, they can suggest lower THC doses and recommend various tools they sell for easy consumption, like vaporizers and distillate cartridges.

What's Your Type?
We all know smoking cannabis isn't as bad for you as smoking cigarettes, but it's still illegal in Utah to consume your cannabis with an open flame. And not everyone likes to smoke, especially if you have compromised lung health or are using cannabis for medical reasons. Vaporizing is a popular choice of consumption among Utah patients, but there are plenty of other smoke-free ways to consume cannabis, and product selection is growing every day in our state's market.

We recommend using your specific medical needs as a guide to choosing your consumption method. For example, if you suffer from arthritic pain, a topical cream might be the best selection. For headaches or inflammation, a tincture or vaporizer can provide instant relief. Insomnia? A high-THC concentrate or some potent cannabis flower might do the trick. If you want to just get relaxed without vaporizing, edibles could be an excellent choice.

How Do You Want to Feel?
Forget everything you've ever heard about indica, sativa and hybrids. Indica strains are known for their relaxing, sedative effects and are recognized for helping relieve pain and anxiety, while sativas have been identified as more uplifting and energetic. All of those feelings are dependent on the individual cannabinoids and terpenes found in each cannabis strain. We learned in other Salt Baked articles that indicas, sativas and hybrids have many differences, but we only dealt with appearance, growth and origins. Interestingly, it is still difficult to gauge possible effects until after testing for cannabinoids and terpenes is done.

Keep it simple. Go into your medical cannabis pharmacy and express to your budtender the general sense of feeling you're hoping to achieve, and they will help guide you to the best products. Leave the indica, sativa and hybrid discussion for your grower.

How Long Should the Effects Last?
Each type of product you'll encounter in a Utah medical cannabis pharmacy will have its own timeline of impact. Edibles, for example, sometimes take 1 ½ hours for the full effects to kick in—once your liver has broken down the THC—and those effects can last up to six hours. Tinctures, vaporizers and cartridges will have more immediate effects that last for only a few hours.

Order Online
You won't be able to ask your budtender for advice when ordering online, but if you're feeling anxious about visiting, this can be the best workaround. All of the various Utah medical cannabis pharmacies have websites with online menus and product descriptions for in-store or curbside pickup.

Utah patients need to register online with the pharmacy they wish to use before their orders can be completed. But registration with these friendly pharmacies often comes with random product discounts texted to your phone—so why not?

Don't Be Shy!
This is a new industry for everyone in Utah. Medical cannabis products are changing daily, new scientific discoveries are being released and pharmacy shelves are ever changing—so, there's never a bad question.

The happy budtenders you'll meet are knowledgeable and eager to answer any concerns you may have. Stay medicated and educated, Green Scene!

Cole Fullmer publishes the cannabis magazine Salt Baked City, where this piece originally appeared. It is reprinted here with permission.

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About The Author

Benjamin Wood

Benjamin Wood

Bio:
Lifelong Utahn Benjamin Wood has worn the mantle of City Weekly's news editor since 2021. He studied journalism at Utah State University and previously wrote for The Salt Lake Tribune, the Deseret News and Entertainment Weekly

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