In this week’s podcast, Tim and Chris speak with Utah Patients Coalition executive director Desiree Hennessy about a number of important topics relating to Utah’s Medical Cannabis law. This highly informative podcast brings viewers up to date on four specific areas.
Desiree explains [5:28] proposed legislation that would allow qualified medical providers (QMPs), like doctors and PAs, to work more closely with pharmacists to prescribe Medical Cannabis. The proposal should make things easier for patients and QMPs. For example, it allows doctors to write letters of recommendation that are then forwarded to pharmacists. It would be up to the pharmacists to write prescriptions, determine dosage, and enter patient information into the EVS.
The proposed legislation is partially motivated by the fact that there are some 800 qualified medical professionals that have already successfully completed the Medical Cannabis course. But only a small number of them are actually helping patients get cannabis cards – or even talking prescriptions with them. Passing the bill addresses some of the QMP’s reservations about getting involved.
The other two topics discussed in the podcast are the government’s controlled substance database (CSD) [31:57] and additional legislation that, if passed, would add to the list of conditions that can be legally treated with Medical Cannabis in Utah.
Desiree and Tim speak of their concerns that the CSD could be used to discriminate against patients with Medical Cannabis Cards. For example, ER doctors may be afraid to prescribe painkillers to patients the CSD says are already using cannabis. Discrimination may not be a problem now, but it could be later.
Ms. Hennessy is a repeat guest on the podcast. Whenever she appears, she brings with her a ton of helpful information that proves beneficial to both providers and users alike. This week’s podcast is no exception.
Chris: Episode 37 of Utah in the Weeds. Tim, how you doing, buddy?
Tim: I’m doing great. I’m glad to be here. We’re glad to have our first return guest. No, I’m sorry, it’s our second return guest.
Chris: Oh, that’s right.
Tim: Just as important. Desiree Hennessy with Utah Patients Coalition.
Chris: Yeah, she was originally on episode six. Episode six of the podcast, if you want to go back and listen to that one too.
Tim: We’re glad to have you. We’re still doing virtual. Here we are in the beginning of COVID winter, and we’re still doing virtual podcasts.
Desiree: Eventually they’ll just start dating life like that. COVID winter number one. First COVID winter.
Tim: I go back, and I talk about the day the world ended. I still remember the weekend my calendar fell apart and everything was erased.
Desiree: Right.
Tim: Now we just push on.
Desiree: Right.
Chris: Where should we start with this, Tim?
Tim: Yeah, I mean I kind of want to jump back in with the Utah Patients Coalition. And when we met with Desiree before, we talked a lot about the history of the bill, the Medical Cannabis bill. What had been proposed, how all of that worked out, the compromise. I remember talking a lot about that, right?
Desiree: Yep.
Tim: And the reason why we asked you to come on again was, we have a new proposal that potentially could expand or not, the cannabis program. There’s some privacy things we can talk about too, but tell us a little bit about where the cannabis program is at, from your perspective, I guess? Let’s just start there.
Desiree: So where we’re at right now, we still have all of the pharmacies open. We still don’t have all of the cultivation, the grows open. We have product on the shelf. We have patients purchasing. We have still a wide range of conditions that are getting utilized. We have a compassionate use board for the patients that are falling outside of that, and they’re reporting back a 90% approval rating for patients that come through. We have issues with product shortages, which isn’t strange from a new program. We have issues with not a lot of different product options. We have a lot of problems with patients still trying to find a QMP or a physician that will get them on the state program.
Desiree: We have good and bad, but the thing that makes me not complain, is I always am seeing progress. So far, I haven’t hated anything too much quite yet.
Tim: That’s good. Now when we talked before, we were in hopes of 100, 150 QMPs. I remember talking to Rich Oborn about this as well. Do you know the current number of QMPs?
Desiree: I should have looked before I got on. No, but it’s above 600 now, right?
Tim: Yeah, I mean, it’s certainly above 500. I don’t know either.
Desiree: Yeah, I think we’ve reached 600. I want to say we were hoping to be around 800 by now, because we were seeing a steady increase all the time. I remember thinking, “Let’s hope for 800 by Christmas,” and I want to say that we’re there or really close.
Tim: That’s good compared to what was originally hoped for on the one hand, right? That we have providers willing to get into the system on the one hand. I know we’re going to get into talking about the potential issues with access, but I think that was a pretty good milestone.
Desiree: It’s very encouraging, to say the least. Now we’ve just got to get all the patients to the doctors.
Tim: Okay, so let’s back up a little bit. Talk about how many there are. Over 20 thousand legal cannabis users in Utah. Is that about around a round number?
Desiree: And again, it’s going up all the time pretty steady. But yeah, just about 20 thousand. The problems that we’re seeing though, is a lot of the QMPs, some are still not recommending, they just wanted to take the course. And some are not accepting new patients. There’s different reasons. Some were just doing a handful of patients. There’s a lot of different reasons why they’ve taken the QMP course, but then those physicians aren’t necessarily… like you know, Tim, they’re not necessarily the ones that are carrying the bulk of the patients that need cards. They’re seeing their few, and then we still have the specialist doctors that are recommending just for Medical Cannabis that seem to be still very needed, right? That’s where we are. That’s actually what kind of birthed this plan that we have come up with this year for this session if you want to talk about that. If not, we can keep asking questions.
