Episode 92 of Utah in the Weeds features Rich Oborn, the director of Utah’s Center for Medical Cannabis.
We started the episode with Rich’s thoughts on Utah’s 2022 legislative session, which resulted in a few changes to Utah’s Medical Cannabis Program. [02:28]
Senate Bill 190, sponsored by Sen. Evan Vickers, will prohibit over-the-counter sales of hemp products with a combined total of THC or THC analogs of 10 percent or more of the product’s total cannabinoid content. However, those types of products will continue to be available for sale at Utah’s cannabis pharmacies. [05:28]
SB 190 further clarifies packaging requirements for products containing synthetic THC, and it removes the prohibition of cannabis pharmacies employing convicted felons. [09:00]
SB 190 also adds “aerosol” as an approved Medical Cannabis dosage form in Utah. Rich says such products exist in other markets, but they’re expensive to manufacture. He doesn’t expect local companies to start making cannabis aerosol products right away. [15:22]
Another change in SB 190 will make it easier for cannabis pharmacy agents to work in Utah’s Electronic Verification System (EVS). [17:07]
Senate Bill 195, sponsored by Sen. Luz Escamilla, expands access to Utah’s Medical Cannabis program by requiring hospice programs to have at least one Qualified Medical Provider. It also adds acute pain as a qualifying condition, making cannabis available as a post-surgery pain relief treatment. [24:09]
Next, Tim and Rich talked about the current state of cannabis research, including an upcoming study to be funded by Utah. House Bill 2, an appropriation bill, sets aside $538,000 for a study on cannabis and chronic pain. [34:24]
Lawmakers did not approve “opioid use disorder” as a qualifying condition for Medical Cannabis in Utah. Instead, medical providers will need to consider a patient’s past drug use when writing a Medical Cannabis recommendation. As Tim points out, this is already a best practice for medical providers. [39:53]
Next, Tim and Rich talked about THC-infused drinks. Senate Bill 190 excludes “liquid suspensions” of cannabis branded as beverages. Tim estimates such drinks will continue to be sold in Utah until some time around November. Liquid suspensions of 30 mL or less will continue to be available. [44:37]
Senate Bill 195 also modifies the state’s advertising standards for Medical Cannabis, allowing cannabis companies to place more types of ads than previously allowed. [46:51]
Rich says Utah’s Medical Cannabis community is growing by about 1,000-2,000 new cardholders per month. At the end of February, there were 44,800 active cardholders registered in the program. About 30% of cardholders do not renew their cards. [52:15]
Next, Rich told us about some of Utah’s educational and informational resources on Medical Cannabis. The state has educational material for both patients and providers. There is also a website to monitor the cost of Medical Cannabis evaluations at clinics throughout the state. [54:55]
This year, the Utah Department of Health is developing an analysis of Medical Cannabis inventory across the state. UDOH will share the results of that analysis with industry professionals in an effort to identify and address any shortages for in-demand products. The Utah Legislature is also working on a governance study to analyze the administration of the Medical Cannabis program. [57:50]
Tim Pickett:
Welcome everybody out to episode 92 of Utah in the Weeds. I am your host, Tim Pickett. And today we have what is becoming our annual legislative update with the Department of Health Director of Medical Cannabis, Rich Oborn. Rich is here to discuss the updates to the legislation in the Medical Cannabis Program. And we will discuss in this conversation the hemp changes and the changes to the CBD and the over-the-counter hemp sales. What has happened with that? How we’ve been able to decrease the amount of THC or delta-8 in those products available to really be purchased by children, which increased patient safety. There was some controversy. And we talk about that as well. Talk about the advertising changes to the program and the added condition that has been added to the Medical Cannabis Program for patients. Is a great conversation, feel free to reach out and comment as this will be posted on YouTube with any questions that you have about the legislation, and we’ll answer them all.
Tim Pickett:
Other than that, subscribe to Utah in the Weeds on any podcast player that you have access to. We’re on all of the platforms. We release these, we try to release these every Friday at 4:20 AM. Last week, we took a little bit of a break and we’re back in the swing of things now. We’ve got a lot of updates coming up for you. The CEO of High Times and partner in Beehive Farmacy coming up in April. We’ve got a special episode coming up with my sister, who I’ve been teaching a little bit about medical cannabis with her condition. Just a lot of good content coming out. Season four of Discover Marijuana is also getting ready to launch in the next month. Of course, April and 420 celebrations are coming. Stay tuned and subscribe to Utah in the Weeds and enjoy this conversation with Rich Oborn. How was the legislative session? I mean, from a workload standpoint?
Rich Oborn:
Yeah, it was heavy I’d say. We had three bills that had direct impact on us. And in the past some time… I guess if I compare it to last year, I don’t think there was as many amendments that we were tracking within the bills. There were two bills last year that had some direct impact on us. And this year there were two main ones, but then there was the third one with SB 153, the medical cannabis governance structured bill. That was one that we tracked and were providing input on throughout the session.
Tim Pickett:
It seemed like this session, there was more work up front. There wasn’t as much work on changes at the back end.
Rich Oborn:
Right, right.
Tim Pickett:
Was that your experience?
Rich Oborn:
Yeah, yeah, yeah. That’s how it should be. We don’t like to see a lot of flurry of things going on at the end, because that’s when you don’t have time to think through things logically, right? You don’t want to see stuff put together in a rush as much as possible.
Tim Pickett:
Sure.
