The Department of Health's Rich Oborn joins Tim and Chris for episode 50 of Utah in the Weeds. This might be the most important episode thus far for those keenly interested in legal aspects of Utah's Medical Cannabis program. Suffice it to say that the latest legislative session has brought significant changes that all Medical Cannabis patients should be aware of.
The two most significant changes involve the expansion of access to medical providers and the implementation of the controlled substance database. In terms of the former, new rules will allow any medical provider with a controlled substance license to recommend Medical Cannabis to up to fifteen patients without having to get directly involved with the state. [42:14] Pharmacies will handle EVS reporting in such cases.
In terms of the controlled substance database, it is a done deal.  Information on patient use of Medical Cannabis will be entered into the database along with all other controlled substances. Medical providers and clinics will have access to the data at any time.
Other legislative changes include:
Episode 50 is longer than most Utah in the Weeds episodes. It is packed with valuable information you don't want to miss. Listen closely to the details and be aware that many of the changes being brought to bear will not be implemented immediately. Some will, but others will not be implemented for weeks or months.
Chris Holifield: All right, well, this is Episode 50 of Utah in the Weeds. My name is Chris Holifield.
Tim Pickett: And I'm Tim Pickett. Congratulations, Chris, on making it to Episode 50.
Chris Holifield: Episode 50.
Tim Pickett: Yeah, I mean every time we record lately — we've had the year anniversary. And now we're having Episode 50. And we've had and today's guest is Rich Oborn, the head of the Department of Health, the Utah Medical Cannabis Program for the Department of Health. And here we are talking to him for the second time, which is perfect for Episode 50. Right?
Chris Holifield: Yeah.
Tim Pickett: And we've been in this program for a whole year. There's just so many things that seem like they're getting better.
Chris Holifield: When we talk about that in this episode, some of the changes with the laws… a lot of good information. Listen to the whole thing, it gets a little long.
Tim Pickett: It does. This is a long episode. But I think it's worth it. This is the legislative update basically for what's going to change in the Utah cannabis program for patients, for providers, for pharmacies. And there's a lot of little tweaks that were made over the session.
Chris Holifield: And what I enjoyed talking with Rich here, Tim, is there was a lot of things that I was kind of first like, "I don't like that." But then with some clarification, I was like, "Well, that's not really that bad of a law really."
Tim Pickett: Right. He does bring it. He brings some context to some of these changes.
Chris Holifield: Yeah, I'm like, "Okay, that makes sense."
Tim Pickett: Which I think is good. I mean he runs a reasonable department, and the Department of Health has been extremely helpful for patients. And anyway, this is a good episode. I encourage people to listen all the way to the end, because there's good things all the way right up until the end.
Chris Holifield: Listen to the end, make sure you're subscribed to the podcast in whatever podcast player and utahmarijuana.org/podcast is where you can get all the other podcasts.
Tim Pickett: That's right. And we're going to put a summary of this podcast on utahmarijuana.org/podcast. If you look for this episode, Episode 50, you'll have a link to a blog post. We'll put it up. And we'll run through those legislative changes if you want to find out more.
Chris Holifield: Or follow along while we're talking.
Tim Pickett: Yep, exactly.
Chris Holifield: There, go to the website, boom, follow along. And that way you guys can be up to date and find out what's going on, because it's important as medical cannabis users to stay up to date on all the laws.
Tim Pickett: I think especially because this is still federally illegal, you really want to be, you want to pay attention. There's information about the controlled substance database. We talk about that towards the end. And I think that's one of the big things that patients need to pay attention to. Let's get into this conversation with Rich Oborn.
Chris Holifield: All right guys, here we go.
Chris Holifield: So there's 24,000 patients in Utah, cannabis patients?
Rich Oborn: Active registered patients in the state of Utah.
Chris Holifield: 24,000.
Rich Oborn: Over 24,000. So we're working on 25,000. It increases every day, the number of active patients in the program.
Chris Holifield: And did you expect what? 6,000?
Rich Oborn: No, I think it's important to focus on the fact that when we projected things, there are certain timeframes in which we thought we would have, and 6,000 was the amount of patients that we thought we'd have by July 2020, because March 2020 is when the program rolled out. And 6,000 sounds like that number is-
Tim Pickett: I remember somebody was saying that, yeah.
Chris Holifield: And I had read 16,000 the first 12 months based on some Arizona numbers, something like that.
Rich Oborn: Right, right, and that was high. And it was all based upon what other states had experienced, because that's the best data we had. But what we've experienced is a growth rate that has been higher than has been seen in other states, which is great for the program, for patients. We didn't expect that our growth rate would be bigger than what other states had at the very beginning. And it took time to get there. But once we adjusted and moved forward, we really saw those numbers increase, especially at the beginning of the year, or actually at the end of 2020, when everybody started to hear that recommendation letters were going to expire and they had to be a registered patient with the Department of Health in order to purchase product. So yeah, there's so many factors that impact but here we are, over 24,000 patients.
Tim Pickett: Yeah, I mean it's really, it's a good system in the making. There's still some kinks to work out, and we're going to talk to you about that and go through some of these legislative changes and not only what's happened over the course of the year, but what we think will make the program better for patients over the course of 2021. Of course, having access to more pharmacies was a huge deal in 2020, and product. And maybe we should just go down kind of this list just to kind of keep it organized.
Tim Pickett: But really, we have this, the legislature passed a 15th —or they're going to allow a 15th retail location. Is that just going to be another pharmacy? Is it going to be something different, some type of hybrid?
Rich Oborn: It will be a brick and mortar 15th pharmacy, and we're excited that it will be dedicated to a rural area. It has to be in Daggett, Duschene. You went to Sevier, Grand, San Juan, Emery or Carbon County, central Utah. San Juan, I suppose, is also southern Utah. It's a giant county. But I would say there's some cities within those counties that are more frequented than other cities, higher population like Vernal or Price or Moab or Richfield, the applicants for those, for that 15th license, they'll propose a specific address that will be in one of those cities. And we'll take a look at the strength of those applications and we'll compare them with a point system that's fair and balanced.
Rich Oborn: And so just because one pharmacy may stick out from another in one category, it doesn't mean they're going to win at all. We got to be balanced in how we review, and I think we expect to get some really strong applicants that we're looking forward to reviewing. It's a request for proposal, an RFP that has to be submitted. So it has to go through what's called the Division of Purchasing with the state of Utah. And that ensures one reason why it's going through that process is that just ensures that the process will be fair and balanced, and that there's a fair and balanced award system for points as they go through that process.