Tim: No, everybody is very interested in this.
Chris: Yeah, please share.
Tim: This new plan, right? Anything that will change or promote the plan, or talk about the plan. Everybody’s talking about this bill.
Desiree: So depending on who you talk to and depending on the moment, these changes are either referred to as huge or small. Right? It’s either a huge change, and at the same time it’s not that big of a change. It was something that I came up with when we were calling QMPs who had written letters but not cards… weren’t putting patients on the card system. Or just calling them to see if they had any questions. Just trying to get a feel for this QMPs or possible QMPs, and if we were going to get this program up off the ground.
Desiree: Knowing that, the climate for raising patient caps is not there at the legislative level. I could cry, scream, beg, whatever, and it’s not going to happen. Really, there’s only a couple doctors or QMPs that have reached that cap. So I don’t really even have a big reason to ask. It’s not like they’re overburdened and they need them raised, except for in a couple situations. So in talking with doctors I found, like I said, there was a couple reasons. You know, either they were afraid that it would risk their license. They had a policy against it from their own work. They didn’t understand, so they just didn’t feel comfortable. They’re like, “Maybe I took my QMP. Maybe I have patients that want to use it, but I just don’t feel comfortable.” Actually interesting enough, a lot of those physicians… and Tim, I know you got some of these as well, where you would have a doctor or a primary care physician from some place like Intermountain Hospital write a diagnosis letter and send it to a QMP.
Desiree: Say, “Hey, I have this patient. I think that they could be using this medication, but I don’t want to do it. Will you?” And it was on letterhead from another doctor’s office, and so that was what kind of started birthing this idea for me. What I’d proposed isn’t what’s shaken out, so I’ll tell you a little bit about what I proposed and then the changes made there. Is the proposal was is that we would allow a patient to get a diagnosis letter from their primary care physician or whoever they were seeing for that condition. They would take the letter to the pharmacist, or it could be faxed over and then verified. Then the pharmacist, who there’s no doubt the pharmacists in Utah have become specialists in Medical Cannabis. They know the products that are out there. They know what conditions they’re working for, and they understand routes and dosing. A lot of medical providers are asking the pharmacist to already handle the dosing and handle the route.
Desiree: That’s something that we already gave them the power to do. There was no change there. We were just saying, “And while you’re doing that, will you put them on the EVS?” That removes the liability that some doctors were feeling about losing their license. They were like, “If I start putting patients on the card system, I’m going to lose my license.” Even though that’s not true, it was a big concern. Also if they had a policy about it saying that they couldn’t recommend, they can diagnose. There’s nothing saying that they couldn’t diagnose a patient and pass that on to a cannabis medical pharmacist, right? So we thought that kind of soled those. In turn, the pharmacies loved this idea, because it gave them better communication with the doctors. Better communication with the patients, and they were willing to manage the EVS.
Desiree: Another thing is that a lot of medical providers had just said that they felt like managing the EVS system was almost a full time job. That in order to be proficient the it, you need to be doing it every day. If they were going to do that, then they needed to hire somebody just for the EVS, and they weren’t interested. So we did have QMPs that got their QMP, then decided not to just because of the EVS. Well the pharmacists aren’t going to have that problem. This is their job, they’re there. Part of the law that we did not like in the beginning required the pharmacist to be there from lights on to lights off. We fought that tooth and nail, didn’t get anywhere. In the end, I’m not mad, because now we have these specialists that are there and can now enter in what’s called a collaborative practice agreement with the medical professional. Get the patient on the EVS. Get them the right dose. Report back to the medical professional or QMP. I mean, sorry, PCP, or whatever we’re going to call them there. It could be an APRN or a PA or whatever.
Desiree: Then any time that this primary care physician says, “No, like I don’t want this patient on here anymore.” They just take them off and then report back that they did. They have that as well. Any renewals like that will just be handled like, “Hey, do you want to renew this patient?” The doctor says yes. The pharmacist does the renewal. If the doctor wants to see the patient at six months, or at three months or whatever, they just report to the pharmacist. “Hey, before you renew this, I would like to see my patient.” They can handle that with the patient, but then they can also leave a note for the pharmacist that says, “Don’t renew this. They haven’t come in.” Right? There’s a ton of communication that can happen there.
Desiree: When I proposed this to the legislative body, or the people working on this law specifically, the interest was definitely there. The concerns were that they felt like if a doctor or a medical professional was going to do this, they felt like they enter in these kind of agreements all the time. If they were going to do it more than say, 15 times, then they wanted them to get their QMP license at that point. Just so they said, at that point they’ve showed that there’s enough interest that we at least want them to take the class. But even if they take the class now, I believe we’re still going to allow them to pass the book and have the pharmacist get the patient on the EVS.