Rich Oborn:
Sometimes that happens no matter what, but… Yeah. Yeah. So, yeah, I’d say that’s a good way to say it. There was some work that went on at the beginning and there are a few tweaks we had to make throughout. And on most of those, we were able to get them in the bills. So that was good.
Tim Pickett:
Yeah. Now, as of this recording, Governor Cox has not signed the bills that we’re going to talk about today, but is there any chance he doesn’t really? I mean, there’s always a chance.
Rich Oborn:
I feel like if there was a possibility, I would’ve probably heard about it. Last year, you’re probably familiar with the bill that was vetoed that related to the hemp program, Department of Agriculture and Food and the Hemp Industry. And that was a big deal that it was vetoed. And so this year they’ve had some time to work on some things, and I don’t expect there to be a veto on any of the bills, including the HP 365, which was the one that related to the hemp issue primarily. But then there’s also SB 190 that does have some hemp components to it.
Tim Pickett:
Let’s jump into that one because it seems like, and I did a little update a couple episodes back of 190 and 195. But 190 was Vickers’ bill and that was the one that was primarily hemp. And it seemed like that was more to do with things that involved the Department of Agriculture. And then there was a lot of controversy over this delta-8 and even the naming of things, right? You can’t even name it. Let’s talk about this because it seems like there’s a lot in this bill that people were a little upset about.
Rich Oborn:
It’s a little more controversial.
Tim Pickett:
It is a little more controversial.
Rich Oborn:
Sure.
Tim Pickett:
So talk about this, what’s the change from what’s before with this delta-8 or over-the-counter psychoactive substances derived from cannabis, I guess? Is that a good way to put it?
Rich Oborn:
Yeah. Yeah. And I want to emphasize the Department of Health, while we are indirectly involved because we oversee the medical cannabis pharmacies that sell these products, the Department of Agriculture is more directly involved in the oversight of these hemp industry. And the Department of Health doesn’t have any jurisdiction over the hemp retailers and growers, but [inaudible 00:06:58] does. And so after December 1, 2022, hemp products in Utah cannot have a combined total THC and any THC analog that exceeds 10% of the total cannabinoid content. So if you’re comparing the different cannabinoids that are in a specific product’s profile, THC or an analog of THC cannot exceed 10% when compared to the other cannabinoids in that product.
Tim Pickett:
Okay.
Rich Oborn:
So that was a critical change. If you’re a hemp retailer, you would not be able to sell those products legally under state law. Medical cannabis pharmacies continue to be able to sell these products to medical cannabis cardholders within the medical cannabis industry pipeline. So it’s not like patients won’t be able to access these products, they will. But it’s only through-
Tim Pickett:
It’s just that the 16-year-old can’t go down the CBD store and buy it over the counter. But this is also added to the already 0.3% total weight.
Rich Oborn:
Right.
Tim Pickett:
Right. This particular piece, you could buy a 1:10 THC tincture, and this would fit that, right? It would have 10 times the amount of CBD than THC, and it would fit this thing. But you add to that 0.3% by weight, and now you have to have a Gatorade bottle full of liquid in order to have, I think it’s 6 or 10 milligrams of THC. So it really, really dilutes the ability to sell. Really they’re called PUCK gummies and they were being sold kind of all over the place.
Rich Oborn:
Yeah. Yep. And the basis of this was to help with product safety and patient awareness so patients are aware of the contents of the medication they’re purchasing. And in the medical cannabis pipeline, those type of products that the processors under SB 190, they’re required to ensure that the label identifies each derivative or synthetic cannabinoid as a derivative or synthetic cannabinoid. So the processor is required to be transparent about which of those cannabinoids are synthetic and which are natural.
Tim Pickett:
This is going to be good, I think, for that garage chemistry. And I’ve talked about this before that a lot of the delta-8 is made by some organic garage chemistry that leaves some byproducts. And I think this helps with the labeling, keeping bad actors out of the market essentially.
Rich Oborn:
Right. And there are some additional restrictions that the Department of Agriculture and Food places on processors in the medical cannabis industry when compared to the hemp industry. And so I think that’s critical to keep in mind that these are medications, and there’s a rigorous scientific approach to these products. We don’t want to have people compromise their medical condition or their safety by consuming products. And so as a regulator, I know the Department of Agriculture does what they can to ensure that those patient protections are kept in mind as there’s different tests for contaminants and different tests are run to ensure that the ingredients of the products are actually what they claim to be on the labels. And also that there’s no misrepresentation or misunderstanding about whether a cannabinoid is synthetic or not. So that’s something that’ll be new that we’ll be rolling out with SB 190.
Tim Pickett:
So that includes the… Does that include the Medical Cannabis Program too that they’re now going to be required to label synthetic versus derived cannabinoids? In most of the packaging that I see, they’re already labeling it as such.
Rich Oborn:
Right. Right. I think that’s important to emphasize is that they’re already labeling it as such, but this just clarifies the law in relation to medical cannabis processors and pharmacies that there’s this more clear requirement that that label must identify whether that cannabinoid is a synthetic, when it is a synthetic. So you can still purchase THC products that are synthetic THC, but when you do that, you’ll be informed on the label that that’s the type of product you’re purchasing. And there were processors that were, I think, already doing a good job of that, but this just clarifies the law, makes it so-
Tim Pickett:
It standardizes it.
Rich Oborn:
… Right.
