SALT LAKE CITY — Six months after medical marijuana became legal for purchase inside Utah for the first time, the program has already surpassed enrollment projections.

But high demand has also led to shortages in both product and providers interested in recommending medical marijuana to patients.

“It’s been going. It’s been going well, as with all new programs and people starting and really pushing to get up and going like they did early on — and now (producers) are starting to find their traction to be able to keep moving forward,” said Cody James, manager of the Utah Department of Agriculture’s Industrial Hemp and Medical Cannabis Program.

“I don’t think that anybody had an idea as to the number of patients that Utah was going to see this early. … I think we’re exceeding all of the studies that we had on the number of patients,” James said.

Utah voters approved a ballot initiative in November 2018 legalizing doctor-approved marijuana treatment for certain health conditions. State lawmakers the next month replaced the measure with a law they say puts tighter controls on the production, distribution and use of the drug. Utah’s Medical Cannabis Act then went through multiple changes in subsequent legislative sessions before the program launched this March.

Now, 10,000 active medical cannabis patients have received medical marijuana cards — a number state officials said they didn’t expect to reach until one year into the program, said Richard Oborn, director of the Center for Medical Cannabis.

Kristin Murphy, Deseret News

“And this means fewer residents in Utah are possessing medical cannabis illegally,” Oborn noted. “These are people that are suffering from qualifying illnesses such as chronic pain and cancer, epilepsy, MS, terminal illnesses. So that’s exciting to see that there’s more people that are not having to take their medication in the shadows anymore.”

Hiccups that occurred with the patient portal through which patients register early on have been corrected, making for a smoother sign-up process, Oborn said. He said people in Utah are also consulting with doctors and pharmacists about medical cannabis “more than they ever have.”

About 220 minors under age 21 have also received cards after getting approved by a compassionate use board. The majority of those petitions have been approved, he said.

Utah County cards

A few thousand more patients without medical marijuana cards, meanwhile, have also been purchasing marijuana with a recommendation letter from their own medical provider, which the law allows them to do through 2020. But as the new year approaches, officials expect many more will apply for patient cards from the state.

Interestingly, more patient cards have been issued in Utah County — 3,600 — than in any other county. Salt Lake County has about 2,400 patients with medical cannabis cards, Weber County has 854, and Davis County has 787. There’s at least one cardholder in each of Utah’s counties.

About 460 medical providers have also registered with the program. But nine counties don’t yet have a qualified medical provider who can recommend marijuana in 2021, when recommendation letters no longer work, Oborn said.

He said it’s possible more people in Utah County have applied for their medical cannabis card than in Salt Lake County because the first pharmacy opened in Salt Lake City. Many patients purchased medical cannabis there at the beginning of the program with only a recommendation letter.

“We believe there’s a high number of those patients that have not yet converted to a medical cannabis card, that they are continuing until the end of the year to rely on just their letter,” Oborn said. It’s also possible that there are also more residents in Salt Lake County who choose to possess illegally and purchase on the black market, he added.

To legally purchase medical marijuana in the state, patients need to receive a recommendation from a qualified medical provider who has registered with the Utah Department of Health. They then need to create an online account with the state and submit an application. After their application gets approved, patients must pay a $15 initial fee to receive their medical cannabis card. They then need to pay a 90-day renewal fee of $5 and a six-month renewal fee of $15.

Qualifying conditions include HIV, AIDS, Alzheimer’s disease, amyotrophic lateral sclerosis, cancer, cachexia, persistent nausea that isn’t related to pregnancy, Crohn’s disease, epilepsy, multiple sclerosis, post-traumatic stress disorder, autism and any terminal illness with life expectancy less than six months. Those without a qualifying condition can petition the Compassionate Use Board for special approval.

Smoking medical cannabis is not legal in Utah. It can be purchased in the form of a capsule, tablet, concentrated oil, sublingual, transdermal or topical preparation, a gelatinous cube, or unprocessed flower.

Kristin Murphy, Deseret News

Medical cannabis users can’t possess more than 113 grams by weight of unprocessed cannabis flower or marijuana drug paraphernalia.

Challenges

The law requires cannabis sold in Utah to be grown in-state, as transporting the Schedule 1 drug across state lines creates additional legal complications.

Also due to marijuana being federally illegal, it must be purchased with cash. If the federal law is ever changed, it would drive down costs and reduce complications, Oborn noted.

“Some of the challenges that I think we’ve seen throughout the beginning of the program and just these first six months, I think a lot of them are caused just by the fact that medical cannabis continues to be federally illegal. So because of that, a number of challenges have come up, and these are happening in other states but I think they’re especially true in a state that just barely begins,” Oborn said.

After the eight cultivators allowed by state law were announced in July 2019, they each needed to work with local governments to meet requirements and show a business license from their city to the agriculture department before getting started.

Cannabis takes between 90 and 100 days to grow.

It then takes a few months longer to process and test the product, James noted.