Desiree: If it’s an EVS issue, if it’s just a time issue, if it’s just keeping up on it or understanding it… Let’s let doctors be doctors. Let’s let them diagnose. Let’s let the pharmacists handle the rest of that stuff. That’s what it’s looking like right now. I don’t personally love the 15 cap, take a class. I hope we don’t see doctors drop off after the 15. But at least it gives us time to see if this is going to work, and again, it’s a compromise. Whenever you’re entering into big changes like this, you’re never going to get anything you want. I feel like at least in this case, I got 70-80%, right? This will be a good first step.
Desiree: Another thing is that I know that if this works really well this year, then it’s a great opportunity to go back and revisit this next year. They seem way more open to raising this number than just patient caps. Because it does keep patients with the original provider, then it leaves these specialist doctors for the patients that their doctor’s unmovable. Right? A lot of patients that absolutely could not find a doctor, the QMPs that are writing letters or getting them on the card system, are reaching the ends of their caps. Then those patients are kind of going to be left in the dark. We would like to leave those specialist doctors for these, especially like veterans, stuff like that. That’s their only option, so not flooding that market with patients that have the possibility of staying with their regular doctor.
Tim: Are doctors then, do you feel like or the legislature feel like, they’re taking the liability away? Because it seems to me, if I write letter, or if I make a recommendation for cannabis, that that is my medical decision. I still have to be the one making the decision. That decision still falls on the medical provider to make that recommendation. That to me doesn’t seem to solve the liability issue. I still feel like I need approval from my employer to do that. I still need medical malpractice to do that. How is that being handled?
Desiree: The truth is if there’s a malpractice suit or something like that, that’s still going to come back. A lot of the doctors just don’t feel comfortable. Or they feel like if they deal with the medical, if they’re recommending… because remember, the big concern was that if they cross that line and they start talking about dosing and routes, then they have entered into almost like a prescription. So we have doctors that are concerned to kind of cross that line. This just is another step removed, of them not having to feel like they’ve crossed that line into something federally illegal. When we vetted doctors, they liked the idea. But you’re right, if somebody wants to sue… like if you write a letter for me, and I fall in the –
Tim: Right. Yeah, I mean the fact is, I’m the one making the recommendation.
Desiree: Right.
Tim: I think if you did it one or two times… and I discuss this with Ray Ward as well. If you’re doing it one or two times, or three or four times, and you don’t carry malpractice for cannabis, then maybe you feel kind of comfortable with that. Whereas if you do it 275 times, you want to potentially get a malpractice policy that covers cannabis. I worked for Steward Medical Group for six years, and they forbid all of us from writing any recommendations. That’s not going to change. They’re not going to add to their… this bill would not help them. Even if you remove them to the pharmacists, I’m sure their employer… because they would have to write it in the chart, right? You would have to say, “Well, this patient comes in for chronic pain. I am going to allow my MA to tell the pharmacist that it’s okay.” I think that that won’t work, but I’m sure there’s a few pharmacists… When I talked to Dr. Ward, Ray Ward, about this, he said a very similar thing as you’re saying.
Tim: The introduction of cannabis into a practice is what the goal is, and this feels like it is a legislation that is trying to introduce cannabis into practices that wouldn’t normally have cannabis as an option. Try and stick your toe in the water.
Desiree: Dangle the carrot.
Tim: So to speak, right? A patient comes in, says, “Hey, doc. I really want to try cannabis.” You’re like, “I don’t really want to, but okay, I’ll write you this letter.” Patient comes back, says, “Hey, I had a great experience. This is really working. The pharmacists helped me get some products, and it’s working.” Then the provider says, “I’ll try that again.” Tries it three or four times, and then decides, “Okay, I want to get involved. I think I should take this a little more seriously.” Is that kind of how you see this working for providers?
Desiree: I think that’s the hope. Also, because they have a pharmacist that they can talk with. They have somebody that’s handling the dose. They’re handling the things that the primary care physician maybe doesn’t understand right in the beginning. 15 times with 15 different patient, we’re hoping that it kind of dips their toe in the water, right? They feel like they’ve done it, they’ve seen it work well. Maybe out of those 15 patients, we can assume that the least 10, it worked well, and they decided to continue use. That medical provider hopefully would then feel like they had enough experience to do it themselves, or like to take the QMP course and try.
Desiree: But we’re not removing the safety net of the pharmacist. The pharmacist is still there as a collaborative partner at that time.
Tim: Is there some safeguards to the pharmacist being involved? The pharmacist is employed by the drug manufacturer. This has always been a very big concern of mine, that you have in no other industry… except we did know that in the opioid industry, when people were involved in the manufacturing and sale of opioids-
Desiree: Right.
Tim: They tended to give people bad advice. And we ended up with a big controversy, and one of our state senators was involved in that controversy.
Desiree: Right.
Tim: We still have pharmacists now that are employed by the manufacturer of the drug they sell. Is it concerning to you, or should it be concerning to patients that we have this unique, I would say, relationship?