Tim Pickett:
So this was passed really as a patient safety and a consumer safety issue, the delta-8 controversy and having young people being able to buy psychoactive products that were potentially dangerous to their health. So personally as a provider, I like this. I can see there was some arguments about low income folks not being able to access their medicine. And this helps people go into the… It kind of forces some of those people into the medical market, but that’s… And I mean, it increases patient safety overall. And so I tended to support this piece despite the controversy of it.
Rich Oborn:
Yeah. And I think there’s some things that the legislators are doing and also private entities are doing to make medical cannabis more affordable in Utah. I think the ideal is still not in place, which would be that insurance would be able to help someone purchase this type of medication. But while we wait for the Federal Government to take action on that, I think there’s some good options out there. Although we know everybody maybe is not aware of those options. And so I feel like private identities, they can take it upon themselves to share information about the options that are out there to get help for making the medication more affordable to them. And it’s great to see that entities are stepping up to play that role and people are willing to donate money to assist others in affording medication that’s not as affordable as other medications.
Tim Pickett:
Right. So still staying on this SB 190, there was another thing with felony convictions. If somebody had a felony over 10 years ago, they weren’t able to work in a medical cannabis pharmacy before, but now that’s not prohibited. That seems like a really good idea.
Rich Oborn:
Yeah. And that was actually something we had contacted lawmakers about. We had a case or two come up where we did have to deny an individual from being able to obtain a pharmacy agent card because of the fact that they did have a felony. And there was this prohibition of any employee of a medical cannabis pharmacy having a felony of any type and it didn’t place a timeframe on it. So the law’s been amended to allow for that. And I think that’s a step in the right direction. Although if you do have a felony within the 10 years, it can still stop somebody from getting a pharmacy agent card. Having a felony within 10 years doesn’t prohibit you from getting a pharmacy agent card. It’s a factor that the Department of Health considers.
Tim Pickett:
Yeah. And then we added some dosing forms, inhaler, nasal spray, nebulizer. I mean, I can see the nasal spray for sure. That actually is a product that I’ve heard that a few people are developing. But the nebulizer and the inhaler, I don’t know of any products out there even in other states that are that type of delivery system, like an albuterol inhaler, right? Or a meter dose inhaler.
Rich Oborn:
Right. They exist, but they’re not that common because they are expensive to manufacture. That’s my understanding. And so we don’t expect any companies to be chomping at the bed to do this immediately. But as I think the program matures, it’ll be a possibility and a processor could decide, “Hey, we feel like there’s a market for this. There’s enough patients that are asking for it.” And it would begin to be a legal dosage form [crosstalk 00:16:28].
Tim Pickett:
It’s extremely useful from a meter dosage in an inhaler form is one of the big problems with moving inhaled cannabis products into the traditional medical market because it’s just hard to dose, right? There’s only very few products that will measure the amount you inhale and they’re $300. And so meter inhaled product, while you’re right, I’m sure it’s really expensive to manufacture. From a medical standpoint, it’s going to be nice. I could think of a lot of patients who could really use it. And then there was this technicality change in 190 where they had EVS… The pharmacy agents couldn’t access the EVS, only the pharmacist could. And I remember thinking, “Oh, that’s interesting because our MAs can access EVS as a proxy.” So this codifies that with 190 and allows them access. Are they going to act as a proxy or do they just have visual access or is that something that the department is kind of yet to determine?
Rich Oborn:
They will have their own role within the electronic verification system. And for those of you who don’t know what that is, it’s the system that… Is the patient registration system that pharmacies rely on in order to verify if someone has a medical cannabis card or not. It’s also the software that a medical clinic and a QMP, qualified medical provider, uses to make a recommendation for a specific patient to receive a medical cannabis card. So pharmacy agents that work every day in the medical cannabis pharmacy, who make up the majority of the employees at a medical cannabis pharmacy, they’ll begin to have access to the EVS. And the way that’s being set up is that a pharmacist in charge for the specific medical cannabis pharmacy location will be able to authorize agents. There will be some agents that the pharmacist in charge may decide should have that access to edit and to view that information.
Rich Oborn:
But there could be some pharmacy agents that really have no role in the EVS they do. They maybe just have a niche in the pharmacy of a certain type that doesn’t require that they get access to the EVS. So that’ll be something that a pharmacist in charge, the PIC, would would determine for a specific location. And so it’ll take some time to work without [ vendor 00:00:19:13] and execute this change in the EVS, but we’ll be engaging with medical cannabis pharmacies and the pharmacists who work there and pharmacy agents on how this is set up and we’ll get their input and ensure that we inform them of when it’s an [ in production 00:19:31] and actually able to be used by pharmacy agents. And one thing that’s coinciding with this requirement is that pharmacy agents will begin to have to complete continuing education course on confidentiality and the protection of patient information.
Rich Oborn:
And I’m sure that there are some pharmacy agents that are already generally familiar with HIPAA and protection of confidential medical information, but there could be some that have no clue about it. So it’s important that anybody that works in a medical facility like a medical cannabis pharmacy has at least an intermediate level training on protection of that information and how patient information must be safeguarded. And how, for example, in the EVS, it would never be appropriate to search for a neighbor’s name in the EVS if they’re not a patient. You have no business doing searches like that in a medical type software like this. And other medical facilities have these same standards. And so these standards also apply to medical cannabis pharmacies, although they’re still selling a federally illegal product.
