The first quarter Medical Cannabis program newsletter published by the state earlier this year includes an entire section on the low and slow approach to Medical Cannabis treatment. One of our team members saw it and began wondering how many new patients had never heard of it before. We decided to publish this post as an explanation.
Utah now has more than 83,000 Medical Cannabis Card holders. We are adding thousands to the roles every quarter. That tells us there are plenty of new Medical Cannabis users throughout the Beehive State who may not be familiar with the low and slow principle.
The low and slow approach two Medical Cannabis treatment is easily illustrated by taking a dip in a swimming pool. Imagine a hot, summer day complete with a blazing sun and no breeze to help you cool down. You are ready to take the plunge, but your brain tells you not to do it. Instead, you are just going to dip your toe in the water. You just want to see how cold the water is before you jump in.
This is essentially the low and slow approach to Medical Cannabis. Rather than taking as much as you can as frequently as possible, you start out slowly. Let us look at both aspects of the principle a little more closely.
Since Medical Cannabis isn’t provided via traditional prescription, you may not have exact instructions from your doctor. The low aspect of the low and slow approach is to start out with the lowest possible dose – just to see what happens. But how low should you go?
We recommend having a conversation with your Pharmacy Medical Provider (PMP). Ask them where to start based on your condition and symptoms. A PMP is arguably the most qualified person to recommend a starting dose.
In addition to a starting dose, your PMP can also recommend a delivery method. Different forms of Medical Cannabis can offer different effects. Here is where the slow component comes in. Do not be ready to jump up to a higher dose if your initial dose doesn’t seem to work. Give it time. You might also try a different delivery method at the same dose. A different delivery method could make all the difference in the world.
When it is time to increase your dose, do so slowly and gradually. The goal is not to get from zero to sixty as quickly as possible. In fact, your goal is just the opposite.
The goal of the low and slow approach is to guide you to the most optimal dose and delivery method. It is to ensure that you are using the smallest possible amount combined with the most effective delivery. That way, you are not taking too much too frequently.
By the way, this approach is not limited to Medical Cannabis. Medical providers tend to take the same approach to prescription medications. They understand that you can get too much of a good thing, which is why they write prescriptions the way they do. Work with your PMP and medical provider to do the exact same thing with Medical Cannabis.
The low and slow approach is a proven strategy that has helped untold numbers of patients realize maximum benefit from Medical Cannabis. If you have any questions about low and slow during your next appointment with a medical provider, do not hesitate to ask. The only way to get answers is to ask questions.
Earlier this year, the state wanted to get a better idea of how medical providers are plugging into the Medical Cannabis program. So they sent out a survey. Both Qualified Medical Providers (QMPs) and Limited Medical Providers (LMPs) could complete the survey. Needless to say, the survey offers up some interesting information.
For the record, QMPs are licensed by the state to recommend Medical Cannabis to a patient count equal to 1.5% of the total number of Medical Cannabis Card holders in the state. They have undergone continuing education and attained a license from the state. LMPs have not been specifically licensed because they have not completed the educational requirements. Yet they can recommend Medical Cannabis to a total of fifteen patients.
The first interesting thing we noticed is who actually responded to the survey. Most responses came from advanced practice registered nurses (APRNs). An APRN can be one of four types of advanced practice nurses: nurse practitioner, nurse midwife, clinical nurse specialist, and certified registered nurse anesthetist.
For the purposes of the survey, the state also included responses from physician assistants and licensed physicians. Whether or not the survey data indicates that APRNs are more likely to recommend Medical Cannabis than other providers is not clear. Perhaps that is something to be studied later on.
We were also fascinated to learn that the majority of the respondents were QMPs. We are not necessarily surprised, given that QMPs are demonstrably more invested in the Medical Cannabis idea than their LMP counterparts. But it would have been nice to glean more data from LMPs.
While the types of survey respondents are certainly interesting and worth looking at, the most important data from this survey demonstrates that the services QMPs provide are far more than just Medical Cannabis Card assistance.
This is important to us given the fact that state regulators went out of their way during the early days of the program to prevent card mills. The last thing they wanted was provider offices giving away Medical Cannabis Cards like candy. We already know the card mill problem hasn’t become reality here in Utah. Survey data backs that up.