Desiree: If cannabis was more of a risky product, then I would say yes. If there was more risk for addiction, if there was more risk for overdose. But right now what we’re dealing with, we’re most of the time not dealing with patients that are new, and they’re trying this out for the first time. So we’re sticking them in a predatory market, where people are just trying to get them as much drugs as possible. We are just trying to stop as many patients as we can from being illegal and using the black market or going out of state. In the name of just trying to keep them safe. If you’ve been using cannabis for a year and a half, and now your letter expires, and it’s been working for you… I can’t think of very many patients that are just going to say, “All right, fine. I’m going back to opiates.”
Desiree: So this is just the avenue that we could come up with, and I do see the similarities in all of those. Like I said, if it was a riskier product, then yeah, there would be a problem. And if in the next couple years, we see that this isn’t working, this is always something that we can change. We can change it in a year from now if we want. We could have a special session and say this didn’t work out. But right now, for the sake of keeping… because the number is coming down, but in the beginning, we had potentially 10 thousand patient that had a letter, that were not going to get a card. We needed to get them on the EVS somehow, because not believing any of them, or at least believing that a majority of them were now just going to become illegal users. This was an avenue that we came up with.
Desiree: Like I said, there’s always room for change, and that has been talked about. We all know that that is how a big portion of this opiate epidemic started is when you’re picking your own funding. That can lead to a lot of problems. We’re hoping that this market doesn’t end up like that, because it’s not as addictive, and these patients are truly just looking for medical help.
Tim: Right. I believe you, and I want to ask that question, because I do have this issue with the pharmacists selling whatever vape card’s on sale. I think that the other thing that I worry about is in the cannabis space, we talk about how cannabis is so safe, it’s so safe. We also created, when we were talking about the QMP program, we use the opposite argument. Cannabis is so dangerous that we need a four hour course, and we need to have these people registered. It’s still federally illegal. It’s still a schedule one. I think we use a double standard. I do too. I catch myself using a double standard too. What I want is more patient caps. I totally see, I’m at my limit and four or five of my providers are at their limit.
Tim: The problem with what I have, is I have 15 providers. I don’t need 15.
Desiree: Right.
Tim: I could use five experts and not 15 people who aren’t as good. I think that’s a bigger problem for patients than having somebody who doesn’t know anything about cannabis write a letter. Do I mind that program? I don’t know. I guess we’ll yet to see on my side, how many patients get it. The one thing that I do think about this bill that I like is for a small percentage of patients who can not afford a specialty consultation… who can go to their primary care provider. Who can convince that person to bill the insurance on the visit for however you want to justify that. There are going to be some patients who really need the help and who can access cannabis in that way.
Tim: I think on that side, I’m a supporter. Do I like the whole thing? So far, I don’t know, Desiree.
Desiree: Right. And we have talked about still creating… we talked about it again yesterday. Creating cannabis specialists, so pockets of doctors that had taken the QMP course, maybe a little bit more education, and they didn’t have a cap. That’s not off the table. That’s something that we talk about all the time. A couple of the lobbyists and I talked about it yesterday. There’s still a lot of interest there. It’s just getting the details nailed out, or hammered out, and that we can get the legislative body on board. That’s where we’re at with that. Because the one thing that they really want is if the doctors are doing that, these specialist doctors, they want them to take insurance. They want it to be the cost of a co-pay. So if we can get there, I think we can make specialists happen.
Desiree: I think that you’re right. If I could send patients to a specialist that was doing what the pharmacist is doing, where they’re reporting back to the original doctors and saying, “This is what I put them on, and I understand the other meds and everything. But it was only costing them $35.” Yeah, that would be amazing, but we haven’t been able to get a consensus on that language. It doesn’t mean that we’re not trying. We tried really hard last year, and more pushback from the UMA this year. But it’s not off the table for this year at all.
Tim: Two questions with that is, what’s the UMA say about this bill?
Desiree: They are the ones that took it from just letting their… if you didn’t have your QMP, then you could just write the letters and send it to the pharmacist. They’re the ones that really advocated to take it down to 15.
Tim: The other question that I get a lot is why don’t you take insurance? I called Aetna and Medicare, and I asked, “Can I put this evaluation under the insurance?” Their response to me was, “Absolutely no. The claim will be denied, and you potentially could get kicked off our panel.” Have you thought about going to the insurance companies and forcing them to accept these visits and cover these visits?
Desiree: I talked with some earlier this year. I actually tried to get them to come and meet with some of the QMPs, but then Coronavirus happened, and we could no longer have meetings. The idea there was they’re not interested, but we have even the doctors of the Department of Health are doing this. They just say, “I saw a patient for pain. I saw a patient for PTSD. I recommended treatment,” and they are convinced… even Dr. Mark Babitz, who works at the Department of Health. When he writes a recommendation, he just charges copay, and he just says, “I saw the patient for pain. I saw the patient for PTSD, whatever.” He says, “I don’t report to the insurance companies when I recommend or prescribe all medications, so I don’t feel like I have to do it here.”
