This site is under maintenance, but will be back up before you can say tetrahydrocannabinol.
Are You Familiar with Utah's Limited Medical Provider Program

Medical Cannabis Cards can be recommended in Utah by two types of medical providers. The first is the Qualified Medical Provider (QMP), the second is the Limited Medical Provider (LMP). The latter group is the topic of this post. How much do you know about them?

Utah’s LMP program was not initially part of the Medical Cannabis package that resulted from passage of Proposition 2 in 2018. In fact, the state didn’t finally approve LMPs until just over a year ago. Adding them to the equation has arguably had a positive impact on Medical Cannabis patients.

Things have been going so well for the Limited Medical Provider program that Utah Physician magazine just ran a detailed piece about it in their October-November 2022 issue. It is a great article that offers some information that was previously hard to come by just by looking at the state’s Medical Cannabis website.

More About the LMP

You might already know that QMPs are medical providers who have taken the necessary steps to be certified with the state to recommend Medical Cannabis. They have prescribing authority, they have met the continuing education requirements, and they have registered with the state. The reward for going through that process is the ability to recommend Medical Cannabis to hundreds of patients.

The LMP hasn’t gone through the certification process. Still, they are a licensed medical provider with existing authority to prescribe narcotics. Your family doctor or nurse practitioner is the perfect example.

LMPs with prescribing authority can recommend Medical Cannabis to up to 15 patients at a time. They do not have to undergo continuing education or pay the annual licensing fee.

Every Bit as Qualified

We think it is important to point out that a Limited Medical Provider is every bit as qualified as QMPs to recommend Medical Cannabis. Even without state certification and continuing education, they are still licensed medical professionals with the same overall training education as the rest of their peers.

Giving them the ability to recommend Medical Cannabis was designed to help patients who may not have easy access to QMPs. Think rural patients who live an hour or more away from one of Utah’s urban centers. Allowing their local doctors to help them out makes life much easier on them.

The Process Is Slightly Different

For us, one of the big take-aways from the Utah Physician article was the knowledge that the process is slightly different for LMPs. When a QMP recommends Medical Cannabis to a patient, they actually interact with the state’s electronic verification system (EVS). That is not the case for LMPs.

An LMP downloads and completes a form on behalf of the patient. The form can then be sent to a local Medical Cannabis pharmacy via electronic means or delivered in person by the patient him or herself. Pharmacy staff enter information from the form into the EVS. A temporary card is issued via email and the patient can immediately make that first purchase.

It is not quite clear why the process was set up differently. If we had to hazard a guess, we would say that the state is trying to make things as easy as possible on LMPs in order to encourage more medical providers to get on board.

At any rate, potential Medical Cannabis patients who don’t have easy access to a QMP can now enlist the help of a willing medical doctor, nurse practitioner, etc. with prescribing authority in Utah. We invite you to learn more about the Utah Limited Medical Provider program whether you are a patient or provider. It is a great program that provides a valuable service.

EVS Status: 4 Options and What Each One Means

It is a good thing that the state decided to implement administration of the Medical Cannabis program online. We all live online these days. So establishing the electronic verification system (EVS) was a no-brainer. That said, the EVS can be confusing. Consider a patient’s EVS status. There are four options that could show up in a patient’s account.

Imagine you just completed your Medical Cannabis Card application and paid your fee. Now you are waiting for your card to arrive via email. You can check your status any time by logging in to your account. Likewise, current patients looking to renew their cards can also check their status.

Here are the four options and what each one means:

1. Awaiting State Review

The first option is ‘Awaiting State Review’. By law, the state has up to 15 days to review your application and render a decision. Reviews are typically completed in considerably less time, but there aren’t any guarantees. Seeing this status on your account page lets you know that your application is being processed.

If you are concerned that it’s taking too long, you can always check with your QMP’s office to see if they have submitted the required information on their end. If you used an LMP, this particular issue doesn’t apply.

2. Active

Assuming your application has been processed and approved, your status should say ‘Active’. You should have already received your Medical Cannabis Card via email. If not, check your spam folder. Maybe it got diverted there by mistake.

You can also print a paper copy of your card directly from the EVS. Visit the EVS website with a smartphone and you should be able to view your card as well. If so, you can save a copy to your phone’s internal storage.