Approximately 72% of Utah’s QMPs offer general patient education in relation to Medical Cannabis therapies. We think that this is huge. Education is key to getting the most out of a Medical Cannabis treatment. But let’s not stop there. What types of additional education are QMPs making available? Survey data suggests the following:
In addition to education, 62% of Utah QMPs also screen for other medical conditions. Additional screening is good for patients because it provides a much better picture of overall patient health and wellness. Screening for additional medical conditions also informs a medical provider’s recommendations.
It is probably a fairly safe bet that at least some QMPs and LMPs offer very little by way of Medical Cannabis services other than helping patients obtain their cards. But it is also a safe bet that some QMP clinics offer other services. Our very own KindlyMD clinics offer a number of additional services including therapy and medication management.
Data from the recent state survey paints a very positive picture of medical provider participation in the Medical Cannabis program. We couldn’t be happier. Card mills have been avoided while patients are the beneficiaries of services provided by medical professionals dedicated to helping them feel better.
State regulations allow potential Medical Cannabis patients to visit with either Qualified Medical Providers (QMPs) or Limited Medical Providers (LMPs) in advance of obtaining their state-issued cards. Repeat visits are necessary whenever a Medical Cannabis Card is up for renewal. From our perspective, visiting with a QMP is the better choice.
Please do not misunderstand our position. LMPs provide valuable services to patients hoping to get a Medical Cannabis Card. We just believe there are certain benefits QMPs offer that LMPs don’t.
The basic difference between a QMP and LMP is state recognition. A QMP has taken the necessary steps to obtain certification from the state. An LMP has not. The implications of this difference explain the benefits that QMPs offer over their LMP counterparts. Let us get to those benefits.
In order to qualify as a QMP, a medical provider needs to undergo a minimum of four hours of continuing education training. Such training is designed to introduce medical providers to the various aspects of recommending Medical Cannabis. Any training program a medical provider intends to utilize must be approved by the state.
Medical Marijuana 411 is one of the approved training programs. It is a six-hour online course covering a variety of topics, including:
The Medical Marijuana 411 program presents its training as being “about medical marijuana based on research and unbiased content.” From our perspective, the research aspect is critical.
Although an LMP may have additional cannabis-related training to rely on, it is not a requirement for them to recommend Medical Cannabis. So there are never any guarantees.
Next, state law makes more Medical Cannabis recommendations available to QMPs. Early on, QMPs were only allowed to recommend to a maximum of six hundred patients. The law has since been changed. We can now recommend cannabis to a total number of patients equal to 1.5% of the current number of card holders in the state. That means more than 1,000 at this point.
On the other hand, LMPs can only recommend Medical Cannabis to a maximum of fifteen patients. Perhaps your GP willingly acts as an LMP for patients in your area. But if they have already reached the 15-patient limit, your GP will not be able to help you. Fortunately, there are enough QMPs across the state to pick up the slack.
When Utah’s Medical Cannabis program first launched, rules designed to prevent card factories were put in place. It quickly became apparent that the restrictions were preventing medical providers from becoming QMPs. The rules were subsequently changed. The rules we now have in place not only limit card factories, but they also encourage QMPs to be more specialized.
An LMP may have rudimentary knowledge of Medical Cannabis and the human endocannabinoid system, but by and large, QMPs possess broader and more specialized knowledge. They have given more attention to the entire Medical Cannabis paradigm because it is something they want to be involved in.
You may have already decided that an LMP is your best bet for obtaining and renewing a Utah Medical Cannabis Card. That’s great. But if you haven’t selected a medical provider or are looking for a new one, we believe a good QMP is a better deal for you.
Whenever society promotes a substance with psychoactive effects, there are usually impairment questions. Concerns over cannabis users driving while impaired are the perfect example. However, a new study out of Australia seems to suggest that proper Medical Cannabis consumption does not impair driving.
Researchers define “proper’” consumption as consumption that adheres to prescription recommendations. Another way to put it is to say that a patient is following a medical provider’s recommendations to the letter. When that is the case, driving ability is not impaired – at least according to the researchers.
In order to get a better understanding of the impacts of Medical Cannabis on driving performance, researchers at Australia’s Swinburne University of Technology’s Centre for Human Psychopharmacology enrolled 40 study participants utilizing Medical Cannabis for a variety of chronic conditions.