Desiree: The doctors that feel comfortable doing that are, and the ones that are worried… I mean I had a doctor that was doing it for months and then was like, “I feel like I just am wading into dangerous waters here,” and so he stopped then started not taking insurance. So I get it, but we did reach out to insurance companies, and they’re hesitant, for sure. They were interested to hear that some doctors were doing it, and I didn’t tell them who obviously. They do see the loophole.
Tim: This is just such a touchy subject. I mean I could dig into this all day, because there’s so many nuances, and there’s nuances that benefit one argument one way and another argument another. What do you think about all this, Chris?
Chris: Hard to keep up on all of it, really. Like you said, I was following what you were saying earlier, and I can’t agree more. It seems like you want to get more of an expert to stay as kind of the main expert when it comes to recommending cannabis, instead of just bringing all these new people on. That part just doesn’t make sense to me.
Tim: Yeah, I think so. Talking to patients, it’s one thing to have… in the beginning of the program, when we were seeing patients in March and in April, we were only getting about one in 10, maybe one in seven that had never experienced or never tried cannabis before. For a primary care provider to recommend that patient Medical Cannabis and have the pharmacist take over, most of the patients, I think that would be fine. Sorry, I guess that was a little bit unclear. But now we are seeing at least one in five of the patients that we see have no experience in cannabis at all. The average age has increased as well. Our average age female patient, for example, is 45 years old. It wasn’t that way earlier in the system.
Tim: I worry, because I want those patients to get a lot of hand holding through the process. I think cannabis is a little different than… like in med school, we learn about all of these drugs. But then a point was made to me. New drugs come on the market all the time, and we don’t get education on those new drugs. We just start writing them, and then we just kind of see how it goes. They’re deemed safe by the FDA or by whoever, and a drug rep comes in and gives us a little bit of education. Then we start to write those recommendations. This bill treats cannabis like that, right? You learn a little bit about it, you write the recommendation, and then you kind of learn as you go.
Tim: Cannabis, I don’t see it like that. You know, I see it as it’s very experiential. I like the specialist idea, but again, there are literally only a handful of specialists in the state legislating around those 10, 20, 50 QMPs. That’s not reasonable either.
Desiree: And I’m not trying to skirt around the specialist issue here. In fact, what I look at, is I guess I’m just looking at the patient and the specialist of the patient. The patient specialist is the doctor that they’ve had since birth, or the doctor that they’ve been seeing for this condition. I’m trying to keep the patient with that specialist. Instead of trying to have another doctor acknowledge all of this other stuff that they’ve gone through, and all of these other conversations and add cannabis over here. Let’s just take the bulk of the patient information with the specialist for that patient and add cannabis over here. And add a collaborative practice agreement with somebody who understands cannabis. Marry those two, and I feel like that’s where the patients are going to get the best care.
Desiree: I love cannabis specialists for other reasons, but majority of the time, I just feel like… I have a son with extreme special needs. If I had to leave his specialists to go find a cannabis specialist, I don’t know if I would do it. I don’t have to go to a new doctor every time they change his heart meds, so I would just feel more comfortable keeping him with the doctors that have truly watched him die and saved him, and done it all, right? For me, I’m trying to preserve this specialist that belongs to each patient more than a specialist that belongs to a drug.
Tim: Yeah, I like the way that you’re putting that. I like that idea. What I hear you saying is that there’s got to be more acceptance of cannabis as a medication in the healthcare community, and there needs to be more education frankly, from the specialists to those other medical providers. So that we can all become better at cannabis.
Chris: Better at cannabis. That’s something I can get behind.
Desiree: Right, can that be our new logo?
Tim: Yeah, better at cannabis. We are better at cannabis.
Desiree: Better at cannabis.
Tim: Talk to us a little bit, Desiree, about the controlled substance database and this other government list they’re threatening to put us on.
Desiree: I’m not going to talk too much on it, because I don’t like it, and I’ve been arguing it. I still don’t like it. I also don’t know that there’s anything that I can do to stop it. But what I am being allowed, and what everybody is working towards, is making sure that there are protections that don’t just… Like now I’m on a list that says I’m breaking federal law. Who would like to look at it? To be clear, you would have to have a warrant to see this list. We have looked to see if anybody has been targeted in other states on a CSD list. Those haven’t happened. I lost a lot of ground when it just hasn’t happened. I can’t say this is dangerous for patients if it’s never been dangerous for patients.
Desiree: Connor Boyack with Libertas and I are hashing out some details. I’m going to do a little bit more research to make sure that we cover the bases for patients. If we can’t get them to not be on this list, my next priority is just making sure that I offer every protection possible. The reason why they want them on is because they truly are, and for our benefit… maybe not with the CSD, but for our benefit in the long run, they want this treated like medication. If it’s going to be a federally scheduled medication, they want it on the controlled substance database. I can see that, and I think the more we can line up with regular medications, the better we are in the long run. I just don’t like this controlled substance database, because it is still federally illegal. If it wasn’t, we wouldn’t be as nervous, right?