Tim Pickett: Because I'd imagine this is going to be pretty competitive. I mean, you're only issuing one more license. There isn't really anything on the horizon that says Utah needs another four or five licenses for a little while. I mean, do you see that there's, does Utah project the need for more than 15 for a while or is that even not on the radar?
Rich Oborn: I think what we've focused on is we need to see what happens with all the 15.
Tim Pickett: Once 15 go in?
Rich Oborn: Right, because we've got eight open right now. The next one to open will likely be Beehive Farmacy in Brigham City. And we have pharmacies open up in places like Springville and-
Tim Pickett: Columbia, Springville.
Rich Oborn: The city of St. George and South Jordan, and those haven't opened yet. And so I think that those are critical factors that haven't fallen yet that will help us learn more about the market and the need for potential additional locations. The law already provides the Department of Health the ability to consult with the Department of Agriculture to determine if additional pharmacy locations are warranted. We don't have to go to the legislature for that.
Tim Pickett: So anytime you could just be like, "Hey, we need a 16th pharmacy, boom."
Rich Oborn: Yes, but we need to establish criteria. And we'll be working with the industry to establish that. That hasn't been established yet, just because we know that all the pharmacies haven't opened up yet. And the past year, there's been-
Tim Pickett: They're not near to capacity, right? I mean, some of these places can do 600 or 700 transactions a day. And there's nobody doing that many transactions a day yet.
Rich Oborn: Right. And something also that's critical that has rolled out not to the extent we need it to in order to understand the market better is home delivery. Yes, there are some pharmacies that are much further along than others. Two are approved to do it, two of the 14.
Tim Pickett: So you've got a Wholesome who's been doing home delivery up from Bountiful, and I think Dragonfly, they've opened it up too, but that's not to say there isn't, certainly Deseret has talked about doing home delivery, and that's going to be a big deal. And that could expand the reach of these pharmacies into other areas and decrease the need. What you're alluding to is that could decrease the need for additional licenses.
Rich Oborn: Potentially, but something else we want to be having a pulse on is the need for an individual to meet in person with a medical provider. And we want to, if they want that, if that's just their preference, then we want to consider that in deciding whether or not we approve an additional brick and mortar to be in some of these rural areas where they simply just don't have that option under even 15. They have to drive over 100 miles in order to get that option to meet in person. There's always this offer for counseling with a pharmacist that could happen over the phone, and that's being taken advantage of already. And that could just expand even more. But for some people, they just prefer to meet in person. They want to be able to see that person, different approaches to getting cares to patient. And it's important to respond to some of those demands.
Tim Pickett: Well, we see it in medicine, too. I mean, telemedicine really took off during the pandemic. But the truth is, there are patients who just want to come see you face to face. And there are times when you really just need to see the person face to face and look them in the eyes and see how they're walking and how they're doing. And so yeah, I mean I can appreciate the idea of needing, potentially needing more spots.
Tim Pickett: When you talk about the pharmacies that are going to open now, the legislature adjusted the timeframe, the time to open. Did they give them a little leeway there?
Rich Oborn: More specific about what that timeframe is. There was a little gap in the law previously and what the SB 192 did is it set that deadline at June 1, 2021. And the prior law just had a little gap. So that was addressed by this absolute deadline of June 1, 2021. And all the pharmacies have confirmed that it's definitely a deadline they can meet, those that haven't opened yet. So we'll see St. George, Cedar City, Springville. And there's one im-
Tim Pickett: Well, Cedar City's Bloom. So you've had yeah, I mean, I've personally talked to Bloom. They want to open. Of course, they want to open by end of April. Justice in St. George, I was actually down there. And they also want to open by April, they got a lot of work to do in those places.
Rich Oborn: Columbia Care in South Jordan.
Tim Pickett: Oh, yes in South Jordan. That's Justice off of 106 or so, where their location will be, and that will be really good to have more locations. I can't imagine being in southern Utah, and not having access to a location now. I think that's tough. But also, the legislature adjusted the rules for possessing cannabis. Was that to kind of cover? Talk to us a little bit about that. Was that to kind of cover that extension to June 1.
Rich Oborn: Yeah, that was the logic behind it is just to give patients I think, especially in those areas where they don't have as much access, the ability to continue to possess out of state product legally. In some cases, it's really important. Also, I think it's important to keep in mind that the supply and the variety of products, I think has improved. We expect more improvement, as any new program would with medical cannabis. And I expected during the summer, it would have improved to a point where it's just not nearly as much of a problem as it has been in the past for supply and variety. Naturally, one of the frustrations from patients has been that there hasn't been the supply and variety, and from the companies, that's been one of their frustrations as well. But everybody who knows cannabis knows that every program has started this way, especially in a program that has started as regulated as ours in the type of atmosphere that it's just had to grow in. So that additional time was given I believe for those reasons.
Tim Pickett: Yeah, I mean, it looks here like you can, so patients can possess out of state product within Utah as long as they're a medical patient and they have a card until June 30 of this year.
Chris Holifield: That's if the products comply though with Utah. You can't bring in like THC drinks and stuff like that.
Rich Oborn: You've never been able to do that.
Chris Holifield: Well that's what I'm saying, so people listening-
Tim Pickett: Okay, guys. you can't go get edibles.
Chris Holifield: And I don't think a lot of people know that, Rich because I see a lot of, Facebook groups online. I'm like, "Man, these people must not know the laws.", because I'm just like, "Man."
Rich Oborn: Yeah, it's important that people educate themselves and if they have questions to talk to people they trust that know the law like an attorney or just someone that works in the industry, so they are aware of those limitations of the type of products that they can possess. Even when you do purchase out of state, you need to make sure you're in compliance.
Tim Pickett: We even have a kind of a rule change within the system now, right? There's been gelatinous cubes with sugar coating. And evidently like the Department of Health, with the industry is kind of adjusting things as they go. That specifically comes up on the Facebook groups and things like this, the sugar coated gelatinous cubes.
Rich Oborn: Right. That was something that was tracked by the Utah Department of Agriculture and Food because they deal with the processors and cultivators. As a Department of Health representative, I deal with specifically the pharmacies and what ends up at the pharmacy. But I do know that the Department of Agriculture and Food did see that happening. And they I think gave a deadline by which the pharmacy would have to stop selling those type of products. They didn't say you have to stop this immediately. They gave them a time.
Tim Pickett: They just said, "Hey, this doesn't really meet what the rules say as far as gelatinous cube." And so I think that some of the products, I know I talked to Zion, the thing about individually wrapping every cube, and there'll be things like that. I think that's kind of me personally, I think that's kind of silly, but I don't know.
Rich Oborn: It's nice to have it individually wrapped like a Starburst or something.