In March, the first medical marijuana pharmacy opened in Salt Lake City. Six of the 14 pharmacies allowed by the law are now open — one each in Salt Lake City, North Logan, South Ogden, West Bountiful, Provo and Lehi. In the next few months, pharmacies are expected to open in central and southern Utah.

Curaleaf in Lehi — one of the most recent medical marijuana pharmacies to open — is already serving 600 active patients, according to company officials.

Curaleaf describes itself as the largest cannabis operator in the country. When asked how Utah’s market compares to those of other states, Stuart Wilcox, senior vice president of business development for Curaleaf, said: “The Utah Department of Health works well with the industry to serve over 15,000 patients in Utah, which is a huge benefit for the health and well-being of the community.

“Utah’s competitive environment is excellent with industry competitors working together to educate and increase patient awareness,” Wilcox said.

With higher-than-anticipated demand, shortages of certain marijuana products like raw flower have cropped up.

“Initially product supply was limited, resulting in the delayed opening of our pharmacy. We have good suppliers in the state which are starting to get the quantity of product to meet our patient demands,” Wilcox said.

“Our concern is the type of cannabinoids available from the type of plants growing with existing cultivators in the state. The Department of Agriculture has been extremely supportive to place pressure on cultivators to produce more products and expand the variety of plants,” he added.

While it may be frustrating for some patients who expect to buy their medicine and find that it’s out of stock, “this is an issue we knew upfront we would be dealing with,” said Connor Boyack, president of Libertas Institute, a patient advocacy nonprofit that has been involved with drafting the law.

Many patients share the perspective of “how amazing it is that we were able to get this law changed at all and if we’re just patient a little, some of these problems will smooth out and the long-term prospects of this program are bright,” according to Boyack.

The demand has led growers to invest in growing a larger crop, some of them using their limit of a 100,000 square foot growing area, James said. A much larger crop will be available starting in winter and into the new year, he said.

“I think that the second year will have bigger grows as far as production, and I think we’ll see better product out there and hopefully be able to meet those demands,” James said.

Patient feedback

“Like the launch of any brand-new industry, the birthing of a new medical cannabis program in Utah has not been without its speed bumps and obstacles, but overall the program launch has gone fairly well,” Boyack said.

Many patients are still struggling to find a doctor willing to recommend medical marijuana to them because in order to become an approved provider, doctors need to pay a $100 initial fee and participate in a four-hour training session with the Utah Department of Health.

“It’s hard to make it worth a doctor’s while to invest that amount of time and expense for a single patient. And so these patients often then have to go try to find another doctor and often that’s out of their insurance network and it’s out of pocket, and so that has been a struggle for many patients,” he said.

Libertas Institute is working with other stakeholders and legislators to find solutions that could be weighed during the next legislative session, including increasing the patient limit for doctors.

Oborn agreed that legislators will likely address the patient limit.

“I think what the beginning of the program has shown is that there’s a need for a higher volume of providers to recommend medical cannabis, because there are a number of patients that want to access it and the providers, it could be a hurdle for the providers,” Oborn said.

“There are a few of the providers that have reached their limit as to the number of patients that they can recommend to, and they want to be able to recommend to more patients, but the current law limits them to either 275 or 600 patients, depending upon whether they have a certification from the American Board of Medical Specialities or not,” Oborn said.

Some patients have also faced run-ins with police officers who advocates say don’t yet understand Utah’s medical marijuana law.

“We are having a big issue with police officers understanding the law or believing that they understand that law, and so they are giving patients tickets for possession and paraphernalia when they show them that they have their medical cannabis card,” said Desiree Hennessy, director of the Utah Patients Coalition.

“And some have just said it’s not legal yet, some believe that there should be blister packs, just a lot of misinformation about even understanding what’s legal, what these patients can have,” Hennessy added.

Her group has helped some patients who were accused by police of having counterfeit patient cards, which Hennessy said has not been true. Some patients, when pulled over by police, have had $200 and $400 worth of medicine that they legally purchased confiscated due to such misunderstandings, she said.

“So that’s been really frustrating, and we’re hoping to be able to educate the police. We’re working right now on some different avenues, talking to the chiefs of police. Unfortunately, to be brutally honest, there hasn’t been a lot of interest when I’ve tried to call and educate,” Hennessy explained.

She said when her group tries to work with police on cases, officers often indicate that they expect the courts to sort out the issue. But she said judges often say, “It must be illegal, or the police officer wouldn’t have given you a ticket if it wasn’t.”

But Hennessy expressed optimism that progress is happening, if slowly.

Last week, one patient who had been cited for possession of paraphernalia received a letter from the police department stating it had been a mistake, and advising the patient to retrieve their medication.

“And so that’s a huge win, and we’re hoping to see more of that happening,” Hennessy said.

Like Boyack, Hennessy said that while the program isn’t yet perfect or even finished, “We’re definitely working every day to try to expand things and make them actually run smooth.”

“I think by next year, things will be better than they were this year. I think every year they’re going to continue to get better because everybody is focused on access for patients,” Hennessy said.