Tim Pickett:
Right. Yeah. But in the normal pharmacy down the street from me, I mean, all of the techs are all going to have some HIPAA training. They’re all going to understand the privacy, the confidentiality. That’s just standard. And I knew that that was one of the reasons why the pharmacy agents didn’t have access before. And so it’s nice to see because there’s an issue frankly with… There was a little bit of a weird thing where the pharmacy agent couldn’t transfer the dosage recommendation from a provider into MJ Freeway because they couldn’t access EVS. And it was kind of a big logistical kind of thing where it brought this up, or it was one of the things that brought this up as something to kind of solve.
Rich Oborn:
Right. And one of the plans we already had in place, regardless of what happened during the legislative session, was to have an integration of information from the EVS regarding the dosing recommendation be sent to the MJ Freeway software. So a pharmacy agent wouldn’t have to go to the EVS to get information about the recommendation. They’d be able to view that within the MJ Freeway software that they use for their patient profile and purchases and point of sale system. So that was already in the works. But this, I think, is just another way that a pharmacy will be able to be efficient in helping customers and supporting them and having a good experience there at the medical cannabis pharmacy as they come in.
Rich Oborn:
One thing that I want to point out though that’s critical is that there will be information regarding a QMP’s notes that they have. Potentially a QMP may want a pharmacy to be aware of a specific patient’s treatment history or medication history. And that type of information, it’s the option of the QMP to pace that into the software. And they would need to advise the patient of this choice they’re making to share this information with an outside party at the pharmacy. So there’s patient consent needed in that type of a case, but there are many QMPs that do choose to keep the pharmacist informed of the other medications that the patient is taking and some details that they feel are relevant about the condition. That helps the pharmacist make the decision about what specific product may be the best for treating that specific condition.
Rich Oborn:
So the pharmacy agents will have access to that information. It’s sensitive information, and we need to treat it as such. And so it’s important that the pharmacy agents go through the training and learn more about how to ensure that they provide the best service to patients as they protect the confidentiality of their medical information.
Tim Pickett:
Let’s switch over now to… That’s a lot of the big items kind of in SB 190, the bill that was kind of on Senator Vickers’ side. Senator Escamilla, she was the one who put out SB 195. That has to do with the Medical Cannabis Program a little bit more on… There was some additions to making the program a little more inclusive. We’re making the general medical community more inclusive of the program. One was the addition of the… If you run a hospice program, you have to have at least one medical provider that’s registered in the system as a QMP.
Rich Oborn:
Right.
Tim Pickett:
I thought that was kind of an interesting addition.
Rich Oborn:
Yeah. The requirement does not begin until January 1 of 2022, or excuse me, 2023. But, yeah, every hospice program has to have at least one medical provider registered with the Department of Health to recommend medical cannabis to patients. Now, one thing that’s critical though is that if the facility accepts federal or insurance money, they would want to consult with their legal counsel and third party reimbursement to determine if the facility may allow for delivery and possession of a federally illegal drug while they’re in that type of a facility. So although they have to have at least one medical provider that is registered as a QMP, there are some things that they should be aware of as it relates to reimbursement of funds from a federal source or insurance money. This doesn’t mean that they are obligated to recommend medical cannabis at that facility. It just requires that they have a qualified medical provider registered with the Department of Health that would be able to do it if they chose to.
Tim Pickett:
And this is every hospital, hospice facility, nursing home, or not in the state?
Rich Oborn:
Well, it’s hospice program. So there’s only so many of those, it’s a specific type of facility. It’s a hospice program that must have at least one medical provider registered with the Department of Health as a QMP. Okay? But then a separate requirement is that an assisted living facility, a nursing care facility or a general acute hospital, the law was modified to allow them to receive deliveries of medical cannabis products from a medical cannabis courier for a patient who is a medical cannabis cardholder. But if that facility accepts federal insurance money or insurance money, I would think that they should consult legal counsel about third party reimbursement because there could be some specific guidance from the federal agency regarding acceptance of those types of products, because they are still federally illegal.
Tim Pickett:
Yeah. Because the idea is that you might have a employee of the facility receive these products in order to hand them to somebody else. And that action of receiving the product is essentially an action of receiving a Schedule I drug. So we need to make sure that that’s on the… You need to talk to your lawyer for sure.
Rich Oborn:
Right.
Tim Pickett:
This kind of goes along with the, and I don’t know if we have this, this kind of goes along with this same idea that we are going to allow schools. There was some clarification on the school system being able to store medical cannabis for a patient that was in the school system. Not that the employee of the school would then handle that if they needed to, but it’s allowed from state statute.
Rich Oborn:
I’m glad you brought that up because that was taken out of the bill.
Tim Pickett:
Ah, because I heard the committee meeting and I heard Senator Escamilla kind of defend that. And there was some very interesting questions, right? One of them was, so basically, are we going to just let this child show up with it in their backpack? And I know of cases where the school district is questioning this because they have a child with a condition and a card. This is a real sticky situation because you want the child to have access and you want the schools to be protected. And by the way, I would mention that schools are like pharmacies. They have a ton of medications that they deliver in store for other conditions, right? This is not something that’s not done, right? We have controlled substances there for children who need them.
Rich Oborn:
Right. But they’re also federally funded.
Tim Pickett:
Yep. So they pulled that out.
Rich Oborn:
They did.
Tim Pickett:
So as of now, the child would essentially need to be removed from the school property to dose their cannabis with their caregiver and then be brought back to school.
Rich Oborn:
Well, I think a general approach would be ensure that you vet this with legal counsel and the school authorities, the school district. There could be some school districts that handle it differently than other school districts. I can’t speak for them, but yeah.