Tim Pickett: Right, and they wrap those. And the other thing about those gelatinous cubes is if they're all together, they tend to melt. So you got, I mean, one way or the other, you got to keep them separated.
Rich Oborn: Yeah.
Chris Holifield: What else have we got on this list here? I mean, I got a bunch of stuff here.
Tim Pickett: Man, we got a lot. The collection of QMP medical clinic fee data, oh yeah, and this involves me. So this healthcare transparency idea that we need to be as transparent as possible, and we're going to supply, we're going to supply the government, the state government with fee data. What's the reasoning behind this?
Rich Oborn: It's something similar to what happens with the payers claims database. And if you know something about Medicare, you might know that there's certain types of facilities that have to report what their fees are to the Department of Health already in the all payer claims database. Those fees are collected. And it's a complex, it's a complex system. It's not as simple as just collecting a fee. There's different things that impact what that looks like. But the State Auditor's Office today, if you go there, you'll find that there's this healthcare transparency tool that exists already for Medicare purposes, for medical providers where they have to report this different types of facilities already do this for those other purposes. And it's already a tool that's used by patients, if they know about it, to help them decide where to go get service. Now, it is, I think-
Tim Pickett: Is this something like okay, look, I'm going to go get a hip replaced. And so at this hospital, I can look up on the database, and I can kind of figure out that it's going to cost about $25,000. But if I go to this other hospital, then the fees end up being $42,000, and that's kind of the idea?
Rich Oborn: Right, so Senator Escamilla, what she wanted to do is to reflect that type of a transparency tool for medical cannabis patients specifically. And I think one of the issues that we found early in the program is naturally there's a limited supply, or limited number of qualified medical providers. Many of those choose to not have their information posted publicly. They would rather just continue to meet with their current patients, and that's their choice. So their name doesn't appear on our website. You wouldn't really know that they provide medical cannabis recommendations as a service, unless you're one of their current patients. Maybe they're an oncologist or a neurologist and they have that specialty.
Tim Pickett: Yeah, not especially new patients, but they'll do medical cannabis recommendations in the course of their own practice.
Rich Oborn: Right. So those type of providers aren't required to post what their prices are, for purposes of medical cannabis evaluations. The type of providers that are required and the type of medical clinics that would need to make sure that their providers report would be those that advertise publicly like your medical clinic, that they do provide medical cannabis evaluations. And there has been some concern of some of the prices that are charged because the number of those type of medical clinics is limited at the beginning of the program. There's a wide variety of prices that are charged, and in some cases, the legislature believed that they were charging too much. Rather than saying you cannot charge over a certain price, the legislature says, "Okay, free market, you do this. But we will require that if you advertise that you provide medical cannabis evaluations, that you communicate those to the Department of Health, who will ensure that those prices that you report are posted on a health transparency tool online the cannabis patient can use as a resource to confirm the price that they would be charged." Now, there's a lot of different factors that impact price.
Tim Pickett: There is a lot of different factors.
Rich Oborn: That's the biggest picture, just that one little slice of the price, right?
Tim Pickett: Yeah, that's right.
Rich Oborn: So I know you'd probably want to talk about that a little bit?
Tim Pickett: Well, yeah, I think that there is there is a lot and there are going to be, of course, there will be clinics that will lower their initial price and lower their initial, the care they give the patient. And unfortunately, fortunately, unfortunately, that's part of the marketplace in all businesses. And I think that hopefully, patients, the bottom line is hopefully, patients will do their research on who they're going to see and they can look at this tool and they can say, "Okay, you know what? I'm going to look at these places, and I know what the prices are going to be. But then I'm going to dig in a little bit more. And I'm going to find out a little bit more about the reviews and who's gone to see them. Are these people giving me the service that I am really paying for."
Tim Pickett: That's really all my concern is when it comes down to putting these prices online, because they're certainly going to be and there are plenty of places out there that are just like, they're the card mills that everybody doesn't like. You're really paying for a recommendation at something like that. And with me, you're paying for an evaluation, a lot of education, a lot of follow up. Maybe you get what you pay for in a lot of places. So do I agree with the legislation in the way it is? No, but will we do it and will we go out of our way to make sure the patients know what they're getting? Absolutely. And in that case, it is what it is.
Rich Oborn: One thing I think is important for cardholders, patients out there to understand is that this isn't something that we are immediately requiring. We need time to set up the software in what we call an API integration, to set up our software so it can connect with the state auditor software. So I would expect that this will be rolled out in the fall. It's not something to expect immediately. But it's something that will change in the future that I think will empower patients, but they need to just be aware that price shouldn't be the only factor and that they need to keep those other factors in mind that you mentioned.
Tim Pickett: Yeah, absolutely. When we talk about the, oh yes, it's the 90 day renewal in the conditional card. This is like a huge thing.
Rich Oborn: But these are good things.
Tim Pickett: Yeah, I think they're really good things. So talk about the legislation surrounding this conditional card, this provisional, they're calling it a provisional card. So are we going back to the letter system?
Rich Oborn: No, we are not going back to the recommendation letter system. So there continues to be a requirement that to legally possess and to purchase product, you must be a registered medical cannabis card, active card holding individual so you cannot possess or purchase product without a medical cannabis card that's been issued by the Department of Health. But one of the things we learned as we move forward in the program is that we believed we could trust the relationship between a provider and their patient. And as long as a provider made the clinical decision to certify the recommendation of someone to give them a medical cannabis card, as long as that was in place, that we could allow for a conditional card to be issued. And that card, the purpose of it would be to give, it's conditional because the final decision about the card hasn't been made. But it just gives the state time to ensure that an appropriate review has occurred on the state's end to ensure that everything is accurate, and there's no fraud taking place that would be evident in the online application.
Tim Pickett: This is a really good-
Rich Oborn: So allowing the patient to go and purchase, but we always have the right within that timeframe to take the card back to revoke it if we notice that there's something funny going on.
Tim Pickett: Right, some box wasn't checked. The clinical documentation wasn't there, something was missing. But this, in my opinion, is just smart legislating of actually, and I think I mean as rare as that sounds, that you get a government that is, is doing something that is really smart. This is one of those things where you've seen 18,000 in 2020, 18,000 applications come across the Department of Health, the EVS system. And you can tell of those 18,000, or however many you did, how many were revoked or how many needed more information. And then you can make a good determination, plus you had the letter, recommendation letter system that already we had gone through. And we had kind of proven as a early system, that we could evaluate patients and give them access to the product. They could go purchase it. And that turned out to be a pretty good, safe system.
