Regular listeners of the Utah in the Weeds podcast have heard our very own Tim Pickett discuss the concept of taking regular breaks from Medical Cannabis. The idea behind doing so is to address cannabis tolerance, which occurs naturally and develops with regular cannabis use.
Tolerance is not a bad thing. It is one of the body’s many defense mechanisms designed to keep things in balance. Yet tolerance isn’t ideal for Medical Cannabis patients because it reduces the effectiveness of their medicines. Taking regular breaks reduces tolerance so the patients don’t continually have to increase dosage and frequency.
Cannabis isn’t the only drug that can produce tolerance. Tolerance is reality with a variety of pain medications, sleep aids, antidepressants, etc. Where cannabis is concerned, tolerance is the result of how THC affects the brain.
THC’s psychoactive effects occur when the cannabinoid binds to cannabinoid receptors in the human body. A receptor is a cellular structure that binds to certain molecules. So cannabinoid receptors bind to cannabinoids, like THC and CBD.
Here is the problem: the body can get used to having a certain amount of THC in the system. As that happens, the body produces fewer receptors in an attempt to balance things out. The result is that the same Medical Cannabis dosage doesn’t produce the same effect.
Tolerance in Medical Cannabis patients isn’t ideal because it ultimately means they need more medicine. When you consider just how expensive Medical Cannabis is, having to continually update your dosage is not a good thing. Your tolerance could be such that you simply cannot afford to medicate any longer. That’s what we’re trying to avoid when we recommend taking regular breaks.
Above and beyond being quite expensive, another possible outcome of unchecked tolerance is that Medical Cannabis eventually becomes less effective as a medicine. Then what? Going back to less effective prescription medications doesn’t seem like a particularly good option.
By now you have figured out that taking regular breaks from cannabis is a way to address tolerance. But what is actually happening physiologically? For that answer, we go back to cannabinoid receptors.
Just as the body produces fewer receptors in order to accommodate an expected level of THC in the system, it will begin producing more receptors as THC levels drop. By taking a break for 3 to 7 days, you are giving your body a chance to readjust. You’re giving your body the opportunity to start producing receptors again.
There are no hard and fast rules dictating how often you should take a break and for how long. A general rule of thumb among Medical Cannabis patients is to tolerance breaks at least once every three months. See our “Reset Your Tolerance” guide for details on getting the most out of your next tolerance break.
If you are a long-term cannabis user and you find that your consumption has increased to the point where you believe the drug is no longer helping you as it should, you might want to consider a longer break. It is not unheard of for long-term patients to take a break of up to a week or longer. Just be prepared to approach cannabis more slowly after your break is over. You’re going to feel the effects of the drug like you used to, so you don’t want to jump back in too fast.
Tolerance is a reality of Medical Cannabis use. It is also a natural biological function. However, it is nothing to worry about, and it can be managed just by taking regular breaks.
Episode 92 of Utah in the Weeds features Rich Oborn, the director of Utah’s Center for Medical Cannabis.
We started the episode with Rich’s thoughts on Utah’s 2022 legislative session, which resulted in a few changes to Utah’s Medical Cannabis Program. [02:28]
Senate Bill 190, sponsored by Sen. Evan Vickers, will prohibit over-the-counter sales of hemp products with a combined total of THC or THC analogs of 10 percent or more of the product’s total cannabinoid content. However, those types of products will continue to be available for sale at Utah’s cannabis pharmacies. [05:28]
SB 190 further clarifies packaging requirements for products containing synthetic THC, and it removes the prohibition of cannabis pharmacies employing convicted felons. [09:00]
SB 190 also adds “aerosol” as an approved Medical Cannabis dosage form in Utah. Rich says such products exist in other markets, but they’re expensive to manufacture. He doesn’t expect local companies to start making cannabis aerosol products right away. [15:22]
Another change in SB 190 will make it easier for cannabis pharmacy agents to work in Utah’s Electronic Verification System (EVS). [17:07]
Senate Bill 195, sponsored by Sen. Luz Escamilla, expands access to Utah’s Medical Cannabis program by requiring hospice programs to have at least one Qualified Medical Provider. It also adds acute pain as a qualifying condition, making cannabis available as a post-surgery pain relief treatment. [24:09]
Next, Tim and Rich talked about the current state of cannabis research, including an upcoming study to be funded by Utah. House Bill 2, an appropriation bill, sets aside $538,000 for a study on cannabis and chronic pain. [34:24]
Lawmakers did not approve “opioid use disorder” as a qualifying condition for Medical Cannabis in Utah. Instead, medical providers will need to consider a patient’s past drug use when writing a Medical Cannabis recommendation. As Tim points out, this is already a best practice for medical providers. [39:53]
Next, Tim and Rich talked about THC-infused drinks. Senate Bill 190 excludes “liquid suspensions” of cannabis branded as beverages. Tim estimates such drinks will continue to be sold in Utah until some time around November. Liquid suspensions of 30 mL or less will continue to be available. [44:37]
Senate Bill 195 also modifies the state’s advertising standards for Medical Cannabis, allowing cannabis companies to place more types of ads than previously allowed. [46:51]
Rich says Utah’s Medical Cannabis community is growing by about 1,000-2,000 new cardholders per month. At the end of February, there were 44,800 active cardholders registered in the program. About 30% of cardholders do not renew their cards. [52:15]
Next, Rich told us about some of Utah’s educational and informational resources on Medical Cannabis. The state has educational material for both patients and providers. There is also a website to monitor the cost of Medical Cannabis evaluations at clinics throughout the state. [54:55]
This year, the Utah Department of Health is developing an analysis of Medical Cannabis inventory across the state. UDOH will share the results of that analysis with industry professionals in an effort to identify and address any shortages for in-demand products. The Utah Legislature is also working on a governance study to analyze the administration of the Medical Cannabis program. [57:50]
Tim Pickett:
Welcome everybody out to episode 92 of Utah in the Weeds. I am your host, Tim Pickett. And today we have what is becoming our annual legislative update with the Department of Health Director of Medical Cannabis, Rich Oborn. Rich is here to discuss the updates to the legislation in the Medical Cannabis Program. And we will discuss in this conversation the hemp changes and the changes to the CBD and the over-the-counter hemp sales. What has happened with that? How we’ve been able to decrease the amount of THC or delta-8 in those products available to really be purchased by children, which increased patient safety. There was some controversy. And we talk about that as well. Talk about the advertising changes to the program and the added condition that has been added to the Medical Cannabis Program for patients. Is a great conversation, feel free to reach out and comment as this will be posted on YouTube with any questions that you have about the legislation, and we’ll answer them all.
Tim Pickett:
Other than that, subscribe to Utah in the Weeds on any podcast player that you have access to. We’re on all of the platforms. We release these, we try to release these every Friday at 4:20 AM. Last week, we took a little bit of a break and we’re back in the swing of things now. We’ve got a lot of updates coming up for you. The CEO of High Times and partner in Beehive Farmacy coming up in April. We’ve got a special episode coming up with my sister, who I’ve been teaching a little bit about medical cannabis with her condition. Just a lot of good content coming out. Season four of Discover Marijuana is also getting ready to launch in the next month. Of course, April and 420 celebrations are coming. Stay tuned and subscribe to Utah in the Weeds and enjoy this conversation with Rich Oborn. How was the legislative session? I mean, from a workload standpoint?
Rich Oborn:
Yeah, it was heavy I’d say. We had three bills that had direct impact on us. And in the past some time… I guess if I compare it to last year, I don’t think there was as many amendments that we were tracking within the bills. There were two bills last year that had some direct impact on us. And this year there were two main ones, but then there was the third one with SB 153, the medical cannabis governance structured bill. That was one that we tracked and were providing input on throughout the session.
Tim Pickett:
It seemed like this session, there was more work up front. There wasn’t as much work on changes at the back end.
Rich Oborn:
Right, right.
Tim Pickett:
Was that your experience?
Rich Oborn:
Yeah, yeah, yeah. That’s how it should be. We don’t like to see a lot of flurry of things going on at the end, because that’s when you don’t have time to think through things logically, right? You don’t want to see stuff put together in a rush as much as possible.
Tim Pickett:
Sure.
Rich Oborn:
Sometimes that happens no matter what, but… Yeah. Yeah. So, yeah, I’d say that’s a good way to say it. There was some work that went on at the beginning and there are a few tweaks we had to make throughout. And on most of those, we were able to get them in the bills. So that was good.
Tim Pickett:
Yeah. Now, as of this recording, Governor Cox has not signed the bills that we’re going to talk about today, but is there any chance he doesn’t really? I mean, there’s always a chance.
Rich Oborn:
I feel like if there was a possibility, I would’ve probably heard about it. Last year, you’re probably familiar with the bill that was vetoed that related to the hemp program, Department of Agriculture and Food and the Hemp Industry. And that was a big deal that it was vetoed. And so this year they’ve had some time to work on some things, and I don’t expect there to be a veto on any of the bills, including the HP 365, which was the one that related to the hemp issue primarily. But then there’s also SB 190 that does have some hemp components to it.
Tim Pickett:
Let’s jump into that one because it seems like, and I did a little update a couple episodes back of 190 and 195. But 190 was Vickers’ bill and that was the one that was primarily hemp. And it seemed like that was more to do with things that involved the Department of Agriculture. And then there was a lot of controversy over this delta-8 and even the naming of things, right? You can’t even name it. Let’s talk about this because it seems like there’s a lot in this bill that people were a little upset about.
Rich Oborn:
It’s a little more controversial.
Tim Pickett:
It is a little more controversial.
Rich Oborn:
Sure.
Tim Pickett:
So talk about this, what’s the change from what’s before with this delta-8 or over-the-counter psychoactive substances derived from cannabis, I guess? Is that a good way to put it?
Rich Oborn:
Yeah. Yeah. And I want to emphasize the Department of Health, while we are indirectly involved because we oversee the medical cannabis pharmacies that sell these products, the Department of Agriculture is more directly involved in the oversight of these hemp industry. And the Department of Health doesn’t have any jurisdiction over the hemp retailers and growers, but [inaudible 00:06:58] does. And so after December 1, 2022, hemp products in Utah cannot have a combined total THC and any THC analog that exceeds 10% of the total cannabinoid content. So if you’re comparing the different cannabinoids that are in a specific product’s profile, THC or an analog of THC cannot exceed 10% when compared to the other cannabinoids in that product.
Tim Pickett:
Okay.
Rich Oborn:
So that was a critical change. If you’re a hemp retailer, you would not be able to sell those products legally under state law. Medical cannabis pharmacies continue to be able to sell these products to medical cannabis cardholders within the medical cannabis industry pipeline. So it’s not like patients won’t be able to access these products, they will. But it’s only through-
Tim Pickett:
It’s just that the 16-year-old can’t go down the CBD store and buy it over the counter. But this is also added to the already 0.3% total weight.
Rich Oborn:
Right.
Tim Pickett:
Right. This particular piece, you could buy a 1:10 THC tincture, and this would fit that, right? It would have 10 times the amount of CBD than THC, and it would fit this thing. But you add to that 0.3% by weight, and now you have to have a Gatorade bottle full of liquid in order to have, I think it’s 6 or 10 milligrams of THC. So it really, really dilutes the ability to sell. Really they’re called PUCK gummies and they were being sold kind of all over the place.
Rich Oborn:
Yeah. Yep. And the basis of this was to help with product safety and patient awareness so patients are aware of the contents of the medication they’re purchasing. And in the medical cannabis pipeline, those type of products that the processors under SB 190, they’re required to ensure that the label identifies each derivative or synthetic cannabinoid as a derivative or synthetic cannabinoid. So the processor is required to be transparent about which of those cannabinoids are synthetic and which are natural.
Tim Pickett:
This is going to be good, I think, for that garage chemistry. And I’ve talked about this before that a lot of the delta-8 is made by some organic garage chemistry that leaves some byproducts. And I think this helps with the labeling, keeping bad actors out of the market essentially.
Rich Oborn:
Right. And there are some additional restrictions that the Department of Agriculture and Food places on processors in the medical cannabis industry when compared to the hemp industry. And so I think that’s critical to keep in mind that these are medications, and there’s a rigorous scientific approach to these products. We don’t want to have people compromise their medical condition or their safety by consuming products. And so as a regulator, I know the Department of Agriculture does what they can to ensure that those patient protections are kept in mind as there’s different tests for contaminants and different tests are run to ensure that the ingredients of the products are actually what they claim to be on the labels. And also that there’s no misrepresentation or misunderstanding about whether a cannabinoid is synthetic or not. So that’s something that’ll be new that we’ll be rolling out with SB 190.
Tim Pickett:
So that includes the… Does that include the Medical Cannabis Program too that they’re now going to be required to label synthetic versus derived cannabinoids? In most of the packaging that I see, they’re already labeling it as such.
Rich Oborn:
Right. Right. I think that’s important to emphasize is that they’re already labeling it as such, but this just clarifies the law in relation to medical cannabis processors and pharmacies that there’s this more clear requirement that that label must identify whether that cannabinoid is a synthetic, when it is a synthetic. So you can still purchase THC products that are synthetic THC, but when you do that, you’ll be informed on the label that that’s the type of product you’re purchasing. And there were processors that were, I think, already doing a good job of that, but this just clarifies the law, makes it so-
Tim Pickett:
It standardizes it.
Rich Oborn:
… Right.
Tim Pickett:
So this was passed really as a patient safety and a consumer safety issue, the delta-8 controversy and having young people being able to buy psychoactive products that were potentially dangerous to their health. So personally as a provider, I like this. I can see there was some arguments about low income folks not being able to access their medicine. And this helps people go into the… It kind of forces some of those people into the medical market, but that’s… And I mean, it increases patient safety overall. And so I tended to support this piece despite the controversy of it.
Rich Oborn:
Yeah. And I think there’s some things that the legislators are doing and also private entities are doing to make medical cannabis more affordable in Utah. I think the ideal is still not in place, which would be that insurance would be able to help someone purchase this type of medication. But while we wait for the Federal Government to take action on that, I think there’s some good options out there. Although we know everybody maybe is not aware of those options. And so I feel like private identities, they can take it upon themselves to share information about the options that are out there to get help for making the medication more affordable to them. And it’s great to see that entities are stepping up to play that role and people are willing to donate money to assist others in affording medication that’s not as affordable as other medications.
Tim Pickett:
Right. So still staying on this SB 190, there was another thing with felony convictions. If somebody had a felony over 10 years ago, they weren’t able to work in a medical cannabis pharmacy before, but now that’s not prohibited. That seems like a really good idea.
Rich Oborn:
Yeah. And that was actually something we had contacted lawmakers about. We had a case or two come up where we did have to deny an individual from being able to obtain a pharmacy agent card because of the fact that they did have a felony. And there was this prohibition of any employee of a medical cannabis pharmacy having a felony of any type and it didn’t place a timeframe on it. So the law’s been amended to allow for that. And I think that’s a step in the right direction. Although if you do have a felony within the 10 years, it can still stop somebody from getting a pharmacy agent card. Having a felony within 10 years doesn’t prohibit you from getting a pharmacy agent card. It’s a factor that the Department of Health considers.
Tim Pickett:
Yeah. And then we added some dosing forms, inhaler, nasal spray, nebulizer. I mean, I can see the nasal spray for sure. That actually is a product that I’ve heard that a few people are developing. But the nebulizer and the inhaler, I don’t know of any products out there even in other states that are that type of delivery system, like an albuterol inhaler, right? Or a meter dose inhaler.
Rich Oborn:
Right. They exist, but they’re not that common because they are expensive to manufacture. That’s my understanding. And so we don’t expect any companies to be chomping at the bed to do this immediately. But as I think the program matures, it’ll be a possibility and a processor could decide, “Hey, we feel like there’s a market for this. There’s enough patients that are asking for it.” And it would begin to be a legal dosage form [crosstalk 00:16:28].
Tim Pickett:
It’s extremely useful from a meter dosage in an inhaler form is one of the big problems with moving inhaled cannabis products into the traditional medical market because it’s just hard to dose, right? There’s only very few products that will measure the amount you inhale and they’re $300. And so meter inhaled product, while you’re right, I’m sure it’s really expensive to manufacture. From a medical standpoint, it’s going to be nice. I could think of a lot of patients who could really use it. And then there was this technicality change in 190 where they had EVS… The pharmacy agents couldn’t access the EVS, only the pharmacist could. And I remember thinking, “Oh, that’s interesting because our MAs can access EVS as a proxy.” So this codifies that with 190 and allows them access. Are they going to act as a proxy or do they just have visual access or is that something that the department is kind of yet to determine?
Rich Oborn:
They will have their own role within the electronic verification system. And for those of you who don’t know what that is, it’s the system that… Is the patient registration system that pharmacies rely on in order to verify if someone has a medical cannabis card or not. It’s also the software that a medical clinic and a QMP, qualified medical provider, uses to make a recommendation for a specific patient to receive a medical cannabis card. So pharmacy agents that work every day in the medical cannabis pharmacy, who make up the majority of the employees at a medical cannabis pharmacy, they’ll begin to have access to the EVS. And the way that’s being set up is that a pharmacist in charge for the specific medical cannabis pharmacy location will be able to authorize agents. There will be some agents that the pharmacist in charge may decide should have that access to edit and to view that information.
Rich Oborn:
But there could be some pharmacy agents that really have no role in the EVS they do. They maybe just have a niche in the pharmacy of a certain type that doesn’t require that they get access to the EVS. So that’ll be something that a pharmacist in charge, the PIC, would would determine for a specific location. And so it’ll take some time to work without [ vendor 00:00:19:13] and execute this change in the EVS, but we’ll be engaging with medical cannabis pharmacies and the pharmacists who work there and pharmacy agents on how this is set up and we’ll get their input and ensure that we inform them of when it’s an [ in production 00:19:31] and actually able to be used by pharmacy agents. And one thing that’s coinciding with this requirement is that pharmacy agents will begin to have to complete continuing education course on confidentiality and the protection of patient information.
Rich Oborn:
And I’m sure that there are some pharmacy agents that are already generally familiar with HIPAA and protection of confidential medical information, but there could be some that have no clue about it. So it’s important that anybody that works in a medical facility like a medical cannabis pharmacy has at least an intermediate level training on protection of that information and how patient information must be safeguarded. And how, for example, in the EVS, it would never be appropriate to search for a neighbor’s name in the EVS if they’re not a patient. You have no business doing searches like that in a medical type software like this. And other medical facilities have these same standards. And so these standards also apply to medical cannabis pharmacies, although they’re still selling a federally illegal product.
Tim Pickett:
Right. Yeah. But in the normal pharmacy down the street from me, I mean, all of the techs are all going to have some HIPAA training. They’re all going to understand the privacy, the confidentiality. That’s just standard. And I knew that that was one of the reasons why the pharmacy agents didn’t have access before. And so it’s nice to see because there’s an issue frankly with… There was a little bit of a weird thing where the pharmacy agent couldn’t transfer the dosage recommendation from a provider into MJ Freeway because they couldn’t access EVS. And it was kind of a big logistical kind of thing where it brought this up, or it was one of the things that brought this up as something to kind of solve.