Active Status and Renewals

A quick word here about the ‘Active’ status and renewals is in order. Let’s say you renew your card a few days before it expires. You check your status and see that it’s still ‘Active’. Great. The state will not issue your new card until the day after your existing card expires.

Make a point of checking in that day after. If you haven’t received your new card via email, check your spam folder. You should be able to see the new card on the EVS page. You can print a paper copy if you like.

3. Incomplete

Seeing the ‘Incomplete’ status on your account tells you that the DHHS needs more information before they can render a decision. They have either sent you an email or will be doing so shortly. So again, check your spam folder.

What more information would the state need? It’s hard to say. Maybe you made a mistake entering your contact information. Perhaps the information you provided doesn’t exactly match what your QMP provided. Hopefully it’s a minor issue you can correct with little effort.

4. Denied

Unfortunately, some Medical Cannabis Card applications do get denied. There can be a number of reasons for such denials. If that’s the case for you, your status on the EVS will state ‘Denied’. Changing your application to that status should trigger an email explaining what happened. Check your spam folder if you don’t get one.

Card status on the EVS site is designed to help Medical Cannabis patients know where they are with their cards at any given time. It is not a perfect system (no system is) but it does the job. As a Medical Cannabis patient, you can check your own status any time simply by logging in to your EVS account.

How to Approach Medical Cannabis During Pregnancy

A number of studies discussing cannabis consumption during pregnancy were published this past summer. Generally speaking, they only looked at the number of women using cannabis to relieve pregnancy symptoms. They did not examine the safety issue. So, unfortunately, an important question remains unanswered: how should a pregnant woman approach Medical Cannabis use?

Medical Cannabis is recommended by medical providers to treat a specific condition. Here in Utah, it might be anything from chronic pain to PTSD and cancer symptoms. A pregnant woman diagnosed with a qualifying condition might still choose to use Medical Cannabis. But should she?

There is no black-and-white answer to that question. Like every other medication, pregnant women are advised to use caution with Medical Cannabis. Caution is always the best approach when the goal is to do right by the baby in the womb.

Low Birth Weight Concerns

A chief concern of using Medical Cannabis during pregnancy is the potential for low birth weight. It is a legitimate concern, though we don’t have enough concrete data to make a determination at this point.

The Cannigma website has a very thorough article on this topic. It is a good read and one we highly recommend. Without getting into all its details here, the article cites numerous studies suggesting that cannabis consumption during pregnancy can result in lower birth weight and shorter gestation.

One of the mentioned studies compared pregnant women who did not use cannabis at all with those who reported cannabis use at 15 weeks. The former group, on average, gave birth to babies with higher weights. Their gestation times also tended to be longer.

Having said that, the cannabis-consuming group still gave birth to babies whose weight, on average, was within the acceptable range for healthy babies, albeit slightly lower. Likewise for gestation periods. They were shorter, on average, but still within the acceptable range for safety.

Still More Research to Be Done

As we say frequently here at, there is still a lot more research to be done into the possible impacts of Medical Cannabis on babies in the womb. Here is what we already know:

It would be unwise for us to assume that Medical Cannabis is completely harmless to babies in the womb without scientific evidence to prove it. Assumptions are never a good thing in medicine. It is best to wait on the science and see what it produces.

In the meantime, pregnant women should not be afraid to discuss Medical Cannabis with their doctors. If you are pregnant or planning to become pregnant, ask as many questions as you have. Combine the answers you get with your own research.

Work with Your Medical Provider

We also want to encourage you to work with your medical provider to ensure both a safe pregnancy and your own health and well-being. If you are dealing with a condition on Utah’s Medical Cannabis qualifying conditions list, you have more than just your pregnancy to worry about.

You and your provider might determine that Medical Cannabis is an appropriate treatment. On the other hand, you might decide that it’s best to look for an alternative. You and your provider ultimately need to reach a decision together.

The lesson here is to approach Medical Cannabis with caution. We have some inkling of how it might affect the baby in the womb, but we still don’t know for sure. Erring on the side of caution isn’t a bad way to go.

5 Things Every Medical Cannabis User Should Know About Terpenes

If you have been using Medical Cannabis for any length of time, you know that there is a lot to learn about it. If you are new to the whole Medical Cannabis thing, you likely don’t know what you don’t know. Both groups could stand to learn more about terpenes. They are one of the least understood aspects of cannabis consumption.