Tim Pickett: There was problems with that. But it was, let's say safe. And now you've made a change that continues that process in a really good way. I think it's great for patients, because it was one of the big things in January and February that we were asked, "Don't you do the recommendation, Tim?" And we're like, "Well, yes. But then you got to wait.", and recently, the Department of Health has been a little bit behind. You're caught up now. But it's great to have people be able to leave the office with that recommendation and go down to the pharmacy. How long will that take to implement? There's the question.
Rich Oborn: I think we're looking at fall 2021 for that type of the lift. That will be to our software vendor that we're working with. So we're really excited about it. I think one thing that's great about an online system is that it can be smart, and it knows when a patient, by the information that's being provided by the provider and the patient, it can make those automated decisions about who should get a card and who shouldn't. We're not pushing paper. We're able to prepare the system so it can automate some of that process like an e-script would.
Tim Pickett: Right, you're sending across the recommendation, just like an e-prescribed medication. And that's being verified by however many factors it is. You verify me, I verify the patient, they're already registered. Yeah, it seems like this is a good, this is going to be good for patients, right? Chris, I mean when you think, now will this happen do you think with renewals? If somebody expires, will they be able to renew their card and immediately be active? That may be a detail you don't know yet, but is it the same type of thing?
Rich Oborn: Right, right. Same process for renewal. It will be an automatic issuance of a conditional upon renewal. And then that individual, as soon as the providers, as you do that certification, the system will read that and then issue a conditional card. And then we'll make sure that everything is on the back end like it should be. And then we'll then issue the second email with the card because all these cards are sent via email. We don't send one in the mail, except for when people request it if they don't have a printer or whatever, we help them out.
Tim Pickett: But that's not really part of the program. How often does that happen where people really need a physical card?
Rich Oborn: Oh, I'd say people, we have probably every two weeks, maybe three, where people just request that, and that's fine.
Tim Pickett: Yeah, we probably have three a month that come into clinic and want us to print it. So it happens. Yeah, we'll print the card.
Chris Holifield: And laminate it too?
Tim Pickett: We need a laminator. No, we will laminate it for them.
Rich Oborn: I think one thing to focus on as we think about how this will benefit patients a little bit is that the 90 day period of the initial issuance and renewal cycle is gone in the new law. It will take time for us to implement the software changes.
Tim Pickett: Right. Because right now, the software automatically creates a 90 day-
Rich Oborn: It's a 90 day. That will continue until the fall, because we need time for our software to make those changes and several other changes, including this one, but it will benefit patients and providers, because I think it will honor the relationship that they have that's critical, that there continue to be a provider involved in the treatment. But rather than 90 days, it will be six months for that initial issuance. There's the conditional card that is for 60 days. But then, as long as the department does our part to ensure that everything's in there, then it will be for six months. So there won't be the need for the user provider to meet with a patient after those initial 90 days again. It will be a six month period.
Tim Pickett: I'm torn about this one, Rich. I'm torn about the 90 day going away. I know it will save us a lot of work. And I know that it will save the patients a lot of headache. A lot of patients, it will save a lot of headache. But there has been a very good relationship built, I think on that. This is why I'm torn. And there's been an opportunity for us to follow up with the patients at 90 days. And when you do a cash pay clinic, or you do a clinic where patients are having to pay out of pocket, and then you don't charge for that 90 day renewal like we don't, it allowed us an opportunity to research how the patients are doing and things like that. And so, like I say, I like the idea of not having that. We're actually going to see the patient sooner than we would have before because right now, we're seeing them in about eight months. And we will be seeing them in about six, about five or six. So we'll still be able to see them. It will change that a little bit.
Tim Pickett: So I think overall good. But yeah, I'm a little torn, because I like getting that feedback from the patient sooner.
Chris Holifield: Or you can keep doing it.
Tim Pickett: And I still, yeah we still-
Rich Oborn: As a medical clinic, you can shorten that time period.
Chris Holifield: You can still do it if you want.
Tim Pickett: Yeah, and we have and I think we'll find ways to follow up with patients and do that. But I think overall, it's going to be nice for the patients to have a little more clear, you get your card, your card is good for six months, your card is good for another six months. And then we can start to work on this, whether or not a year is good for the patient. And that's kind of the idea behind this change, is that right?
Rich Oborn: Yes. Another change that's coming up is there's a prohibition against alteration or removal of a medical cannabis product label that came from the processor.
Chris Holifield: I thought that was already.
Rich Oborn: Right. So this was just clarifying that I think we wanted to make it really clear that-
Chris Holifield: You're talking about the labels you get when you go to the pharmacy with that-
Rich Oborn: It's on the actual product you purchase.
Tim Pickett: Yeah, okay so it's actually the label on the jar, now there's a going to be a rule that says you can't remove that.
Rich Oborn: Right.
Tim Pickett: Why is that important?
Chris Holifield: It's like a mattress label, right?
Rich Oborn: That helps protect the patient, if by chance they're pulled over by law enforcement, law enforcement can track down that product to make sure that it was a legally purchased product. Also, for recall, if there's a problem with the actual product and the patient experiences and adverse reaction. If you keep the label, it allows us to research how many other patients might have been impacted by that same product that had an issue.
Chris Holifield: My question though is sometimes you might buy a few small ones and put in a big one, put it into a big jar at the store. And then if you don't have-
Tim Pickett: Yeah, I mean if you bought a couple of eights, and you had a little bit of a jar-
Chris Holifield: Yeah, you might throw them all together.
Tim Pickett: So now you got to be careful.
Chris Holifield: Maybe save all your empty containers, I guess.
Rich Oborn: This law, what it does is it focuses on the alteration or removal of the actual label. And part of it has to do, I think it's applicable more to cases where you're transporting product if you're going back and forth to work with it.
Chris Holifield: I got you, I got you.
Rich Oborn: Right? Because those are cases where you would actually potentially be pulled over, and if that becomes an issue, cardholders need to know.
Chris Holifield: They need to be able to identify themselves, show what they have.
Rich Oborn: Right, if that becomes an issue. It may not, but part of it is just to prepare a patient and a law enforcement representative to be able to, as a patient, protect themselves and as a law enforcement representative, to investigate. It makes that process quicker.
Chris Holifield: See, that's why I like you on the podcast here because you can kind of clarify things.
Tim Pickett: That's right. I mean it's because I think a lot of people are just going to look at that and be like, "Yeah, that's silly." There's no reason behind that, but yeah, I mean it makes okay, yeah, these guys are thinking this through before they just willy-nilly change the rules.
Chris Holifield: I want to talk about this one on here, though. It's the one that says a pharmacy medical provider must review each medical cannabis transaction. So each time you purchase something at a pharmacy, you're going to have to have a pharmacist there to review it?