Rich Oborn:
Right. And one of the plans we already had in place, regardless of what happened during the legislative session, was to have an integration of information from the EVS regarding the dosing recommendation be sent to the MJ Freeway software. So a pharmacy agent wouldn’t have to go to the EVS to get information about the recommendation. They’d be able to view that within the MJ Freeway software that they use for their patient profile and purchases and point of sale system. So that was already in the works. But this, I think, is just another way that a pharmacy will be able to be efficient in helping customers and supporting them and having a good experience there at the medical cannabis pharmacy as they come in.
Rich Oborn:
One thing that I want to point out though that’s critical is that there will be information regarding a QMP’s notes that they have. Potentially a QMP may want a pharmacy to be aware of a specific patient’s treatment history or medication history. And that type of information, it’s the option of the QMP to pace that into the software. And they would need to advise the patient of this choice they’re making to share this information with an outside party at the pharmacy. So there’s patient consent needed in that type of a case, but there are many QMPs that do choose to keep the pharmacist informed of the other medications that the patient is taking and some details that they feel are relevant about the condition. That helps the pharmacist make the decision about what specific product may be the best for treating that specific condition.
Rich Oborn:
So the pharmacy agents will have access to that information. It’s sensitive information, and we need to treat it as such. And so it’s important that the pharmacy agents go through the training and learn more about how to ensure that they provide the best service to patients as they protect the confidentiality of their medical information.
Tim Pickett:
Let’s switch over now to… That’s a lot of the big items kind of in SB 190, the bill that was kind of on Senator Vickers’ side. Senator Escamilla, she was the one who put out SB 195. That has to do with the Medical Cannabis Program a little bit more on… There was some additions to making the program a little more inclusive. We’re making the general medical community more inclusive of the program. One was the addition of the… If you run a hospice program, you have to have at least one medical provider that’s registered in the system as a QMP.
Rich Oborn:
Right.
Tim Pickett:
I thought that was kind of an interesting addition.
Rich Oborn:
Yeah. The requirement does not begin until January 1 of 2022, or excuse me, 2023. But, yeah, every hospice program has to have at least one medical provider registered with the Department of Health to recommend medical cannabis to patients. Now, one thing that’s critical though is that if the facility accepts federal or insurance money, they would want to consult with their legal counsel and third party reimbursement to determine if the facility may allow for delivery and possession of a federally illegal drug while they’re in that type of a facility. So although they have to have at least one medical provider that is registered as a QMP, there are some things that they should be aware of as it relates to reimbursement of funds from a federal source or insurance money. This doesn’t mean that they are obligated to recommend medical cannabis at that facility. It just requires that they have a qualified medical provider registered with the Department of Health that would be able to do it if they chose to.
Tim Pickett:
And this is every hospital, hospice facility, nursing home, or not in the state?
Rich Oborn:
Well, it’s hospice program. So there’s only so many of those, it’s a specific type of facility. It’s a hospice program that must have at least one medical provider registered with the Department of Health as a QMP. Okay? But then a separate requirement is that an assisted living facility, a nursing care facility or a general acute hospital, the law was modified to allow them to receive deliveries of medical cannabis products from a medical cannabis courier for a patient who is a medical cannabis cardholder. But if that facility accepts federal insurance money or insurance money, I would think that they should consult legal counsel about third party reimbursement because there could be some specific guidance from the federal agency regarding acceptance of those types of products, because they are still federally illegal.
Tim Pickett:
Yeah. Because the idea is that you might have a employee of the facility receive these products in order to hand them to somebody else. And that action of receiving the product is essentially an action of receiving a Schedule I drug. So we need to make sure that that’s on the… You need to talk to your lawyer for sure.
Rich Oborn:
Right.
Tim Pickett:
This kind of goes along with the, and I don’t know if we have this, this kind of goes along with this same idea that we are going to allow schools. There was some clarification on the school system being able to store medical cannabis for a patient that was in the school system. Not that the employee of the school would then handle that if they needed to, but it’s allowed from state statute.
Rich Oborn:
I’m glad you brought that up because that was taken out of the bill.
Tim Pickett:
Ah, because I heard the committee meeting and I heard Senator Escamilla kind of defend that. And there was some very interesting questions, right? One of them was, so basically, are we going to just let this child show up with it in their backpack? And I know of cases where the school district is questioning this because they have a child with a condition and a card. This is a real sticky situation because you want the child to have access and you want the schools to be protected. And by the way, I would mention that schools are like pharmacies. They have a ton of medications that they deliver in store for other conditions, right? This is not something that’s not done, right? We have controlled substances there for children who need them.
Rich Oborn:
Right. But they’re also federally funded.
Tim Pickett:
Yep. So they pulled that out.
Rich Oborn:
They did.
Tim Pickett:
So as of now, the child would essentially need to be removed from the school property to dose their cannabis with their caregiver and then be brought back to school.
Rich Oborn:
Well, I think a general approach would be ensure that you vet this with legal counsel and the school authorities, the school district. There could be some school districts that handle it differently than other school districts. I can’t speak for them, but yeah.
Tim Pickett:
Yeah. I’m glad we talked about that because I thought that had stayed in, but it hasn’t. So that’s good to know. The other thing that was interesting to me is we added acute pain as a qualifying condition. So this means that a person who is about to get a knee surgery, if the provider, the orthopedic surgeon says, “You know what? This is going to cause a lot of pain. I don’t want you on as many opioids and I’m going to offer to recommend a short term card.” Am I thinking of that correctly?
Rich Oborn:
Yes. So any cards issued with acute pain as a qualifying condition, they will always expire after 30 days. Just as when a medical provider prescribes opiates for a limited duration because of a surgery, it’s acute pain. So they’re not going to prescribe opiates for a long period. It’s for a specific condition of some acute pain that’s coming up because of that surgery. So, yeah, a medical provider would generally prescribe opiates for limited duration, but now they’d be able to recommend medical cannabis as an alternative to opiates. And we expect that medical providers will exercise this with great discretion and in cases where they feel like it would be a better alternative medically for a certain type of patient. They’re now able to have that as an option.
Tim Pickett:
So these two things we’ve just talked about, the hospice and this acute pain thing, this doesn’t sound like something that the Department of Health they were… It sounds like this was something that you were told was going to be proposed in the bill and not something that the Department of Health would’ve had a horse in the race, so to speak.
Rich Oborn:
Right. I mean, there’s certain things where we contact the legislature and we see if they might be able to tweak something that we feel would help promote public health, very rarely do we come out in opposition to specific provisions publicly. And so we’re just typically neutral on some of those provisions that maybe don’t have as much evidence as others for being an effective type of treatment. And then we’re responsible to execute the laws that are passed by the legislature. So we want to ensure that they’re implemented in a way that’s fair and easy for patients to take advantage of if their provider chooses to recommend them.
Tim Pickett:
You’ve done a very good job of… I’ll shoot an opinion here about this particular qualifying condition. I personally think this is kind of silly. I can see why an advocate would propose this condition. As a provider who recommends cannabis, I think that 99.9% of the time, if you’re getting your knee replaced and you need a 30 day card, you certainly qualify for a medical cannabis card in the original system. And evidence with acute pain is different than evidence with chronic pain, but there you have it from Tim and I’m not a employee or a regulator. So I get to voice my opinion a little bit more freely about this one. I like expansion of the program; that I’m certainly for. I think this was kind of a funny one myself.
Rich Oborn:
Yeah. We just hope it’s exercised with wisdom and that providers are careful with how they exercise it, just as we hope with every other type of recommendation they do what we hope that they-
Tim Pickett:
And it will be good to study… This will be a unique thing to kind of study how many of these are issued? What’s the progress? How many of these cards get converted to a regular longer term card? What’s the success of reducing opioids after surgery? We could design some really interesting studies around that. And in fact, not to skip through and go right to the bill that funds a study, there was a bill that funds a study.
Rich Oborn:
… Right. Yeah. So Senate Bill 2, that was a big appropriation bill. And in that bill, the legislature appropriated $538,000 to fund a study of medical cannabis and chronic pain. And that was proposed by representative Ray Ward. And the Department of Health was able to provide some general thoughts about how that should be done, and we’re working out details of that. But it’ll be done through an RFP process where academic researchers at universities have an opportunity to bid on receiving these funds. But we’re very serious about funding research, and we’re excited about the legislature having an interest in doing it. And so we want to ensure that it’s done in a way Utah can be proud of, that can be shared with other states and help them learn as well as we move forward with trying to understand more about medical cannabis and its impact on chronic pain, without federal funding. It’s not easy without getting federal grants to do research.
Tim Pickett:
Is $538,000 a large amount for a study, a small amount? Do we have perspective on that?
Rich Oborn:
That’s a good question. It depends on what type of study, because there’s double blind studies that really cost thousands more than that of dollars beyond the $538,000. So this won’t be something like that. It’ll be something on a lower scale, but it will still be, I think, something that researchers and providers in Utah and outside of Utah will find helpful. We want it to be not just something that’s tucked away, but is something that providers can learn from and patients can learn from and pharmacists at the medical cannabis pharmacies can apply to work they’re doing. Although, we defer to those studies that have a lot more funding that are published as studies that just have more resources to do something that’s even more extensive. Those are exciting to see, and we hope to see those happen even more outside of Utah. We see some of those in other countries, Israel and Canada, or to the countries that we see them more in than within the United States.
Tim Pickett:
Yeah. And I’m interested in why, I know Ray Ward was very interested in getting a little allocation for some research to be done. There was talk about whether to research a condition like this, or to research the program itself and how it was working. So it’ll be interesting to get this process started. I think there’s a ton of research on cannabis. I find it interesting that the medical community still says, “Oh, there’s no evidence” when there’s thousands of studies being done. Like you say, Israel and Canada has some fairly decent, if not excellent, research on some of these things already. But Utah is unique. We like our own programs, right? We like to see things done our way, and this is the beginning of doing that. It’s kind of a culture thing, I think. We like to see ourselves.
Rich Oborn:
Yeah. I think most people agree though is that when you compare the studies done on other drugs to those on cannabis, there is more of a volume of studies of scientific rigor on other types of medications that we don’t see on cannabis yet. There’s just a bigger volume. So it’s just the nature of dealing with a federally illegal drug that there’s not as much research on it, even if you add the research in other countries. So that’s one of the sources of some of the reluctance of some providers to join in and make recommendations regarding medical cannabis. There’s been some good literature that has taken a look at studies not just in United States, but these other countries.
Rich Oborn:
And even combining all of that, there’s still some weakness when compared to other drugs. So I think that that’s important to keep in mind. I don’t want that to take away from some of the, I think, positive experiences people are having with medical cannabis as they treat their medical conditions and finding more success in treating their conditions with medical cannabis compared to other drugs. We don’t want to take away from those experiences and Utah law allows for those experiences to happen legally, which is great. But we still want to be able to continue to add to the evidence out there regarding treatment of A, B and C condition with medical cannabis.
Tim Pickett:
In a really rigorous way, I agree. There’s not comparison studies and the double blind studies, and there’s a huge amount of inclusion bias in cannabis studies, which is always kind of an issue in medicine. So when we added a little bit of history, they weren’t able to get opioid use disorder as a condition. So it seems like we compromised or the advocates kind of compromised here and added this language that we’ve got to now consider the patient’s qualifying condition history of substance use or opioid use disorder when we’re doing this. This seems like something we’re already doing, but-
Rich Oborn:
It should be. Right. Yeah.
Tim Pickett:
… This should be something. If they have opioid use disorder, this would be a reasonable alternative to opioids.
Rich Oborn:
Well, I think the purpose of this amendment to the law is to have a medical provider be more careful in their consideration of a recommendation when they learn about a patient’s history of substance use or opiate use disorder. Because there are some studies that find that individuals that have those conditions, that they have the propensity to overuse medical cannabis in some cases beyond it’s medical purpose.
Tim Pickett:
Yeah.
Rich Oborn:
So [crosstalk 00:41:20] interacts with those disorders. And there’s some studies done that show that it actually exacerbates or makes them worse when used in the wrong way. So it’s important that there be a screening done. I think this is the best practice and people ask, “Well, what’s screening?” Well, there’s a few types of screenings that are out there. People that work at these type of facilities are very familiar with the types of screenings and different types you do. But as a medical provider, it’s just important that there be an awareness of the patient’s substance use or opiate use disorder history if there is one. And if there is one take, take a step back, consider whether recommending medical cannabis should still be done in light of that patient’s condition.
Tim Pickett:
Yeah. I’ve had patients who we have removed their ability to access all forms, right? Reduced it to… Been asked by a patient frankly to reduce their forms to only topicals because they were having trouble, they were spending too much money, consuming too much, had a history of addiction to other substances. And it’s… Yeah. I do think it’s real. I think there’s about a 9%, I think the statistics are between 8- and 9% of cannabis users can become addicted, which interestingly is just barely below the number for opioids. But I think that just goes to show that people get addicted to things. They like… Humans, we like the dopamine.
Rich Oborn:
Right. And I think researchers out there have said there’s little evidence that it works as an effective treatment of substance use or opiate use disorder. There’s mixed results in the studies that show that. And in fact, there’s some studies that show that it makes them worse. So we want to see providers take a step back, consider that recommendation in light of the patient’s qualifying condition if they have a history of substance use or opiate use disorder. This is what a provider does when they recommend controlled substances outside of the Medical Cannabis Program for other drugs that are federally illegal, they consider, “Okay, how does this drug impact these other conditions that this person may have, right?”
Tim Pickett:
Yeah, we’d even call other providers and say, “Hey, I’m about to prescribe your patient or our patient now. When you’re a specialist, we’re going to add this to their drug list. And what do you think? The neurologist, the psychiatrist.
Rich Oborn:
Right.
Tim Pickett:
Create more of a team approach. I like the idea. I think it does create a little bit of increased liability on the provider to make sure that they’re doing their due diligence. And so providers shape up, right? Let’s see. Oh, the drinks. I keep getting emails about the drinks. When are the drinks going away? When are the drinks going away? So currently you can buy a drink, you can buy a Seltzer, you can buy something in a can, there’s a few of these around, and we’re going to take that back down to 30 MLs. So basically a tincture bottle or a little oil bottle. There was some controversy on this too.
Rich Oborn:
There was. And I think I can’t speak for policy makers, but naturally they weigh benefit and harm. And they decided there was more risk to liquid suspensions being above 30 milliliter than there was benefit. And I think it’s easier to abuse the use of a medical cannabis liquid suspension when it’s above 30 milliliter-
Tim Pickett:
Yeah. And I’ll say it, I mean, a can of spiked Seltzer with THC in it just looks wreck. It just looks more recreational as a product than a tincture oil, or even a Select Squeeze where Curaleaf makes that drink additive. Even that looks less recreational or [ adult 00:00:46:05] use than a four pack or a six pack.
Rich Oborn:
… Sure. And you don’t typically see from a Walgreens, you don’t go to the pharmacy and purchase a liquid suspension to treat the types of conditions that are [crosstalk 00:46:23] conditions in the state of Utah.
Tim Pickett:
NyQuil doesn’t come with a can that you crack open.
Rich Oborn:
Right. Right. Yeah. There’s a reason why it is the way it is. It’s for patient safety.
Tim Pickett:
Sure.
Rich Oborn:
So same goes in this respect.
Tim Pickett:
Patients have until the end of November. Basically Thanksgiving, folks. They’ll maybe be on the shelves till then, but I doubt they’ll make any more of them. I bet they just clear out their inventory and then that’s kind of it.
Rich Oborn:
Right. Yep.
Tim Pickett:
Let’s talk about advertising because this was something that got changed a little bit, not a ton. I see you’re getting out your cheat sheet here because this is wholesome co-delivery, doesn’t the delivery third party… Explain the advertising changes.
Rich Oborn:
Yeah. So I think there was a lack of clarity in the current law and with these bills that goes it into place with SB 195, there’s more clarity as it relates to advertising and the limits that are placed on medical clinics and medical cannabis pharmacies. And so the law states that a medical cannabis pharmacy, they’re able to advertise in any medium. So there’s no longer restriction on the type of medium they can use for advertising. In the past there was, but with SB 195, there will not be. But they’re able to include information in their advertising such as a service available at the pharmacy, the best practices that the medical cannabis pharmacy upholds, education materials, they can advertise those obviously. That’s important.
Rich Oborn:
And their inventories, they can advertise their inventories obviously. And a medical cannabis pharmacy may provide information regarding subsidies for the cost of medical cannabis treatment to patients who affirmatively accept receipt of the subsidy information. So all those things are really important. Pharmacies will be able to do those things, some of which they could not do in the past because they were restricted in the type of mediums that they could engage with patients in. So that, I think, will have an impact on patients for the good. There’ll be information that’ll be more accessible about education materials and best practices that the medical cannabis pharmacy upholds. So I think it clarifies some of that.
Tim Pickett:
You’re not passing out coupons at the county fair, right? You’re having to essentially be a patient and opt in to those communications to receive a coupon, a subsidy program.
Rich Oborn:
Right. Right. So a pharmacy would not be able to advertise promotional discounts or incentives. They would not be able to advertise a specific medical cannabis product in their advertising. And they would not be able to advertise an assurance regarding an outcome related to medical cannabis treatment, for example. Those are some things that they would be prohibited from doing. So those are some of the advertising limits that will be in place under SB 195.
Tim Pickett:
Yeah. I think that clarity is somewhat helpful. We’ve already run into it with utahmarijuana.org with billboards and [ reagan 00:00:49:56] and everybody’s kind of trying to shift and adjust and making sure that everybody’s in compliance. And so I’m sure you’ll have a lot of questions coming up. In fact, I was talking to Cole today who was like, “Oh, you’re talking to Rich, ask him about the advertising.”
Rich Oborn:
One thing that I think is great is that a nonprofit that offers financial assistance for medical cannabis treatment to low income patients, they may advertise the organization’s assistance if the advertisement doesn’t relate to a specific medical cannabis pharmacy, or a specific cannabis product. So there is this emphasis on allowing the nonprofits to do that.
Tim Pickett:
Yeah. I don’t know that you can register a 501(c)(3) related to cannabis yet, but certainly our uplift program that subsidizes low income Medicaid and terminally ill patients was one of the things that I know the lobbyists and the activists kind of made sure to mention to the legislators that said, “Hey, we’re bringing people through the program who can’t afford it because it is costly for a lot of people.” And the program essentially was designed for these low income folks and terminally ill and really chronically ill patients. And yet there’s a bunch of them who can’t afford to even get into the program as it is. So helping those patients, it’s been surprising how interested the growers, retailers, processors are in giving back to those programs and subsidizing that, which kind of, I don’t know whether some people think it’s ironic, right? That they’re using their profits to help subsidize the poor. But on the other hand, you kind of have to have fire… The cashflow is fuel to the fire. This thing has to run.
Rich Oborn:
Yeah. And so we’ll be working with the industry on putting together some additional standards and rule that relate to some of these advertising standards that are in the statute. We’ve got some authority to do that. And so we’ll be reaching out to get some of that input.
Tim Pickett:
Cool. So let’s talk about the growth before I let you go. What are we up to cardholder wise?
Rich Oborn:
Yeah. So as of the end of February, we were at 44,800 active medical cannabis cardholders. And that represents a growth of, I’d say, between 1000 and 2000 cards per month new active medical cannabis cardholders. And so we’ve seen a steady rate of growth happen, which is good to see, although we know that medical cannabis isn’t for everybody. And so when we did an analysis, we found that there was about a 70% card renewal rate. And there’s lots of reasons why people would choose to renew their card. And a lot of reasons why they may not choose to renew their card. They may find that, “Hey, medical cannabis isn’t working for me, but these other medications do or these other treatments do. So I’m not going to renew my card. I’m going to work with my provider on these other medications or treatments that are looking better for my chronic pain.” Because, like anybody, people just don’t want to buy something. To buy it, it’s expensive. So also-
Tim Pickett:
Yeah, and I know cost is a significant answer we get when people let their card lapse. Cost of the QMP visits, cost of the product, whether or not all of that’s justified or not, that’s just a big reason people leave the program.