Terpenes may influence how Medical Cannabis affects you. Even if you are unaware of it, the different terpene profiles of the Medical Cannabis products you use could influence how each product makes you feel. So while research into terpenes continues, it is in all our best interests to learn as much as we can about them.

Here are five things every Medical Cannabis user should know about terpenes:

1. They Aren’t Limited to Cannabis

Terpenes are aromatic compounds found in plant life. As such, they are not limited to cannabis alone. Here in Utah, the chances are pretty good that you are familiar with what pine trees smell like. Pines get their unique odor from their terpenes. The same goes for roses, carnations, and even the grass in your front yard.

2. It’s Not Just One Terpene

Next up, it’s not just a single terpene that gives a tree or plant its unique smell. Many trees and plants contain multiple terpenes. That is certainly the case with Medical Cannabis. The different properties of a plant’s combined terpenes determine its complete odor and flavor profile.

3. Terpenes May Contribute to Efficacy

Though the jury is still out on efficacy, the currently available data suggests that terpenes may influence it. In other words, certain ones may enhance the effects that you feel from Medical Cannabis. Processors and manufacturers alike are currently studying terpene profiles in hopes of finding a definitive answer.

At the very least, some terpene profiles may make your Medical Cannabis products more enjoyable to use. If nothing else, making you feel more positive about your medicine will encourage you to use it more consistently. That is never a bad thing.

4. They May Promote the Entourage Effect

The cannabis industry is also looking into the possibility that terpenes can encourage the entourage effect. What is this effect? It is observed when multiple products within a Medical Cannabis regimen work better as a combined medication.

You might try a particular tincture and discover that it works okay for you. Same with an edible. But if you layer them – which is just another way of saying you use both – you might find that you feel a lot better. This is the entourage effect. Terpenes may very well promote the entourage effect for some people.

5. Terpenes Are Not Regulated

Last but not least, you should know that terpenes are not regulated. Processors and manufacturers are not required to test for terpenes or report them. They also aren’t required to include detailed terpene profiles on their labels.

What does this mean to you as a Medical Cannabis patient? By all means research different terpene profiles to learn as much you can. At the same time, be prepared to not have all the information on the terpenes in your Medical Cannabis products. The industry is still working through how to handle terpene reporting and labeling.

There is a lot to know about Medical Cannabis. Terpenes and how they affect users are just a small part of a very broad topic. As a patient, you owe it to yourself to get as much education as you can. Thankfully, Utah MArijuan offers an introductory guide to terpenes and other of resources to help you get started.

If Cannabis Gives You the Munchies, Here's Why

We are all familiar with the stereotypical cannabis user becoming insatiably hungry in the minutes and hours following consumption. While it makes for funny plot lines on TV and in film, what we affectionately call “the munchies” is a reality for many cannabis users. It sort of comes with the territory.

Interestingly, not all Medical Cannabis users experience the munchies. And among those who do, the sensation can vary in intensity. One patient can be incredibly hungry while another is just mildly hungry. So what’s going on? The current data suggests there might be two things going on.

THC Stimulating the Brain

Experienced Medical Cannabis users know that THC and CBD affect the body by binding to cannabinoid receptors in the brain. They also know that the human endocannabinoid system plays a role in regulating dozens of physiological functions, including hunger.

In terms of the munchies, what’s going on inside your body could be nothing more than a reaction to THC. In other words, THC is binding to some of the receptors that regulate your appetite. They are also stimulating those receptors. This makes you hungry — even if you were not prior to consuming.

A Hormone Release in Your Stomach

Another possibility is that the THC in your Medical Cannabis is stimulating production of a hormone known as ghrelin. This particular hormone is produced by the enteroendocrine cells in your gastrointestinal tract. It is believed that THC can stimulate those cells to produce more ghrelin. More ghrelin means more sensations of hunger.

A third possibility is that both reactions are occurring simultaneously. Again, people react to cannabis differently. It is hard to say exactly what happens in every case. But it wouldn’t be surprising if Medical Cannabis patients exhibiting strong hunger pangs are actually experiencing both reactions.

Delivery Method Makes a Difference

If you are thinking that delivery method could contribute, you’re on the right track. One delivery method might not produce a more intense hunger than another, but the speed at which you start to feel hungry can definitely be affected.