Rich Oborn: Right, so already, a medical cannabis pharmacy during all business hours has to have a pharmacist, or they call it a pharmacy medical provider physically present during all business hours. That's already a requirement in Utah, and it's in other states like Minnesota and Connecticut as well. So that's already been a requirement. But one thing, one critical role that a pharmacist in a retail pharmacy like a Walgreens plays is they are responsible for any differences between a prescription and what the patient actually leaves the pharmacy with. A critical role that pharmacist plays is just being responsible for what's dispensed. That's the verb that's used to describe that responsibility in a regular retail pharmacy.
Tim Pickett: You're talking about at the end of the transaction, when I buy my amoxicillin, the pharmacist, there's the pharmacy tech that does the whole thing. But then at the end, the pharmacist comes up and grabs the medication and says, "Hey, I'm going to double check that. Do you have any questions for me?"
Rich Oborn: And a lot of time, you don't see how that happens right there exactly. But especially with controlled substances, you'd see how important that is with opiates and narcotics before it's dispensed, to ensure that the patient is actually getting something that is consistent with the prescription. So that's what happens in a regular retail pharmacy. Now, we're going into a medical cannabis pharmacy that naturally has some differences in how things happen. But there are some things that the policymakers felt very strongly about. And one of those things is if there is a recommendation from the qualified medical provider like Tim, and when they purchase a product with that recommendation, is that recommendation being followed? Are the dosing guidelines or directions of use that have been communicated by Tim in our software being followed?
Tim Pickett: No.
Rich Oborn: And the legislature wanted to emphasize the need to ensure that a pharmacist is involved in making sure that actually happens in a medical cannabis pharmacy like it does in a retail pharmacy. The pharmacist is responsible to ensure that whatever is recommended as a dosing guideline is actually followed. And also keep in mind that a qualified medical provider can choose to leave those dosing guidelines and directions of use up to the pharmacist at the medical cannabis pharmacy, which is good.
Tim Pickett: And even more so now, yeah, it is good. And maybe even more so now with some of the modifications that we can talk about next. And I guess it will take a little time for the pharmacists and the pharmacies to get this in place to where this is a little bit, this is smooth for the patients, right?
Rich Oborn: Right.
Tim Pickett: I kind of look at this particular rule as a doubling down. The legislature is kind of doubling down on the medical aspect of this program.
Rich Oborn: Yeah. And in their words, I think they are just emphasizing their original intent. They intend for a pharmacist to operate in a medical cannabis pharmacy, just as they do in a regular Walgreens retail pharmacy, just like they do in Connecticut and Minnesota. And they wanted to clarify that that is their intent in the law. So now it's very clear what their intent is. And now as the Department of Health, we are working with, I was just speaking with one of the medical cannabis pharmacies today about how to implement this. And so I think we'll work out those plans in the best way. There's in the short term, how it will be implemented. And in the long term, the long term will have the software revised so it will be able to make it really seamless and easy. The short term, that will be a little bit more of a challenge, but in a retail pharmacy, it happens. So let's take that model and mirror it in a regular medical cannabis pharmacy setting.
Tim Pickett: When does that take effect? Is that taking effect more immediate? That's something that they'll have to, these pharmacies are going to have to abide by pretty soon, right?
Rich Oborn: Yeah. So the governor actually still hasn't signed the bill, either HB 170 or SB, it's SB 170 and SB 192. That will happen later this week. There's no reason why I believe he wouldn't sign these bills. So they become effective upon the governor's signature. But as a regulatory agency, we're reasonable. We don't expect, like a light switch for pharmacies to be able to implement things upon the switch. So actually, we're having conversations with pharmacies, even today about how to implement things in the short term. And we don't have a specific date yet. But it's something that patients I think should be aware of, because what may begin to happen is that they may go in and experience where they want a certain product. But if the pharmacy medical provider, the pharmacist that's physically present there, has a recommendation that doesn't quite match up with what the patient wants, then the pharmacy is obligated to limit their purchase to what has been recommended by either the qualified medical provider, or if there weren't any recommendations of dosing guidelines or directions of use, the recommendation of that pharmacist at that facility.
Rich Oborn: So that is something that they need to keep in mind, because they'll experience that it will be happening more often, that there could be that difference. In most cases, I don't think it will be an issue, because I believe the pharmacies right now are ensuring that that happens. This just makes it more clear. It gave us some teeth in the law to educate the pharmacies about, and it gave us the ability to require something in the process, where a pharmacist would be required to show the Department of Health, "Here's evidence that I approved what that patient actually ended up with in the end.", that the pharmacy agent wasn't running the whole show until the end, that there was actually a pharmacist involved. Because after all, this is a medical only program. And I think that's reflected in this emphasizing of the need to dispense accurately, and not just to sell whatever the patient wants.
Tim Pickett: Right. So the law also changed, and is now going to allow every medical provider with a controlled substance license to write recommendations for up to 15 of their patients. Right?
Rich Oborn: Right.
Tim Pickett: And in this they had to change, it looks like they had to change the way that was done because those providers aren't going to be required to input the information into EVS. The pharmacy looks like they'll be the ones entering those patients. Am I right about this?
Rich Oborn: Yes.
Tim Pickett: So with this rule, is this rule designed to kind of expand maybe rural access or access? How did this come about?
Rich Oborn: I think there's a few reasons for this amendment to the Medical Cannabis Act. One is, is that if I've been someone that is a patient that is treated for chronic pain, and I really trust my provider, and man, chronic pain sure is messing up my life, why would I want to change my provider?
Tim Pickett: Why would I want to go somewhere else, pay money if I can stay right here?
Rich Oborn: Right, and I love the fee that they charge, they take my insurance and it's convenient. It's just down the road. Why would I want to drive 100 miles to somebody else?
Tim Pickett: And then if we role play this, I would say as the provider, really I'm not somebody who wants to get involved in cannabis in a big way. But I know you, you're a patient, it's probably reasonable you tried cannabis. I don't know a lot about it. Now, I'll write the recommendation.
Rich Oborn: Yeah. So this law, it gives the option to any physician, APRN, PA or podiatrist that was-
Tim Pickett: Oh yeah. And they're adding all podiatrists into the Medical Cannabis Act, which is a good idea. They went to medical school.
Rich Oborn: So as long as you are in one of those license groups, and as long as you have a controlled substance license, then you could participate in recommending, ordering the pharmacy to help your patient get a medical cannabis card.
Tim Pickett: You're essentially writing an order for the pharmacy. You clarified that in a good way. You're essentially writing an order that the pharmacy help this patient, get a card, get a recommendation and work through that process.