Each participant’s driving abilities were assessed in a simulator both before and after taking a prescribed dose of cannabis medication. Additional post-consumption simulations were performed at 2.5 and 5 hours. Researchers did not observe any notable impairment at either follow-up period.
The 5-hour post-consumption assessment is of particular interest due to the longstanding belief that residual THC can affect driving abilities for hours after cannabis consumption. We now know that is not the case based on data from this study.
Full disclosure dictates that we acknowledge the small-scale nature of the study. A cohort of just forty study participants is not enough to unequivocally say that a Medical Cannabis patient would not be impaired by their medications. Still, the evidence is strong enough to be compelling and we hope to see the results of further research on this topic in the future.
We should also point out that the study is by no means an excuse to be careless with Medical Cannabis. Patients who use their medications according to medical provider recommendations should still pay close attention to how they feel before getting behind the wheel of a car.
As for the broader implications of the study, they point to the fact that driving while impaired is probably not something we have to worry about among Medical Cannabis patients who follow their provider’s instructions. Medical Cannabis appears to be no more impairing than an over-the-counter cough medicine.
If you are ever concerned that your medications are impairing your ability to drive, do not hesitate to talk to your medical provider. Whether it is the Qualified Medical Provider (QMP) such as Utah Marijuana who helped you get your card or the Pharmacy Medical Provider (PMP) at your Medical Cannabis pharmacy, trained medical professionals are the most qualified to answer your questions and offer advice.
The same is true for any other concerns you might have. Maybe you feel like your current medication isn’t working well enough. Talk to your PMP about it. Have a discussion if you don’t like the way your medication makes you feel.
Remember that using Medical Cannabis is a journey – it takes time to figure out the ideal doses, delivery methods, and products for any given patient. A willingness to work with your QMP and PMP can help you get there faster.
As for the Australian study, we can sum up our thoughts in a simple statement: always approach driving cautiously. You can never be too safe about taking to the road while medicated. Impairment is not likely to be a problem if you use Medical Cannabis according to your provider’s advice. Still, you don’t need to take any chances.
The 2023 legislative session brought about some significant changes to Utah’s Medical Cannabis program. Among the changes is the number of patients Qualified Medical Providers (QMPs) can work with at any given time. We’ll get to the hard numbers in a minute. For now, just know that the number has increased significantly.
This is an important change given the constant growth of our Medical Cannabis program. According to the most recent state update, there are now nearly 70,000 valid Medical Cannabis Card holders in the Beehive State. Each one of them needed the assistance of a QMP or Limited Medical Provider (LMP) to get that first card.
As you know, follow-up visits are required at card renewal time. Increasing the number of patients a QMP can work with gives patients greater access when they need it most. That is a good thing.
State lawmakers took the occasion of the 2023 legislative session to recalculate the total number of patients a QMP can work with at any one time. Without getting too technical, QMPs were limited to around 600 patients prior to the change. Exceptions could be granted under certain circumstances.
Under the new rules, a QMP’s patient limit will be calculated as 1.5% of the total number of active Medical Cannabis Card holders. Based on current calculations, QMPs can work with 1003 patients simultaneously. The calculation is updated every quarter, by the way.
Going from 600 to 1,000 is quite the change. Medical providers across the state, including those who staff our clinics, can now see more patients. They can help more new patients get their first Medical Cannabis Cards; they can help existing patients with card renewal.
Given that more patients are being added to the active card holder totals every day, it is a good bet that some of you reading this post are new to the whole Medical Cannabis thing. And maybe you’re not familiar with how it all works. No worries. We have you covered.
In order to legally use Medical Cannabis in Utah, you must have a card issued by the state. Utah issues cards for a number of qualifying conditions including chronic pain, acute pain, cancer, PTSD, and seizure disorders.
The state follows a basic step-by-step process for issuing cards:
Once an application is submitted, it needs to be approved by the state. This generally happens pretty quickly. Approval results in the patient receiving a valid Medical Cannabis Card via email. Patients can keep their cards on their phones or print paper copies.
One last thing to know is that you will need your Medical Marijuana card in your possession to buy medical Cannabis products. The pharmacy will ask to see your card and check it against information in the Electronic Verification System (EVS).