When you vape, dry heat, or use a cannabis tincture, you’re getting THC into your system nearly instantly. You begin feeling the effects within minutes. It stands to reason then that you would start feeling the munchies sooner as well.

On the other hand, it can take an hour or more for an edible product to change the way you feel. It takes longer for edible THC to make it into your blood stream and brain. So if it takes an hour or two, the munchies would probably be delayed that long as well.

Since delivery methods do impact the amount of THC that actually gets into your bloodstream, it is conceivable that you experience less intense hunger pangs with an edible as opposed to a vape or tincture. But that’s just speculation.

Nothing to Worry About

The munchies are a very real side effect some cannabis users experience. Let us set your mind at ease by saying that it’s nothing to worry about. It is perfectly fine to satisfy your hunger in the moment. And no, there is no evidence to date suggesting that satisfying the munchies means you’ll gain weight.

There seems to be a mechanism in play that helps your body more quickly burn calories while you are experiencing the munchies. Hopefully, future research will help us understand whether this mechanism is real and, if so, how it prevents weight gain.

At any rate, now you know why you sometimes get the munchies after using cannabis. It is a normal and natural reaction to THC.

The PMP Is an Important Member of the Cancer Patient's Care Team

Chronic pain and cancer are among the top five reasons people apply for Medical Cannabis cards in Utah. Interestingly, cancer patients often choose Medical Cannabis to help deal with the pain of the disease and its treatments. In such cases, a cancer patient’s Pharmacy Medical Provider (PMP) becomes an important member of the care team.

Cancer is a bit unusual in the sense that treating it often causes more discomfort than the disease itself. Chemotherapy and radiation treatments are not easy on the body. So it’s not unusual for cancer patients to experience significant pain along with other symptoms, including nausea.

Medical Cannabis can help alleviate both symptoms. However, a patient’s oncologist may not know the best way to utilize Medical Cannabis for each individual patient. That is where the PMP comes in.

PMPs Are More Qualified

The PMP is the most qualified medical provider to advise on Medical Cannabis use. As a licensed pharmacist, the PMP is trained in all things pharmacology. They are intimately familiar with the human endocannabinoid system. They understand how Medical Cannabis interacts with that system.

Oncologists, general practitioners, etc. are not trained in pharmacology. Their medical school training focused primarily on biology and physiology, along with some anatomy. So while an oncologist may discuss Medical Cannabis with a cancer patient, they may not fully understand how the drug should be used to help that particular patient.

Asking Questions at the Pharmacy

The lack of knowledge among oncologists can leave cancer patients wondering where to turn for answers to their questions. According to a recently published study from Boston’s Dana-Farber Cancer Institute, patients often rely on the advice of dispensary and pharmacy staff.

Their study interviewed twenty-six dispensary/pharmacy employees in thirteen states to try to understand their knowledge of Medical Cannabis as a therapeutic response to cancer pain and nausea. Unfortunately, the interviews revealed a lack of knowledge among these cannabis professionals.

In a previous study, the same Boston research team found that some 80% of oncologists were willing to discuss Medical Cannabis with patients. Yet only 30% felt they had the qualifications to actually recommend its use.

This takes us back to the PMP at the Medical Cannabis pharmacy. In Utah, every pharmacy is required to have a PMP on staff whenever the doors are open. PMPs are there to answer questions, offer advice, and even consult with patients to help them come up with a strategic care plan.

So Many Options

We consider the PMP one of the more critical members of the care team when it comes to Medical Cannabis therapeutics. The reason is simple: there are so many choices. It is easy for patients to walk into a pharmacy and immediately feel overwhelmed by the different products and delivery methods.

Things are made more complicated by the fact that people experience cancer pain and nausea in different ways. For some people, the pain is moderately annoying but tolerable. Other people find cancer pain nearly debilitating. It takes an experienced professional to help patients find the right therapeutic formula.

The oncologist is not adequately trained in pharmacology. That’s fine. No one expects it. On the other hand, the PMP is trained. That makes the PMP an important member of any cancer patient’s care team.

If you use Medical Cannabis, do you take advantage of your local pharmacy’s PMP? If not, you really should. Your PMP is a fountain of helpful knowledge and advice that could really make a difference in your treatment. Why not take advantage of everything your PMP knows?