Rich Oborn: Yes. So what's critical is that the pharmacy be prepared to accept that order. Now, there's certain information that appears on a prescription for a controlled substance, the name of the doctor, their controlled substances license number, their professional license number. One thing in addition that these orders will need to include is the medical condition, because that will need to be entered into the electronic verification system that represents, the pharmacy kind of works as an agent of the physician. The physician really doesn't want to work with the electronic verification system so they just authorize the pharmacy agent or pharmacist at this particular pharmacy to act as their agent in entering this critical information into the software database that then triggers the issuance of a medical cannabis card to the patient. So it would make it so I could just stick with my provider, as long as that provider agrees to make that recommendation for me. The provider will have to do a little bit education on the pharmacies, and the pharmacies will be able to set up their own ways for that order to be communicated either electronically or on paper. If it's on paper, then there'll will need to be a verifying of that, actually, the legitimacy of that order directly with the medical clinic or provider that submitted the paper order. So that is how it will work.
Tim Pickett: This seems like it's going to be another one of those kind of upgrades and modifications in the EVS system to change to create a new role, so to speak as the provider, a tier two provider, let's say or something like that, somebody with only 15 of these, and you got to follow them a little more. Is it going to be more work for the Department of Health for these types of in this system with these types of patients? Do you foresee that this will be more work for the Department of Health?
Rich Oborn: Yes, not an enormous amount of work. But there's some additional oversight that we'll need to create. One thing that's critical is that we set up a software in a database that is able to do a lot of the work for us. If we can trust it to set certain rules and to allow us to go and audit the software, then great. Let's automate things to make things as easy as possible. So that's critical. And I want to emphasize this is a good example of something that will not be rolled out really soon, the limited medical provider role will be something that it will require until the fall at the least for us to roll out. So again, a lot of these changes we've been talking about, they're not able to be actually implemented until we have the software to support it. But once we get that software in place, it will I think provide some better options for patients, especially in this one case where they're able to just stay with their current provider, which I think is the best type of circumstance as long as the provider feels comfortable recommending and ordering a pharmacy.
Tim Pickett: Yeah, to do this with them. I mean, I think I'd give a little bit of my opinion here. And I hope people expect that a little bit from me at this point. The more research I do about cannabis, and the more I learn about cannabis medicine, the more I see that having a relationship, when it comes to true medical marijuana treatment, having a relationship with a medical provider, whether it be the pharmacy medical provider, or a QMP or somebody who you trust, helping with dosing and delivery discussions who knows the patient's condition well enough to know and cannabis well enough to know what to recommend, the outcomes seem to be better when you have that relationship.
Tim Pickett: So while I agree with increasing patient access with this modification of the bill, I hope that the providers who are going to do this are willing to learn enough about medical cannabis to move forward in their own education, because I think the patients get more benefit when somebody knows what they're talking about when they're doing the dosing.
Tim Pickett: And I think the pharmacists have a role to play there too. Of course, you know, I'm going to be biased and say, "Look, I like our process." But this is an interesting experiment, I think, and I've talked to Ray Ward about it too. And that idea of trying to bring these other providers into the fold of agreeing that this is medicine and it's okay, it's just another tool in the toolbox. It's a complicated tool. It takes a while to get good at using it. But I agree the more providers that we get involved and get more education, the more likely it is we're going to see cannabis used in the hospital. And that really is the end goal. So yeah, I like and dislike this one. And I think that it's going to be more work, obviously more work for the pharmacies, a little more work for the Department of Health. And we'll kind of see, we'll kind of have to see how this goes. Maybe we'll bring on a doc in a year, who decided, "Hey, I'm going to write one of these recommendations.", and then all of a sudden realized, "Oh my gosh, I prescribed less opioids. My patients are coming off their benzos. It's actually working."
Rich Oborn: And I think one thing a lot of us are looking forward to is when the federal government makes research more possible when we can get more FDA approved drugs that have gone through the traditional process and where a traditional doctor would obviously trust that it would be sold by a regular retail pharmacy. But of course, the law is still what it is. It's still federally illegal if it has 0.3% or more THC, then it's still federally illegal and you've got this patchwork of 35 states or so that Utah-
Tim Pickett: That have different programs. And they all have a little bit different programs all the way around, right?
Chris Holifield: What else have we got on this list?
Tim Pickett: So the controlled substance database, the privacy, so it ended up passing, right? Okay, well, the people won in a lot of ways, and maybe we lost in this one. So now, the controlled substance database, will it be patient's information is going to be going on to the controlled substance database. Will it be tied into the EVS system? Is that just how it's going to be built? How is this going to actually work?
Rich Oborn: Yeah, so there's a few different databases. There's what we call the EVS. That's the patient registration system. There's the ICS. That's the seed to sale software database.
Tim Pickett: That's MJ Freeway?
Rich Oborn: Yep, that's MJ Freeway. And then there's also in this, particular to this amendment to the law, the controlled substance database for Utah. Every state has a controlled substance database, or they call it a prescription monitoring program in other states, and in about 15 other states that have medical cannabis, they incorporate already medical cannabis product information. And legislators thought, "Hey, we want the providers that are participating in the program to be able to be aware of the medical cannabis products that are being purchased and whether or not their particular patient is a participant in the program."
Tim Pickett: Okay, so basically, somebody comes into the ER, when I'm working a shift. I drug test the patient for whatever. They have THC in the system. I look them up in the controlled substance database. They're not registered. Then I could essentially tell that patient's not a member of the program and they're using, well they're essentially using it illegally. Is that part of this?
Rich Oborn: That's one part of it. Yeah, that's part of it.
Tim Pickett: I mean it's kind of an example.
Rich Oborn: Through your lens.
Tim Pickett: Right through my lens, because I still work some in the ER, and I'm trying to imagine how we're going to use this, and I can see exactly how-
Chris Holifield: What good would it be? So what if they're using it illegally? I mean, what are you going to do? Throw them in jail in that case? Or what would that do?
Tim Pickett: No, because my experience is patients are discriminated against when they use marijuana products. And that's just, I mean, that's just my experience, I would have guessed that that would be borne out by some type of studies or research but when somebody comes in and a provider has a bias against marijuana, cannabis use in general, drug screening them is a way to discriminate essentially. And so I don't want that. It was one of the arguments against using the, putting this data into the controlled substance database. However, there are some, being able to see that a patient comes up THC positive and is in the controlled substance database, if I'm a provider that doesn't have a QMP license, now I've protected the patient from discrimination. So as much as I just made an argument against, I'm making an argument for the patient in this case, because now the patient is actually protected and they can say, "Well, I prove it. I'm in the CSD and I came up positive." Well, it's no wonder.