Even though the system might sound complicated, it is pretty simple once you get used to it. And now it is even better thanks to state lawmakers increasing the total number of patients QMPs can work with. A higher number means greater access for both new card applicants and existing patients who need to renew.
The pharmaceutical market is worth more than $1 trillion globally. Here in the U.S., Big Pharma earns hundreds of billions of dollars every year. But is the industry affected by Medical Cannabis? Absolutely. Medical cannabis harms Big Pharma’s bottom line.
Medical Cannabis proponents are not in favor of harming any industry. Yet the harm to Big Pharma is indisputable at this point. According to a first-of-its-kind study published in the PLOS ONE journal, the pharmaceutical industry loses upwards of $10 billion every time a state legalizes medical or recreational cannabis use.
The financial hit is impressive enough. But there is something more important here: the reasons behind the financial hit. Could it be that legalization encourages people to explore the therapeutic potential of cannabis, instead of OTC and prescription medications?
Big Pharma loses with cannabis legalization on two fronts. The first is stock price. According to the study, returns on pharmaceutical stocks tend to be as much is 2% lower some 10 days after a legalization event. That may not seem like much at first, but 2% of tens of millions of dollars is a lot of money.
The second front is actual pharmaceutical sales. Study data suggests average sales losses of up to $3 billion annually, per legalization event. So when Utah legalized Medical Cannabis back in 2019, it is possible that some drug company stocks fell. Once our program was implemented the following year, those same companies started losing billions in sales.
We can easily see how Medical Cannabis legalization would affect Big Pharma just here in Utah alone. We know from our own experience that patients often turn to Medical Cannabis as an alternative to other therapies. They have tried other medications that didn’t work. They have tried things like physical therapy and lifestyle changes.
Imagine being a patient trying to manage chronic pain with prescription opioids. The opioids make you feel terrible, but OTC pain medications just don’t offer enough relief. Then a friend suggests you get your Utah Medical Cannabis card. He swears by cannabis and its ability to help you feel better.
After visiting with a Qualified Medical Provider (QMP) and getting your Medical Marijuana card, you begin your Medical Cannabis journey. You discover your friend was right. Within a few months, you are finding enough relief with cannabis that you’re no longer taking prescription opioids.
The company that manufactures your opioids is no longer earning revenue from you. But you are just one patient. There could be tens of thousands of others, just in Utah alone, that have given prescription opioids the proverbial heave-ho. All those prescriptions no longer being filled puts quite a dent in the bottom line.
Right now, the cannabis industry has no equivalent to Big Pharma. That’s primarily because cannabis remains a Schedule I controlled substance under federal law. But if Washington ever moves to decriminalize it, watch out. Corporate consolidation will be the trend to follow.
Our current fractured state market will undoubtedly experience enough consolidation to create Big Cannabis. It may take a while, but it will happen if cannabis is ever decriminalized. What will that mean for patients? Only time will tell.
What we do know is that cannabis legalization is hurting the pharmaceutical industry. Every time a state gives the green light to either medical or recreational cannabis, Big Pharma loses billions. That only demonstrates the reality that Medical Cannabis users are turning to the plant-based drug as an alternative to traditional prescription meds. What more do we really need to know about its usefulness?
It was pretty amazing to see voters rise up and pass Proposition 2 back in 2018. Lawmaker efforts to legalize Medical Cannabis had fallen short up until that time, so passage was needed to force the state’s hand. Could we be headed for something similar with medical psychedelics?
Other states have already begun looking into psychedelics for medical purposes. All the typical suspects are on board including Colorado, Oregon, and California. But Utah could end up joining them at some point down the road.
Remember that Governor Cox signed a bill earlier in 2022 that effectively created a task force to look into psychedelic therapies. The task force is supposed to study psychedelics before making recommendations about their therapeutic benefits at a later date.
One of the biggest hurdles to cannabis and psychedelic reform in Utah is our traditionally conservative mindset. As you know, the state is heavily influenced by The Church of Jesus Christ of Latter-day Saints. But its influence over Medical Cannabis and therapeutic psychedelics may be waning.