CBD, THC, and Random Workplace Drug Tests

Imagine you are sitting in a job interview listening to the HR manager talk about workplace policies. She mentions random workplace drug testing and your mind begins to race. You use Medical Cannabis from time to time to help with migraine headaches. Meanwhile, CBD supplements are part of your daily routine.

Will either Medical Cannabis or CBD show up on workplace drug tests? And if so, could the results of a drug test prevent you from being hired? You just don’t know. You are terrified when the HR manager directly asks you about drug use.

First of all, relax. We have come a long way here in Utah regarding Medical Cannabis and cultural acceptance. You may have nothing to worry about. Just explain to the HR manager why you use Medical Cannabis. A simple explanation can go a lot further than not saying anything until you test positive.

CBD and Drug Tests

You probably have nothing to worry about where most of your CBD products are concerned. CBD doesn’t show up on drug tests simply because the tests are designed to detect it. Employers generally don’t have issues with CBD because it’s not intoxicating.

As you may know, CBD products sold in the United States must contain less than 0.3% THC by volume to be considered CBD by law. So in most cases, you’ll be all right. However, there are some exceptions to pay attention to:

If you prefer CBD isolate, you should have no worries at all. An isolate is a concentrated form of the cannabinoid. There should be no THC in it whatsoever.

THC and Drug Tests

THC does show up on workplace drug tests because the tests are designed to detect it. You are using Medical Cannabis to treat chronic pain, so there is a good chance that at least trace amounts of THC will be in your system when a random drug test is called for.

Here’s what you need to know regarding the law in Utah: private sector employers retain the legal right to establish their own workplace drug policies. The law allows them to say no to Medical Cannabis if they choose. This is primarily because private-sector employment is at-will employment, giving both employer and employee the legal right to terminate the relationship at any time and for any reason.

This is not to say that a prospective employer would refuse to hire you because you use Medical Cannabis. A simple explanation may be enough to satisfy an HR manager that you are not a risk. As for public-sector employees, the law is much different.

Thanks to a pivotal court case and action taken by the state legislature, public-sector employers are required to treat Medical Cannabis like any other prescription medication. As long as cannabis consumption does not affect an employee’s work or present a safety issue, employees cannot be discriminated against for Medical Cannabis use.

Things Are Getting Better

Things are getting better with Medical Cannabis in Utah. The current legal framework certainly isn’t perfect, but it is a lot better than it was three years ago. That being said, your best bet regarding CBD, THC, and random workplace drug tests is to know and understand what the law says. Knowing your legal rights is the best way to make sure they are not infringed upon.

Medical Cannabis Journaling Tips for Chronic Pain Patients

You are in good company as a Medical Cannabis patient who uses the medicine to treat chronic pain. Among all the conditions on Utah’s qualifying conditions list, chronic pain ranks number one. Hopefully, you are finding the relief you need. If not, are you keeping a patient journal of your chronic pain and experiences with cannabis?

Journaling for chronic pain patients is a practice recommended by both state regulators and experienced medical providers. It is the practice of recording how you use Medical Cannabis, when you use it, and how it makes you feel. Journal data can be helpful for several reasons, such as helping you to truly understand how your medicines are working. That same data can give your medical provider valuable information that makes their advice better.

Use a System That Works for You

As important as Medical Cannabis journaling is, it cannot be something you consider drudgery. Otherwise, you are not going to do it. So pick some sort of system that works for you. You may prefer a spreadsheet on your computer. You might be the type of person who prefers mobile apps on your phone. If you like old-fashioned paper and pen, the state produces a free PDF journal form you can download and print.

The thing about journaling is that consistency is the key. When you’re treating chronic pain, your experiences are bound to change from time to time. You need a consistent journal to account for those changes. If you are inconsistent, you and your medical provider may not be able to figure out the best path for you.

Important Things to Track

Chronic pain can be a very complex condition. So to make journaling as effective as possible, it helps to keep track of some very specific things. Taking all the information you recorded with you on every pharmacy visit helps your Pharmacy Medical Provider (PMP) fully understand what is going on with you.

Here’s what you should be tracking:

1. Your Goals

First and foremost are your goals. Why are you using Medical Cannabis? Is it only to deal with chronic pain, or are there other symptoms you are trying to address? For example, cancer patients use Medical Cannabis for both pain and nausea.