Rich Oborn:
… Right. One of the most critical things that the Department of Health has been implementing just recently is the limited medical provider recommendation program. And there have been approximately 50 limited medical provider recommendations since January 19th, 2022, when it was launched. And these are providers who are not registered with the Department of Health, but who choose under the state law to recommend medical cannabis to up to 15 other patients.
Tim Pickett:
There’s something like 16,000 controlled substance license holders in Utah, right?
Rich Oborn:
Right.
Tim Pickett:
Available for the limited medical provider program.
Rich Oborn:
Right. Any MD, DO, APRN, PA or podiatrist falls under that. And so we’ve seen just a steady growth, but it’s been a slow growth just because naturally it takes time for providers to feel comfortable, I think, with a new program. And so we’ve done some webinars just recently. We’ve done four webinars since January to help providers who are interested in learning more about limited medical providers and how they can recommend cannabis in an easy way. There’s information on our website that a patient could direct their regular physician to if they wanted their physician to explore that possibility of recommending to them and making them one of their 15. And so that’s one thing that I think is helping patients make a medical cannabis visit more affordable because in some cases, in the past, there have been some clinics that I think have been charging a lot more than other clinics for a similar service.
Tim Pickett:
I did a podcast and the guy’s in the $5,000 range over the two years because of a clinic that was having him come up every 90 days for 400 bucks. It was the worst I’d heard about, but there still are. And now there’s a website people can go to where they can see a little bit of this. They only see the cost, but there is a website where people can look at the initial visit cost, right?
Rich Oborn:
Right. So policy make were listening and they thought this is not right. We need to do something. So they created this limited medical provider program as just one strategy to address this concern. A second strategy was to require that the Department of Health work with the state auditor’s office on gathering data from all the medical clinics that have QMPs who advertise publicly that they offer medical cannabis evaluations, that they report those fees to us that they charge. And that those fees be posted on the state auditor’s website. And so we’re getting about 200 to 400 visits a week to that website, which is a good sign. We like to see that people are using it. And this is not just for people that are wanting to get a medical cannabis evaluation for the very first time. But it’s for those that have been in the program for a long time.
Rich Oborn:
Maybe they joined in March, 2020, and they, at this point, are ready to just learn more about what some other clinics are charging and they want to compare some of those costs. And as you know, Tim, there’s different reasons why clinics charge different fees. Some clinics take more time with their patients and maybe have more training than other providers do on a particular subject related to medical cannabis.
Tim Pickett:
Yeah. Not a bad place to start your search. Definitely not a place I would say to end your search in who to go see.
Rich Oborn:
Right.
Tim Pickett:
But more information is always better.
Rich Oborn:
Right.
Tim Pickett:
What’s some of the plans for 2022 in the program that the Department of Health has?
Rich Oborn:
Yeah. So one thing that we’re excited about is putting together an analysis of medical cannabis product inventory across the state. And I think there’s from some concern about not finding a certain type of product in Utah, and we want to be able to do an analysis that actually relies on some of the actual inventory available across the state to really see if some of those concerns are valid. And then we want to share that analysis with clinics, with pharmacies, with the industry in hopes that they would find creative ways to address some of those gaps that may exist throughout the state.
Tim Pickett:
Yeah. We’ve heard of those where we’ll send a patient for a certain product and then it’s not there. But, yeah, it’d be very interesting to know and be able to kind of look at whether or not that’s really true.
Rich Oborn:
And we understand there are some unique conditions that people suffer from that require unique types of products. And so there may not be a market right now in our program, but as the maturity of the program increases and there’s more patients, there may be a market in a year or two for certain types of products to be worth it for a processor to manufacture such as a breathalyzer or something like that.
Tim Pickett:
Yeah.
Rich Oborn:
We also want to do additional outreach to medical providers, medical clinics and stakeholders to ensure that they’re receiving accurate information about the laws in Utah and also best practices. And there’s some great information in a publication that the Cannabinoid Product Board has put together that we feel is underutilized and could be, I think, shared more universally and distributed with providers. And we want to share it in a way that’s easy for them to digest and it’s not complicated. So I think we’ll do some additional outreach. And we’re excited about those plans. We’ll be helping lawmakers with a medical cannabis governance study during the next year. There was Senate Bill 153 in the past that required that lawmakers put together a committee that will study the feasibility and the benefits, potential benefits, of having the responsibilities of the Department of Health under a single agency with the responsibilities of the Department of Agriculture and Food.
Rich Oborn:
And other states have that type of a governance model where it’s all under one single agency. And there’s reasons why that could work, there’s reasons why it may not work, but legislature wants to do this study and we’re happy to help them conduct that. And they plan to include not just us in it, but I think even more importantly, patients and providers in the industry and getting input on how things are put together long term. And the legislature plans on putting together this study and conducting it. I think the deadline is October 2022. And then potentially taking action, legislative action, during the legislative session of 2023 that the study has recommendations that lawmakers want to take action on.
Tim Pickett:
Sounds like you got a busy year, and you got to upgrade the EVS system.
Rich Oborn:
Yes.
Tim Pickett:
Right?
Rich Oborn:
Yeah. I know that’s something that’ll impact pharmacies quite a bit and also providers in clinics as they are the primary users of that system. And we want to make things just easier for people to get access to information so they can spend more time with patients and help them get through some of the things they’re dealing with with medical conditions. And we want patients to be able to just have better access to the counseling that’s available at the pharmacies. And sometimes it starts with improving the softwares that they use to allow for more time that they can spend one on one with the patient. So that’s one goal we have.
Tim Pickett:
Well, there’s a lot that’s updated. This has been a great conversation. I think we’ve gone through a lot of this stuff that people will be interested in hearing about. If you’re not subscribed to Utah in the Weeds, you can subscribe on any podcast player that you have access to. Anything else we’re missing?
Rich Oborn:
No, that was quite a bit. We’re excited that [crosstalk 01:02:59].
Tim Pickett:
Last year we ended up taking a long time as well. So this is turning into our annual legislative update with Rich Oborn, the Department of Health Medical Cannabis Program Director. And appreciate your time today.
Rich Oborn:
Yep. Good to chat with you, Tim.
Tim Pickett:
All right, everybody. Stay safe out there.
Like just about any other drug, Medical Cannabis does have its side effects. They are numerous, and patients react to them differently. Some experience only a few while others many more. The one thing to remember is this: it is important to speak with your Qualified Medical Provider (QMP) or Pharmacy Medical Provider (PMP) about any side effects that you experience.
Your provider is the most qualified person to help you understand why you are experiencing particular side effects. Likewise, working with your provider to find solutions is the best way to minimize any side effects that you find uncomfortable.
For the record, here are some of the more common issues associated with using Medical Cannabis:
None of the side effects are considered medical emergencies. If you experience them, it is not the end of the world, but seriously consider discussing them with your provider. Here are five reasons that might encourage you to do so:
If you have been using Medical Cannabis for any length of time, you know that the variety of products only continues to grow. There are never-ending strains along with different delivery methods to choose from. As it turns out, certain side effects may be an indication that you are using the wrong product.
For example, you may notice that THC makes you nauseous while not providing as much relief as you had hoped. Your provider might recommend you use CBD instead. Or perhaps THC is really what you need, but vaping is not the best delivery method. Your provider might recommend an edible instead.
In addition to potentially using the wrong product, certain side effects could indicate that you are using the wrong dosage. Your provider can help you figure that out. To make things easier, track your usage on a regular basis. Your provider can use tracking data to help adjust your dosage accordingly.
We have all talked to people who have stopped using prescription medications because they did not like the side effects. The same thing can happen with Medical Cannabis. But discontinuing use of your medicines is like throwing the baby out with the bathwater. It may not be necessary. Your PMP or QMP might be able to help you adjust delivery method and dosage to alleviate side effects. You don’t necessarily have to stop using the drug.
Some Medical Cannabis patients do not experience maximum relief because the side effects they are experiencing are much stronger than they should be. It’s a shame when it happens. Why? Because Medical Cannabis is supposed to bring relief. If a patient is not experiencing maximum relief, the whole point of using the drug is negated.
Finally, some side effects might suggest that you’re using too much cannabis. Maybe you are not sure of the best dosage for your circumstances. Perhaps you are a long-term user starting to develop significant tolerance. Whatever the case might be, it is important to reduce your cannabis consumption to a level more appropriate to your situation.
Side effects are normal with any drug, including Medical Cannabis. If you are experiencing side effects yourself, make a point of discussing them with your provider. There may be ways to alleviate them and increase the effectiveness of your medications at the same time.
There are a lot of cannabis-related phenomena that, up until recently, were things people just talked about behind closed doors. But with cannabis legalization spreading across the country, some of these phenomena are starting to come out of the closet. One such phenomenon is known as the “cannabis shakes.”
Anecdotal evidence suggests that the cannabis shakes are legit; people really do experience them from time to time. Perhaps you have. At any rate, the cannabis shakes are not dangerous. Yes, they can be uncomfortable and a little disconcerting, but shaking after consuming cannabis is not likely to harm you.
We know from the testimonies of Medical Cannabis users that the shakes are legit. Unfortunately, we don’t know what causes them. There hasn’t been a whole lot of scientific research into this particular phenomenon. That is going to change at some point but until then, we can only offer some educated guesses as to why some cannabis users experience the shakes.
The Cannigma website recently published a great post talking about the cannabis shakes. They offered a number of possible causes:
Animal studies have demonstrated that THC can cause a drop in body temperature. The same thing has been observed in human beings as well. So if that’s the case, even a slight drop in body temperature would make a person feel cold. That could be enough to induce shaking.
As a cannabis user, you might be so preoccupied with the shakes that you don’t realize you feel cold. Figuring it out would prompt you to grab a blanket or throw on a jacket. As you warmed up, the shakes would go away.
Some people experience mild anxiety when using cannabis. For others, the anxiety could be significant enough to cause shaking. It is really not all that different from being so angry that you’re shaking, or even being so scared by something that you get the shakes. It’s just your emotions getting the better of you.
It is possible that some people get the cannabis shakes because they combine their Medical Cannabis with other stimulants. For example, have you ever heard people say they avoid coffee because it makes them jittery? The caffeine in coffee is a stimulant. If you were to experience the shakes first thing in the morning, after drinking a cup of coffee and then using Medical Cannabis, chances are that you’re experiencing the result of combining multiple stimulants.
Using too much cannabis in too short a time can result in a phenomenon known as “greening out.” We recently published another post discussing this phenomenon, if you’re interested. That said, one of the symptoms of greening out is feeling anxious or uneasy. Combine those feelings with another symptom, increased heart rate, and you could experience the shakes.
Experiencing the shakes can be a bit unpleasant. Is there anything you can do about it? Yes, but only after you figure out the exact trigger. If you are shaking because you are cold, put on some warmer clothing. If the shakes are a result of greening out, slow down. Do not use so much cannabis in so short a time.
As a Medical Cannabis patient, don’t be alarmed if you experience the shakes from time to time. The shakes are a normal reaction to the drug that some patients experience. It is not a dangerous condition, and it generally goes away on its own. If you persistently experience the shakes, talk with your QMP or PMP about using CBD instead.
Episode 91 of Utah in the Weeds features Collin Mekan, a beloved patient experience agent at Utah Therapeutic Health Center. Collin’s friendly demeanor, great sense of humor, and knowledge of Medical Cannabis have made him an invaluable team member at UTTHC.
We started this episode with a brief overview of Collin’s work experience within the cannabis industry. Before joining UTTHC, Collin worked in cannabis cultivation. [03:25]
Collin’s knowledge of cannabis and the human body’s endocannabinoid system help UTTHC’s patients feel comfortable with cannabis medicine. [06:23]
Collin spends some of his free time playing music. He said he owns several guitars and he likes to “folk out” now and then. He and Tim shared some of their memories about learning to play instruments as students. [11:57]
Next, they talked about cannabis and other plant-based medicines. Tim and Collin agree that Utah’s Medical Cannabis patients should have the legal right to grow their own medicine. [15:56]
Collin and Tim touched on the spiritual aspects of cannabis use – a topic that doesn’t often get discussed in a medical setting. Then they talked about some of the legal pitfalls Utah’s Medical Cannabis users could face. [20:04]
Collin told us about his experience turning 40, and Tim also shared a few insights about being in his early 40s. [23:29]
Next, they talked about the therapeutic potential of some of the lesser-known cannabinoids, like CBG and CBN. Both hope to see more non-psychoactive products available to Utah’s Medical Cannabis patients. [24:41]
Collin told us about his own use of Medical Cannabis, including the use of cannabis to deal with social anxieties. One benefit of Medical Cannabis is “layering,” or using multiple delivery methods to achieve the desired effect. [31:15]
Tim and Collin discussed the stigma and stereotypes surrounding cannabis, and how Utah is already ahead on that front. [36:18]
Tim mentioned the Discover Marijuana YouTube channel’s series of giveaways in March. This led to a discussion about Tim and Collin’s favorite dry herb vaporizers. [38:41]
Collin talked about visiting Scotland for his 4o birthday and some of his other travels with his wife. [41:30]
Next, they discussed the supportive atmosphere at Utah Therapeutic Health Center, which echoes the familial quality of Utah’s Medical Cannabis community. [42:32]
When asked about his favorite cannabis strain, Collin said it’s more important to focus on the cannabinoid, terpene, and flavonoid content of the product. [45:46]
We wrapped up the episode with a discussion about cannabis cultivation, and the opportunities Utah has yet to explore. [47:55]
Tim Pickett:
Welcome everyone out to episode 91 of Utah In The Weeds. My name is Tim Pickett and I’m the host, here with you and Colin Mekan, a friend of mine, and I think the only person in Utah who has both experienced growing and worked in the patient side of the medical cannabis program. Very excited to share this with you because his perspective and his experience is unique.
Tim Pickett:
For those of you who want to get into this industry, listen to Colin’s experience when he talks about how far he drove and the sacrifices that he made and was willing to make in order to get into the industry, the cannabis space. Which is very heartening.
Tim Pickett:
Then his experience with the patients and how that experience helped him grow into, well, really one of our best experienced agents. And somebody who really cares about people and cares about that education and their health, helping them all along the way, transition from prescription medications to natural therapy and plant therapy with the cannabis plant.
Tim Pickett:
I Also want to mention that right now we have started the March giveaway series. We’ve partnered with DaVinci Vaporizers for March for our Discover Marijuana YouTube channel. You can go to Discover Marijuana on YouTube, subscribe, and then comment on this week’s Discover Marijuana video on our YouTube channel. You must be a United States resident aged 21 or older, or a Utah medical cannabis cardholder, to win. There are, of course, a few people under 21 that are medical cannabis cardholders here in Utah and they would be eligible as well.
Tim Pickett:
But we’ll announce the prizes during the videos launched on Wednesdays. Okay? That is the rule. Basically subscribe to Discover Marijuana on YouTube, comment on this week’s Discover Marijuana video on that YouTube channel, and you’ll be entered to win. Every week of March those prizes are going to increase and everybody who’s entered will continue to be part of that drawing and part of that.
Tim Pickett:
It’s really a cool program, we’re really excited to give back to the community here with some swag and some DaVinci products. They’re a really good medical vaporizer product for dry flower, if you want to use flower in Utah this is a non-flame state and will continue to be a non-flame state for the foreseeable future. There was no discussion in the legislation this year about adding flames, whatsoever. Anticipate that’s going to continue for years to come.
Tim Pickett:
Here’s this interview with Colin. Just a great guy. A lot of talk about the endocannabinoid system. I hope you enjoy this episode. Subscribe on any podcast player that you have access to, Utah In The Weeds. I’m Tim Pickett, thanks for listening.
Tim Pickett:
Yeah, okay. Tell everybody your full name and what you do.
Collin Mekan:
My name is Collin Michael freaking Mekan and I am a patient experience agent here at UTTHC, working for UtahMarijuana.org.
Tim Pickett:
What did you do before this?
Collin Mekan:
Oh, at one point I was working for True North in cultivation, moved on-
Tim Pickett:
Our friend Brandon.
Collin Mekan:
My friend Brandon Alonzo, big shout-out to him, taught me everything that he knew. I was in charge of the mothers and their clones at one point, which I really enjoyed.
Tim Pickett:
Did you get to be involved in that, when they were in their new facility?
Collin Mekan:
I did. I was a big part of that move. I was working with them in Plymouth, along with indoor and outdoor Riley, who are now with Standard [crosstalk 00:04:13].
Tim Pickett:
Yeah, for those of you who don’t know Riley Meyer, you should listen to whatever episode that is, it’s probably in the 60s, 70s.
Collin Mekan:
It’s a good one, absolutely.
Tim Pickett:
It was a good one. Yeah, go back and listen to that.
Collin Mekan:
Yes. Riley’s incredibly knowledgeable. We would drive three hours a day back and forth, going to Plymouth in commitment to that job. But at one point we were just in a little warehouse out in the middle of nowhere and it was a lot of fun to help make that expansion.
Tim Pickett:
Was that the first thing you did in cannabis?
Collin Mekan:
It is. I really have to make a shout-out as well to my friend Andrea Silva and Matt [Chiota 00:04:49] Vagabond, just for getting me into the industry once Proposition 2 passed. It was a great experience.
Tim Pickett:
Okay. Talk about that. You drove three hours?
Collin Mekan:
I did.
Tim Pickett:
Who in their right mind, for a job?
Collin Mekan:
Passionate people, Tim.
Tim Pickett:
Right.
Collin Mekan:
Very passionate, committed people.
Tim Pickett:
Okay. It’s like I set you up for that question.
Collin Mekan:
Yes, thank you very much, Tim. We were very passionate. We all felt the same, that the universe was taking us in a direction and we were just going with the current of it and all meeting each other while were doing. And really inspiring each other and piquing each other’s interest and learning from that.
Tim Pickett:
Do you feel like… What made you switch from cultivation then to the patient side of things? [crosstalk 00:05:32].
Collin Mekan:
I was relieved from duty at one point. I was working for Harvest as one of their managers and they made a switch. I found my position dissolved. Then I found myself without a job for a little while. I just twirled my mustache and thought-
Tim Pickett:
It’s pretty nice.
Collin Mekan:
Thank you. Unemployment and cat oil, ear wax, and human saliva, just twirling away. But eventually I kept educating myself through your videos, Tim, and it was very Utah specific. One day I noticed at the bottom of the website it said careers. I just pressed that button there and here I am.
Collin Mekan:
I like to say this, I feel like I’m on a different side of cultivation now where I feel I get to see this community grow. Cultivating a community instead.
Tim Pickett:
Yeah. Nice. That’s a really good way to look at it. I haven’t met anybody, except you, who’s been on both sides of this. Right?
Collin Mekan:
I love it.
Tim Pickett:
From the cultivation and the growing side and the patient care side. You have an experience and a perspective that nobody else, you’re the only one, literally [crosstalk 00:06:42]. Yeah, you really are the only one.