Tim Pickett:
Yeah. I’m glad we talked about that because I thought that had stayed in, but it hasn’t. So that’s good to know. The other thing that was interesting to me is we added acute pain as a qualifying condition. So this means that a person who is about to get a knee surgery, if the provider, the orthopedic surgeon says, “You know what? This is going to cause a lot of pain. I don’t want you on as many opioids and I’m going to offer to recommend a short term card.” Am I thinking of that correctly?
Rich Oborn:
Yes. So any cards issued with acute pain as a qualifying condition, they will always expire after 30 days. Just as when a medical provider prescribes opiates for a limited duration because of a surgery, it’s acute pain. So they’re not going to prescribe opiates for a long period. It’s for a specific condition of some acute pain that’s coming up because of that surgery. So, yeah, a medical provider would generally prescribe opiates for limited duration, but now they’d be able to recommend medical cannabis as an alternative to opiates. And we expect that medical providers will exercise this with great discretion and in cases where they feel like it would be a better alternative medically for a certain type of patient. They’re now able to have that as an option.
Tim Pickett:
So these two things we’ve just talked about, the hospice and this acute pain thing, this doesn’t sound like something that the Department of Health they were… It sounds like this was something that you were told was going to be proposed in the bill and not something that the Department of Health would’ve had a horse in the race, so to speak.
Rich Oborn:
Right. I mean, there’s certain things where we contact the legislature and we see if they might be able to tweak something that we feel would help promote public health, very rarely do we come out in opposition to specific provisions publicly. And so we’re just typically neutral on some of those provisions that maybe don’t have as much evidence as others for being an effective type of treatment. And then we’re responsible to execute the laws that are passed by the legislature. So we want to ensure that they’re implemented in a way that’s fair and easy for patients to take advantage of if their provider chooses to recommend them.
Tim Pickett:
You’ve done a very good job of… I’ll shoot an opinion here about this particular qualifying condition. I personally think this is kind of silly. I can see why an advocate would propose this condition. As a provider who recommends cannabis, I think that 99.9% of the time, if you’re getting your knee replaced and you need a 30 day card, you certainly qualify for a medical cannabis card in the original system. And evidence with acute pain is different than evidence with chronic pain, but there you have it from Tim and I’m not a employee or a regulator. So I get to voice my opinion a little bit more freely about this one. I like expansion of the program; that I’m certainly for. I think this was kind of a funny one myself.
Rich Oborn:
Yeah. We just hope it’s exercised with wisdom and that providers are careful with how they exercise it, just as we hope with every other type of recommendation they do what we hope that they-
Tim Pickett:
And it will be good to study… This will be a unique thing to kind of study how many of these are issued? What’s the progress? How many of these cards get converted to a regular longer term card? What’s the success of reducing opioids after surgery? We could design some really interesting studies around that. And in fact, not to skip through and go right to the bill that funds a study, there was a bill that funds a study.
Rich Oborn:
… Right. Yeah. So Senate Bill 2, that was a big appropriation bill. And in that bill, the legislature appropriated $538,000 to fund a study of medical cannabis and chronic pain. And that was proposed by representative Ray Ward. And the Department of Health was able to provide some general thoughts about how that should be done, and we’re working out details of that. But it’ll be done through an RFP process where academic researchers at universities have an opportunity to bid on receiving these funds. But we’re very serious about funding research, and we’re excited about the legislature having an interest in doing it. And so we want to ensure that it’s done in a way Utah can be proud of, that can be shared with other states and help them learn as well as we move forward with trying to understand more about medical cannabis and its impact on chronic pain, without federal funding. It’s not easy without getting federal grants to do research.
Tim Pickett:
Is $538,000 a large amount for a study, a small amount? Do we have perspective on that?
Rich Oborn:
That’s a good question. It depends on what type of study, because there’s double blind studies that really cost thousands more than that of dollars beyond the $538,000. So this won’t be something like that. It’ll be something on a lower scale, but it will still be, I think, something that researchers and providers in Utah and outside of Utah will find helpful. We want it to be not just something that’s tucked away, but is something that providers can learn from and patients can learn from and pharmacists at the medical cannabis pharmacies can apply to work they’re doing. Although, we defer to those studies that have a lot more funding that are published as studies that just have more resources to do something that’s even more extensive. Those are exciting to see, and we hope to see those happen even more outside of Utah. We see some of those in other countries, Israel and Canada, or to the countries that we see them more in than within the United States.
Tim Pickett:
Yeah. And I’m interested in why, I know Ray Ward was very interested in getting a little allocation for some research to be done. There was talk about whether to research a condition like this, or to research the program itself and how it was working. So it’ll be interesting to get this process started. I think there’s a ton of research on cannabis. I find it interesting that the medical community still says, “Oh, there’s no evidence” when there’s thousands of studies being done. Like you say, Israel and Canada has some fairly decent, if not excellent, research on some of these things already. But Utah is unique. We like our own programs, right? We like to see things done our way, and this is the beginning of doing that. It’s kind of a culture thing, I think. We like to see ourselves.
Rich Oborn:
Yeah. I think most people agree though is that when you compare the studies done on other drugs to those on cannabis, there is more of a volume of studies of scientific rigor on other types of medications that we don’t see on cannabis yet. There’s just a bigger volume. So it’s just the nature of dealing with a federally illegal drug that there’s not as much research on it, even if you add the research in other countries. So that’s one of the sources of some of the reluctance of some providers to join in and make recommendations regarding medical cannabis. There’s been some good literature that has taken a look at studies not just in United States, but these other countries.