Desiree: Connor and I are going to talk about this. We’re going to make sure that patients are protected. Brad Daw even is still involved in these discussions a little bit. He really wanted this CSD patient added to that, but he still also agrees that, let’s make sure that there’s protections. As soon as we’ve got consensus and I can talk explicitly about the protections that we’ve added, then we’ll do that. Right now, for the record, I don’t love it, I don’t want it, but I don’t think we’re-
Tim: I’ll tell you, I would say a couple of things about the CSD. One, if the federal government classifies this as a scheduled medication and reschedules it as a controlled substance then put it on the controlled substance database, they may reschedule it into a lower schedule. Then you don’t have to go on the controlled substance database. I have seen the controlled substance database used to discriminate care amongst patients, and I have talked to emergency room physicians who have told me point blank, “Patient comes in, I’m going to look them up. If they look shady at all, I’m going to look them up on the controlled substance database. If they have a weed card, I’m not giving them any narcotics.” They’re going to treat the patient differently in the emergency department. They’re going to discriminate care. That doesn’t get written down. That doesn’t get charted. That, I think, will be a tragedy for patients beyond the privacy issues. I fear for the patients in that regard, and I hope they decide not to list this on the controlled substance database.
Tim: I certainly have other concerns about the bill in general, but I would think that would be something… I would hope there would be a lot of people who support the bill, but the CSD, then we don’t support it.
Desiree: I love that with ER doctors though. I have not talked to them. My husband is a fireman. I’m going to talk to him about that too, and see if we can reach out to that demographic of care providers. I already knew that there was a hurdle with pain patients. I’ve had many of them tell me… and these are the ones that rely on a cannabis specialist, right? “If my pain doctor finds out that I am using cannabis, even PRN, then I will lose all my other opiates.” They have felt like they’ve reached this balance, where they are using this amount of Gabapentin and this amount of cannabis, and they finally have pain relief.
Desiree: They are terrified. Their care will stop on the day that they’re added to the database. I don’t have numbers to prove that it’s going to be catastrophic, and I won’t have those until after it happens. Like I said, I can throw a fit. I can say I don’t like it. I can yell it from the rooftops. But right now, until I have damage caused by this, I can’t find a way to stop it. But I if can reach out to ER doctors and I can reach out to paramedics or something that says, “Yeah, we’re going to be checking that, and yeah, we do discriminate.” If I could get them to testify, even that that is a possibility, I think maybe that gives us enough reason to say, “Can we just wait?”
Desiree: Even if it gets rescheduled federally, I don’t know if that will be enough to stop discrimination. If they ever are on the CSD, or if it gets rescheduled… if they don’t have to go on the CSD, then it stops that. If they ever have to be on there, then I think we will always have discrimination there. Still a lot of pain doctors, crazy enough, that do not believe that you can take both.
Tim: I know. I talked to one in the summer. Yeah. I get the referrals from the doc, or the patient comes in and then I call the pain specialist. I say, “Hey, they don’t want to get kicked off the pain contract.” They’re like, “Oh, yeah. They’re going to get kicked off.”
Desiree: Yeah. And then they’re-
Tim: And they can’t. That’s not fair.
Desiree: They’re taking away their… yeah. It’s a mess.
Tim: Man, I have really dominated the questions today, Chris. But this is-
Chris: No. No, no, no. It’s fine. I’ve learned a lot just sitting here listening. I mean, there’s so much to learn and so many ways to get active.
Desiree: Tim, this is your arena, right?
Chris: I just kind of want to absorb it all, you know?
Tim: Right. I mean, you’re right in my wheelhouse now. Now we’re getting to the point where I can see the things that potentially could use a change. Of course, I always have my opinion. Everybody has their own opinion and their own paradigm from which they see things. And I can really appreciate, although I think… You know, we’ve had a good discussion today about things that I don’t agree with. But I agree with some of the things that you’re talking about and some of the things that are needed with the program. It’s nice to know that in America, we can still have a useful dialogue and learn a thing or two from each other.
Desiree: Right.
Tim: We’ve proven it again, Chris.
Chris: Is that possible?
Tim: With cannabis, anything is possible.
Desiree: Right.
Chris: We’ve proven it again. We’re the myth busters. So what else? Is there any other bills that we need to talk about? Anything else that we need to talk about with changes?
Desiree: I think we need to remember that there’s a lot going on with hemp right now. I don’t have the details of that, but just know that no consensus has been found with those. So just know that those are being worked on, and… there’s something flashing. The hemp issues are being worked on, and the sponsor is not… they don’t want to put anybody out of business. They, I don’t think understood the ramifications of what the draft was. But also remember a draft is only just a draft. That is the time when it’s like, “Hey guys, this is what I’m thinking. Let me know what you’re thinking.” That’s the call to become involved.
Desiree: I always tell people, it’s really notes on a napkin. Take it for what it is. I think that we’re going to see big changes in what they proposed to do with hemp. We’ve been trying to stick a little bit closer to what is federally going on in other states, what the federal government has proposed and what’s happening in other states. That’s going to be discussed. I won’t be as involved in that. Mostly I’m just helping make sure that it’s happening, and then I’ll go back to dealing with a couple other things that we’ve got going on with patients. I did do some law enforcement education this last month. It was really good. We were going to do in person meetings, but then it was right when the governor said, “Let’s shut down again,” right before Thanksgiving.