Tim Pickett:
Here, one of the reasons why I wanted to get you on this podcast was that perspective. Because you see patients and something, I don’t know what it is, some of it is the passion for cannabis as medicine, some of it is your knowledge it seems like. But there is something different about the way you talk to people than the way, really, everybody else.
Tim Pickett:
I love everybody who’s here, don’t me wrong about that, but there is something a little different about it.
Collin Mekan:
I can honestly say that stemmed from one of our original meetings that you were a part of, where you mentioned treat these people like they’re your family. Treat them like they’re your grandmother and that you have a great connection with these people.
Collin Mekan:
I really took that to heart, Tim, and I try to use it every day. I feel real passionate for these people and I’m excited for them on this journey. There’s still a huge stigma to it and I Feel like we’re breaking that every day.
Collin Mekan:
I also feel like one day we’re going to look back and feel like we were part of a movement rather than individuals getting their medical cannabis card. Because what better place to do this than here? It’s really working.
Tim Pickett:
Yeah. Walk us through what you do here. How do you talk to patients? When we worked in Bountiful, I’d do the visit, we’d talk through all of their medical history and the evaluation process and give them basically the key to the door. Then they come to you. What are you excited about telling people when you talk to them?
Collin Mekan:
I think that that’s my job. I try to get them excited about it. Recently I had somebody approach me outside of work and tell me that I got her her first card. I was very proud of that, and still I was able to give her some pointers and some tricks to saving some money.
Collin Mekan:
I just like to keep people pretty excited about their endocannabinoid receptor system. It’s pretty fascinating that we even have it, to be honest with you.
Collin Mekan:
But if I can get people excited about that and let them know what their options are, then we can really make the program succeed.
Tim Pickett:
For me with cannabis, it started out a lot about the plant and about the endocannabinoid system and choosing to use the right strains or the right products. There’s a lot to that now and we give a lot of education about that.
Tim Pickett:
But there’s also something that seems to be underlying and cannabis is really just the tool that we use. Because when you talk to patients, you’re not getting them excited, it seems like, about their endocannabinoid system almost as much as you’re getting them excited about learning something new. Right? And taking control a little bit.
Collin Mekan:
Absolutely. They’re 100% in charge of this whole situation. I love to inform them of that because I find that incredibly empowering and kind of beautiful at the same time. Some of our patients, that’s quite a relief for them. You see that every day.
Tim Pickett:
Yeah. I think that’s one of the most powerful things that we do. I mean it’s like Lance Armstrong wrote the book It’s Not About The Bike. I feel like that in some ways here, that it’s-
Collin Mekan:
That it’s not about the [bowl 00:10:00]?
Tim Pickett:
It’s not about the bowl. I mean it kind of is, but that’s just the key and the tool that we use to get people to wake up.
Collin Mekan:
Also I like to point out to people these new devices. A nice vaporizer really allows you to give new life and respect to your marijuana. Saves those terpene profiles, they’re known as precision vaporizers. Then you can stretch out your product by saving your AVB and really doing whatever you want with it.
Collin Mekan:
Once I realized that, I started eating my AVB, putting it on my ice cream at night. But I sleep the whole night through and that’s a miracle for me sometimes, totally uninterrupted.
Tim Pickett:
How much have you learned here versus what you were exposed to when you were growing or in cultivation?
Collin Mekan:
I’ve learned quite a bit here, because my focus was able to shift a little bit. When I was working in cultivation I was very plant oriented. When I was working with clones, I had a dream I was growing roots out of the back of my neck and that was very unnerving.
Collin Mekan:
But now that I’m working with patients, that’s very rewarding. I feel like I’m very connected to this community, where before working with the plants was amazing but my face was in a plant every day. Here I get to actually communicate and see how this is helping people. It feels like quite the blessing.
Tim Pickett:
Have you… You’ve used a bunch of different ways now, that you weren’t using before even?
Collin Mekan:
Yes. Well, for one I think putting-
Tim Pickett:
Consumed, I guess. What’s the term? Use, consume, whatever.
Collin Mekan:
My dosing method.
Tim Pickett:
Dosing method, right.
Collin Mekan:
I do a little bit of everything, in reality. But now putting fire to my flower seems kind of comical. I couldn’t even do it. One, I know that I’m wasting so much of my product, which costs me money. But then I’m also missing out on medicine which helps me sleep at night. Again, that’s a game changer for me.
Tim Pickett:
What do you do for furn?
Collin Mekan:
I like to entertain my wife actually. I love to make her smile and laugh and I love to cook for her. But I play guitar as well and I like to write a lot of music.
Tim Pickett:
Oh really?
Collin Mekan:
Yes. I’m very good.
Tim Pickett:
Electric?
Collin Mekan:
No, I play acoustic. I had to pin it down to acoustic folk Americana I suppose. I like to folk out every now and then.
Tim Pickett:
Nice. How many years have you been playing?
Collin Mekan:
I’ve been playing since I was 12. I went through that phase when you’re 12, people think you’re a phenom, adults see you sing and play guitar and you’re like wow, he’s going to go places.
Collin Mekan:
I did not. I did graduate from an arts academy. I went to Interlochen, which was one of the number one arts academies in the country at the time. Since there I find myself doing a lot of karaoke, which I find is a great form of expressionism and maybe therapy even. I guess those would be my pastimes.
Tim Pickett:
How many? Do you have one guitar?
Collin Mekan:
I have about five guitars right now. Lately I’ve been playing my acoustic bass quite a bit. Not one that I picked up very often for a while, so been picking it up, slapping it around, seeing what other gifts I have available to me I suppose.
Tim Pickett:
Did you play in a band?
Collin Mekan:
No. I do play with a friend of mine every now and then. But it’s mainly just for fun, a way to express ourselves I suppose.
Tim Pickett:
I mean now we’re going to need to hear it. I mean are you willing to bring it to the Christmas party?
Collin Mekan:
I would 100% bring it to the Christmas party, Tim. I even wrote a jingle for you. I don’t know if I’m going to be sharing today, because there are a lot of swear words in it, Tim. And it’s 15 minutes long.
Tim Pickett:
Oh, sweet.
Collin Mekan:
I do look forward to sharing it with you one day.
Tim Pickett:
I really have always loved music. I grew up singing mostly, played a little piano, played a little guitar. Everybody who sings and grows up playing the piano might play the guitar. Right? I can play three or four songs. I have one, I have a guitar.
Collin Mekan:
You don’t see pianos in many households anymore. You see universal, that universal instrument. Go over to a friend’s house, sit at the piano, play a few songs. Now it’s the acoustic guitar. You can go over to almost anyone’s house, see that acoustic guitar. I never see an oboe or a reed instrument.
Tim Pickett:
No. I played the clarinet.
Collin Mekan:
Like hey man, do you mind if I play that clarinet of yours over there?
Tim Pickett:
I played the clarinet in junior high, moved to the saxophone, played the baritone sax in junior high. Then I had an alto sax. That’s just an instrument that was very popular when I was in junior high, that age group. Kenny G.
Collin Mekan:
Oh really?
Tim Pickett:
Do you remember Kenny G?
Collin Mekan:
Oh my goodness, do I ever.
Tim Pickett:
Right? He played the soprano. [crosstalk 00:14:49] for those of you who are too young to know.
Collin Mekan:
Excuse me.
Tim Pickett:
Know Kenny G, I went to a concert, a Kenny G concert. That is a crazy [crosstalk 00:15:00] long, permed hair too. Right? That brings back some memories.
Tim Pickett:
I did not use cannabis at that time. I was way too young and yeah, that’s [crosstalk 00:15:13].
Collin Mekan:
Can we pop on some Kenny G now? Is that [crosstalk 00:15:16]?
Tim Pickett:
I’ll have Nate put the Kenny G, play it over the-
Collin Mekan:
Really set the mood.
Tim Pickett:
Yes.
Collin Mekan:
Oh man, that’s ridiculous. You know, actually when I was working with clones I started doing a lot of research on what they heard. Because I knew that they sensed vibrations, they’re hearing something as well was the idea.
Collin Mekan:
I started doing research on what instruments mimicked nature and it came down to string instruments. I started playing a lot stringed music for my plants and they were responding really well to it. I was thinking of thunder, [inaudible 00:15:51] thunder, how they respond to that. It seemed to work quite well for a while.
Tim Pickett:
Is growing at home something that is important to you, to try to work for?
Collin Mekan:
Absolutely. I mean just the idea of growing in general, I like to promote growth all around me, within myself and the people that I care about and run into every day. But I love my little herb garden. I’ve really came to respect the herbs over the years.
Collin Mekan:
That was one of the things that brought me into it actually. You’ve mentioned this a few times on your podcast or different videos, but that idea of aspirin being derived from the bark of the willow tree. I had a willow tree outside of my apartment at this point. I never made my own aspirin, but I remember making that connection and how close medicine actually was to us and all around us and that really piqued my interest.
Tim Pickett:
For example, van Gogh’s Starry Night painting, the theory goes that he saw it that way because of his heart failure and he was on dandelion root for a diuretic. They used to use, well I mean they still do, dandelion [crosstalk 00:17:02]. If you drink a lot of dandelion tea-
Collin Mekan:
I love my dandelion root.
Tim Pickett:
Yeah. Okay. If you’re ever in a weight loss competition [crosstalk 00:17:15] here you go.
Collin Mekan:
I don’t know if that is going to be happening for me, Tim.
Tim Pickett:
If you’re ever in a weight loss competition, the last couple of days you got to get some dandelion root at the GNC and you got to overload on the dandelion root and you’ll pee out three or four pounds.
Collin Mekan:
That’s gross, Tim.
Tim Pickett:
But it’s plant based medicine.
Collin Mekan:
All right then. I’m going to trust you and get some of that dandelion root tea. I actually love my home apothecary. I go to some of the local apothecaries around town and they’re amazing.
Collin Mekan:
One of them, you walk into it’s like a classroom in Hogwarts. Just full of all these mason jars, every herb and spice you can possibly think of, fungis, and this and that.
Tim Pickett:
This is something we don’t talk a lot about in Western. Western medicine is so allopathic. You have a symptom, oh yeah, we created a pill or a drug or something for that. Plant based medicine just not at all. Right?
Tim Pickett:
It’s one of the problems we have with cannabis, I think, is the doctors, the providers, they have a hard time using a drug that is so broad.
Collin Mekan:
Yeah. Figuring out how to actually dose with it.
Tim Pickett:
You’re trying to create a solution to one symptom, but you’re using something that affects multiple systems.
Collin Mekan:
Oh, it’s phenomenal.
Tim Pickett:
Yeah. Which is [crosstalk 00:18:35] for us, for you and I, this is why wouldn’t you?
Collin Mekan:
Why wouldn’t I.
Tim Pickett:
Why wouldn’t you do this? It’s not only going to help you with your pain, but your headaches and your attitude, your anxiety.
Collin Mekan:
I see our endocannabinoid receptor system, I know the way that it works with me when I use marijuana. But to see it affect the elderly, I feel almost like our CB system was designed for them.
Collin Mekan:
As you get older, I mean it’s hard to go through life without one of these qualifying conditions. To even have our endocannabinoid receptor system in the first place blows my mind. People say it looks like we’ve evolved side by side with this plant to actually have that system.
Collin Mekan:
But more likely than not we’ve just been eating the animals that will ingest it, I suppose. But the fact that it’s there for us to tap into as a processing unit, I find that fascinating. The fact that we can manipulate it with layering, I find once you start layering and manipulating your CB system, you really take control of it and it helps you process all types of things you don’t even realize.
Collin Mekan:
I mean I think of the analogy of walking to your car and then dropping your coffee just as you open the door and ruining your day and you’re crying. Or else dropping your coffee and laughing it off and saying typical. You know? How do you process your stress throughout a day? How do you process trauma without even noticing it? It’s so subtle, it’s quite beautiful.
Tim Pickett:
I like your attitude about the plant.
Collin Mekan:
There’s spiritualism to it, in a way.
Tim Pickett:
That’s something we don’t even hear. We don’t almost have time, it seems like, to talk about the spiritual side of cannabis.
Collin Mekan:
No.
Tim Pickett:
But these psychoactive medications and the plants that are so psychoactive, peyote and ayahuasca and these other-
Collin Mekan:
Shifts your perspective a little bit.
Tim Pickett:
Yeah. When you talk about evolving next to the plant and the shaman or the medicine person in the tribe would help people use things like this, it wasn’t just about medicine. It really was about that spiritual experience.
Collin Mekan:
Connecting you to the earth, set in the setting almost. Setting intentions.
Tim Pickett:
It’s a whole ‘nother realm of cannabis as a medicine that we talk about quite a bit, I guess. It’s one of the reasons why I think people have a hard time getting away from, like rolling a joint. Right? Because it’s not just the joint, smoking the joint, that was [crosstalk 00:21:18].
Collin Mekan:
It’s the ritual.
Tim Pickett:
It’s the rolling, yeah.
Collin Mekan:
How tight it is.
Tim Pickett:
Yeah. And that experience of grinding. I think we get that with the vaporizer.
Collin Mekan:
I find that we can. I mean it’s really hard for me to go back to that experience. I mean I feel like I’m wasting so much of it, and I also don’t want to get arrested, Tim.
Tim Pickett:
Yeah. The law [crosstalk 00:21:39] we have had, in fact, I had a patient, I think it was a couple of weeks ago, who got a ticket for having papers in their trunk.
Collin Mekan:
Oh no.
Tim Pickett:
Yeah.
Collin Mekan:
No tobacco to go with those papers?
Tim Pickett:
Yeah, no tobacco to go with the papers and there you go. They got a ticket for paraphernalia.
Collin Mekan:
That’s quite unfortunate to hear those stories.
Tim Pickett:
Even though they had a card.
Collin Mekan:
But I mean we still have to be careful. It’s still a fledgling industry and people are still learning the laws. As we go, even some of our law enforcement, I suppose.
Tim Pickett:
Sure. Have you ever run into law enforcement with cannabis?
Collin Mekan:
No, I am lucky. I have always abided by the laws, Timothy Pickett. But I have been quite lucky. As I got older, I honestly had this… I was tapping into some of my privilege that I didn’t even recognize was there.
Collin Mekan:
Just by the look of me. I like to look fairly respectful to my peers and people that I meet, a way to honor them I suppose. But also I wasn’t somebody that you would really pin as…
Tim Pickett:
Pin as a lawbreaking-
Collin Mekan:
As an outlaw, [crosstalk 00:22:48] Tim. As an outlaw.
Tim Pickett:
As somebody who had two pounds of weed.
Collin Mekan:
Which I never did.
Tim Pickett:
[crosstalk 00:22:53] no, I mean well, I didn’t either. I totally agree with that privileged idea too.
Collin Mekan:
Oh, it’s embarrassing to look back on to now.
Tim Pickett:
Yeah. So we didn’t get in trouble, which was good. Thank God we didn’t get in trouble. Right?
Collin Mekan:
Ironically too, I have a face that police officers do not seem to enjoy very much as I was growing up. All of a sudden they got a lot younger than me, that was a strange shift as well. When that cop walks up to your window and-
Tim Pickett:
And they’re younger than you?
Collin Mekan:
They’re like 20 years younger than me.
Tim Pickett:
How old are you?
Collin Mekan:
I’m 40 years old now. I’m a man. I’m a man now, Tim. I made it.
Tim Pickett:
You survived.
Collin Mekan:
Yeah, I was in Scotland for my 40th birthday, it was quite the experience.
Tim Pickett:
Congratulations on being 40. 40 was fun.
Collin Mekan:
It feels good, it feels good.
Tim Pickett:
40 was a fun year. It is a novel year, right?
Collin Mekan:
You’ve told me it gets worse after this. You say, “Wait until you’re 43.”
Tim Pickett:
[crosstalk 00:23:53]. Yes. For those of you out there, for those of you whoa re 39, 40’s great. It’s really there’s a novelty to it.
Collin Mekan:
You’re bringing me down, man.
Tim Pickett:
Yes. And 41 is even not so much worse than 40.
Collin Mekan:
Oh great.
Tim Pickett:
42, you start to think shit, I’m kind of knee deep in this.
Collin Mekan:
There is no birthday after this.
Tim Pickett:
Yeah. And 43 and you realize what everybody says it’s true, Colin. As you get older, it is harder to recover.
Collin Mekan:
Oh, 100%. I keep convincing myself that the weather’s going to be changing any day now because I can feel it in my knees and my shoulders. They’re tight like rubber bands, Tim, it’s terrible. I need to stay medicated.
Tim Pickett:
I noticed when I hurt my back it took a lot more cannabis and THC than I thought it would to really dig in to severe pain.
Collin Mekan:
[inaudible 00:24:57] CBG, CBD, CBN, and CBC. A little bit of THC is great but they really work best in combination with each other. But those other cannabinoids, I mean that’s where the real miracles are happening.
Collin Mekan:
They’re all antiinflammatory, almost all of them help you fight against pain and process that. It’s pretty amazing. I wonder what the rest of the cannabinoids are going to end up doing in the end. I wonder if we’re going to cure brain disease. I don’t think we’re that far away from it, in all honesty.
Tim Pickett:
We might not be [crosstalk 00:25:26]. For those of you who don’t think there is enough evidence for cannabinoid medicine, I think you’d be… I just don’t think… Well, I don’t agree with you.
Tim Pickett:
This is definitely a plant that’s been studied more than probably any other plant that’s ever grown.
Collin Mekan:
It’s one of our oldest medicinal plants, yeah.
Tim Pickett:
Right. And used probably as much or more than any other plant has been used as medicine, ever to grow. That’s a pretty big statement, I guess. I guess I don’t know that for sure.
Collin Mekan:
But, Tim, I am apt to believe you. I feel like I trust the things you say. I’m going to go with that.
Collin Mekan:
With the way that we can dose now too, it amazes me. As I started to educate myself, I like to tell people I found that this is truly the ideal way to be dosing when it comes to flower. I mean still, I mean rolling the joint, passing it around with your buddy, honestly there’s nothing more communal than that. It’s such a unique, personal experience.
Collin Mekan:
But there’s nothing [crosstalk 00:26:28] the peace pipe. You create a circle, you pass it around. I think it’s very communal. Something that [crosstalk 00:26:36].
Tim Pickett:
COVID has ended that too.
Collin Mekan:
Sure.
Tim Pickett:
Not only the flame laws here in Utah, but I mean-
Collin Mekan:
Yeah. People are less apt to pass on a-
Tim Pickett:
Lick each other’s lips, pass it around the circle.
Collin Mekan:
Oh, that’s what I miss before those COVID days, is licking each other lips around the circle. I don’t remember that very well, but I mean if that’s your pre-COVID. I do not judge, Tim. That’s one of the great things about our community.
Tim Pickett:
I love layering and we talk a lot about this with our patients. The oral, using an oral method first and then layering on top of that. I found especially with my back that, to your point about cannabinoids, CBC, CBD, CBG, you don’t get a lot of those with the oral stuff. Where you get a little more of the entourage effect with the flower.
Tim Pickett:
Which really seems to make layering more efficacious, is the word I would use. More useful from a medical standpoint. I hear you talking about that to patients all the time.
Collin Mekan:
Oh, I think it’s really key, is trying to find ways to fill up those receptor sites so you have that entourage effect with full spectrum of all those minor and major cannabinoids that are available to us. It’s really hard to do that because I mean usually your flower’s going to have some THC, maybe some CBD. Same goes with cartridges, can be THC with maybe one or another minor cannabinoid.
Collin Mekan:
If you can find a good non-psychotropic cartridge, I think that’s amazing for layering. I’d love to find some really nice non-psychotropic full spectrum tinctures that we could offer as well.
Tim Pickett:
Yeah [crosstalk 00:28:33]. When you talk about non-psychotropic, we have one, it’s made by Clean Leaf, Kyle Egbert. And Logan. Great guy.
Collin Mekan:
Absolutely. Great job as well.
Tim Pickett:
He does.
Collin Mekan:
In it for the right reasons too, which is something that’s really inspiring in this community. I don’t know if a lot of people know this, but there’s a huge amount of people in this industry that didn’t get into it because of them. They got into it because of a family member or something along those lines, that inspired them to do so.
Collin Mekan:
It’s just really inspiring to see people want to do it because it’s medicine and it’s helping people and that’s their true motivation behind it.
Tim Pickett:
Yeah. You describe these non-psychotropics and I think they’re really undervalued.
Collin Mekan:
Absolutely.
Tim Pickett:
In the medical marijuana market itself, because I mean you come here, you come to our clinic for an evaluation for a card to use THC. A lot of our patients undervalue the other minor cannabinoids when they come here.
Collin Mekan:
That’s why it’s our job to bring it to their attention, Tim. If they didn’t know about these things, we can’t send them on their path correctly. I feel like it’s almost our obligation to bring these things to their attention, let them know what their options are really. That keeps them excited in the program, I believe.
Tim Pickett:
Over and over people who’ve used cannabis for three, four, five, six months will come back and then realize oh wait, there’s more to it. Right? Phase one seems to be learning how to associate when you get high and what’s that like and dealing with delta nine and that.
Collin Mekan:
Right. It seems so far away to me, I have to remember that it affects people this way.
Tim Pickett:
Yeah. Then seems like phase two, or phase three is-
Collin Mekan:
Dialing in your dosing.
Tim Pickett:
Yep. And figuring out that there’s, wow, there’s more to the plant than just the psychotropic effects.
Collin Mekan:
So much more to it. I mean I think that the THC gets you into it originally, if you’re younger. But man, [crosstalk 00:30:40].
Tim Pickett:
It’s the rest of the plant that really has probably more, well, certainly more of the actual healing benefits come from the other cannabinoids and things inside the plant, than THC.
Collin Mekan:
100%. I mean THC is lovely as well. I think of it as a vehicular molecule, in combination with all of them together it helps it travel up the central nervous system. Really, they do work best in combination.
Collin Mekan:
A low amount of THC, in all honesty, goes a long way when it comes to the healing properties of this medicine.
Tim Pickett:
You were saying, I caught there, that you don’t get high a lot.
Collin Mekan:
Oh, I haven’t gotten high in years, Tim. But I do stay fairly medicated throughout a day. Excuse me. I was just… I would say my tolerance is fairly high. My wife recently called me a pothead and I was… I won’t lie, that hurt. That cut deep.
Tim Pickett:
Cut deep.
Collin Mekan:
But I could probably utilize a tolerance break, but then I wouldn’t be able to move throughout the day as seamlessly as I do.
Tim Pickett:
What’s a tolerance break look like for you?
Collin Mekan:
Oh man. Sadness. I don’t know. For me it is very habitual, but also I’m very familiar with my body and how I try to fill up my receptor system. It wouldn’t be the same without THC.
Collin Mekan:
I also have crippling social anxieties, which I’m able to mask with this. It’s something that I overcome and I get to decide not to be socially awkward. I face it and just own the awkwardness of the moment. I live in an awkward world too.
Tim Pickett:
We all live in an awkward world.
Collin Mekan:
Thank you. Thank you, Tim.
Tim Pickett:
I’m surprised that you feel like you have this anxiety.
Collin Mekan:
That’s because my tolerance level, Tim. See? That’s manipulating my endocannabinoid receptor system right there.
Tim Pickett:
Yeah. If you are listening to this, Collin is a perfect example of what you can do with a cannabis blend.
Collin Mekan:
However, I did start younger than I feel like I should have. I probably started smoking around the ag of 16 and my brain hadn’t fully developed. And look at me now, Tim. Look what it did to me.
Tim Pickett:
When was the first? Take us all the way back to the first time you were exposed to cannabis.
Collin Mekan:
I was breaking into the artistic world in high school, trying to develop my bravery I suppose. I was learning that I can sing, I was feeling pretty artistic. While building my confidence, I had my art friends, I suppose, and I tried it on seven different occasions.
Collin Mekan:
I thought I was immune to marijuana. Then we were on our way to see The Big Lebowski and I remember driving downtown Kalamazoo, Michigan and all of a sudden there’s a joint in front of my face and I took two hits. I remember the spatial, what you call, all of a sudden my seatbelt grew in size immensely and I did not know what was happening.
Collin Mekan:
But it turned out I was just falling towards the seatbelt. In my vision, it was growing as I was getting closer to it. After that I remember thinking it was like walking through a crowd of people at the movie, like I was in a dream and moving so fluidly.
Collin Mekan:
Afterwards I heard that it was because I was walking around, moving my arms like I was underwater. Back then the THC had a really strong effect on me. It was like I was in a dream and I was pretty hilarious I suppose. I made a fool of myself quite a bit.
Collin Mekan:
But I am so far away from that I forget that it has that effect on people. That’s, I believe, part of the stigma about marijuana too. People believe that the effect that it has on them is the same effect that it’s going to have on everybody. So if it made them a fool, they think that there are a lot of stoners out there walking around in a daze.
Collin Mekan:
I found the other side of that. I forget that it has such a strong effect on people because I know the effect that it has on me. That’s knowing your body, I suppose, and really exploring your different methods.
Collin Mekan:
Oh, come back to this. You had mentioned earlier how I dose. I like to utilize everything with layering. I love having a tincture, I really like those non-psychotropic items. I think this is one of the only medicines that layering is actually an option.
Tim Pickett:
It is one of the only. I mean there’s certainly no other medication that I’ve prescribed that you think about. You know what [crosstalk 00:35:29] you should do, is you should take half a milligram of this and then you should-
Collin Mekan:
Drop some under your tongue and see what that does.
Tim Pickett:
Yeah. And then inhale it. Well, I mean take an inhaled method like albuterol. You’re not going to layer albuterol in a pill form and then an inhaled form. No. Your heart rate, for one, would just go through the roof.
Collin Mekan:
[crosstalk 00:35:50] it made me feel weird.
Tim Pickett:
Yeah. Or your blood thinner, your blood pressure medication, your insulin. I guess we do layer diabetes medication. We take metformin and then some people take insulin on top of that, if their diabetes is bad enough. But that’s just not a great example, compared to cannabis.
Collin Mekan:
There’s not a lot of things to compare.
Tim Pickett:
There’s just not a lot of, yeah. When you’re talking about how you felt when you first used or you first felt the effects of THC when you have that joint in high school, and I feel the same, that same stigma. Not only for people who use it themselves but for also people who’ve seen one other person high or one other movie with a high person, with that stereotypical on the couch. Pineapple Express comes to mind.
Collin Mekan:
It can happen, though.
Tim Pickett:
[crosstalk 00:36:51] yeah, those definitely can happen. But that’s not the baseline. There are 45,000 Utah patients. You think all of them are-
Collin Mekan:
Intelligent professionals, caring, empathetic people.
Tim Pickett:
[crosstalk 00:37:05] who really want to feel better.
Collin Mekan:
The Uplift program has been such a success. I find that very inspiring, to see that this community, I mean if not generous, we want to share this experience.
Tim Pickett:
We had a patient [crosstalk 00:37:16] today give $104.20.
Collin Mekan:
104.20, yes.
Tim Pickett:
104.20.
Collin Mekan:
Gentleman right after her gave 50, so it’s-
Tim Pickett:
Very committed community.
Collin Mekan:
Absolutely.
Tim Pickett:
Not only of people here who work here and work in the industry, like you and hopefully people say that about me and the providers that we have. But all of the staff here seems like they’re not only just employees but they’re really activists. We have [crosstalk 00:37:45] talked about this.
Collin Mekan:
Well, this is your team, Tim. We’re all into this because we’re real passionate. At least I know I, for one, am definitely into this because I felt the universe bring me here and I feel incredibly passionate about that. I want to share that with other people.
Collin Mekan:
It gets me so excited just even talking about it. I love it. I feel like we’re really going somewhere with this. You’re quite an inspiration to a lot of people, seeing how you’re doing this correctly.
Collin Mekan:
I think you’re setting a template for other states that haven’t been able to do this quite yet. The success that we’ve seen in Utah has been phenomenal, it’s been crazy. I mean they expected 10,000 cardholders. What, we’re at over 40?
Tim Pickett:
Yeah, 4, 45 plus thousand and rising. Yep.
Collin Mekan:
Then your podcast. I mean your YouTube, Discover Marijuana. I know that’s over 2,000 listeners at this point.
Tim Pickett:
Yeah, over 2,000 subscribers [crosstalk 00:38:38] I think. As of right now when we’re recording this. In fact-
Collin Mekan:
Well, hopefully we can bring that up.
Tim Pickett:
For those of you who are listening to this and on the release of this podcast episode, if you’re not subscribed to the Discover Marijuana channel, we are doing a giveaway in March.
Tim Pickett:
This week I think it’s a micro, DaVinci micro. It’s a glass stash jar, medicine jar. It’s a t-shirt I think. I don’t know, what the heck are the rules? I don’t know. Somebody knows the rules. If you go to Discover Marijuana on YouTube or you follow us on Instagram. Go to our website.
Collin Mekan:
Tim, do you not [crosstalk 00:39:20]?
Tim Pickett:
There are rules to win. Okay? There are rules. I can’t do this all by myself anymore.
Collin Mekan:
Put me in the running. I could definitely use one of those DaVinci micros.
Tim Pickett:
Micros, it is so small. But I use the IQ2.
Collin Mekan:
Yeah, me too.
Tim Pickett:
It’s really become my favorite vaporizer.
Collin Mekan:
Absolutely.
Tim Pickett:
The taste is good. The taste is as good as the Firefly but that seems like for some reason the pull is better.
Collin Mekan:
I will miss the Firefly, Tim.
Tim Pickett:
I do love the Firefly [crosstalk 00:39:52].
Collin Mekan:
But the DaVincis are lovely, the 10 year warranty is amazing.
Tim Pickett:
Have you used the phone app?
Collin Mekan:
No, I don’t have enough space on my phone.
Tim Pickett:
You have to download… Okay, it’s a little bit clunky because you can’t download the DaVinci app in the App Store, from an Apple phone. So you got to download this browser.
Tim Pickett:
I downloaded the browser and then you can connect it to your IQ2 and then you put in how much THC percentage your flower is, if it’s a new loaded bowl in the DaVinci, and it will tell you how many milligrams of THC. I mean it estimates it based on how much you pull on the thing.
Tim Pickett:
But surprising how… And it doesn’t even need to be accurate to the milligram to give you a sense of how much you’re getting, because let’s say you inhale up to where it says 30 milligrams. Well then, all you got to do next time is inhale till it says 30 milligrams again.
Collin Mekan:
Wow. That’s what makes it the precision vaporizer that it is. It dials in the temperature but also you can really see how you’re dosing. It’s pretty amazing.
Collin Mekan:
For somebody like me, I wouldn’t really utilize that very often. I don’t want to say technology is intimidating to me, Tim, but I’ve worked in cultivation for a while and I’ve always leaned away from technology. Up until now I suppose.
Tim Pickett:
It’s you’re more of the dirt grubber type?
Collin Mekan:
Oh absolutely. The friendly fungus in there, helps fight depression and keeps you happy.
Tim Pickett:
When you… What’s your favorite place to go? You went to Scotland for your 40th birthday?
Collin Mekan:
I did. My wife and I travel fairly often. I wouldn’t be able to do this at all without her in my life. But our family lives in Scotland, so we got to go over there and see them.
Collin Mekan:
It was beautiful, it was amazing. But we were also locked down. My birthday is the day before New Year’s, it’s December 30th. We wen there for Hogmanay and we’re not able to really experience Hogmanay. But I do have some heritage there, I got to follow that ancestry line and it was fascinating. It was a beautiful experience.
Tim Pickett:
Where’s the next trip?
Collin Mekan:
We are going to Costa Rica. Yeah, it’s my wife, the amazing saleswoman that she is, she got top sales and won us a trip to Costa Rica. Last time she won us a trip to the Bahamas. So I need to request a little time off, Tim.
Tim Pickett:
Well, if it’s to Costa Rica, there you go. It’s fine. Take all the time you need.
Collin Mekan:
What a guy.
Tim Pickett:
You know? Health and happiness in the team has got to be… We are literally in that business. If you don’t live it on the employee side and on the team side, I think that would be pretty hypocritical.
Collin Mekan:
This is a pretty amazing job, Tim, because of those reasons. It’s a job where you really feel as an employee that you matter. You can give you some direction and helps motivate you. At least me I know. But I really appreciate [crosstalk 00:43:05].
Tim Pickett:
Thank you, Collin. I think that you get a lot of that from everybody else on the team too. I think we-
Collin Mekan:
Oh, we uplift each other. Right?
Tim Pickett:
Yeah. We do. I’ve never worked at a place like this. When I worked in surgery, people were always pissed off at us for all the pain and suffering we caused. We did solve a lot of problems for people, surgically.
Tim Pickett:
But here it seems like everybody’s happy when they leave. Not only the team is happy but the patients are all happy. Before COVID hit, I mean I would get a hug from two out of three patients.
Collin Mekan:
I’ve gotten a handful of hugs. I used to gauge my success of the day on how many hugs people would try to give me.
Tim Pickett:
Yeah. Go into another area of medicine and that’s just not the case. For most people who are here, they’ve never worked in any other part of medicine. They came into this because of the cannabis draw.
Collin Mekan:
Sure. Something about it’s appealing. I don’t know what it is. It’s specialized, I mean [crosstalk 00:44:07].
Tim Pickett:
We get to bridge both worlds. You get to bridge something that you love already, that you’re into already, you want to share with everybody else, the cannabis part. You get to work in medicine where you’re part of something that’s an industry that’s really been run by the pharmaceutical companies for so long. It’s like a movement against… It’s like the anti-medicine.
Collin Mekan:
Yeah. What do you call it? An exit drug.
Tim Pickett:
Yeah. Yeah. Yeah. I think we’re doing a pretty good job in Utah. And thanks to this program, thanks to what we do, I think that’s the case.
Collin Mekan:
I’ve been reading up a lot on this, Tim. We are the people that keep ourselves educated. I know that California got the ball rolling but the way that Utah’s doing it, ironically, I mean what better place to do it for one. I mean reeducate, remedicate, and destigmatize.
Collin Mekan:
I mean the success rate of this is pretty amazing here in Utah. I give it up to our community. We’re destigmatizing it every day, just by sitting in front of each other and educating ourselves.
Tim Pickett:
Talking about it out loud.
Collin Mekan:
Out loud.
Tim Pickett:
As if it’s not illegal.
Collin Mekan:
The fact that it’s so patient oriented too, that we’re excited for these people. It’s not just about pushing the medical card. It’s about assisting them and giving them the tools to succeed and want to continue with the program. That’s why the program is working in Utah, I believe, is we’re doing it right somehow.
Tim Pickett:
It seems like there’s a lot of good things happening. What’s your favorite strain?
Collin Mekan:
Ooh, I love this question because I’ve really come to realize it doesn’t really come down to favorite strain for me. They’re all hybridized as it is. It’s all about terpenoids, flavonoids, and cannabinoids, Tim.
Collin Mekan:
Once people start paying attention to that, they can believe that they love Bubba Kush and Bubba Kush has never done them wrong. But in reality they probably loved one of those harvests, because every harvest and every batch is different from the next.
Collin Mekan:
Unless you’re paying attention to that one did you right, let’s see what the THC level was, let’s see what the terpenes involved were, once you can dial into that I think then that’s what people are really into, I believe.
Tim Pickett:
Do you think that having the consistent flower choice is important for patients? Or do you think patients should be using multiple strains and that’s just an evolution? There’s some people in some camps who are like I want the same strain every time, that’s what I need and want. And then there’s this reality that a mother won’t last forever, a cannabis mother plant won’t last forever.
Tim Pickett:
So that is just not [crosstalk 00:47:08] a realistic expectation. When you talk about every harvest being a little bit different too.
Collin Mekan:
Also your CB system’s always changing. Every day you wake up it’s a little different than it was before. I really think it is great. Keep a journal, we bring this up quite a bit. Keep a journal of what’s working for you and go back to it.
Collin Mekan:
But as your tolerance builds and you can utilize [inaudible 00:47:35] a little bit more, it’s always changing. It’s as unique as we are and just as we’re changing everyday so is our endocannabinoid receptor system. I just love saying it, it’s a beautiful beautiful thing.
Tim Pickett:
It is. It’s funny to hear you say it too.
Collin Mekan:
I’ve really figured it out. I say it trippingly off the tongue.
Tim Pickett:
What about if you could grow any strain? Would you be able to pick one or would you just grow a bunch? Would you grow some 73 dayers, some 62 dayers?
Collin Mekan:
If I could, I would grow the longer.
Tim Pickett:
Why the longer [crosstalk 00:48:12] ones?
Collin Mekan:
I think that with these shorter cycles, unfortunately there are some strains that we’re never going to be seeing in Utah because of that. Unless there’s some cultivation companies that take it upon themselves to do these longer strains.
Tim Pickett:
[crosstalk 00:48:26] I know I hate to bring this up, but there’s some production. There’s a lot of just straight up production happening in Utah. They’re limiting their strains to not even [crosstalk 00:48:39] yeah, not allowing the full maturity. Right? They’re not letting clear, they’re to getting clear on the trichomes.
Collin Mekan:
Sure. Well, they go from clear, they get a little milky. It’s a beautiful thing. But also I understand why they’re doing that right now. As the community grows every day, these companies are still trying to expand and keep up with this growing community.
Collin Mekan:
Right now there’s not… I mean they’re doing the best they can. I got to give a shout out to all those cultivation companies, because I’ve worked for two of them and I can honestly say they are amazing. Buy locally.
Collin Mekan:
I think of it like local honey curing your allergies for the season. The closer to your backyard the better. I think the same thing about these plants. They’re breathing our air and drinking our water and they’re in the same environment that we are in. I think they help out quite a bit.
Tim Pickett:
I think the intention actually does make a difference in the medicine. That’s one of the reasons why I think homegrown would add that different level of care. I think if you are growing your own medicine in your own backyard, I think that would change your experience a little.
Collin Mekan:
You say production-wise too, I can say I know that these cultivationists, they put their heart and their soul into it. And they love these plants. I would go in and greet my mothers every morning, say good morning, ladies, how is everyone today. How was your evening? I’d tell them my dreams and ask if they had any nightmares from the night before.
Collin Mekan:
I loved these plants, though. When they’re tending to them, they take great great care of them. They truly do.
Tim Pickett:
They do. Well, just like everything else in this industry, you don’t get into… You get into it because you want to get into it. Right? I don’t feel like there’s very, if any, people I’ve met in growing, production, that literally just got in it because they were-
Collin Mekan:
Look at me now, Mom.