2. Product Type and Details

Your Medical Cannabis pharmacy is undoubtedly stocked with a variety of products. You have gummies, tinctures, and vaping products. Each one may have a different terpene profile. You also have different strains to work with. Tracking all these details can help you pinpoint which products work best for you.

3. Dosage and Delivery Method

You have probably discovered that different dosages and delivery methods address your pain with differing levels of success. So tracking both gives you a better idea of what does and doesn’t work. Dosage and delivery method information is especially helpful to your PMP.

4. Your Medication Setting

Believe it or not, the setting in which you consume Medical Cannabis can make a difference. Track where you are when you take your medicine. Record the date and time. If there is anything unusual about the setting, write that down as well.

5. How You Feel

Wrapping it all up is how Medical Cannabis makes you feel. You may find great relief in one case but very little relief in another. Keeping track of this will help your PMP draw correlations between all the other information and each unique experience it pertains to.

Journaling for chronic pain patients is a fantastic way to get the most out of Medical Cannabis. It is especially helpful for chronic pain sufferers whose circumstances and experiences change from time to time. If you are not journaling yet, why not start today?

It has been a long time since we have discussed cannabis reciprocity here in Utah. Therefore, we thought a refresher was in order. With tens of thousands of Medical Cannabis patients in Utah now, new patients are being added to the roles daily. Reciprocity is a topic that needs to be discussed more often.

What is cannabis reciprocity? How does it affect you? Keep reading to find out. As you read, bear in mind that Utah Therapeutic Health Center assists patients looking to obtain or renew their Utah Medical Cannabis Cards. We have a number of clinics located throughout the state.

The Basics of Reciprocity

The concept of reciprocity, from the perspective of state law, is pretty easy to understand. States involved in a reciprocity agreement recognize and honor the laws of the other states involved in the agreement. Your driver’s license is the perfect example.

All fifty states and the District of Columbia practice reciprocity when it comes to driver’s licenses. So even though you earned your driver’s license in Utah, it is valid anywhere in the country. That’s reciprocity. All the other states agree to honor Utah’s driver’s license. In exchange, Utah honors licenses from all the other states as well.

It is Never Guaranteed

Reciprocity is a necessity in the U.S. due to how our federal and state laws are implemented. First of all, anything not explicitly mentioned in the Constitution is regulated at the state level. That is why we do not have a federal driver’s license. Our state-heavy system keeps Washington at arm’s length. At the same time, it also means different laws from one state to the next.

The reality is that reciprocity is never guaranteed. We know this all too well where Medical Cannabis is concerned. To date, there are only thirty-eight states that legally recognize Medical Cannabis. Patients cannot use Medical Cannabis in the remaining twelve states. So right off the bat, there is a reciprocity issue with those states.

Even among states with legalized Medical Cannabis, reciprocity isn’t universal. There are a few states that have reached reciprocity agreements. Utah is not one of them, so there is no guarantee that your Utah Medical Cannabis card will be recognized anywhere else.

Non-Resident Medical Cannabis Cards

Utah doesn’t recognize Medical Cannabis Cards from other states, either. But not all is lost. The state does offer another option: the non-resident Medical Cannabis card. People from other states can apply for these temporary cards in advance of a planned visit.

A non-resident card gives out-of-state visitors the same legal rights and access as residents with permanent cards. The only real difference is how long the cards are valid for. Resident Medical Cannabis Cards are issued for six months at a time. Non-resident cards are only good for 21 days.

Patients should also note that they must have a valid Medical Cannabis Card from their own state and be diagnosed with a qualifying condition according to Utah regulations. As long as those two conditions are met, non-residents can get temporary cards.

Reciprocity and Interstate Transport

One last thing you should be aware of is that reciprocity doesn’t necessarily mean you can transport Medical Cannabis across state lines. Under federal law, you cannot. The same goes for Utah. Visitors are not allowed to carry Medical Cannabis into the state; residents cannot carry it out of the state. Reciprocity has no bearing on that particular aspect.

Here’s hoping that Medical Cannabis Cards will one day be just like driver’s licenses. Perhaps a decade from now, a card from any state will be recognized by every other state and the District of Columbia.

Add a Little Green to Your Inbox

740 E 3900 S
Suite 108
Salt Lake City, UT 84107
chevron-down linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram