Who is Narith Panh? (00:00)
What does the community mean to Dragonfly Wellness? (03:56)
What experience does Narith have with marijuana outside of his work with Dragonfly Wellness? (06:55)
What are Narith’s favorite ideas for the Utah marijuana system? (07:40)
What kind of products can we expect from Dragonfly? (15:33)
What problems does Narith see with the Utah system from the perspective of a pharmacy? (22:34)
What are Narith’s suggestions for people who want to get medical marijuana in Utah? (29:42)
How do I get in touch with Narith, Dragonfly Wellness, or the podcast in general? (46:15)
UtahMarijuana.org
DragonflyUT.com
Utah in the Weeds Podcast
Narith Panh is the son of Cambodian refugees who came to America. He’s also passionate about cannabis, and the Chief Strategy Officer at Dragonfly Pharmacy. Dragonfly has been a hot topic of discussion on Utah in the Weeds for weeks, so it only made sense to bring him on to chat about the current medical marijuana situation in Utah.
The short answer: everything. Narith, and many members of his team, are immigrants who are first-generation Americans. The Utah community welcomed their family with open arms, and now they want to give back.
Narith recalls patients who cried tears of joy after getting their medical cannabis and witnessing for themselves just how impactful and beneficial it can be for them. That, he says, is what it’s all about.
Since his girlfriend’s family lives in California, he often finds himself traveling back and forth. As such, he has experience in the recreational market in California, which has given him an insight to the pros and cons of their system. He uses this knowledge to provide the best possible service for patients from Dragonfly and, indeed, from the Utah medical marijuana system as well.
Narith is passionate about cannabis. He wants to expand on some of the things that can make Utah the best medical marijuana state in the country. One of the things he cites as a huge fundamental advantage of the Utah system is the ability for producers to bring CBD into the cannabis ecosystem – essentially allowing products that are a mixture of CBD and THC. These two compounds are synergistic and work together to maximize the user’s experience.
However, in many states, producers are forbidden to mix the two chemicals. But not in Utah. This brings down the end user’s cost significantly, since the license for producing CBD costs $2,000 per year, whereas the license for producing THC is $100,000 per year. Being able to couple CBD products with THC brings costs down significantly across the board, which means a smaller financial burden on patients.
Another key concept that Narith is interested in is the seed-to-sale tracking method the state is mandating for all sellers of marijuana. This system requires that each marijuana plant is tagged when it reaches 8 inches tall. Then, once it’s processed into flower, it’s tagged again. Then again as an oil, and so on until it is sold as a finished product (for example, a THC cartridge).
The reason this is so important can be highlighted with the problem in 2019 with black-market THC cartridges causing severe illness in dozens of people. As it turns out, almost all of those bad vape cartridges were traced back to one source, but it took months of hard investigative work. With the seed-to-sale system in Utah, a bad cartridge could be traced back to its origin, production halted, and a recall issued in a matter of hours.
First, let’s clear up one thing. Dragonfly Wellness is not a dispensary. In fact, Narith personally hates the word “budtender”, because it implies a more casual “slinging” of product, rather than a true medical consultation coupled with the sale of marijuana.
Dragonfly Wellness is a pharmacy. It specializes not only in selling marijuana products and devices, but also in medical advice, dosing, and patient care when it comes to cannabis.
Another couple of misconceptions to clear up: First, getting marijuana flower will not be a problem. It’s the most popular form of marijuana by a considerable margin, and will be available. However, an open flame cannot be used to smoke the flower. Instead, it will have to be puffed through what’s called a dry herb vaporizer. Dragonfly offers a wide selection of dry herb vaporizers, from entry-level handheld puffers to state-of-the-art heavy-use systems like The Volcano.
The other misconception to be cleared: No, marijuana flower will not be sold in blister packs. State legislators were considering forcing producers to package flower in blister packs (similar to how you might find over-the-counter pills) with the safety of patients in mind, but they found it would have only been a burden on both patients and businesses, with no added safety to users. So, thankfully, they scrapped it. Your flower will come how it’s supposed to: in jars.
As for the products that Dragonfly will be offering, expect to find a dazzling array of marijuana products. Everything from an already highly-recommended 25-to-1 tincture (that is, 25 mg CBD to 1 mg THC), to capsules, to edible gelatin cubes, to topicals, to the almighty flower, is available. They also have a wide selection of consumption devices so you can get the marijuana experience you need.
Dragonfly Wellness also has something you can’t get in a typical dispensary: a medical consultation. When you enter Dragonfly Wellness, you’ll have a meeting with a pharmacist, either out on the floor or in a private office. He or she will walk you through marijuana use and help you pick out the proper dosage and consumption method. The goal here is to get patients the most effective cannabis experience possible, without going overboard.
Narith’s biggest issue, currently, is all of the confusion and misinformation. Dragonfly has to turn away dozens of people every day who come into the pharmacy thinking that a letter of recommendation from their doctor is enough. It’s not. In order to gain access to the pharmacy, you need a valid medical marijuana card, which you can only get through an evaluation by a licensed medical professional (such as Tim Pickett).
It’s no one’s fault that this misinformation was spread. After all, this entire medical marijuana system was built from nothing in, really, under a year. In governmental terms, that’s lightspeed. It’s expected that there will be a few hiccups. Thankfully, Dragonfly is doing all they can in order to accommodate as many people as possible. In fact, they’re risking it all for their patients.
Last week, Tim touched on the fact that Dragonfly was taking on a huge risk by opening so early in the rollout. Narith explains that there is a very direct reason for that. It wasn’t them jumping the gun. On the contrary, they understood the risks and knew that the first few weeks would be rocky. But they could not, he says, delay the care their patients so desperately need in order to protect their own financial interests.
Is it tough right now? Definitely. Narith makes it clear, however, that seeing the tears of joy roll down the first-ever Utah medical marijuana customer’s face makes it all worth it. That’s what Dragonfly Wellness is all about.
House Bill 425 made it possible for Dragonfly Wellness to take letters of recommendation for cannabis use from doctors in lieu of a medical cannabis card while the card system suffers from logjam. At the time of this podcast, HB425 had not yet been passed.
At the time of this podcast’s recording, Narith says that patients should not wait until House Bill 425 clears. This is because, even if it passes with no problems, it will still take some time for the change to be implemented. That seed-to-sale tracking system that was mandated by the government does not yet have the ability to process, verify, and approve letters of recommendation. Software changes will have to be made, which will take time.
So, Narith says, patients should continue to go through the current medical card system with a doctor’s evaluation. That would ultimately be the fastest way to get their cannabis.
Narith also makes a point to note that Dragonfly Wellness is not trying to rock the boat. As the first cannabis pharmacy opened in Utah, it’s all eyes on them. They will be strictly adhering to every law that applies.
For example, Dragonfly is not allowed to make suggestions about which doctors to use. Dragonfly is also not allowed to sell merchandise or advertise on the radio. In fact, Narith would not have been allowed to appear on a video version of this podcast, because he was wearing his Dragonfly Wellness uniform. Doing so would, under state law, constitute an advertisement.
Dragonfly won’t toe the line on any of these rules. They’re the only cannabis pharmacy in the state, so they’re not going to risk forsaking their patients by getting shut down.
How to get in touch with Narith and Dragonfly Wellness:
Go to DragonflyUT.com and subscribe to the newsletter for the fastest information
Follow Dragonfly Wellness on Facebook and Instagram
How to get in touch with the podcast:
Call Tim’s office at 801-851-5554
Visit Tim’s clinic websites at UtahTherapeutic.clinic and UtahMarijuana.org
Email the show directly at UtahInTheWeeds@gmail.com
Who is David Sutherland? (00:00)
What was David’s monthly drug routine like after his car accident and rehab? (04:00)
How did David make the journey from all those drugs to solely cannabis? (06:00)
What does David envision his life would be like without cannabis? (13:20)
What would David say to patients who are afraid of getting off painkillers? (15:37)
How does Chris compare his largely non-medical experience with cannabis to David’s medical one? (18:00)
As one of the first people ever to use it, what are David’s thoughts on Utah’s medical marijuana system? (22:10)
For Tim, how has the system been on the provider side? (31:48)
How can I get in touch with Tim and the Utah in the Weeds podcast? (36:05)
UtahMarijuana.org
DragonflyUT.com
Utah in the Weeds Podcast
David Sutherland is the first-ever cardholder for medical marijuana in Utah. He comes on the show today to share his story with cannabis, and his experience with the new medical marijuana system in Utah.
David works for the state doing IT work. Eight years ago, he was involved in a car accident that left him with a concussion, burst vertebrae, a broken sternum, and nine shattered ribs. After two years of intense physical therapy and rehabilitation, he was left with permanent chronic back pain and ongoing muscle spasms.
David had to use a back brace for months. He went through approximately 200 vicodin per month, and was on a daily dose of gabapentin, Celebrex, and a slew of antidepressants, anti-anxiety medications, and muscle relaxers.
David had obviously heard of the medical benefits of marijuana before. He noted feeling primarily excited about getting off of painkillers, but also nervous. For him, and indeed for many in his situation, a life without painkillers can seem daunting, or even impossible.
He was worried about how his family might react when it comes to his cannabis use. And of course, because he started his cannabis use before medical marijuana was legal in Utah, and therefore was in violation of federal and state law, he was apprehensive about conflicts with law enforcement.
David got his start in treating his pain with cannabis about four years ago, when he went on a camping trip to Colorado. Despite his tragic accident, it seemed as though luck had not yet abandoned him. He won a Powerball lottery to the tune of about $10,000, and decided to cash it in and spend some at one of Colorado’s recreational dispensaries.
That seemed to do the trick, and David spent the next 8 to 10 months weaning himself off of the prescription drugs in favor of a cannabis-based solution.
It’s a good thing he did, too, because as soon as his doctors discovered that he had been using marijuana, they cut him off of the prescriptions. Believe it or not, that’s the standard move for someone who wants to experiment with cannabis as a pain treatment.
Tim Pickett touches on just how harmful this philosophy can be when trying to find the best treatment for someone with chronic pain. For a patient, going cold turkey from opioids and antidepressants can be a death sentence.
The reason many doctors do this, he explains, boils down to two key factors. First, many doctors are still uneducated about the benefits and science behind marijuana. Second, since many doctors are simultaneously medical professionals and business owners, they want to limit their liability when it comes to illegal drug use.
The solution, then, is both education and a legal framework that allows patients to decide whether or not they want to try marijuana to manage their pain, and to provide a safe context for which they can switch from opioids to cannabis. The latter is now in the works in Utah.
Before his transition to cannabis, David was depressed and suicidal. Day-to-day life was not only physically grueling, but mentally exhausting as well.
Now, with cannabis, David feels more clear-headed, energized, and calm than he ever was on traditional medications.
The prevalence of stories like these speaks to the undeniable benefit that marijuana can have for those with chronic pain.
David would speak to his own experience. Many of those who are afraid of getting off of painkillers are really just afraid of the pain itself. David would reassure them that cannabis can not only be a perfect substitute for painkillers, but that it can actually be better at managing pain than opioids.
David argues, and Tim agrees, that while painkillers lessen the pain, they don’t eliminate it. It’s always there. Cannabis, similarly, lessens the pain, but it also takes your mind off it. David compares it to putting the pain in a box and placing it to the side. It’s not like cannabis completely erases pain; nothing does. Rather, it prevents the pain from bothering you.
While Chris, having not been in an accident as severe as David’s, can’t really comprehend what it’s like to go through the kind of physical pain, rehab, and drug use that characterizes a lot of medical marijuana journeys, he can certainly see the remarkable impact it has on those with chronic pain.
As someone who has used and enjoyed recreational marijuana, Chris wants to see less stringent requirements on who can get access to it. He points out that it’s the patient, not the doctor or the government, who experiences the pain. Therefore, it should be the common philosophy that the patient has the right to say whether or not they want to try cannabis.
He also explains that, contrary to the way some medical professionals act, using marijuana to treat pain is not a new concept by any stretch of the imagination. In fact, medical marijuana has been used in parts of the United States for decades. We should use this fact, as well as more education, to remove the stigma around marijuana, so more people can experience the benefits that David has.
David’s outlook on the medical marijuana system in Utah is very optimistic. As an example, he delves into his experience at the Dragonfly marijuana pharmacy:
Despite official dosing recommendations made by Tim, which should have enabled David to skip this step, the pharmacist still elected to have a meeting with David to discuss his dosing and delivery method. David explains that while this wasn’t necessary for him, dosing advice could be essential to someone with less experience in marijuana use, and whose doctor did not give dosing advice.
The meeting, he said, consisted of the pharmacist asking about his prior marijuana use, listening to David’s needs, and taking his words and thoughts into account.
David did mention that there was a rather startling lack of measurement on some of the tinctures, such that the buyer would have to calculate for themselves how many droppers to take in order to get the correct dose. This could be particularly difficult for those preoccupied with pain and illness, or the elderly.
He describes the prices as reasonable, and maybe even cheaper than Colorado recreational products. The podcasters attribute some of this to the fact that, in Utah, medical marijuana products are not taxed. Instead, there’s a $3 transaction fee on purchases of any size, whether you’re buying $5 worth of product or $5,000.
David expresses his gratitude that the Utah system appears to be patient focused, rather than profit focused. This ensures that patients truly get the product they need at a reasonable price.
Tim’s phones have been ringing nonstop. There was clearly a lot of pent up demand for medical marijuana in Utah, and we’re now seeing a massive influx of inquiries about it. There are over 100 phone calls a day at Tim’s comparatively small practice, so it’s no surprise that the system is a little backed up.
There are tons of applications waiting to be approved. Compared to the number of people who want them, medical marijuana card issuing has been extremely slow.
Tim points out that this represents a problem for Dragonfly pharmacy, which is ultimately a business. They could have waited a few weeks before opening, but chose to get in early. Now that the system is backed up, business is only trickling in. It’ll likely be a few weeks or months before business at Dragonfly is in full swing, which means they could go under before they even really get started.
Despite the issues with the system, the podcasters all agree that the government should stick with the current system and wait for the logjam to break up before making any confusing adjustments.
To get in touch, use the following methods:
How did the podcast get started? (00:00)
Why are many doctors hesitant to get on board with marijuana? (05:46)
What can people expect from this podcast? (07:29)
What is the current state of medical marijuana in Utah? (10:43)
What is Tim, as a medical marijuana expert, going to be bringing to the podcast? (14:52)
Are you going to be able to show patients how to use marijuana? [15:48]
Why do so many say there’s no medical use for marijuana? (22:00)
How can one go about getting medical marijuana? How will the pharmacies work? (26:55)
If I have questions about medical marijuana, or I am a cannabis professional and want to come on the show, how do I reach out? (35:37)
Leafly.com
UtahMarijuana.org
UtahMarijuana.clinic
IAmSaltLake.com
Utah in The Weeds Twitter
The Utah in the Weeds podcast is the brainchild of experienced podcaster Chris Holifield and veteran medical marijuana consultant Dr. Tim Pickett, PA-C. Chris and Tim had recently spoken on the 420th episode of Chris’s other podcast, I Am Salt Lake, and the two had such rapport that they decided to start a new podcast altogether, dedicated to the use of marijuana in the great state of Utah. Enter, Utah in the Weeds!
Marijuana has a history of being demonized. From social stigma around anything marijuana-related to fears of marijuana use leading to heroin addiction, many people shy away from marijuana entirely. We seek to break down those walls by demystifying some misconceptions about marijuana and shining some light on the benefits medical marijuana could have for millions.
It’s not just us, either. In fact, certain schools around the country have introduced degrees related to marijuana. The marijuana industry is constantly changing, and one of the most noticeable changes is its legitimization in the professional and educational world.
We want to bring more and more professionals from the marijuana industry onto his other podcast, I Am Salt Lake. However, doing so would require a rebrand, we decided to bring that idea to life with a brand-new podcast, Utah in the Weeds, where listeners can expect everything cannabis! From interviews with cannabis professionals to demonstrations of use, we are looking to inform Utah about everything there is to know about marijuana.
At the time the podcast was recorded, the first medical marijuana pharmacy was just about to be opened, barring a passing inspection by the government. Calling them pharmacies is little more than an attempt to legitimize the medical marijuana industry, and a more apt name might be “dispensaries.” However, that is a minor gripe compared to the huge benefit that the legalization of medical marijuana would have for the population of Utah.
Ultimately it will be the role of an educator. I want to bring on cannabis professionals, authors, pharmacists, and doctors to discuss the ins and outs of the medical marijuana industry. I also plan to perform direct education by demonstrating some of the practical concepts in marijuana, such as growing and usage.
If you’re a professional in or around the cannabis industry in Utah, please reach out! You can call at 801-841-5554 or email me at tim@utahtherapeutic.com!
We think so, but this is something we’re still unsure of. In Utah, you’re not allowed to use an open flame to consume your medical marijuana, meaning you must ingest it in the form of an edible or vaporize it using a special tool called a dry-herb vaporizer. Some vaporizers allow you to dial in an exact temperature in order to ignite and release different unique sets of cannabinoids.
Igniting marijuana flower at one temperature will release a completely different set of cannabinoids than another temperature, since each group of cannabinoids have different combustion points. This allows the user to customize their marijuana experience and fine-tune it to their exact needs!
This goes back to the fact that misinformation about marijuana has been spreading like a bad plague for decades. As children, many of us were told that marijuana is a gateway drug and leads to heroin use. We were constantly reminded that it could land you in jail and is, therefore, nothing but bad news.
Part of the problem is the strict dichotomy of the way people think about marijuana and its relation to the medical field. Many people favor legalizing marijuana because they want safer, more trustworthy solutions to ailments than some of the drugs currently dished out by the medical industry. By the same token, however, the medical field has now been charged with the herculean task of introducing medical marijuana to those same people. The result is a ton of misinformation about marijuana, which causes confusion and slows down the process of change.
But things are changing. People are being educated about its benefits, and the truth is coming to the surface. We’ve seen in the last few years just how much progress has been made, with 11 states legalizing recreational marijuana for those over 21 years old, and 33 states allowing the use of medical marijuana.
Here’s the basic process for obtaining marijuana in the state of Utah: First, you’ll need to go online and pre-register for a medical marijuana card as a patient. Then, you’ll meet with your doctor, who must be a qualified medical cannabis consultant, and get approval from them to receive your card.
You’ll only get approved for a card if your doctor finds your condition to qualify for treatment with medical marijuana. After the appointment, and if you get approved for a card, one will be emailed to you. Then, you’ll go to a pharmacy and purchase your marijuana.
Here’s where things can get confusing. When you enter the pharmacy, you’ll typically meet with the pharmacist, who will help determine the dosage you need. If you got your card through Tim, however, you’ll be able to skip this step, since Tim gives dosage recommendations as a service. Only one or two providers in the entire state, Tim predicts, will have the knowledge and experience in cannabis to provide dosing recommendations.
To get in touch, you have a number of options, including:
When did you get introduced to medical cannabis? [6:07]
How do you respond to people who say that this is just a way to make marijuana recreationally legal? [8:09]
What’s the history of medical marijuana? [13:05]
How do you get a medical marijuana prescription or recommendation? [14:08]
How will patients be monitored? [16:37]
What type of treatment do you normally start patients with? [17:55]
What effect does the THC-CBD tincture produce? [19:04]
How will dispensaries be set up? [23:10]
How are providers trained on medical cannabis? [24:10]
Where can I go to find out more information about medical marijuana in Utah? [26:33]
How can medical marijuana be delivered in Utah? [27:23]
Why wasn’t anxiety included as a qualifying condition? [32:22]
What has been the most rewarding part of this work? [39:35]
How can people contact you? [45:46]
UtahMarijuana.org
Utahmarijuana.clinic
IAmSaltLake.com
I have quite a few people that have had life changing experiences because of cannabis. I have family members with cancer, and cannabis benefited them remarkably.
A good friend of mine, who ended up in the cannabis growing industry in Utah and is one of the growers, said to me “Hey, we’re going to get into this medical cannabis. There’s nobody doing it. The state is building this multi-million dollar industry from the bottom up, but there’s no one helping patients get access.” He drove me crazy all last year about it until I started looking into it. Last summer when I really started diving in.
My response to these naysayers is to please come to my clinic, come talk to the people and listen to the people that I see. Sure, I see people who are using it both recreationally and medically? Yes, but those are not the patients that I see.
The patients that I see come in at 68 years old saying, “I’m addicted to Percocet. I can’t get off my five pills a day. I’ve never smoked weed in my life, but I just want to quit taking these pills.”
That person has a legitimate need for some alternative. Cutting them off from their narcotics is not the right thing to do, but this is what makes sense.
I’m not saying that we need to give them marijuana forever. The goal is not to switch them to medical marijuana for the rest of their life. The goal is to reduce their opioid use now and see where that takes them.
As early as the 1970s medical marijuana was being delivered in California.
In the 1990s, a law was finally passed. However, because of federal laws, physicians were getting indicted by the federal government, and they had to fight for their right to discuss it and recommend it to patients.
There are very few providers in the state of Utah, including myself.
You can ask your regular doctor to write a recommendation for one of the 15 qualifying conditions in Utah, which include pain lasting longer than two weeks.
The majority of people who use medical cannabis are using it for pain. Nausea, chemotherapy induced nausea are also common among people who are prescribed medical marijuana.
If they are willing and knowledgeable about this, then they can say yes. However, the reality is they’re not doing it.
A reason for this is the scope of medicine. Once a doctor recommends medical marijuana, are they then going to recommend a delivery method? Are they going to recommend that you take pills or a tincture or you vape it? Do they even know that those options are legal. What is the dosing that they want you to try?
If your doctor has experience with cannabis, they might know already how much they can handle with an edible. If this is somebody with no experience, they need that instruction, or they need at least somewhere to go find the information.
In Utah they’ve set up a good system for followup. A patient will come in to see me initially, and then they’ll need to come see me again in 30 days. Their card, once the Utah Department of Health makes those cards available, will be good for 30 days.
You will then have to go back for a follow up. During that period of 30 days, you’re going to try to get your therapeutic dose established and then come back for a checkup.
After 30 days, you’re going to see that provider every six months to renew your card and make sure that the therapy is good.
I recommend that those people start with a tincture because they can get the lowest possible dose.
I recommend a THC-CBD ratio of at least one-to-one. The evidence says that we need to be using these things together.
We also use CBD to keep the psychoactivity or the high to a minimum. This is because we can increase the CBD dose in comparison to the THC, and we can keep people from becoming forgetful and dizzy.
It works on the mind to disassociate you from your pain. It’s not necessarily making the pain go away. It’s letting you be okay with the pain. The CBD has the neuro-protective effect, protecting the brain. It’s also protecting the nerves, so they just work together.
The people that I talk to in the growing and the producing industry are putting together a dispensary that looks and feels as professional as possible. All of the dispensaries are going to have pharmacists or medical providers on staff, which is going to increase their cost quite a bit, but they’re going to be trained.
If a doctor doesn’t recommend a delivery or dosing system, then the patient needs to meet with a pharmacist at the dispensary to get that recommendation because they’re only going to be able to buy a 30-day supply.
However, unless you have a Utah medical marijuana card, you won’t be able to get access to the dispensaries.
Currently, there is no formal training. We are all self-taught.
However, I’m going to be teaching cannabis medicine to PA students at the University of Utah and Rocky Mountain University. It will be a few lectures long, discussing Utah law, the endocannabinoid system, where we’re at with medical cannabis, the delivery systems and how to keep patients safe. Those lectures will start later this spring, and will part of their regular pharmacology program.
You can go to UtahMarijuana.org. There you’ll get information about all of the qualifying conditions, how to find a medical provider, what to expect at a visit, what the diagnosis of pain might look like, etc.
You can’t use a flame, meaning you cannot smoke a joint or use a bong. That may seem ridiculous, but when you talk about cannabis from a medical standpoint and you want to make it look like medicine, there is no medical reason to have a lighter
Marijuana can be electrically heated, which is a safer method of delivery. You’re not getting the carcinogens from the flame and the combustion. You’re just heating it between 320 and 450 degrees. This activates all of the terpenes and the cannabinoids in the plant and safely delivers it to the respiratory system.
Anxiety was discussed as an option. However, overdosing on THC makes people anxious and paranoid. With cannabis, some people are genuinely more susceptible to becoming paranoid and highly anxious than other people.
Seeing people reduce the amount of prescriptions that they take. It changes their lives, including the way they function and how they take care of their kids.
They are not getting high. They are just becoming more of who they wanted to become.
I have seen people stop stealing drugs out of their families drawers because of cannabis. I have seen patients who are fully functional, high performing people who’ve gotten off their opioids on their own.
It’s important that these people have access to this. You cannot say enough about these people being given more control over their own illness. I do this because I think people have the right to control their illness better, and this gives them more control.
UtahMarijuana.org is a great place to start. That’s going to give you a lot of information.
UtahMarijuana.clinic is my clinic website.
You can also call me at 801-851-5444. I answer all the phones right now because I want to talk to every patient myself. I want to be involved in the whole process from the beginning.
Optimal Medical Marijuana dosing practices will make your experience with the cannabis plant more enjoyable and help it work better for you, regardless of your condition. Medical Marijuana is plant-based medicine at its most sophisticated. It is not like a typical prescription medication that is given to reverse a particular symptom or illness.
Medical Marijuana dosing is unique. It’s not like regular prescription medication.
Marijuana, just like any strong medication, has risks. Just because your neighbor can take a 200mg THC edible does not mean you should, or that you could even handle that amount. Yet though no deaths have resulted from a marijuana overdose, it is still a very intoxicating substance at moderate to high doses and should be treated with respect.
The most common reported side effect of marijuana is “dizziness.” Other common side effects can include sleepiness, anxiousness (from too high a dose of THC), dry mouth, dry eyes, poor balance, and coordination, decreased short-term memory function, and reduced motor skills.
Safe marijuana use starts with learning your tolerance to the plant, the method you are choosing to take it (oral, sublingual, or vaping), and the duration of its effect with that delivery method and dose. All of these things take some planning.
New marijuana users may get absolutely no effect from the first or first two times they use it. Recreational users know this fact well and will often site personal experience of not getting “high” the first time they smoked marijuana.
The Endocannabinoid system needs to be “primed” first to be able to react to the medication. Sometimes this takes one or two days of microdoses before trying to find a dose that will treat your condition.
To keep things simple, I usually recommend planning a three to five-day sensitization period no matter the delivery method chosen. Typically the sublingual product will give you the ability to keep the dosing low and even take it drop by drop if needed.
To begin with, I always recommend taking a quality CBD product to be taken daily or twice daily. I recommend 10-25mg CBD in any form, such as capsule, liquid, or vape. A full-spectrum CBD product with 0.3% or less THC is preferred.
More information on the Utah Medical Marijuana Program
Plan to take a dose of 1-2.5 mg THC orally in the evening time when you are in a safe and comfortable location. Having someone you trust to be available is preferred. Keeping a mindful approach will make your relationship with marijuana all the better.
Write down your plan in a journal with the dose of CBD along with the planned dose and time for the THC.
Finding a therapeutic dose of marijuana is next. The process follows a similar path to sensitization, but at higher and more regular times during the day or evening.
The delivery method starts to make a considerable difference depending on whether you vape flower, take a sublingual preparation, or take a capsule by mouth. The onset of action for vaping might be 2 minutes, while the capsule may take 2+ hours to take effect.
Also, the duration of the vape might be 1 hour, and the capsule may linger for the whole day (10+ hours). This article discusses a sublingual tincture, which typically has effects beginning as early as 45 minutes to one hour after ingestion.
I offer specific dosing protocols for each new patient individually because each person is different and has different goals and tolerances. Check with your provider or contact me for detailed information. UtahMarijuana.org is building comprehensive dosing protocols for all products based on my experience with patients, current research, and known best practices.
Patient Qualification Information
On the morning of day one of finding a therapeutic dose (day 1T), take your small dose 1-2.5 mg of THC when you are ready to begin. I suggest the afternoon or early evening allow for the onset of action and enough time before sleeping. For this example, let’s use 2 pm As our starting time.
At 5 pm, if you do not feel the effects of the marijuana plant in your body, take an additional dose of 1-2.5 mg of THC. This is it for today. Wait a few hours and take an inventory of how you feel. Awareness of the effects of marijuana is the key to establishing a good relationship with the plant as medicine.
If you found that by 7-8 pm you feel more relaxed and separated from your pain, then you are on your way to finding the right dose for yourself. If you found yourself feeling anxious or uncomfortable, you may have taken too much and need to find a “middle ground on day 2 (T2). If you felt nothing or sensed only mild effects, but did not feel improvement in your symptoms, move on to Day 2.
Day 2 (T2) of finding a therapeutic dose starts with the dose you left off from day 1. If you have already noticed that 2.5 mg of THC is allowing you to feel better and you are tolerating the side effects without any trouble, congratulations! You have found your dose.
If you are tolerating the side effects well and are not quite getting beneficial results, start with the dose you left off from day 1 (T1), 2-5mg of THC. Three hours later, take a mental inventory of how you feel. Are you starting to have relief from pain? Are you able to relax into your pain and notice that it is still there, but not as bothersome?
If the answer is no, and the side effects are not noticeable or are tolerable. Specifically, do you have trouble concentrating, or are you feeling a difference in coordination? Do you feel safe?
At this point, you can add 1-2.5mg of THC and record in your journal the effects. This will help you remember the dosing as well as the impact; list the side effects and pain level you are feeling.
Day 3 follows the same plan. Take the dose you did the day before to start, whether that was one, two, or three doses of 1-2.5mg. Remember to make each dose the same. Do not take 1mg doses, then if you don’t feel the effects after 3mg, jump to 6mg out of frustration.
Commit to finding the right dose for you. Trust me, it is worth building a solid knowledge of how this plant affects you, and the more care you take in this stage, the better your relationship with marijuana will be long-term.
Three hours after the initial dose, take another dose if you still feel that the side effects are small, and the therapy is not working. Continue this daily practice until you find that the pain is improved and the side effects are tolerable.
Two things may happen when you follow this type of protocol. On the positive side, you will find a dose that helps your pain level decrease while you can tolerate the side effects. Alternatively, you may find that the side effects become the dominant force, making you uncomfortable.
If you find that the side effects are strong, but you are not getting much benefit from the medicine, you are not alone. Many of my patients report that the psychoactivity of the THC or other side effect bothers them during this first phase.
It is well known that humans develop tolerance to marijuana through studies of recreational users. Medical patients, mine included, typically report that the adverse side effects become lessened over time, but the therapeutic benefits remain. Even with the same dose of THC!
This is excellent news for Medical Marijuana patients. Simply lower the dose you are taking until you find the side effects are tolerable and maintain that dose for three-four days in a row, without change to build up a tolerance to some of the negative side effects. Then return to finding that dose that helps.
Remember the CBD you are taking daily? CBD acts as a buffer to some of the psychoactivity of THC and can lessen the adverse side effects at higher ratios. You may also increase the amount of CBD during this exploration phase of treatment to help blunt some of the side effects as well.
Therapeutic dosing with marijuana follows a bell curve distribution, as shown in the picture. Too low a dose may not give the patient enough benefit to make sense. And too much will cause bothersome side effects along with negative impacts.
If 10mg of THC is an ideal dose to help you decrease your other pain meds, or sleep better and avoid pain meds altogether, and you consistently take 20mg in order to get that “high” effect, you will eventually need to take 20 mg of THC in order to treat your condition. Your cost per month will continue to increase.
This can typically be avoided by using the correct dose that you found by following the above protocol. Evidence suggests that the Endocannabinoid system will maintain balance long-term with optimal dosing strategies.
Sensitizing the body to marijuana and finding a truly optimal dosing strategy can be an exciting journey to find just the right balance. Check your mind and your body, keep a journal and talk to your medical provider with questions and concerns. Good advice from trusted sources is always helpful.
As always, if you have comments or questions about any of my articles, or want more information on individualized dosing strategies for any condition, reach out to me.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-provider relationship, and should not be used as a substitute for professional diagnosis and treatment. Read the full disclaimer here.
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These are 5 of the important details about becoming a Utah Medical Cannabis doctor, PA, or NP. If you are a patient looking to find a qualified medical provider, here is what it takes to be great.
Physicians, Advanced Practice Registered Nurses, and Physician Assistants who are licensed to prescribe a controlled substance will be allowed to recommend medical cannabis treatment for their patients. Providers must register as a qualified medical provider through an Electronic Verification System (EVS) established by the UDOH.
PAs, NPs, and physicians are the medical professionals who can legally write recommendations for cannabis medical cards in Utah. Some states, like Montana, only allow physicians to write the letters. Luckily (especially for me) PAs are qualified here.
This is an interesting field of medicine because it is almost entirely “self-taught,” for medical providers. This means that it likely does not matter whether a patient sees a PA, NP, or physician because it is that provider’s personal level of education, not the degree that matters. The fact is, none of us had any medical training on the endocannabinoid system in medical school.
Providers must take a 4-hour course on the endocannabinoid system, Utah law, and cannabis medicine best practice to be allowed to register as a qualified provider. There are currently at least three approved courses. Two online courses are:
There is also an IHC in-person course that is taught by Dr. Jeremiah West, a pain specialist in Layton, Utah. His course page can be found through this link. The cost of the online course is $250, while the in-person IHC course is $120 for outside providers, and $90 for IHC employed providers.
I have completed the Answer Page course and give it a very good recommendation. It covers the law in Utah and the basics of the endocannabinoid system. It has a lot of reference material, is very thorough in its approach to safety, and is straightforward. The course has a slight negative bias toward cannabis medicine, in my opinion.
My critique of the course is basically my standard critique of cannabis science. The evidence presented is not specific enough, it uses smoked cannabis and recreational cannabis studies where we need more truly medical research. The safety education is decent, but more research needs to be done on plant-based dosing (not synthetic) and on medical dosing protocols vs recreational use, again in my opinion.
I will leave a comment below after I attend the IHC course later this week. I anticipate a better discussion will take place in person and so I am looking forward to that session.
Yes, PAs and NPs (Advanced Practice Clinicians) can indeed recommend Medical Cannabis in Utah. They must complete the same education and registration as the MDs / DOs do, pay our $300.00 registration fee with the Utah Department of Health, and register.
PAs must also have a delegation of services agreement with their supervising physician that explicitly states they can evaluate and recommend Medical Cannabis. This is not the case for NPs, but all providers regardless of title must have explicit permission from their employer and practice group to evaluate and recommend cannabis. There are reasons why that I discuss below.
This brings up an important point. To date, the University of Utah and Intermountain Health Care do allow for providers to evaluate and recommend cannabis to established patients who meet the criteria. Each has its own set of criteria and, in addition, each provider will determine if additional requirements exist for their patients to obtain a recommendation.
Other private health care networks in Utah have been clear with their providers and not allowed them to recommend Medical Cannabis. The two larger private groups, Steward Health and HCA (MountainStar) have national reach, crossing state lines, and may be slow to allow providers to recommend the federally illegal plant. Please comment below if you know of another group’s policies.
In addition to the Utah law requirements for Medical Cannabis, many PAs, Docs, and NPs have additional requirements. Some IHC providers require a long-standing relationship (greater than 6 months) and require patients to attend a clinical education seminar about Medical Cannabis, led by a clinical pharmacist before the recommendation is given. We should require that for narcotics and Xanax!
Most patients know that insurance will not pay for the medical visit to have an evaluation or recommendation for Medical Cannabis. This is because the DEA still considers Cannabis a Schedule I drug, without any therapeutic benefit and a high risk of abuse. New York is the only state in which patients might expect to have insurance cover the cost, because of a 2018 legal win for patients there.
But there’s more. Providers billing insurance for visits where cannabis, even as a secondary issue, is discussed might be placing themselves and the patient visit at risk. This documentation in the chart can trigger a denial of the claim for payment, just as if the office visit was solely for a Medical Cannabis evaluation and recommendation.
Recommending cannabis during a normal visit that bills insurance may get rejected by the insurance. This may be putting yourself and the patient at risk of being dropped by the insurance.
Many providers ask the patient to pay a separate cash fee for the cannabis evaluation and document that visit separately. This might allow better protection for the patient from the claim being denied. But this brings up another issue…
Does your malpractice insurance even cover you for Medical Cannabis recommendations? If you don’t know then it is likely not covered. This was my experience and it took two months for me to obtain good coverage due to the lack of policies written in Utah as of 2019. The insurance in Florida, for example, for a sole provider Medical Cannabis doctor, PA, or NP is between $1,000 and $2,000, but in Utah, all I have found is triple that amount.
There are 15 conditions in the Utah Medical Cannabis Act that a patient may qualify for a cannabis card. Of those conditions, pain will be the most common complaint. Of course, you want your patients to reduce opioids and there is quality evidence that cannabis is a safer and reasonably effective alternative or additive to their pain meds. But what about all of the other diagnoses?
My practice is to contact the referring provider directly for most of the other diagnoses, such as seizures, Alzheimer’s, and Terminal Illness. This creates an open dialogue between the entire care team and is better for the patient. Direct communication is the safest and most effective way to keep the patient safe.
But if this is too much to ask or your practice is very busy and the time commitment to learn cannabis medicine is daunting, maybe seeing patients with pain and or nausea alone is the best option.
Patients who have longstanding pain and who are already utilizing cannabis in the shadows will mostly know what they like to take, what works, at what doses. These patients tend to teach me more than I offer them. But patients who have never tried cannabis, or who did not have a good experience need guidance… and time.
It is not enough to evaluate patients and give them a recommendation for medical cannabis if you are not familiar enough to discuss the risks and benefits alongside some best practices on delivery and dosing. You might even want to discuss strain types, cannabinoid ratios, and terpene profiles to best treat their specific condition.
Too much information? You are not alone. I realized early in this project that “plant-based” medicine is very different than the allopathic method we use in western medicine. It requires a broad discussion of symptoms, more like a rheumatology visit, and treatment with cannabis can positively (or negatively) affect a wide range of symptoms sometimes not related to their chief complaint.
Utah requires that either you know this stuff and discuss it with the patient, decide on dosing, and enter your recommendations into the dispensary system. If you do not, then you must make available enough clinical data for a state-employed physician or pharmacist to consult the patient themselves and recommend dosing. So far, every single one of my patients has preferred me to a state-run cannabis dosing person.
Add that to the fact that you can only recommend cannabis to 175 patients in total unless you are a specialist in anesthesiology, neurology, gastroenterology, oncology, pain, hospice and palliative care, physical medicine and rehabilitation, rheumatology, or psychiatry. This may be too much for many providers and they may choose not to deal with this at all, just focus on what they are already good at.
Despite this, you may be concerned about referring your patients to an outside clinic specializing in cannabis. Patients trust you, they have come to you in health and sickness and that trust is important. Furthermore, you want them to have a good outcome and a safe outcome.
I see two options. One is to establish a relationship with a provider who specializes in cannabis medicine as you specialize in _____. Reach out and talk to them and get a feel for what type of provider they are. Heck, go see their clinic and make sure it meets the standards of your referral.
Expect communication and feedback from your patients about the experience. Treat the referral like any other; one where you expect the highest quality care because this is a high-quality patient.
Another alternative is to franchise your visit out to a provider or group that has the infrastructure, insurance, and quality education you demand. This brings the outside services to you. You still see the patient and do the recommendations, but the visit fee is paid through the outside group and covered with separate insurance by the outside group.
You keep the patient in-house, but they are willing to support the patient’s education and questions throughout the process. There are plusses and minuses to this option, but if done with a reputable group, I can see how this could work nicely.
There are many items in this bill that are up for discussion in and modification during the current 2020 legislative session in Utah. I am sure that pop-up clinics will be discussed on one side, as well as numbers of patients allowed on another. Qualifying conditions will be argued, and we may inch closer to proposition 2’s original language. Even blister-packed flower will likely return to the discussion. Either way, there will certainly be modifications to the law so stay up to date with our newsletter by signing up for free below.
The material on this website is not to be used by any commercial or personal entity without the expressed written consent of the blog author. The statements on this blog are not intended to diagnose, treat, cure or prevent any disease. The author does not in any way guarantee or warrant the accuracy, completeness, or usefulness of any message and will not be held responsible for the content of any message. Always consult your personal medical provider for specific medical advice. Full Disclaimer.
It has been somewhat confusing for patients in Utah who would like to discuss Medical Marijuana with a doctor, PA, or NP because the Utah Medical Cannabis Card system is not up and running, dispensaries are not open yet, but Medical Cannabis is already legal. And then there is this weird feeling you get when you think about talking (out loud) about a drug that you grew up thinking was harmful, illegal, addictive, and terrible.
First, take a look at the list of qualifying conditions. You can also call our office or go to my previous article and look over the qualifying conditions. Anxiety and depression, insomnia, migraines, and glaucoma are NOT qualifying conditions in Utah, even though they can be treated in other states.
Pain greater than 2 weeks, not controlled with standard treatment – Persistent Nausea – Alzheimer’s – Crohn’s disease – Ulcerative Colitis -Cancer – ALS -Cachexia (weakness &/or weight loss due to illness) – HIV or AIDS – Epilepsy – Seizures – Persistent muscle spasms – Multiple Sclerosis – PTSD – Terminal Illness – Rare Condition or Condition you feel should be evaluated by the Utah Compassionate Use Board
The vast majority of patients will use pain as a complaint. This has been the case in all other states Medical Marijuana is legal. Utah defines pain qualification as the following.
Pain lasting longer than two weeks that is not adequately managed, in the qualified medical provider’s opinion, despite treatment attempts using: conventional medications other than opioids or opiates: or physical interventions.
For example, a patient has a metal plate in their arm after surgery three years ago and the metal plate causes long-term pain. Ibuprofen and Tylenol do not work well and the patient did physical therapy after the surgery but is still left with some ongoing pain. This pain obviously is longer than two weeks and conventional medications are not effective. In my opinion, This patient would qualify for a Medical Cannabis Card.
I have discussions with orthopedic surgeons who agree that any of their knee replacement or hip replacement patients would qualify even before surgery because their pain is greater than two weeks and because it will require surgery to fix. Even if ibuprofen and Tylenol help the pain, the fact that they need surgery proves that “conventional” medical treatment is not effective for their condition and “physical interventions” did not work.
It gets trickier when the patient has a toothache for three weeks, takes Norco, which helps, but Tylenol does not. Technically this will qualify, but many providers will still not recommend in this case.
This patient has painful migraine headaches, they come on every two-three weeks, last about a day and a half, but the medication they are prescribed does not really help, and this drug is the second one they have tried. The condition has been bothersome for over a year. Do Migraines qualify? No, they do not. But do they qualify for the PAIN associated with the Migraines? Yes.
Translation: The pain is bad and affects life enough that the patient is asking for help from a PA, NP, or doctor.
The Migraine patient has a Pain Disorder (as defined above) because she has pain in her head (anatomical site), she is seeking help (clinical attention), it causes her to miss work or otherwise affects her life, and the pain is not faked (feigned).
If you still don’t know that you would qualify or you are just plain scared about it, please please call me at 801-851-5554 and let’s talk about it. I grew up in Utah and I think I know the feeling. Also, contact the clinic and we will send you a secure form for health questions. Please do not send health information in an email.
Now you can find a provider (hopefully me), and make an appointment. Try either going online to my calendar or calling 801-851-5554.
Once you schedule you will instantly get an emailed link to the secure intake form and consent, and be able to confirm the appointment with your deposit. The total cost of the evaluation and recommendation is $250 paid by credit or debit card at your visit. There is no deposit.
Come prepared to talk about marijuana, cannabis, weed, pot, ganja, hashish, tincture, oil, creams, joints, bongs, dabs, wax, resin, and anything else you want to talk about. Yes, we are comfortable with the whole process and we want you to be too. Destigmatizing Medical Cannabis for you is part of this process.
You should also bring any medical records if we requested to confirm your diagnosis for the qualifying condition.
If you qualify and we decide together that you would like to try Medical Cannabis for your condition, you will get a letter from me THE SAME DAY that will allow you to legally possess and use cannabis in Utah.
After March 1st, Utah requires a 30-day follow-up visit after the initial recommendation. This is included with our initial cost, but may not be with other doctors. Check with your doctor before you go!
Medical Cannabis Cards in Utah expire after six months. We will send you a reminder one month before it expires to remind you to confirm a renewal visit. Many times the renewal will be offered via telemedicine (zoom video chat). Please note that telemedicine visits are subject to availability and are offered under limited circumstances. Call us at 801-851-5554 to ask about arranging a telemedicine visit.
While you are in ultimate control of what you use and how you use it, we also include education and expertise with delivery methods (oral, inhaled, cooked, creams, tinctures) and dosing help. In my opinion, you should be wary of those that are not willing (or able) to discuss this with you. Don’t you think your medical provider should know a lot about what they are recommending?
You can always get more information at UtahMarijuana.org and join the email list below to get education about cannabis in your email inbox.
Now you know a little more of what to expect with a Utah Medical Marijuana Card evaluation and hopefully, this made you feel a little more comfortable with the process. Please comment below if you have questions or need clarification on anything!