Rich Oborn: Right. So another I'd say advantage of this and one reason why I think legislators are so strongly supportive of it was because this will allow, let's say I go to my chronic pain physician isn't interested at all in recommending medical cannabis. So I go to a medical clinic that's separate, to get a recommendation for my medical cannabis. This initial provider that was treating me for my chronic pain, if I continue to go to that provider, that provider would be able to see that indeed, "Oh, okay, I see you're a legal patient in Utah's program. And I can see what products you're purchasing. Interesting, I can see your frequency as well of purchasing A, B and C products." And I think it will give that provider a complete picture of how that patient is treating their chronic pain, has chosen to treat their chronic pain that they may not otherwise have.
Tim Pickett: This is objective data that I'm interested in, because we have had a number of patients who, although most pain providers do urine test pretty frequently, we've had a number of patients that have come through to us where they'll get, they'll qualify certainly. And they want to reduce their opioid use. And they'll start using medical cannabis, but they are afraid of being cut off from their provider. So I can see this working a little bit of both ways. I think the important thing with this one is that if you are a medical cannabis patient and you're listening to this, and you have a pain contract with a pain provider, you need to be aware when this takes effect, that this is going to be the source of truth for the providers. And they will be able to see all of the controlled substances that you're using, which is we check the controlled substance database when patients come in for medical cannabis. That's requirement by the statute. So we get all the truth. But we also don't, we don't broadcast that back to whoever. If the patient requests that that information doesn't go back to their provider, then it doesn't go back there. But now that will be available.
Rich Oborn: Right. And so I think one factor is just thinking about the need for continuity of care. And if I were a physician, I'd be able to ensure that I'm aware of the all the controlled substances, including those that are federally illegal, like medical cannabis, that they're taking. Now, if they're buying off the black market, you wouldn't see that of course. You could be able to see that oh, this patient is a medical cannabis cardholder, their card is active, but nothing's showing up. And that may tell the story of if the patient's using, then they're probably buying off the black market, especially after July 2021 when it's illegal to possess product.
Tim Pickett: What do you think about all this, Chris? As somebody who's outside of this, what do you think? Do you think this is just flat out an invasion of privacy? Or you think-
Chris Holifield: This particular thing?
Tim Pickett: Yeah, this particular thing.
Chris Holifield: My first thought was invasion of privacy, but after discussing it and after hearing some of these other angles, I'm like, "Okay, that makes sense." I mean, especially if you kind of want to regulate a little bit and keep an eye on things. I think it could be a good thing, but it could also be, I don't know if I'd say a bad thing, but it could be, it could cause some-
Tim Pickett: This is going to cause some anxiety in certain people.
Chris Holifield: Yeah, yeah.
Tim Pickett: And it's going to be, I guess it just comes down to how it's used. It really depends on the provider, the type of relationship you have with the patient. It encourages certainly honesty. It definitely should encourage honesty between the provider and the patient and what is happening. And I think that as we move this movement of de-prescribing, I don't know if you've ever seen this hashtag around, but it is a growing movement that really, we've started to become a big part of this de-prescribing movement and using cannabis as a tool to de-prescribe-
Chris Holifield: Opiates-
Tim Pickett: Opioids and benzos, gabapentin, Ambien, these things that just treat symptoms. They don't treat disease. They just treat symptoms. And cannabis is similar but may have less long term negative side effects. And so this controlled substance database, in that sense could help.
Chris Holifield: I just don't like being on any databases. So the thought of putting people on that, you know what I mean? Like the less, but at the same time, it's kind of like, well it is what it is, the EVS system I mean already has I guess all the patient's information too. So I mean, the information's out there.
Rich Oborn: Right. Yeah, I'd say that just an additional advantage to think about is just the ability for the provider to do research. We've got one of the best world class medical institutions here in the state of Utah at the University of Utah, right? So they want to do research. And they want to know what's the impact on use of medical cannabis on opiate use. So we've got data that tracks both for specific people that can be protected and be kept confidential. But there's ways with this connection to protect that data, but at the same time, use it for research that's legitimate. And so that's one thing that I think excites some of the individuals that were behind this is that it just allows them to do that research with the approval of what's called an institutional review board to ensure that patient confidentiality is always protected and there aren't a bunch of files going around with patient names on it.
Tim Pickett: Right, because essentially, what you're saying is I could take, if I'm the University of Utah, and I get permission, I could take data based on 2020 opioid prescriptions in Utah. And then I could take, once I get access to this, I could compare that to opioid prescriptions in 2022 now that we have cannabis, and we're researching that.
Rich Oborn: Right, and even look at specific records of unique identifying individuals. And take a look at oh, we noticed that this individual, as they use medical cannabis, their prescriptions-
Tim Pickett: Of other controlled substances-
Rich Oborn: Other controlled substances decrease. Now, there's research out there already. Some of it suggests that they decrease. Some of it suggests that over time, it actually that is not the case. It depends on a lot of different factors. And we need to be careful with making conclusions on the current research about that. But this just strengthens the ability for researchers to be able to take a look at that over time, and then to publish studies in the future, that Utah could really be, I think a model for that, depending on how things move forward with the University of Utah in their interest in doing some of the research. The funding is tricky for that type of research. That's quality research, where they have to spend a lot of time crunching numbers and doing all that that I'm not the expert on. But it just requires funding. And it can't be federal funding because of the fact that-
Tim Pickett: Because you're studying federally illegal substance still, but you're studying a federally illegal substance in the best way you can, which is this.
Rich Oborn: Yes. So the controlled substance database and the inclusion of the medical cannabis product information, I think has that potential benefit.
Tim Pickett: So overall, do you feel like the legislative session was a success for patients, for providers, for pharmacies, for the program?
Rich Oborn: It definitely was. I think there are a few things where we have yet to see. And that's part of what the legislature's job is, is to say, "Okay, let's just see if this little tweak makes it a more pleasant experience for patients.
Tim Pickett: I like that.
Rich Oborn: Right?
Tim Pickett: Right.
Rich Oborn: Or makes it just a little easier for provider to be involved in the continuity of care of their current patient. What tools can we create? So policymakers approach it like that. I think it was, that's something that Senator Escamilla and Senator Vickers were looking at and Representative Ward and Representative Gibson is a sponsor of these two bills. Now, there's some other bills that impact the agriculture side of things, a little bit more with hemp, and I know that that's something that some people listening may have interest in as well. But I'm not an expert on those issues. But as far as the medical cannabis patients go, I think it was definitely progress. And as we learn more about the program, I think we'll be able to even make further tweaks. We are excited to continue to launch the program. Full launch hasn't happened yet. We still have these additional pharmacies that need to open. We're learning more as we-
Tim Pickett: And those still need to grow.
Rich Oborn: Right, yes.
Tim Pickett: There is a ways to go still, before full implementation and we're to full capacity, we've got a ways to go.
Rich Oborn: Right. But I feel like the legislature took some steps to set a firm foundation that we can build on, and we'll see where some of these amendments will lead us.
Tim Pickett: Yeah, okay. Well, I mean I'm excited again. I kind of am. Rich has got me a little excited-
Chris Holifield: You got to try these things.
Tim Pickett: I still think there wasn't any appetite for increasing patient caps this year. And hopefully next year, we can get around to that. That will be our big, hopefully, they can understand that I think it's okay to have a couple of medical cannabis specialists around town. But other than that, I like this provisional card thing I think is my favorite. There's some real benefits to having the 90 day renewal go away and just make that much more straightforward for people. So there are some things in there that I think are going to be good.
Chris Holifield: My only complaint is when are we going to be able to start bringing prices down? But I guess that's not up to you guys really. That's up to the pharmacies, I guess what they're charging.
Rich Oborn: I think there were some efforts to decrease the prices that the total cost of being a medical cannabis patient in Utah, one of those-
Chris Holifield: I'm talking before the medicine is selling.
Rich Oborn: Right, and I think if you take the big picture, and think about the total cost of being a medical cannabis patient, you can focus on the healthcare transparency tool.
Tim Pickett: And you you can also focus on increasing the number of pharmacies by making a 15th. That in general should decrease prices overall.
Rich Oborn: Right. So when you look at the prices of a beginning medical cannabis program, I emphasize medical cannabis, medical only. If you compare us to Arizona or to Colorado or to Nevada, you're comparing apples to oranges.
Tim Pickett: Yeah, because of rec, it’s completely different.
Rich Oborn: Right, but ours is a medical program. So if you compare us to the other medical only programs, we're in the middle and we just barely started. So you ain't seen nothing yet. That's kind of what I think about when I think about where we're at. A year has passed. It takes a while. It's like a big stone and gosh, it's slow at the first, right? Because it doesn't have momentum, there's a few little things that are rough, but it gets rolling, it gets rolling, it gets rolling.
Rich Oborn: And at the same time, we're protecting patients. We're protecting the public. Law enforcement becomes more aware of what's happening. I think the federal government, we're seeing more attention to medical cannabis and cannabis in general. But I think in Utah, for the foreseeable future, it's going to be medical only. Things get rolling. So I hate to remind people about this, but it's true that you just sometimes have to be patient with some of the realistic factors that are in place. We started moving a little bit quicker toward, I think true progress in our medical only program during the last session. When what we've talked about today actually begins to be implemented in 2021, that's when we'll be able to start to, I think, learn about the changes and see how this limited medical provider idea makes a difference, the controlled substance database.
Rich Oborn: Are they actually using that as a tool? Are people using the healthcare transparency tool? It just takes time for this big boulder to get moving more and more. But it will get, it's moving quicker than it was before.
Tim Pickett: Oh, yeah, I'm just grateful it's here, man.
Rich Oborn: Right. And we still have a goal of ensuring that patients get access under the supervision of a qualified medical provider and a pharmacist at a pharmacy that is more educated and is in the niche of medical cannabis and understands what products interact with what medications even better than we were when we started the program. So that's the goal of Utah's program. We want to make sure those connections between the patient and provider stay there, and we're moving forward and I'm excited about the base that we've created and building on that.
Chris Holifield: I'm excited too. Do you have other questions? I guess we covered them all on here.
Tim Pickett: I mean, really I'm sure I'll have questions for Rich tomorrow.
Chris Holifield: When people go to the EVS site, the EVS, what's the website?
Tim Pickett: Well, they have the government website is medicalcannabis.utah.gov, and that would have all of this information too or eventually I guess it would all be up.
Rich Oborn: It will, right. So again, the the governor still hasn't signed the bills we've talked about today. But that will happen I hear soon, we expect. And once those pass, we'll be able to update our website with some fact sheets and some information where people can go for some of the general high level information. And it's just important to keep in mind, these won't launch immediately. A lot of the changes we've talked about, it will take us some time. But yeah, they can find more information at medicalcannabis.utah.gov. And we see our numbers growing more and more and more providers are joining the program. That number continues to increase, which is really healthy for our young program to see the number of providers continue to grow. Also, something that changed I'll just stand with is that physician assistants no longer require-
Tim Pickett: We had a huge, huge win for PAs in Utah becoming essentially independent practitioners, but equivalent to the nurse practitioner, from an independent standpoint that after five years of practice, you do not need a supervising physician any longer in our role as PAs. It is a massive, massive win for PAs practicing. And having the ability now to be a QMP without a supervising physician, this QMP is just an added benefit to that. But it's a big deal.
Rich Oborn: Right. And so who knows? I mean, the cost of getting service could decrease because of that to actual medical cannabis patients because of that change because that PA doesn't have to have that supervising physician anymore. Because in the law, the former law, there was a requirement that that PA have a supervising physician who was also a qualified medical provider. So Tim operated like that, but in the future, he won't.
Tim Pickett: Yeah, I don't have to. Yeah, I mean I caution all providers, please get medical cannabis malpractice. It's really, really important before you go out and recommend any of this stuff and know what you're getting into. But if you've got questions about that, and you're a provider, you're a PA out there, then reach out to me at utahmarijuana.org. I talk to PAs almost every, a couple of PAs and a couple of NPs every week, help people get connected with medical malpractice if they need it. We have great contacts for that. I don't want to, I mean we can't take care of all the patients but we would definitely be able to take care of a lot, but we definitely need more people who are actively involved in this program. Well, thanks for coming out Rich. We're going to have, I'll put a fact sheet and a blog post together utahmarijuana.org and at utahmarijuana.org/podcast with this episode. Chris posts those episodes every week.
Chris Holifield: Every Friday.
Tim Pickett: Every Friday at 4:20 in the morning.
Chris Holifield: Every Friday, 4:20 comes in your podcast feed. So make sure you're subscribed.
Tim Pickett: And we'll put these legislative updates there. So you can come there and you can get a highlight of all of these things that might affect you as a patient. And I think that will be a good place for people to go get a synopsis before the state or race the state to get it up.
Chris Holifield: Well, thank you so much, go subscribe to the podcast, follow us on Instagram.
Tim Pickett: Stay safe out there, everybody.