Tim Pickett:
Yeah.
Collin Mekan:
Shout out to my mom, by the way. I love you, Mom. And look at me now.
Tim Pickett:
Yeah. I mean we want to be a part of this movement.
Collin Mekan:
Absolutely. I feel really passionate about that and excited to see where this is going to take us. I don’t know. I feel good about it. Like something’s telling me stick with it, you’re making a difference. I get to see that in these patients almost daily and it’s really inspiring. Makes me feel like I am doing something right and that I truly am part of something that’s bigger than me.
Collin Mekan:
I feel like I’m part of this community and helping it grow all the time.
Tim Pickett:
You certainly are, Collin.
Collin Mekan:
Cultivating the community.
Tim Pickett:
This has been really fun. It’s fun to chat with somebody face to face. I don’t do the podcast face to face very often.
Collin Mekan:
It’s always a pleasure to chat with you, Tim.
Tim Pickett:
It’s really fun. Is there anything else that you think we missed, you wanted to talk about that we didn’t?
Collin Mekan:
I’m probably going to listen to this later and I’ll be in the shower putting in my conditioner in my hair and thinking why the hell did I say that. You know? Shame, right?
Tim Pickett:
Too late, buddy. Too late.
Collin Mekan:
Let’s discuss shame in the cannabinoid.
Tim Pickett:
It’s totally fine. Just switch over to CBN or use some other cannabinoids. Reduce that anxiety and-
Collin Mekan:
Layer.
Tim Pickett:
Layer.
Collin Mekan:
There it is. Stay safe out there, Utah.
Tim Pickett:
I’m going to let you… Okay. There you go. For the sign out today, before we sign out or we sign off, Utah In The Weeds podcast, if you’re not subscribed and any podcast player that you have access to, please subscribe. Go to Discover Marijuana on YouTube, subscribe there. You can listen to the podcast there, that’s a great place.
Tim Pickett:
That’s actually a better place, in my opinion, because one, I can see it. But two, if you have questions you can comment and we answer all of the comments.
Collin Mekan:
Please comment.
Tim Pickett:
Yeah. Please comment, because your questions are questions that somebody else has and we can answer them and we don’t have to keep it a secret just between you and I, Collin.
Collin Mekan:
Isn’t that a way to get in the running too?
Tim Pickett:
It is. I think commenting on the videos plus being a subscriber. Again, there’s rules to giveaway and I don’t know all the rules. But I promise in the intro I will give you all the rules.
Tim Pickett:
Utah In The Weeds, thank you for being here Collin.
Collin Mekan:
Tim, it has been a true pleasure. Thank you for having me, absolutely.
Tim Pickett:
Everybody-
Collin Mekan:
Play the Kenny G. Oh, yes. Stay safe out there, Utah. Did I say that right? Is that… Thank you, everybody.
Tim Pickett:
You just… Perfect job, Collin.
Collin Mekan:
Appreciate it.
Episode 90 of Utah in the Weeds is for anyone interested in using cannabis for pain management. Listen to a presentation on this topic from Tim Pickett and his Discover Marijuana co-host, Blake Smith.
Tim Pickett:
Welcome, everyone, out to Utah in the Weeds. My name is Tim Pickett, and this is episode 90, episode 90. This episode is the episode before my two-year anniversary, and you know what? We go along so fast and we’re doing these episodes. Chris Holifield reached out to me and mentioned, “Hey, you know what came up in my Facebook feed? The fact that this is the two-year anniversary of Utah in the Weeds this month.” I wasn’t even thinking about it.
Tim Pickett:
Next week, we’re going to do something special and give away something for the two-year anniversary of Utah in the Weeds, so stay tuned. Subscribe at any podcast player that you have access to. Subscribe to Utah in the Weeds. Tell your friends we’re going to give away something, something cool. Definitely a sweatshirt, definitely a Utah in the Weeds sweatshirt is coming at you, probably a t-shirt, as well, and then something else that’s a surprise, so there’s the hook.
Tim Pickett:
Today’s episode is with Blake Smith. We did a webinar. We’re going to rebroadcast that because we talk a lot about pain, and we talk about cannabis for pain, so a little more educational, maybe, this podcast. I love to rerelease these webinars because they’re kind of a different style, a little more educational format. You can always catch that webinar on Discover Marijuana on YouTube, just about to hit 2000 subscribers.
Tim Pickett:
If you’re not subscribed to Discover Marijuana, you’re going to want to be subscribed because March is a massive month for giveaways. We’re going to be giving something away every single week on Discover Marijuana on YouTube. If you know what we gave away last time, we gave away a PAX 3 complete kit. We gave away some, I think, PAX 2. We gave away a bunch of clothes and swag. We’re going to blow the doors off this time. Excited to keep these episodes coming at you. Again, subscribe. This is Blake Smith and Tim talking about pain and the Utah cannabis program and how it might help you. Enjoy.
Tim Pickett:
Welcome, everybody, out to our webinar, Discover Marijuana webinar series. I’m Tim Pickett.
Blake Smith:
I’m Blake Smith.
Tim Pickett:
Blake is the chief science … You’ve got so many titles. I can’t even keep them all straight. CEO of Zion Medicinal, chief science officer.
Blake Smith:
Yup.
Tim Pickett:
Zion Medicinal.
Blake Smith:
I’m also-
Tim Pickett:
I … Go ahead.
Blake Smith:
I’m also the chief science officer and CEO of Intrepid Biosciences and the chief technical officer for [inaudible 00:03:08] and probably the chief science officer for the Henderson Group.
Tim Pickett:
I think you may need to start saying no to some things.
Blake Smith:
That’s absolutely right. That’s absolutely right, but they’re all doing good things. They’re trying to make life better for people, and they want to do it doing cannabis science and nanotechnologies and so how can I say no?
Tim Pickett:
I know. That’s what’s so hard. Tonight, and for those of you who don’t know me, I’m a medical cannabis provider. I specialize in taking care of people who need to use medical cannabis for their medical condition. I teach people how to use cannabis. I educate them on all of the things surrounding cannabis. I love it. It’s so rewarding and so fun to watch people feel better with something natural instead of something and reduce the use of pharmaceuticals.
Tim Pickett:
Tonight, we’re going to be talking about pain specifically, kind of all about pain, chronic pain, acute pain, cannabis use for pain and so well titled here, The Hurt Blocker. Yeah, again, we’ll talk about acute and chronic pain. We’ll get into a little bit of the mechanism of action of cannabis and cannabinoids, what we know and maybe what we don’t know. We’ll talk a little bit about cannabinoids and terpenes that may be good for pain, deep dive into THC, and, of course, our favorites, some suggestions at the end.
Tim Pickett:
Let’s talk about acute pain first. What is acute pain? We’re talking sharp pain, sudden pain. Ten days ago, my psoas spasmed up, and I was completely incapacitated. That’s acute pain, couldn’t walk from the bedroom to the kitchen. Acute pain disappears as injury heals. That’s the key with acute pain. It happens now, but it’s going to go away. We have a good process in the body for acute pain, broken bones, surgery, of course, labor and childbirth. God bless them, dental and orthodontic work and everything, bump your hand.
Tim Pickett:
Chronic pain is a little different. In Utah, for the cannabis program in Utah, chronic pain is two weeks or more of pain that is not well controlled with a typical treatment or medication or therapy. Typically, chronic in medicine is something that is longer than three months, tends to be kind of that threshold of chronic when we talk to patients and something lasts a little bit longer than three months.
Tim Pickett:
The issue with chronic pain is sometimes the … With acute pain, you get a broken bone. You have pain. You have healing. You have no more pain. What if your bone healed, but you still had pain? That’s kind of one of the keys with chronic pain. It’s a disassociation with what’s happening physically, and it becomes this longterm thing almost regardless of whether or not you have some type of physical or mechanical dysfunction or problem in the body, but you just have this pain response. [crosstalk 00:07:02]. Go ahead.
Blake Smith:
One other thing that often causes this is when you think about injury, so you break a bone, for example. You have nerve bundles. You have nerve fibers. You have certain areas in the body that are hard for your body to get all of the repair mechanisms into those spaces. Your bone may heal within eight weeks completely, but the nerve fibers themselves may not heal in that same amount of time and so longer. What will often happen with chronic pain is your acute pain masks something that’s going to last much longer and so as the acute pain starts to go away from the broken bone or the burn, you’ll discover that you had other injuries that you were unaware of that is going to take a lot more time to get fixed.
Tim Pickett:
Yes. Nerves are notoriously hard to heal, if they ever heal, a lot of times. I think in school, we were taught that nerves can grow about a centimeter a year, so sometimes, you get some nerves back. Arthritis here, I want to highlight arthritis because arthritis is it’s the number one cause of chronic pain, I think, nationwide. It has to do with the aging population, frankly. Everybody’s going to get arthritis, eventually some type of arthritis from overuse. We just, we’re not built to live forever.
Blake Smith:
Well, and arthritis particularly occurs where you have joints and you’re not using bone or muscle or tendon. It’s, literally, like the material in your nose, the material in your ears, but in your joints, typically, because the way this typically works is you have all these self-recognition proteins that tell you in the case of Tim, “Hey, I’m Tim. I’m a Tim cell.” Then an immune system cell will go by and communicate and say, “I’m also a Tim cell. Everything’s cool.” Those transmembrane-bound, self-recognition proteins inside your body identifies things that are foreign invaders and so it mounts an immune response when it says, “Hi, I’m Tim.” And the other one says, “Well, I’m not,” or, “I’m Bob,” or whatever it is.
Blake Smith:
What ends up happening there is when you look at your joints with collagen and things like that, you break off through multiple use those was transmembrane-bound proteins and so all of a sudden, your immune system doesn’t recognize your own joint cells as being self cells. One of the first immune responses you have is to attack it with chemicals, histamines, [isophils 00:09:50], neutrophils and all of these other things. That is where you get this red inflammation and the locking of the joints and pain with arthritis. The problem is you can repair those proteins for most cells. You cannot repair them for your joints, for cells that are, basically, fixed, that don’t have an ability to multiply and then replenish themselves. Sorry, I went on a diatribe, but [crosstalk 00:10:21].
Tim Pickett:
No, you didn’t. No, you absolutely didn’t. Now let’s switch over to the mechanism of action, what we know about … Well, we were really talking about kind of the mechanism of pain, right? We’re talking about when we talk about the mechanism of action, explain a little bit more about the mechanism of action. It’s hard to describe the mechanism of action of the endocannabinoid system as a whole, right, other than to say from my side, when I talk to patients, I talk about the fact that cannabinoids are going to stimulate healing when it needs to be, when something needs to be healed. Cannabinoids are going to inhibit things when they need to be inhibited. I use broad terms when I talk to patients because the endocannabinoid system is a system that strives for homeostasis. It strives for balance, right?
Blake Smith:
Yup.
Tim Pickett:
And cannabis tends to, I feel like it tends to try to balance things.
Blake Smith:
So a body enters into homeostasis because, ultimately, it’s thermodynamically more favorable for a body to do that. The whole purpose of organic life is to fight entropy. I’m getting kind of really big here, but when we think about it, we’re thinking about it like there’s a finite amount of usable energy in the universe. When we say usable energy, we’re talking about energy that can do other things, convert and so forth. Heat energy doesn’t convert back to, say, kinetic energy or heat energy doesn’t convert back to usable other forms of energy.
Blake Smith:
Your body uses energy to stay organized. We’re now talking about the second law of thermodynamics, all ordered things start to move to an unordered state and the only way to maintain that order is to use energy to do so. What ends up happening is your body has been designed, and whether you believe in God or evolution or whatever it is, your body has been honed in based on these laws of thermodynamics to specifically be in its most energetically favorable state.
Blake Smith:
When we talk about homeostasis, what we’re talking about is expending the least amount of energy to do all the functions that your body has to do. Endocannabinoids, or your endocannabinoid receptor system, is a helper to your normal central nervous system at maintaining homeostasis. Think about it like if you have a bag of M&M’s and all those M&M’s are neurotransmitters. If you have more brown ones, your body’s natural inclination is to get more brown ones into equal piles onto both sides. What ends up happening is if you have imbalance, cannabinoids can help reestablish balance in places where you’re either having deficit or too much. Anyway, sorry.
Tim Pickett:
No. I think what’s important there is we understand the broad piece of the endocannabinoid system, right? We understand broadly what it does and we’re trying to figure out all of the little details. There are certainly too many details that we don’t know, but we know it finds balance. Chronic pain, when you’re talking about pain, it’s essentially trying to figure out the system and try to balance it back out.
Tim Pickett:
There’s a theory. It’s a growing theory that because humans evolved next to the cannabis plant, that cannabinoid deficiency actually almost can be a cause of these chronic problems.
Blake Smith:
Yeah.
Tim Pickett:
Let’s go to we’re talking about cannabinoids for pain relief, terpenes for pain relief. I feel like my favorite terpene for pain relief is beta-caryophyllene. It’s a good antiinflammatory, tends to be strong in strains that are good for pain relief, Kushes and Hazes, but talk [inaudible 00:14:51] information about cannabinoids for pain.
Blake Smith:
Yeah. Again, most cannabinoids are mimicking a natural neurotransmitter that’s already being produced. Now, we don’t know all of them, but we know some of them. When we look at CBC, CBC is typically an anticonvulsant, and it is most effective for things like Parkinson’s and seizure-type conditions that are energetic seizures, not necessarily freezing-type seizures, where all of a sudden you lock. Instead, this is one where you’re having misfires of energy, energetic signals. CBC can help with pain, specifically, because if you’re having nerve misfiring, CBC can help regulate that.
Blake Smith:
When we look at CBD, CBD is mimicking normal GABA pathways. Now, one of the things that’s cool about CBD is it doesn’t inhabit all the normal receptor sites that GABA does, but it inhabits some of them. This is why when people talk about CBD, well, it’s great for pain. It’s great for inflammation. It’s great for stress. It’s great. If you want to know all the things that CBD potentially can affect, start looking at all the different receptor sites and uses that your body has for GABA. That’s why that one becomes so effective in terms of pain relief.
Blake Smith:
When we think about CBG, CBG is absolutely, and you’re going to get to this in your slides, basically CNS pain that comes from the brain down versus pain from an acute place moving back up to the brain. CBG is extremely effective at blocking signaling coming from an acute source to the brain that basically says we don’t have to enact the sympathetic nervous system to start having a histamine reaction, epinephrine, cortisol, and all these other things associated with a pain response, which are almost always associated with fight or flight, right? CBG is effective in that particular space.
Blake Smith:
CBN downregulates, when you’re awake, serotonin pathways. It downregulates also, when you’re going to sleep, the melatonin pathway. If you’re having overall stress or anxiety or sleep issues and that’s causing longterm pain, CBN is effective. Especially if you think about your body does almost all of its repair while you’re sleeping, so if your pain is keeping you awake and you’re not getting good sleep, you’re not fixing the thing, your body’s not fixing those areas of pain, so CBN can be extremely effective there.
Blake Smith:
Delta-8 has a very high absorption cellular rate and so when we look, especially, at organ pain, stuff that’s in the trunk of the body, Delta-8 is extremely effective at lowering inflammation or, at least, the pain response associated with that. Whereas Delta-9 is a more CNS response where your body then responds and stimulates the dopamine pathway, ultimately, and so you mask pain using Delta-9.
Blake Smith:
The terpenes are particularly interesting. You brought up beta-caryophyllene. Beta-caryophyllene and your other caryophyllenes in general are all derived from pepper plants and so at some point, humans were growing weed with pepper plants. Most likely, what we’ve seen genetically is that mostly came from the Middle East. Plants have a unique thing where they will often share genetic and chemicals back and forth with each other. Terpenes are one of the things that plants will freely share back and forth over periods of time in generations and so it’s likely that most forms of weed that are high in caryophyllene were originally derived from the Middle East, but that’s neither here nor there. The point is we know pepper plants are often used for acute pain and relief of those type of things in several ways or forms and that’s the reason why.
Blake Smith:
Here’s the biggest problem with terpenes in general is I believe very, very much that they’re effective. The mechanism of action of terpenes is almost impossible to determine. It’s just like lavender and some of these other things. I don’t think they don’t work. I mean, there’s plenty of studies that show that enough people are affected in a positive way by taking certain types of oils and natural products that it’s effective. When we try to break it down how it actually is a dose response, 10 milligrams of lavender oil equates to this lowering of stress, it’s really hard to do. On the terpene profile, I believe in it, but I don’t know how it’s doing what it’s doing per se.
Tim Pickett:
That’s where you come into more than these cannabinoids, as well, right?
Blake Smith:
Yeah.
Tim Pickett:
We’re describing these, the mechanism of action a little bit, or the function of these cannabinoids in the body, but there are 120 cannabinoids, so most, the vast majority we still don’t know much about.
Blake Smith:
Yeah. Really, most of these start with the precursor molecules. GABA is a precursor molecule. In the case of Delta-9 and Delta-8, it’s anandamide that are initially starting that process for the production of dopamine and so forth. We can look at those precursors, but they’re pretty tightly linked with an ultimate outcome of a final chemical. The terpenes are like, the precursor molecules with terpenes are, like, there’s 30 or 50 of them or even more, so it’s like, well, where does humulene go in and actually cause an effect? I don’t know. We have a grab bag of all kinds of places it could go and all kinds of things it can do. That’s why when you find a really cool combination of cannabinoids with terpenes, high five. Stick with it because there’s something synergistic going on with that combination that is providing the relief that you need.
Tim Pickett:
That particular point right there is good enough to be repeated. When you find a strain or a product and a combination of cannabinoids and terpenes that work for you, you’ve got to write that down. Write the strain down. Write the product down because it’s no kidding that one strain is going to work for somebody and it might not work for somebody else. I think there are probably countless examples of this. One I know of in Israel, a seizure patient who is using a cannabis product, a natural cannabis product, seizures are almost completely gone. Change the formulation, seizures come back. They had to do a lot of research to figure out the breakdown of what they grew.
Blake Smith:
Tim, so you’re very smart, too, and really, really good job on this one because that bears repeating, too. This is the biggest challenge in the marijuana industry as a whole, both on the medical side, as well as the adult use side, getting the same product every single time, produced in the same way, with the same outcomes, is really not many people are doing that or doing that well. That’s one of the things that makes this really important as we do this because we have to treat this like medicine and so that somebody who’s relying on this for relief gets the same thing every time they take it.
Tim Pickett:
Yup. Okay. Let’s dive into Delta-9. Really, in my opinion, Delta-9 is one of the biggest factors for pain relief. It’s because of the disassociation. You’re, essentially, putting your pain over there on the couch. That’s what Delta-9 does, from a practical standpoint. It disassociates the brain and the thought process from that pain and that symptom. People will have headaches or toothaches, and it’s almost like I am my headache or I am my toothache. THC takes the toothache, puts it over there. It doesn’t necessarily take away the pain. It takes away the perception of the pain so that a person can move on and do what they want to do during the day.
Tim Pickett:
I think it’s important to talk about that because we talk about a lot of cannabis users just want to get high. Then we talk about chronic pain and people just want to get high. Well, the truth is people being high, for some patients, is part of the process.
