Megan Keller, an Orem massage therapist, was preparing for a client last week when exhaustion washed over her along with the sensation she recognized as an “aura,” the telltale sign that a seizure was building in her body.

She’s been through this thousands of times and knew exactly what would happen next.

Her right leg would go numb. Then, her right hand would tremble. Her speech would disappear and, with it, her ability to ask anyone for help. The feeling, she says, is like being “trapped inside my body.”

Often, her muscles contract with such force that the seizure dislocates her hip and shoulder. A few times, she’s regained consciousness to find her teeth cracked from the clenching of her jaw.

Last week, as she began losing feeling in her leg, Keller quickly canceled her massage appointment and texted her husband, who hurried to her side with an oil infused with cannabis compounds. He spooned a few drops of the medicinal oil underneath Keller’s tongue, and the couple waited.

Instead that day, she said, “I ended up canning blackberry jam and cooking a full meal.”

Keller, a 40-year-old mother of two, said medical cannabis has changed her life, virtually eliminating the seizures that used to be a painful part of her daily reality. And she’s one of 3,670 Utah County patients who now possess a state-issued card affirming their legal right to buy and use the substance as part of Utah’s fledgling cannabis program.

In fact, Utah County is now leading the way in embracing legal access to the medicinal plant — despite roundly rejecting the 2018 voter initiative that helped open this pathway in the first place. Six months into the cannabis program’s full launch, Utah County accounts for 44% of the patient cardholders in the state — far outstripping the more populous and socially progressive Salt Lake County.

Keller isn’t surprised by this. Now that there’s an official framework for using medical cannabis, she said, Utah County’s devout residents will follow it to the letter.

“Utah Countians like to obey the law,” she said. “We don’t want to be buying off the black market.”

Utah County Commissioner Nathan Ivie says he’s thrilled about his jurisdiction’s high patient cardholder numbers, interpreting them as a sign that people are seeking alternatives to dangerous prescription painkillers.

The county has a culture of trusting authority figures, doctors included, Ivie explained. So when physicians began prescribing opioids with greater frequency, he said, many people fell into addiction.

Two years later, medical cannabis is giving Utah County residents “an opportunity,” Ivie said, “to treat their chronic pain or other conditions in a much safer manner.”

Heather Lewis of the Utah County Health Department agreed with Ivie that the opioid epidemic might have played a role in the number of local patients. But she has a different gut reaction to the cardholder figures.

“I would say it’s alarming to me to find out that Utah County is the highest with patient cards,” Lewis said.

Because she’s the department’s director of substance misuse prevention, her mind jumps to the possibility that this medical cannabis might find its way onto the black market or into the hands of youths. She wouldn’t discourage, however, a patient from trying the plant-based treatment at the advice of a medical professional as long as they store the substance responsibly.

And last week, officials and advocates attended the ribbon-cutting for Utah County’s first cannabis pharmacy, Deseret Wellness in Provo. Jeremy Sumerix, the company’s market president, said he’s encountered curiosity as he prepares for the location’s Aug. 31 launch — but no pushback from officials or the surrounding community.

Ivie was among those who helped celebrate the pharmacy’s ribbon-cutting and later tweeted about how many of the state’s patient cardholders live in his county. He also tossed in a lighthearted reference to the Word of Wisdom, part of the health code found in the sacred canon for The Church of Jesus Christ of Latter-day Saints.

After years of benefiting from legal CBD oil, Keller joined the effort in 2018 to put a cannabis initiative on the ballot, circulating Proposition 2 petitions in the Provo neighborhood where she’d grown up.

She collected names from Brigham Young University professors, Latter-day Saint leaders and one of Utah’s oldest registered voters. Only a couple of people turned her away, she said. Most were eager to sign, and some even grabbed her petition and ran it over to their neighbors so they could add their names, too.

“It really split neighbor against neighbor down here.”

The church’s letter on Prop 2 unsettled James Boley, a Latter-day Saint from Saratoga Springs, who up until then had been campaigning quietly for the initiative. After reading it, he decided, he needed to become more vocal.

“I didn’t feel comfortable with a church that I belonged to telling me how I should vote,” he said, “or telling its members how they should vote.”

For Keller and Boley, though, there were consequences for activism.

Boley said he received anonymous messages taking him to task and accusing him of apostasy. His lay bishop called him in for a meeting after someone complained about his advocacy, while his stake president, who oversaw a number of LDS congregations, told him he was free to support the initiative — but not publicly.

“I felt like I was in high school,” he said.

Because of Keller’s support for Prop 2 and her use of CBD oil, her church leaders told her she couldn’t teach Sunday school anymore. They put her in an addiction class instead, she said.

A church spokesman declined to comment on the experiences related by Boley and Keller.

Keller said she remains deeply committed to her faith. But she no longer attends church.

Though the LDS Church opposed Prop 2, it did get behind a compromise medical cannabis plan that Utah lawmakers approved in December 2018 to replace the voter initiative. That law has evolved into the medical marijuana program the state officially kicked off earlier this year.

Ivie said he doesn’t see Utah County’s opposition to Prop 2 as at odds with the high number of patients there who have gotten cannabis cards.

“People were not willing to openly support it because of the stigma that came along with marijuana culturally,” he said. “Now that it’s coming from your doctor, there’s not this stigma of ‘you’re a pothead.’ You’re simply taking a medication to treat your condition.”

And the statistics don’t necessarily mean that Utah County has the state’s highest number of cannabis patients, since cardholders are just one subset of the total.

Earlier this year, Utah lawmakers approved a bill to create a more gradual on-ramp for patients as officials work out the kinks in the state’s cannabis registration system. Through the end of 2020, patients can buy medical cannabis without a state-issued card as long as they have a recommendation letter from a physician.

The Utah Department of Health reports that about 6,000 cannabis patients have been buying medical marijuana by presenting a letter of recommendation.

Christine Stenquist, a cannabis advocate and vocal opponent of the legislation that lawmakers passed to replace Prop 2, agrees with Keller that Utah County residents are more apt to sign up for cards to stay in compliance with the law and with guidance from their faith leaders. In her view, problems with the state’s cannabis program have likely driven away patients with more secular backgrounds.

“I would say that many of the Salt Lake residents are liberals or liberty minded and are aware the program is flawed,” she said. “Most of them have a traditional [black] market source.”

Amy Coombs, a social worker who practices at a Lehi pain clinic, said her Latter-day Saint clients struggle with shame over exploring medical cannabis as a treatment. Many express a longing for someone to tell them it’s OK to soothe their pain, she said, and the cannabis cards might give these patients the sense of permission they’re seeking.

It’s much different at her Riverton practice, where some patients freely admit they self-medicate by illegally buying recreational cannabis, she said.

Keller prides herself on never having bought from an illicit source. With the passage of Utah’s medical cannabis law, she’s been able to transition to an oil that blends CBD with a bit of THC, the main psychoactive ingredient in marijuana.

She’s gone from dealing with 30 seizures a day to being seizure-free for two years, she said.

Several times each week, she’ll hear from fellow Latter-day Saints, “cancer survivors and fighters, people in a lot of pain,” who are curious about medical cannabis and whether it might work to relieve their suffering.

Keller said she’s always happy to help them find treatment — the legal way.