Rich Oborn:
And even combining all of that, there’s still some weakness when compared to other drugs. So I think that that’s important to keep in mind. I don’t want that to take away from some of the, I think, positive experiences people are having with medical cannabis as they treat their medical conditions and finding more success in treating their conditions with medical cannabis compared to other drugs. We don’t want to take away from those experiences and Utah law allows for those experiences to happen legally, which is great. But we still want to be able to continue to add to the evidence out there regarding treatment of A, B and C condition with medical cannabis.
Tim Pickett:
In a really rigorous way, I agree. There’s not comparison studies and the double blind studies, and there’s a huge amount of inclusion bias in cannabis studies, which is always kind of an issue in medicine. So when we added a little bit of history, they weren’t able to get opioid use disorder as a condition. So it seems like we compromised or the advocates kind of compromised here and added this language that we’ve got to now consider the patient’s qualifying condition history of substance use or opioid use disorder when we’re doing this. This seems like something we’re already doing, but-
Rich Oborn:
It should be. Right. Yeah.
Tim Pickett:
… This should be something. If they have opioid use disorder, this would be a reasonable alternative to opioids.
Rich Oborn:
Well, I think the purpose of this amendment to the law is to have a medical provider be more careful in their consideration of a recommendation when they learn about a patient’s history of substance use or opiate use disorder. Because there are some studies that find that individuals that have those conditions, that they have the propensity to overuse medical cannabis in some cases beyond it’s medical purpose.
Tim Pickett:
Yeah.
Rich Oborn:
So [crosstalk 00:41:20] interacts with those disorders. And there’s some studies done that show that it actually exacerbates or makes them worse when used in the wrong way. So it’s important that there be a screening done. I think this is the best practice and people ask, “Well, what’s screening?” Well, there’s a few types of screenings that are out there. People that work at these type of facilities are very familiar with the types of screenings and different types you do. But as a medical provider, it’s just important that there be an awareness of the patient’s substance use or opiate use disorder history if there is one. And if there is one take, take a step back, consider whether recommending medical cannabis should still be done in light of that patient’s condition.
Tim Pickett:
Yeah. I’ve had patients who we have removed their ability to access all forms, right? Reduced it to… Been asked by a patient frankly to reduce their forms to only topicals because they were having trouble, they were spending too much money, consuming too much, had a history of addiction to other substances. And it’s… Yeah. I do think it’s real. I think there’s about a 9%, I think the statistics are between 8- and 9% of cannabis users can become addicted, which interestingly is just barely below the number for opioids. But I think that just goes to show that people get addicted to things. They like… Humans, we like the dopamine.
Rich Oborn:
Right. And I think researchers out there have said there’s little evidence that it works as an effective treatment of substance use or opiate use disorder. There’s mixed results in the studies that show that. And in fact, there’s some studies that show that it makes them worse. So we want to see providers take a step back, consider that recommendation in light of the patient’s qualifying condition if they have a history of substance use or opiate use disorder. This is what a provider does when they recommend controlled substances outside of the Medical Cannabis Program for other drugs that are federally illegal, they consider, “Okay, how does this drug impact these other conditions that this person may have, right?”
Tim Pickett:
Yeah, we’d even call other providers and say, “Hey, I’m about to prescribe your patient or our patient now. When you’re a specialist, we’re going to add this to their drug list. And what do you think? The neurologist, the psychiatrist.
Rich Oborn:
Right.
Tim Pickett:
Create more of a team approach. I like the idea. I think it does create a little bit of increased liability on the provider to make sure that they’re doing their due diligence. And so providers shape up, right? Let’s see. Oh, the drinks. I keep getting emails about the drinks. When are the drinks going away? When are the drinks going away? So currently you can buy a drink, you can buy a Seltzer, you can buy something in a can, there’s a few of these around, and we’re going to take that back down to 30 MLs. So basically a tincture bottle or a little oil bottle. There was some controversy on this too.
Rich Oborn:
There was. And I think I can’t speak for policy makers, but naturally they weigh benefit and harm. And they decided there was more risk to liquid suspensions being above 30 milliliter than there was benefit. And I think it’s easier to abuse the use of a medical cannabis liquid suspension when it’s above 30 milliliter-
Tim Pickett:
Yeah. And I’ll say it, I mean, a can of spiked Seltzer with THC in it just looks wreck. It just looks more recreational as a product than a tincture oil, or even a Select Squeeze where Curaleaf makes that drink additive. Even that looks less recreational or [ adult 00:00:46:05] use than a four pack or a six pack.
Rich Oborn:
… Sure. And you don’t typically see from a Walgreens, you don’t go to the pharmacy and purchase a liquid suspension to treat the types of conditions that are [crosstalk 00:46:23] conditions in the state of Utah.
Tim Pickett:
NyQuil doesn’t come with a can that you crack open.
Rich Oborn:
Right. Right. Yeah. There’s a reason why it is the way it is. It’s for patient safety.
Tim Pickett:
Sure.
Rich Oborn:
So same goes in this respect.
Tim Pickett:
Patients have until the end of November. Basically Thanksgiving, folks. They’ll maybe be on the shelves till then, but I doubt they’ll make any more of them. I bet they just clear out their inventory and then that’s kind of it.
Rich Oborn:
Right. Yep.
Tim Pickett:
Let’s talk about advertising because this was something that got changed a little bit, not a ton. I see you’re getting out your cheat sheet here because this is wholesome co-delivery, doesn’t the delivery third party… Explain the advertising changes.
Rich Oborn:
Yeah. So I think there was a lack of clarity in the current law and with these bills that goes it into place with SB 195, there’s more clarity as it relates to advertising and the limits that are placed on medical clinics and medical cannabis pharmacies. And so the law states that a medical cannabis pharmacy, they’re able to advertise in any medium. So there’s no longer restriction on the type of medium they can use for advertising. In the past there was, but with SB 195, there will not be. But they’re able to include information in their advertising such as a service available at the pharmacy, the best practices that the medical cannabis pharmacy upholds, education materials, they can advertise those obviously. That’s important.
Rich Oborn:
And their inventories, they can advertise their inventories obviously. And a medical cannabis pharmacy may provide information regarding subsidies for the cost of medical cannabis treatment to patients who affirmatively accept receipt of the subsidy information. So all those things are really important. Pharmacies will be able to do those things, some of which they could not do in the past because they were restricted in the type of mediums that they could engage with patients in. So that, I think, will have an impact on patients for the good. There’ll be information that’ll be more accessible about education materials and best practices that the medical cannabis pharmacy upholds. So I think it clarifies some of that.
Tim Pickett:
You’re not passing out coupons at the county fair, right? You’re having to essentially be a patient and opt in to those communications to receive a coupon, a subsidy program.
Rich Oborn:
Right. Right. So a pharmacy would not be able to advertise promotional discounts or incentives. They would not be able to advertise a specific medical cannabis product in their advertising. And they would not be able to advertise an assurance regarding an outcome related to medical cannabis treatment, for example. Those are some things that they would be prohibited from doing. So those are some of the advertising limits that will be in place under SB 195.
Tim Pickett:
Yeah. I think that clarity is somewhat helpful. We’ve already run into it with utahmarijuana.org with billboards and [ reagan 00:00:49:56] and everybody’s kind of trying to shift and adjust and making sure that everybody’s in compliance. And so I’m sure you’ll have a lot of questions coming up. In fact, I was talking to Cole today who was like, “Oh, you’re talking to Rich, ask him about the advertising.”
Rich Oborn:
One thing that I think is great is that a nonprofit that offers financial assistance for medical cannabis treatment to low income patients, they may advertise the organization’s assistance if the advertisement doesn’t relate to a specific medical cannabis pharmacy, or a specific cannabis product. So there is this emphasis on allowing the nonprofits to do that.
Tim Pickett:
Yeah. I don’t know that you can register a 501(c)(3) related to cannabis yet, but certainly our uplift program that subsidizes low income Medicaid and terminally ill patients was one of the things that I know the lobbyists and the activists kind of made sure to mention to the legislators that said, “Hey, we’re bringing people through the program who can’t afford it because it is costly for a lot of people.” And the program essentially was designed for these low income folks and terminally ill and really chronically ill patients. And yet there’s a bunch of them who can’t afford to even get into the program as it is. So helping those patients, it’s been surprising how interested the growers, retailers, processors are in giving back to those programs and subsidizing that, which kind of, I don’t know whether some people think it’s ironic, right? That they’re using their profits to help subsidize the poor. But on the other hand, you kind of have to have fire… The cashflow is fuel to the fire. This thing has to run.
Rich Oborn:
Yeah. And so we’ll be working with the industry on putting together some additional standards and rule that relate to some of these advertising standards that are in the statute. We’ve got some authority to do that. And so we’ll be reaching out to get some of that input.
Tim Pickett:
Cool. So let’s talk about the growth before I let you go. What are we up to cardholder wise?
Rich Oborn:
Yeah. So as of the end of February, we were at 44,800 active medical cannabis cardholders. And that represents a growth of, I’d say, between 1000 and 2000 cards per month new active medical cannabis cardholders. And so we’ve seen a steady rate of growth happen, which is good to see, although we know that medical cannabis isn’t for everybody. And so when we did an analysis, we found that there was about a 70% card renewal rate. And there’s lots of reasons why people would choose to renew their card. And a lot of reasons why they may not choose to renew their card. They may find that, “Hey, medical cannabis isn’t working for me, but these other medications do or these other treatments do. So I’m not going to renew my card. I’m going to work with my provider on these other medications or treatments that are looking better for my chronic pain.” Because, like anybody, people just don’t want to buy something. To buy it, it’s expensive. So also-
Tim Pickett:
Yeah, and I know cost is a significant answer we get when people let their card lapse. Cost of the QMP visits, cost of the product, whether or not all of that’s justified or not, that’s just a big reason people leave the program.
Rich Oborn:
… Right. One of the most critical things that the Department of Health has been implementing just recently is the limited medical provider recommendation program. And there have been approximately 50 limited medical provider recommendations since January 19th, 2022, when it was launched. And these are providers who are not registered with the Department of Health, but who choose under the state law to recommend medical cannabis to up to 15 other patients.
Tim Pickett:
There’s something like 16,000 controlled substance license holders in Utah, right?
Rich Oborn:
Right.
Tim Pickett:
Available for the limited medical provider program.