Blake Smith:
Yeah. Look, especially if you’ve been self-medicating for a really long period of time, if you’re self-medicating, how do you know that your self-medication is doing what you need it to do? Well, a head change is a really clear indicator that you know the medicine is doing what it’s supposed to do. We’ve talked about this before. It’s a challenge because you have this legacy group that uses, that that’s the indicator they use, but as we’ve talked about before, it would be really odd if you take a Tums and you got high from that to let you know your Tums is working or your aspirin or something. Most medicine is not designed to have you feel a particular way as an indicator that it’s doing what its job is.
Blake Smith:
This is one of the reasons why a lot of people who are high in THC think that CBD is not very effective because they’re expecting to feel this grandiose change. What I would say is from my case, I have bum shoulders from being too rowdy in my younger days. Without CBD or a lot of NSAIDs, I can’t raise my arm above my head. I just did it right now, but I can tell you it’s because my inflammation is so much lower. It’s not like I take CBD and I’m like, oh, I could do cartwheels now. I don’t feel like a billion bucks. The difference is when I’m sitting here talking with you, I can raise my arms, whereas if I’m not taking it, oh boy, that would probably cause me pain for about two to three days.
Tim Pickett:
It is going to be different for chronic pain. It’s going to be different for acute pain. One thing that I really noticed recently with my, frankly, with my back injury, is you have … Let’s talk about chronic pain for a minute and then acute pain. With chronic pain, I like to have people learn how to low dose or microdose more consistently and then use inhaled methods on top of their low dose because it gives you a more therapeutic, kind of tends to give you more therapeutic effect. The microdose may be at the head change level or below and so just enough maybe disassociation that you know it’s there or, like Blake said, maybe you can raise your shoulder. You don’t feel high, and there is THC on board. It’s disassociating you from your pain, but you don’t know. It’s not enough. It’s enough to reduce your symptoms, but it’s not enough to get you high. That’s ideal.
Blake Smith:
Yeah.
Tim Pickett:
That would be ideal.
Blake Smith:
Yeah. One of the coolest things about THC Delta-9 as a pain reliever, especially for acute use, is like you get a root canal, for example, and they traditionally would give you codeine or whatever it is. What really just needs to happen is basically, you’ve just had your jaw punched a bazillion times. You just need to heal. That’s all that really needs to happen there. You don’t. And so you need some time-
Tim Pickett:
You need time. You need time to heal.
Blake Smith:
That’s right. You just need to heal. Okay. Rather than being loopy with your codeine or something like that, we’ll just go ahead and disassociate using some THC, which is not as much as you have to take on the codeine side. It doesn’t have the negative effects, and it can get you over that acute pain pretty quickly. It’s really a kind of a cool way to think about it.
Tim Pickett:
This is exactly what happened to me with my back 10 days ago. I mean, you lock it up and there’s healing that needs to take place. There’s anti-inflammation that needs to take place. In my case, there was prednisone involved to try to really lower that inflammation and get that going. There was a significant amount of and there was a lot of discussion with a couple of other providers about this, but there was a lot of THC use because really, what I needed was time. I needed muscle relaxation and I needed time. Me personally, I tend to be a person who’s very, very motivated to get a lot done, so it is extremely hard for me to lay in a bed all day long for two or three days. It really takes some disassociation in order to do that for me to kind of keep me down.
Blake Smith:
Yeah, and it’s more effective to use an indica-like strain so that you want to sink into your couch versus wanting to go do pushups. Right?
Tim Pickett:
Yes.
Blake Smith:
Sometimes, you’re going to want to disassociate, but still have to get up and run around and do stuff, and so that’s one type of sativa-like strain you would want. Then there’s other times you literally just need to be in bed and sleep it off, so let’s get you sinking into your couch. That’s why there’s two ways to kind of think about using the different types of sativa versus indica.
Tim Pickett:
And that comes to, really, product selection. There’s going to be products that are going to be better for chronic issues, some better for acute issues. Obviously, pain can be mechanical, can be in the gut. There’s all kinds of places it can be. That’s where we try to, we, as providers, and Blake, as a producer, he’s trying to design products that are specific for specific conditions or specific types of pain. I’m trying to figure out with the patient, listen to the patient. What type of pain is it? Where is it? What do we know about the cannabinoids? What do we know about Delta-9, Delta-8? How can we build a product or how can we choose a natural flower that is going to help, help you get through, help you get more time, do more things, if that’s what, where you’re at in the pain cycle.
Tim Pickett:
I found that there was a couple of strains from local growers that I used a lot of that did not work near as well as when I switched to a Fatso or a Mad Max. It was really night and day, so in the physical therapy situation, it was very, very strain specific. If you’re using one strain, it’s not as helpful. If you’re using another strain, it is. Every strain is different for people. Temperatures seem to be a little bit deal, too. Not a part of this webinar, but …
Blake Smith:
Well, one of the things, if I can address, is I think this is super interesting, by the way, because if you go and look at the genetic profile of most flower that’s in the universe, the THC is always going to be somewhere within a couple percentage points one way or another. Really, the only difference is a couple percentage points on the terpene profiles, so what makes one more therapeutic than another?
Blake Smith:
Really, it has to do with those profiles and how you’re metabolizing those profiles. The reason why Mad Max, and I’m going to throw down with Mad Max because I like it so much. The reason why I like Mad Max so much is because it’s high enough in CBG that even if it’s not your normal strain that would help, like if you’re used to Dutch Treat, for example, or you’re into-
Tim Pickett:
[crosstalk 00:31:50]
Blake Smith:
… Golden Spike or something [inaudible 00:31:55] progeny, so-
Tim Pickett:
Did you see that?
Blake Smith:
I saw that.
Tim Pickett:
That’s Mac.
Blake Smith:
If you’re using those and those are usually helpful for you, they don’t typically have much difference in the profile. Mad Max, specifically, always has somewhere between 6% and 8% CBG, so I know it’s going to lower inflammation. Now, it may not be enough to fix you, but I know you’re at least going to get an anti-inflammatory effect from it. That’s why I like that strain so much. The Fatso is really high in caryophyllene, which makes sense of why that one is usually quite therapeutic. Anyway, that’s kind of the thing. It becomes hard to find your right thing, but there are some ways to sort of tip it in your favor, right?
Tim Pickett:
Yeah.
Blake Smith:
Get out your [crosstalk 00:32:45]-
Tim Pickett:
When you’re going to the pharmacy, you’re trying to choose. Sometimes, it’s choosing an eighth of two different things and then going home and trying them both. Sometimes, it’s mixing them and that can be a thing. For when it comes to flower, it’s a journal. It’s a journal issue. It’s what did I take? How do I feel two hours later? What did I take? How did I feel two hours later? Then you can go back and you can look at the profiles a little bit more and you can make a little bit better … You can tip the scales even more in your favor when you choose new strains because there will always be … I’m talking to Brandon at Two North and there will always be strains that come and then eventually, the mothers, the genetics will change. The mother will change maybe. I don’t know. The genetics are going to change just a little bit through time, I feel like, with flower. Would you agree with that, Blake?
Blake Smith:
Yeah, absolutely. That’s one of the main reasons why almost every flower that’s out there is a hybrid now There’s very few true sativa or true indicas. You’re getting an indica or a sativa experience based on the terpene profile, but yeah, true, unique by themselves strains sort of don’t even exist anymore.
Tim Pickett:
They don’t, and they just don’t last forever.
Blake Smith:
That’s right.
Tim Pickett:
I mean, the plant eventually won’t … The mother eventually will be discarded.
Blake Smith:
Yeah, that’s right. That’s exactly right. And if you’re treating your weed like the soup of the day, people are just cycling as many combinations as they can cycle as quickly as they can cycle it, just like I want to try Kitchen Sink. Next week, I want Donuts. The week after that, I want Cherry AK. The week after that, I want Fatso. That’s also a challenge because a lot of growers are cycling their flower so quickly because just trying to appeal to a taste or a sensation, like getting a new candy or a soda, which is awesome, in some ways, but it’s also like, well, if you found the right flower for helping a particular illness, you can’t find that flower anymore, it’s a problem.
Tim Pickett:
Right. Oral, I’ve chosen a couple of my favorites here. The Plush gummies I like because they’re a mix Delta-8, Delta-9 and so they tend to be a little less psychoactive, a little better in the GI system from a absorption standpoint. I don’t have experience with the fuel cubes, but have had a lot of people have good results with that.
Blake Smith:
I hear a lot of people like them. I hear a lot of good things about the fuel cubes. I think they’re probably a pretty cool product out there. I haven’t had any myself yet, but there’s time.
Tim Pickett:
There’s a lot of products.
Blake Smith:
There’s a lot of products.
Tim Pickett:
There’s a lot of products out there.
Blake Smith:
Yeah. It’s hard to get through them all.
Tim Pickett:
Then topical, I always go to the Sage balm, but I go to the Sage balm because it’s an ointment and ointments tend to stay on the skin longer, absorb longer. To me, it’s just a practical thing from a medical, from what we learned in dermatology, a cream or a lotion. It’s nice and it feels nice and it’s not greasy, but an ointment, eh, stays on longer. It’s going to absorb a little bit better and so it’s going to work a little better.
Blake Smith:
Yeah. Really, we have found now we have a lot of patients that use the Cypress Sage for foot pain because what you do is you slather it on your feet because your feet have a lot of callouses and so forth, so you’re having to get through a lot more skin in the feet, so a lot of topicals don’t really hit it the way that it needs to. Standard Wellness produces a pretty cool patch that works for certain things. The patch doesn’t work great on feet because it can’t get through. In the old days, we used to throw things like DMSO in with it, which makes you can bypass your skin and get right into the bloodstream using DMSO. DMSO is not healthy for you. It has some implications for your liver and some other things and so you don’t really want to do that. You get a thicker balm. You literally put it on your feet, put a sock over it, whew. You’re golden. It’s going to absorb. It’s going to make your feet feel better. We have a whole bunch of people that even have avoided bone spur surgery as a result of using the Cypress Sage balm.
Tim Pickett:
I’m so surprised.
Blake Smith:
Sorry. This is not designed to be a plug for my stuff [crosstalk 00:37:22].
Tim Pickett:
No, but topicals in general are surprisingly effective in ways that you don’t really think that they will be, like with back pain. Again, coming back to that, you think well, the muscle, the muscle belly is too big. It’s too deep. The psoas is too deep. It just works. Some things just work. Topicals just kind of, they just tend to work.
Blake Smith:
We have found also with menstrual cramping and so forth that a nice balm, especially with little CBN, is really effective at relieving pain there. I [crosstalk 00:38:01]-
Tim Pickett:
Whether it’s distracting or it’s working down into the tissues doesn’t really matter because it’s safe and it works. Some things just work.
Blake Smith:
That’s right.
Tim Pickett:
Okay. Let’s get to some questions. We have-
Blake Smith:
Four so far.
Tim Pickett:
I’d like to … Okay. Let’s look. Let’s look. We’ve had a little bit of chat discussion. I’m familiar with a little bit of the chat discussion. Let’s go with, okay. Terry. How long would it take for the cell to heal? I’m going to say different different times. Depends on the cell.
Blake Smith:
Totally depends on the cell. Typically, cells have different life spans. Blood replenishes within about 24 hours and so forth. Muscle cells repair pretty quickly because they have a lot of access to ATP and energy, plus, they have high oxygen rate. Typically, when you think about healing for cells, you’re looking at oxygenation is a huge part. Oxygen is a huge part of that whole process. That’s because of the CREB cycle and the citric acid cycle. Essentially, it’s the conversion into energy that’s important for healing mechanisms.
Blake Smith:
Protein is also important, areas that have higher amount of protein, so you have little, tiny machines, essentially. I mean, they’re little organs, but your endoplasmic reticulum basically chart out and make proteins and so you use amino acids to, basically, allow your endoplasmic reticulum to make proteins. Those proteins are essential.
Blake Smith:
When you have muscle, muscle has tons of endoplasmic reticulum. It has tons of mitochondria for producing energy. Muscle will heal quick. Nerve cells already are firing electricity back and forth. You don’t move a lot of excess energy into nerve cells. You don’t oxygenate nerve cells the same way as quickly, so nerve cells take a lot longer. Some cells heal really fast and some don’t heal almost. It takes really long periods of time.
Tim Pickett:
[crosstalk 00:40:07].
Blake Smith:
That probably was an unsatisfactory answer, but it depends on the type of cell.
Tim Pickett:
Okay. What if the pain is all over the body? To me, this is kind of the same question is how do you figure out what will work? I know they seem unrelated, but to me and the patient discussion, they’re related. You start from scratch. You learn how … Here’s what I would say. You need to know your lowest effective dose for a head change. That’s a dose that you absolutely need to know. You need to know kind of how many milligrams THC you can take orally and get a head change. That’s the threshold dose. That’s kind of the baseline. You want to stay with that. That’s a dose you can take very consistently and be very productive, not have a lot of psychoactivity, be very functional. Then you need to know your maximum dose, the dose at which you are-
Blake Smith:
Paranoid.
Tim Pickett:
If you take anymore, you’re going to get paranoid, right, the maximum dose of THC that you can have. While not everybody needs to know that dose, it is helpful when you’re trying to create a therapy for somebody with pain all over the body or trying to figure out what will work. You need to know that. Then for me, it’s going through what Blake said earlier, which is try to tip the scales. Use the pharmacist. Use the Q and P, the provider, to try to choose products that maybe in that window, and then you’re keeping a journal.
Blake Smith:
Yeah.
Tim Pickett:
That really is kind of a practical answer. It’s not really cannabinoid or a terpene answer. It’s just practical.
Blake Smith:
One of the reasons I like doing this with you, Tim, is because your answer was spot on and really practical. I tend to go off into these weird tangents, which I’m about to do.
Tim Pickett:
Lay it on us.
Blake Smith:
When you think about whole body pain, you need to actually affect the central nervous system. It’s different from putting a balm on because a balm is acute. It’s going to fix your joints in the area. It’s going to fix your lower back for arthritis. It’s going to fix things locally. You need to affect endocannabinoid receptor system, one, and you need a full across the blood-brain barrier to affect the entire system for whole body pain. That’s the only effective way to start thinking about this because you need to actually start shifting the way the body is thinking and dealing with the pain structurally across the entire organism versus just something that you’re fixing in an area.
Blake Smith:
I also like layering. You talk a lot about this, Tim, and I agree with you on this one a hundred percent, layering your products. I take a tincture before bed. I wake up the next day. I take my gummy or rub, vice versa, whatever it is. Then all of a sudden, I’m at work and I feel like I’m going to die. This is now an inhalation method or this is now I’m going to dose again. It’s that’s to get immediate relief, but I’m keeping the normal under control through my daily ritual of taking something. That’s my response.
Tim Pickett:
We’re going to get to more questions. We kind of answered this question earlier. Can topicals help with deep tissue pain, and for some reason, for some reason they do. Blake can’t tell me the mechanism because you can’t get it deep enough. You cannot get the THC deep enough in the tissue, but it works.
Blake Smith:
So I don’t fully know the mechanism, but I do know this. There’s cellular to cellular communication and if one cell is in pain and the cell right next to it has been relieved, the one that’s relieved says, “I’ve been relieved. I don’t have a stress response anymore.” That tends to calm down the cells that are next to it, as well. For treating, I only have to get to a nerve cell to start treating it with cannabinoids and nerves are about an eighth of a millimeter in, so I’m not going to, to your point, Tim, and I agree with you. If I’m trying to hit my glute or something, I’m not going to get deep enough. I don’t really need to get all the way to where my muscle is hurting on my quadriceps. I only have to get to the nerves around the quadriceps to start downregulating the pain response. That seems to be one-
Tim Pickett:
I’m learning something right now. This is interesting, and it makes a lot of sense.
Blake Smith:
Yeah.
Tim Pickett:
This is besides the mechanical help that you’re getting really from the massage of rubbing in the topical, too. Touch is a very powerful healing tool, as well, and so if you can combine the cellular communication things with the natural product and you don’t have to get high, why not?
Blake Smith:
Yeah. I like topicals a lot, and plus, they last a long time, so you’ll go and you’ll buy one. They’re a little bit pricey, but they should last you 3/4 of a month or a month and so you’re not buying them. Most of the people I know who are buying flower are buying flower every week, sometimes multiple times. I don’t have to do that with tinctures and balms. Typically, those will last me a month.
Tim Pickett:
Next question is, let’s see, we’ll go to-
Blake Smith:
Can you get a card for migraines as in the slide? Can you do-
Tim Pickett:
As in the slide?
Blake Smith:
Yeah. You’re the guy on that one. You know better than I do.
Tim Pickett:
Okay. In Utah, qualifying under the pain qualification, I wrote an article about this in 2020, in the very, very beginning when we were starting out, so pain lasting longer than two weeks that is not well controlled with a typical medication. Every provider is going to have a little different approach for this and with migraines, if you have migraines and you’ve been diagnosed with them and tried some medications for them and they’re not working and you want to try cannabis, then we look at well, do you qualify under the pain? Are you missing work for a migraine? Do these migraines bother you over and over and over in a pattern?
Tim Pickett:
Then most providers, myself included, I would say, “Look, yeah, that’s a chronic pain issue.” It’s pain. It lasts longer than two weeks, and it is not well controlled. We are, with migraine patients, we’re trying to use indica and hybrid medications, trying to stay away from sativas. Inhalation methods tend to work. A lot of CBD sometimes helps, but technically, migraine is not a qualifying condition in Utah, but pain is a qualifying condition.
Tim Pickett:
Let’s see. What would you suggest for a very busy, active person who has been diagnosed with chronic back pain, with the only solution being pain management for during the working day? Easy at night.
Blake Smith:
Can I make one quick comment about migraines?
Tim Pickett:
Yeah.
Blake Smith:
We have found it’s pretty effective, actually, to take like the Cypress Sage balm or an equivalent topical. You put it right at the base of the skull right here, rubbing on when because most people can feel them coming on. You start getting your tunnel vision and you can feel it happening, so you put the topical right there. You also put a little bit right across your forehead. Go into a dark room. Sit and close your eyes for about 15 minutes. We’ve had a lot of success on people arresting or stopping their migraine from starting because what ends up happening a lot with migraines is you get tons of vasoconstriction. You get optical restriction around the optic nerve and so getting stimulation for all your senses down won’t cause as much energy influx in the head, so you’re going to want to take all of that down. Then the balm, the topicals in those areas will help relax blood flow and everything within those areas and so it’s an effective way to think about migraines.
Tim Pickett:
Great recommendation, Blake. Okay. Excuse me.
Blake Smith:
Very active person.
Tim Pickett:
Active chronic pain person. It feels like I’m talking to myself.
Blake Smith:
Teresa is running around everywhere. Can’t stop.
Tim Pickett:
Running everywhere.
Blake Smith:
Just going crazy.
Tim Pickett:
Got running shoes on all the time, all the time. Yeah, what are you going to do? So this is where I layer. This is where layering comes in big time because you want, first of all, I feel like you want CBD at a milligram per kilogram. Take the pounds you weigh. Divide it by 2.2. You need that much CBD every day. That’s where I would start. Then I would layer a oral cannabis method with THC or Delta-8, Delta-9, whatever works better for you. I would put that at the threshold of psychoactivity or just barely below because on a scale of one to 10, 10 being maximum dose, three being where that head change is, I want you at a three or a two, 2.7, but I want you to take regular doses morning, noon, night. I want to make sure that those doses are pretty consistent. Then when it’s bad, then I can use an inhaled method on top of that and go up to seven or five or six.