Desiree: So we canceled all the in person meetings and did some Zoom meetings with, even sergeants, supervisors, on down to just beat cops that were watching on their phones in their cars. They had excellent questions, and the feel of all of the meetings were that they were really just wanting to do this right. Department of Health did it with me, they actually invited me. They did a presentation about what was legal, because we were finding that so many times, when I have a run-in with a patient, the police officer truly didn’t understand the law. So they wrote a ticket, funny enough, the code is usually like 58-37, whatever, which is the exact code that says you’re legal, but they just didn’t understand. So they thought, “Well, I’ll give the ticket, and then it will be worked out in court.” Then the court was turning around and saying, “Well, the cop wouldn’t have written the ticket if this wasn’t illegal, so we’re going to prosecute.” It’s been a mess.
Desiree: Having these education classes has been amazing, because they truly needed the education. But since that day… then we made a handout that we gave to them for them to give to all of their officers. It doesn’t tell them how to handle a traffic stop or an encounter with a Medical Cannabis patient, but it gives them the law. Like, this means this… and I can send it over to you. We’re actually creating one, a patient toolbox letter as well, just for patients to carry.
Tim: Oh.
Desiree: It’s almost done. It’s basically done, we just need to make sure that lawyers look over it and it’s good. The patients can carry this as well and say, “Okay, but look up these law codes really quick.” We not only say look them up. We cite them. So it’s boring, because it’s just, this is the problem, this is the law code. You say that I can’t have it out of a blister pack, here it is, you know? You say I can’t have raw flower? Yes, I can. So because I have a Medical Cannabis Card, you can’t charge me with paraphernalia because I have a vape pen. Which they’re like, “Well, we’re not going to give you possession, but we can still give you paraphernalia,” has happened a couple times. We have those written out.
Desiree: We gave one to the law enforcement officers. I’m hopeful, and I’m crossing my fingers here… but since we did that, I have not had any cannabis patients come to me saying that they were targeted by law enforcement even though they were legal. That’s been the longest span since this plan started, that I haven’t had patients come to me. I’m hopeful that we actually did see some change there. That the trickle down and the education got passed around. They really were trying to understand. Some of them had said they had a traffic stop, and they were unable to get on their… I forget the name of it. It’s a weird name. But they have a system, where they can look and check if you have anything, a controlled substance, I believe, and cannabis. We put it on the same one. They could just look. It doesn’t say anything else except, “Desiree Hennessy, yes or no.” It’s like, “Desiree Hennessy. Does she have a Medical Cannabis Card? Yes.” No other information.
Desiree: Some officers were simply just, “I can’t get on that. When I’ve tried, I haven’t been able to, so I gave a ticket.” So the Department of Health was able to talk them through that and help get them in touch with people that would help them be able to access that and understand it. Hopefully that made some big changes, and we’ll quit seeing patients targeted.
Tim: Yeah, that’s important.
Chris: What was it yesterday, you were talking about some PTSD qualification on a video I was watching on Facebook?
Desiree: Yeah, so the product review board meets every month. They are led by our friend, Perry Fine. They meet, and they discuss products. They recently started discussing conditions that we’ve approved. The product review board, their job is not to take conditions or add conditions. That was done by the legislature. But they do make recommendations, and it’s up to the state to follow them or not. They have taken a couple of different conditions. One was MS a couple months ago. They were like, “That has little to no value. Medical Cannabis, we feel like has little to no value.” Then they vote on it. Well yesterday in the morning, what they did was, there was some confusion and a lot of concern, that they had voted that with Medical Cannabis, they felt like it had no value, zero value with PTSD.
Desiree: They voted as a board that that is their position now. Which is unnerving if you’re a PTSD patient. That does not mean that they have the power to take it off the list, but they will mention that as a recommendation to the state of Utah. I do not see them taking it off the conditions list this year. It is something that we all need to be aware of, and especially me, and doctors that have put patients on for PTSD. We need to be ready to push back if that arises. Like I said, we have no reason that they’re going to make any movement on that this year. I do believe it’s the first condition that they’ve said they’ve found had zero value, with Medical Cannabis had zero value with PTSD. I don’t think any of the other ones that they voted on had zero benefit.
Desiree: Now they’re just looking at studies from outside of Utah. They’re not looking at patients. They’re not talking to them. They’re just looking at studies. That’s what they voted on.
Tim: Gosh.
Desiree: I hate it.
Tim: That’s so frustrating. The MS one is frustrating as well.
Desiree: It hurts my heart.
Tim: I mean, I can hear my MS patients telling me, “If I don’t have cannabis in the morning, the middle of the day…” they’re low dose people. “I can tell when I adjust my dose, and I feel better, and I can do more.” All these things. The PTSD. There’s not going to be good studies. These are psychological illnesses that take people discussing this with people who use the product. I have some data. I have anecdotal data that I could share with the board, you know? Self-reported data.