Rich Oborn:
Right. Any MD, DO, APRN, PA or podiatrist falls under that. And so we’ve seen just a steady growth, but it’s been a slow growth just because naturally it takes time for providers to feel comfortable, I think, with a new program. And so we’ve done some webinars just recently. We’ve done four webinars since January to help providers who are interested in learning more about limited medical providers and how they can recommend cannabis in an easy way. There’s information on our website that a patient could direct their regular physician to if they wanted their physician to explore that possibility of recommending to them and making them one of their 15. And so that’s one thing that I think is helping patients make a medical cannabis visit more affordable because in some cases, in the past, there have been some clinics that I think have been charging a lot more than other clinics for a similar service.
Tim Pickett:
I did a podcast and the guy’s in the $5,000 range over the two years because of a clinic that was having him come up every 90 days for 400 bucks. It was the worst I’d heard about, but there still are. And now there’s a website people can go to where they can see a little bit of this. They only see the cost, but there is a website where people can look at the initial visit cost, right?
Rich Oborn:
Right. So policy make were listening and they thought this is not right. We need to do something. So they created this limited medical provider program as just one strategy to address this concern. A second strategy was to require that the Department of Health work with the state auditor’s office on gathering data from all the medical clinics that have QMPs who advertise publicly that they offer medical cannabis evaluations, that they report those fees to us that they charge. And that those fees be posted on the state auditor’s website. And so we’re getting about 200 to 400 visits a week to that website, which is a good sign. We like to see that people are using it. And this is not just for people that are wanting to get a medical cannabis evaluation for the very first time. But it’s for those that have been in the program for a long time.
Rich Oborn:
Maybe they joined in March, 2020, and they, at this point, are ready to just learn more about what some other clinics are charging and they want to compare some of those costs. And as you know, Tim, there’s different reasons why clinics charge different fees. Some clinics take more time with their patients and maybe have more training than other providers do on a particular subject related to medical cannabis.
Tim Pickett:
Yeah. Not a bad place to start your search. Definitely not a place I would say to end your search in who to go see.
Rich Oborn:
Right.
Tim Pickett:
But more information is always better.
Rich Oborn:
Right.
Tim Pickett:
What’s some of the plans for 2022 in the program that the Department of Health has?
Rich Oborn:
Yeah. So one thing that we’re excited about is putting together an analysis of medical cannabis product inventory across the state. And I think there’s from some concern about not finding a certain type of product in Utah, and we want to be able to do an analysis that actually relies on some of the actual inventory available across the state to really see if some of those concerns are valid. And then we want to share that analysis with clinics, with pharmacies, with the industry in hopes that they would find creative ways to address some of those gaps that may exist throughout the state.
Tim Pickett:
Yeah. We’ve heard of those where we’ll send a patient for a certain product and then it’s not there. But, yeah, it’d be very interesting to know and be able to kind of look at whether or not that’s really true.
Rich Oborn:
And we understand there are some unique conditions that people suffer from that require unique types of products. And so there may not be a market right now in our program, but as the maturity of the program increases and there’s more patients, there may be a market in a year or two for certain types of products to be worth it for a processor to manufacture such as a breathalyzer or something like that.
Tim Pickett:
Yeah.
Rich Oborn:
We also want to do additional outreach to medical providers, medical clinics and stakeholders to ensure that they’re receiving accurate information about the laws in Utah and also best practices. And there’s some great information in a publication that the Cannabinoid Product Board has put together that we feel is underutilized and could be, I think, shared more universally and distributed with providers. And we want to share it in a way that’s easy for them to digest and it’s not complicated. So I think we’ll do some additional outreach. And we’re excited about those plans. We’ll be helping lawmakers with a medical cannabis governance study during the next year. There was Senate Bill 153 in the past that required that lawmakers put together a committee that will study the feasibility and the benefits, potential benefits, of having the responsibilities of the Department of Health under a single agency with the responsibilities of the Department of Agriculture and Food.
Rich Oborn:
And other states have that type of a governance model where it’s all under one single agency. And there’s reasons why that could work, there’s reasons why it may not work, but legislature wants to do this study and we’re happy to help them conduct that. And they plan to include not just us in it, but I think even more importantly, patients and providers in the industry and getting input on how things are put together long term. And the legislature plans on putting together this study and conducting it. I think the deadline is October 2022. And then potentially taking action, legislative action, during the legislative session of 2023 that the study has recommendations that lawmakers want to take action on.
Tim Pickett:
Sounds like you got a busy year, and you got to upgrade the EVS system.
Rich Oborn:
Yes.
Tim Pickett:
Right?
Rich Oborn:
Yeah. I know that’s something that’ll impact pharmacies quite a bit and also providers in clinics as they are the primary users of that system. And we want to make things just easier for people to get access to information so they can spend more time with patients and help them get through some of the things they’re dealing with with medical conditions. And we want patients to be able to just have better access to the counseling that’s available at the pharmacies. And sometimes it starts with improving the softwares that they use to allow for more time that they can spend one on one with the patient. So that’s one goal we have.
Tim Pickett:
Well, there’s a lot that’s updated. This has been a great conversation. I think we’ve gone through a lot of this stuff that people will be interested in hearing about. If you’re not subscribed to Utah in the Weeds, you can subscribe on any podcast player that you have access to. Anything else we’re missing?
Rich Oborn:
No, that was quite a bit. We’re excited that [crosstalk 01:02:59].
Tim Pickett:
Last year we ended up taking a long time as well. So this is turning into our annual legislative update with Rich Oborn, the Department of Health Medical Cannabis Program Director. And appreciate your time today.
Rich Oborn:
Yep. Good to chat with you, Tim.
Tim Pickett:
All right, everybody. Stay safe out there.