Tim Pickett:
The three, this does a lot of things. The layering does a lot of really cool things. It keeps you at that level so that you’re using inhaled. You’re going up to the seven, but you’re only coming back down to the level three when that wears off, which it will do earlier than the oral. It keeps your inhaled methods down over your lifetime, so you’re inhaling 10, 20, 30% less over your lifetime. Your lungs will thank you. You won’t get COPD and chronic bronchitis from. Not that you will, if you’re not using a lot, but the inflammation in your lungs will be less.
Tim Pickett:
That low threshold tends to be something that patients get used to. They don’t have the psychoactivity, but they keep the therapy. A lot of patients can continue to use the same dose for two to five years. I have a patient that has been using the same dose for five years for his chronic pain, same dose.
Blake Smith:
Tim Pearl asked earlier, too, was asking about well, does your tolerance always go up? It doesn’t have to. It’s only when you keep stimulating and taking more that all of a sudden, you’ll start noticing tolerance changes. If you find an effective dose, that will stay effective as long as all things being equal don’t change. Right?
Tim Pickett:
Mm-hmm (affirmative). Yup.
Blake Smith:
The other thing I would just … Tim, you’re so smart at all of this stuff. I mean, you are exactly right. I will say this. I have lower back pain. I have arthritis in my lower back. After sleeping in the same position for multiple hours and I need a good sleep and so I will often take CBN or something and knock myself out. Then I wake rested, but my back is so stiff, it’s hard for me to move out of bed. I have a topical by the bed. I put it on a little bit in the morning and within 30 seconds to a minute, I can move out of bed and I can move for the day. Then I layer on top of that.
Tim Pickett:
Hmm. That’s a great idea. Let’s see. We’ve got a stage four metastatic pancreatic cancer. What can I use for abdominal pain? I don’t know about you Blake, but this is one of these specific conditions where you go no holds barred.
Blake Smith:
Yup. I agree.
Tim Pickett:
You go all the way. We’re going to jack up the CBD dose, if we can tolerate that. We’re going to do oral methods consistently through the day. We’re going to learn what’s good in the daytime, what’s good in the bad, what’s good when I have a really bad day, what’s not. Then I’m going to layer on not only flower, potentially, but I’m going to layer on even concentrates.
Tim Pickett:
Here’s where, before we get too far into the discussion, because I know you want to add to this, here’s where tolerance to me, it becomes a little different discussion. I want to build up tolerance here because I’m not so concerned about using more and more and more because we have metastatic pancreatic cancer. The reality is there, right? What we want to do is we want to have a high enough tolerance that we can use a lot of cannabinoids because I now think I need to load this person up with cannabinoids. I need to be getting a lot of milligrams of cannabinoids in this person to help.
Blake Smith:
Yeah. Tim, I am a hundred percent in agreement with that because most people who have pancreatic cancer, it’s not whether or not you had a good day or a bad day. I either had a bad day or I had a worse day and so really, it’s no, I agree with you. There’s no holds barred. You want to build up a tolerance to multiple cannabinoids and you want to hit it with everything. Unlike certain types of cancer, we have not seen cannabis directly solve that as a cancer issue. There are some implications that cannabis can help with certain types of cancer. Pancreatic cancer has … I’ve heard of people being healed, but there’s not a lot of data to support that. There’s pretty good data to suggest that CBG helps with glioblastoma in the brain. Pancreatic cancer, you need relief to enjoy your life, what life you have left, and so you do what you got to do. Your doctor should [crosstalk 00:54:57].
Tim Pickett:
Yeah, and this is where journaling is important because if one strain is not working, you need to discard it and move to another strain. If one product isn’t working, you need to either increase the dose. This is where you’re really trying to get religious about it. Get technical about it, I think, too, because some things, there’s going to be some strains that help with appetite more than others and finding those might be helpful during the day. Then at night, other products. I also put a plug in for RSO here, true RSO, because I think for some reason, there’s something to the whole blend up the whole cannabis plant kind of mentality.
Blake Smith:
Yeah. I agree with that, too. Really, Delta-8 may be helpful taking the edge off, too. If we’re talking about specific products, Delta-8 may help taking the edge off. It won’t be sufficient for all your pain, but at least it will start that process because Delta-8 will just give you more of a body high than a head change. In the trunk, you have a high absorption rate of cannabinoids and so I like Delta-8 in those circumstances.
Tim Pickett:
But excellent question. Okay. We’re available for this type of discussion outside of the webinar series. Okay. Colin asks non-psychotropic cannabinoid cartridges. Yes or no? No question a CBD, a heavy dose of CBD vape cart helps immensely. It’s like topicals to me. I’m just surprised at how effective they are when you use a straight CBD product or a CBD-CBN-CBG. There’s more and more of these good products on the market. I’d say yes.
Blake Smith:
Yeah, so yes, definitely. Be careful where you get it.
Tim Pickett:
There’s a bill on the hill. We don’t want to go down this rabbit hole, but you’ve got to-
Blake Smith:
You’ve got to be-
Tim Pickett:
I can give you two products I carry. I know where it’s made, the cartridge in Logan. I know where your tincture is made and grown. Just limit yourself to good, reputable products, adequate testing.
Blake Smith:
You have to.
Tim Pickett:
Yes, especially with inhaled and especially with cartridges.
Blake Smith:
Especially with cartridges. Trust who you have making them.
Tim Pickett:
Yes. Yes. Okay. What if you can’t get the same product? Yup.
Blake Smith:
Okay. Here, I can answer this from a Zion perspective. If it’s a Zion product and you can’t seem to find that same Zion product, literally just email the company. If it’s a product that we have that worked for you, but for some reason we discontinued, I will make it just specifically for you. Tell me what pharmacy you go to and I will ensure that they always have that product for you, always. I can’t offer that for everybody else. I can offer that for Zion products because we typically don’t phase out a lot of our products very often and so because when you make a medicine, people become reliant on that medicine, so you always have to have it available.
Blake Smith:
That’s actually a good indicator about companies in general. I don’t just mean Utah. I just mean in general in the universe. If somebody is changing their product so often that you can never find the same product repeatedly over and over and over again, they’re not doing it from a perspective of trying to make a medicine for somebody to have for the rest of their lives and so make it.
Tim Pickett:
He [crosstalk 00:58:57].
Blake Smith:
Send an email that is strongly worded email that says, “Hey, I use this for medicine. Keep making it.”
Tim Pickett:
Yeah. Okay. Last question, and a difficult one. This is a patient. I know specifically the patient. If the Delta-8 is causing vertigo and headaches, this is a patient with a lot of chronic pain, lot of chronic abdominal pain, flares. It comes and goes, but it’s hospitalizations, that type of thing, so if I change to a different, but the Delta-8, so we talked about Delta-8, recommended it. For some reason, causing vertigo and headaches.
Tim Pickett:
Here’s my question. I don’t think we’re going to get to a great answer on this tonight, but I guess I could generalize it for the rest of the audience here a little bit, too, is when you have a chronic pain issue and the products that you’re trying to take are causing a side effect that you don’t love, that is, it’s causing a problem and you can’t get through the side effect to get the relief, what do we do? I think that really is more of the question here, like we have this problem. We think we’re leaning, we’re again, tipping the scales to products that we want, we think are going to help based on what we know, but we’re getting a side effect that we can’t get through. So what do we do?
Blake Smith:
Yeah. My initial gut, man, I would love to know what the product is and the administration route is the first two things I think of because a lot of times, I’ve heard this specifically around vape carts, around Delta-8. Sometimes, I’ve heard people getting vertigo from an inhaled method of Delta-8, but they don’t seem to have the same problems with like a gummy with Delta-8, so I’d want to know the route of administration. Also, the product in particular, because it could be the terpene combination or if somebody’s using botanical terpenes, not … By the way, I’m not against botanical terpenes per se, but it may not be the right thing. Also, if you don’t know where they’re being made, so it looks like try gummies, tincture, and capsule. Do we have Delta-8 capsules in Utah?
Tim Pickett:
Mm-mm (negative). I don’t think so.
Blake Smith:
Because if all-
Tim Pickett:
Oh, this is … I-
Blake Smith:
Oh, you’re in Colorado. Okay. I’m going to even take a couple steps back. This is the whole debate around Delta-8. Delta-8 is a cannabinoid that is an analog to Delta-9. It’s typically made the way most people make it is they take sulfuric acid or hydrochloric acid and they dump it into either CBD or Delta-9 and they start to force the bond to shift thermodynamically under heat. The acid serves a catalytic bridge to move that bond over, and then they either take the acid back out. They neutralize it. They should be washing it. There’s a whole bunch of stuff to do to clean that Delta-8 up. If they don’t clean it up, you can notice a lot of health implications around that. You can get vertigo. I mean, I have heard headaches. I’ve heard all kinds of things associated with that, so knowing your source and how they make it becomes really important.
Blake Smith:
Now, you don’t have to make Delta-8 that way, by the way. I’ll just speak for my own company. We use energetic oxygen, heat, and UV light, and you can still get the bond to move without having to use harsh acids to do that. I would try one from Zion or somebody else that’s local, where you know where it’s being made. I would try that first to see if it helps. If it does help and you don’t have the exact same experience, it tells you that your Delta-8 you were using before is adulterated. If you do use it and you get the same effect, what that tells me is we need to think about different forms or higher levels of Delta-9 with lower levels of Delta-8 so that you’re getting a masking of that.
Blake Smith:
I would continue to use Delta-8 if you need … If it’s giving pain relief and you find unadulterated and it works, that’s the right way to do it. If you can’t find unadulterated Delta-8, I would switch strains because if you don’t know how it’s being made and somebody’s in their garage with radiator hoses dumping hydrochloric acid in something, that’s sketchy. You need to be careful of that. That’s not the right way to think about it.
Tim Pickett:
And let me bring this back to medicine with the medicine that I was practicing before, which is to prescribe a pill. If you come in with a problem and I make a prescription, usually, we are taught that you should try three different medications, basically at least three, if the first one didn’t work, so we’re going to give one a trial. Then we might give a different one a trial, and we might give a third one a trial. In many cases, in some conditions, we’re trying up to five medications before we’re giving up on that even almost class of medication.
Tim Pickett:
This isn’t to say this is common. I’m not trying to dilute the issue, but this is it’s unfortunately kind of where we’re at is sometimes, these things take a while to figure out and again, why keeping a journal is probably a good idea. Trying multiple products is a good idea, but like Blake said, when anything you know about with Delta-8 is just such a controversial topic that you want to know. You want to know where you’re getting your products.
Blake Smith:
Yeah. I-
Tim Pickett:
And to Terry’s point, comment there, getting help for chronic pain is hard because providers are we’re busy. We’re impatient. You come in. We write your prescription. You’re out the door. Thank you for your copay. That’s just, we don’t like that. It’s the reason why Blake and I or part of the reason why Blake and I are in this.
Blake Smith:
Well, and this one, in particular, hits a home with me a lot because when we had the stuff going on with my daughter and thinking about what the implications of that are, when I went and got product from everywhere, I was getting inconsistent results, metals, pesticides, horrible chromophore showing up, all kinds of things everywhere, which is why I got into this in the first place because I decided I had to go just do this on my own.
Blake Smith:
I’ve been trained as a bioanalytical chemist. My background is bioanalytical chemistry and so I’ve been used to making medicine the way Tim is used to it in the pharmaceutical company. I’m like why can’t cannabis be the same way because that’s the thing that helps my daughter. I’m moving away from all this craziness. There are more producers of cannabis products in the US than most other businesses at this point, but you can’t trust 80% of them.
Blake Smith:
I do like medical markets a lot because medical markets typically are more tested and more rigorous than often adult use markets. That doesn’t mean there’s not good products there. It just means that typically in Utah, I’ve been audited. My company’s been audited by the state every week for the last, like, month and a half. Maybe it’s because they’re just really trying to find something wrong. The point is every single thing I make is tested. The state is in my business all the time and so you can trust it.
Tim Pickett:
Well, Blake, this has been a good discussion.
Blake Smith:
It is.
Tim Pickett:
I like this one. I think we’ve done a good job. Let’s see. How do we know-
Blake Smith:
There’s so many smart people who have been on tonight and so many people who are just so great. Thank you everybody for attending. I hope it was useful. If you have more specific questions, you can always come to Tim and if he needs [crosstalk 01:08:18]-
Tim Pickett:
Well, yes. One of the best ways to do this, too, is to go to Utah, is to go to the YouTube channel. In fact, we’re answering questions all the time. If you go to the YouTube channel on Discover Marijuana where this would be posted and you make a comment on one of those videos, you ask a question on one of those videos, we’ll try to answer it. That way, we can answer it for everybody and we don’t have to just keep the answer to ourselves and keep it secret just between us. I think that is probably the best way to get ahold of us. Subscribe to that YouTube channel. We really appreciate feedback that we’ve gotten tonight and Teresa, to your question, yes, all the pharmacies are selling mostly the same products. There’s a little bit of variation, but most are selling a lot of similar products from the same companies, all tested. Anyway, take care, everybody.
Blake Smith:
Thanks everybody.
Utah in the Weeds host Tim Pickett is heavily involved in the 2022 Utah legislative session. In this 89th episode, Tim gives us an update on recent cannabis-related discussions on Utah’s Capitol Hill.
First, Tim talked about Utah Therapeutic Health Center’s new educational partnership with Gray Matters. Gray Matters is dedicated to educating the public about the risks of adolescent cannabis use. [00:58]
Next, Tim gave an update on UT THC’s Uplift program, which subsidizes Medical Cannabis evaluations for terminally-ill and low-income patients. [05:32]
Then, Tim talked about the Discover Marijuana YouTube channel’s recent activity. The channel has a new series of videos to help viewers get to know Tim and his co-host, Blake Smith. [05:52]
To start the discussion about Utah’s 2022 legislative session, Tim talked about Senate Bill 190, a Medical Cannabis bill sponsored by Sen. Evan Vickers. SB 190 would add restrictions to cannabis advertising and labeling, and ban synthetic THC analogs like Delta-8, among other changes. [08:15]
Next, Tim talked about SB 195, sponsored by Sen. Luz Escamilla. The bill would add further restrictions on advertising for Medical Cannabis businesses, and add “acute pain” as a qualifying condition, among other changes. [27:11]
Tim talked at length about both bills, and their potential impacts on patients and healthcare providers.
Podcast summary coming soon.
Podcast transcript coming soon.
If you haven’t heard yet, a new rule regarding renewal of the Utah Medical Cannabis Card went quietly into effect earlier this year. The new card renewal rules eliminate the ninety-day term of a new patient’s initial card and replace it with a six-month term. Suffice it to say that this is good news. But what does it mean for you?
Before we get into that, it is important to note that the new rule does not affect current Medical Cannabis Card holders. It doesn’t change the ninety-day renewal requirement for anyone whose initial card expires prior to April. With that said, let us get into a more detailed explanation.
Utah law dictates that Medical Cannabis Cards are not open-ended. You cannot get a card that allows you to use Medical Cannabis for the rest of your life without seeing your Qualified Medical Provider (QMP) for periodic renewal. And for the record, that’s the way it should be. Medicine should always be administered under the supervision of a medical provider.
Prior to the new rule’s establishment, a patient’s first card was only good for ninety days. It had to be renewed by completing an online form and visiting a second time with a QMP. Fortunately, the renewal term itself was six months.
Under the new rule, a ninety-day renewal has been eliminated. All new patients obtaining their Medical Cannabis Cards for the first time will be issued cards that are good for six months. Prior to expiration, they will still need to visit with their QMPs in order to obtain another six-month card.
Understand that the new card renewal rules only affect a patient’s initial Medical Cannabis Card. All the other rules remain intact. That includes the rule governing one-year renewals. They are still possible, but three conditions must apply and be verified by a QMP:
A QMP must certify all three on the renewal application in order to recommend a one-year renewal. Then, as always, it is up to the state to decide whether to renew the patient’s card.
Everything else about the state’s Medical Cannabis Card program remains the same. To apply for your initial card, you have to use the Electronic Verification System (EVS) accessed by way of the state’s Medical Cannabis website. You cannot apply for a card with paper documents. You cannot visit a state office and apply in person.
Next, you cannot obtain a legal card without first visiting with a QMP. The state is currently developing a program to allow medical professionals to recommend Medical Cannabis for up to fifteen patients without becoming QMPs, but that program is not yet in place. So for now, the QMP requirement remains hard and fast.
You will also need to visit with a QMP to have your card renewed. It may not be necessary for an in-person visit; online visits are appropriate in some cases. Either way, your QMP will have to recommend renewal after evaluating your current health.
In terms of extending initial cards from ninety days to six months, regulators have done the right thing. The change represents a good move that will streamline the system, increase efficiency, and allow interested QMPs to take on more patients. It also eliminates some of the unnecessary administrative work created by the old ninety-day term. Well done, Utah regulators.
Things in the Medical Cannabis space continue to change at a rapid clip. Thanks to increasing cannabis demand around the world, a lot of the changes we are seeing are directly related to cannabis cultivars and non-plant products derived from THC and CBD. Of particular concern right now are PGR cannabis products.
‘PGR’ is an acronym for ‘plant growth regulators’. These are essentially synthetic hormones applied to cannabis plants in order to modify growth and development. They can be used to maximize production. They can also be used to enhance some characteristics while stifling others.
Here are four things you should know about them as a Medical Cannabis user:
Competition within the cannabis space – both medical and recreational – has a lot of entrepreneurs and corporate entities wanting their piece of the pie. These days, it is all about maximizing production. The best way to do so from the grower’s perspective is to grow more plants more quickly. Adding PGRs is one way to do that.
The result is that PGR use is becoming more frequent. From small farms to corporate growing operations, businesses see PGRs as the ticket to higher profits by way of more plants. As PGR use gradually takes over the industry, it is probably going to be harder to find non-PGR products.
Left to its own devices, a cannabis plant will grow in a certain way. It will exhibit a specific chemical structure when tested in a lab. But throw in a foreign substance, like a PGR for example, and you end up changing a plant’s chemical structure.
Studies have shown that PGRs can change the chemical structure of cannabis plants. To what degree those changes occur is still up in the air. But one definitive change is that trace elements of PGRs can remain in plant material after harvest. And if this is the case, consuming PGR cannabis also means consuming PGRs themselves.
Above and beyond chemical changes, PGRs can also change the flavor and texture of a given plan. The problem is that the synthetic hormones interfere with a plant’s natural hormones. This can affect everything from trichome counts to a plant’s cannabinoid and terpene profile.
Differences in flavor and texture can be anything from subtle to drastic. There is no way for growers to be sure without actually adding PGRs and then seeing what comes out the other end. As for consumers, it is not unusual for them to observe drastic differences between similar products based on whether PGRs were introduced to the growing process.
Finally, utilizing PGRs to increase cannabis production is still a relatively new practice. As a result, their effects are not yet widely known. We know that PGRs affect plant growth to some degree. We do not yet know just how significant those effects are.
We also don’t know how PGRs affect human health. Future studies could prove them to be entirely harmless. On the other hand, we may someday learn that Medical Cannabis patients haven’t been enjoying the full effects of their medicines because PGRs inhibit how THC and CBD interact with the endocannabinoid system. The fact is that we just do not know right now.
The best advice we can offer is to avoid PGR products if you are at all concerned about the potential for side effects. In the meantime, we need more scientific study into how the synthetic hormones affect everything from plant structure to medical efficacy.