Desiree: Right. And that’s what I told them. I said, “You know, it’s kind of sad…” when I was talking to the Department of Health. I said, “It’s sad, because maybe you don’t have good data from other states or out of country.” Although I’ve seen some, but the product review board is so very critical. But I said, “The funny thing with PTSD is I don’t get a call from the patient themselves saying, ‘Oh my gosh, that was wonderful. That helps me so much.’ I get a call from the spouse, and they say, ‘Wow, I’ve got my husband back… or my wife is finally happy again.'” And it’s hard, because I’ve heard those testimonials. The thought that somebody easily just looked through a book and said, “We see no value.” It hurts after months of getting to know these patients, loving them, and seeing their progress. Seeing them be suicidal and then not.
Desiree: It’s hard to hear. It definitely is just hard to hear. Now one thing that we need to remember is that the product review board is probably our next biggest hurdle to stop us from adding any conditions to the conditions list that we have. Although they don’t get to add them or take them off themselves, the legislative body is relying heavily on them to do the research on what conditions we can add. That’s why everybody hates the compromise, but we have to remember… we fought tooth and nail to get anything on paper. Everything we have had on paper has not been taken away. Once the compromise happened, they have not backtracked at all. We knew it was still gonna be hard to expand it, especially the conditions list. We’ve tried every year. But like it or hate it, the compromise is that safety net that has stopped them from taking anything else.
Desiree: If we had passed Prop 2, which again, I will say it til I’m blue in the face, we never never thought that we would keep Prop 2. From the day we started writing it. Did we want to? Yes. Did we think that they were going to let us keep it? No, we live in Utah. But we knew that after we walked out with the compromise, not loving all of it, but realizing that they wouldn’t take any of that away. They haven’t. Adding is hard, but the product review board is probably our biggest obstacle in adding new cases. I personally would like to see sleep disturbances added. I felt like we had some interest in adding some anxiety and depression, but then at the end, it was decided that maybe we’d let the product review board decide if they recommend it.
Tim: You’re going to have a tough time with anxiety with the product review board. Tough, tough time.
Desiree: Well, because they do believe that anxiety, bipolar… they still believe that mental issues can have a potential of making it worse. Almost like a 50/50 chance. Like, it could make it worse. It could make it better. They don’t want to put patients at risk, but my thought is, are there other medications you’re trying not putting the patient at risk for other things? I mean, my husband’s a fireman, and he’ll tell anybody, “I’ve never been on a suicide patient that wasn’t on an anti depressant.” He’s like, whatever reason that is, it’s either not working, or whatever else. He said, “It’s not stopping all of them, so why not allow them to try something else before they take an exit?”
Tim: Yeah. Well, Desiree, this has been great. I’m always excited to talk to you, because I believe that you have the patient’s interest in mind. You definitely want what’s best for the patients, and you go for it. So bravo. I think you do good work when it comes to that, and I appreciate you being willing to come on and talk about the process. And be honest about the process, about how it’s going, and what you think the pros and cons are of what’s being proposed. So Utah Patient’s Coalition, I think it’s a good-
Chris: Yeah, thank you.
Tim: It’s a good place for Utahans to know they’re getting good support.
Desiree: Thank you, thank you. We have a Facebook page, which is probably the best way, especially if they’re watching this. Utah Patients on Facebook. We have Twitter. We have Instagram, that I don’t use a lot, but I have somebody that’s just offered to do media. So hopefully you’ll see stuff there. I just can’t do Twitter. I’m too old. We also have a website, so UtahPatients.org. If you get on our website, you can go up to a tab like compassionate use board. Say you have a good or bad experience, you can leave a review. That just helps us know when we talk to them, what concerns to bring up or stuff like that. It’s a little interactive there, so…
Chris: Anything else that you guys want to talk about before we wrap this episode up or anything?
Tim: I don’t think so.
Chris: Okay, we’ll go over more things in future episodes, Tim. To let listeners know as the end of the year kind of wraps up with getting cards and what not.
Tim: Yeah.
Chris: How can people get ahold of you, Tim? What’s the best way for that, if they want to get their card or anything?
Tim: Best way is utahmarijuana.org. We’ve got educational video series that we have that have been posted there. We always host the podcast there and do a transcription or a summary of those, if you want to look through and you want to pick up on the cannabis culture in Utah. Kind of learn about all the history and the stakeholders. We have a lot of people on here now, Chris. So utahmarijuana.org is a great place to go. How about you?
Chris: Very cool. You can listen to my other podcast, IAmSaltLake.com. I got a really fun episode actually coming out this weekend, so a couple days after this episode releases on all the dog friendly places in Salt Lake City that you can go to. If you’re a cannabis patient, and you have a dog, you might want to check that episode out.
Tim: That’ll be a great Sunday morning.
Chris: Yeah, otherwise, just reach out to Tim or myself, if you want to come on the show and leave us a review or reach out and say hello. Yeah, we’ll wrap this episode up then, you guys. Thanks for coming on, Desiree.
Desiree: Thank you, guys.
Tim: Thanks, Desiree. Stay safe out there, everyone.