Mormon bishop and former Republican state representative Brad Daw has come out publicly in favor of both psychedelics and Medical Cannabis. In a recent appearance on the Jimmy Rex Show, he explained how he went from being anti-cannabis to a proponent of both.
You may not remember, but Daw was against Medical Cannabis as late as 2018. So what changed his mind? You’ll have to listen to the previously mentioned podcast to find out. If you do, you will also learn that Daw traveled to Costa Rica in order to experience an ayahuasca ceremony for himself.
Daw’s Costa Rican trip was partly motivated by a church member who confided in him about her own psychedelic use. He decided to experience it for himself. Needless to say, the ceremony completely changed his mind about psychedelic therapeutics.
As for cannabis, he remains dead set against recreational consumption. However, he is now a full proponent of Medical Cannabis. If you’re surprised, you are not alone. Few thought that highly conservative state lawmakers would ever get on board.
As for the future of therapeutic psychedelics in Utah, all eyes are now on the state task force. They have a big job ahead of them. Their findings should result in recommendations lawmakers can consider over the next couple of years. Will there be anything to talk about in 2023? We’ll have to wait and see.
Meanwhile, we do know that lawmakers are continually looking at Utah’s Medical Cannabis law for ways to improve it. Our program is by no means perfect. However, numerous modifications over the years have made it better. Utah patients are in a far better place now than they were back in 2020.
If psychedelics are eventually approved for medical purposes, they will give patients yet another option. To us, this is most important. Prescription medications and traditional Western therapies are not always the right course of action. Patients need as many choices as possible.
Five years ago, there was no shortage of people who were convinced that Medical Cannabis would never come to Utah. Yet here we are. Thanks to public education and a well-worded ballot proposition, Utah patients now have access to Medical Cannabis.
Could psychedelics be next? Anything can happen. A few years from now, we might be writing blog posts about the benefits of psychedelics for a whole range of diseases and maladies. Stay tuned. We should know more about the fate of psychedelics in Utah within the next year or two.
The world lost someone truly special when 73-year-old Olivia Newton-John succumbed to cancer in early August 2022. Newton-John was very public about her disease and treatments. We could all learn a lot from her and the bravery she showed over many years of being ill. In particular, the cannabis community can learn a lot from her example.
Olivia Newton-John became a household name after starring alongside John Travolta in the 1978 musical Grease. She was also a Grammy award-winning singer with tons of hits. But in 1992, Newton-John was diagnosed with breast cancer. Her remission lasted until 2013, when the cancer returned in her shoulder. It eventually found its way to her spine.
Cancer pain can be debilitating to some people. So it’s no surprise that in 2018, Newton-John made public the fact that she was using Medical Cannabis to treat her cancer pain. Back then, she called cannabis a “magical, miracle plant” that helped her manage daily pain.
You probably already know that chronic pain is a qualifying condition for Medical Cannabis in Utah. So is cancer. So between the two, patients suffering similar to how Newton-John suffered are eligible to get Medical Cannabis Cards in the Beehive State.
We also reported earlier this year that state lawmakers added acute pain to the qualifying conditions list. This is pretty big, especially for medical providers and patients who would otherwise settle on opioid painkillers following a surgery, some sort of accident, etc.
Knowing what we know about Olivia Newton-John’s battle with cancer, she would probably encourage Utah patients suffering from cancer or chronic pain to get their Medical Cannabis Cards. She was the living embodiment of the principle of not letting physical health fully dictate one’s life.
Newton-John was not ashamed of using Medical Cannabis to manage cancer pain. She was open and honest about it. She also made it clear that it was her husband who introduced her to the idea. Thankfully, he wasn’t afraid to share his knowledge on cannabis with his wife.
We sincerely hope that you aren’t avoiding getting a Medical Cannabis Card because you associate negative thoughts or emotions with cannabis. Medical Cannabis patients have nothing to be ashamed of. Their medicines are no different to any other prescription medications.
If you are dealing with cancer and the pain that comes with it, you have enough to worry about. You need relief from pain that is just making it harder for you to deal with cancer and its treatment. Medical Cannabis could work very well for you. At least talk to your medical provider about it.
Should you decide to get a Medical Cannabis Card, the process isn’t difficult. You create an account on the state website and initiate the process by filling out your portion of the card application. Then you visit with your provider. They complete the other half of the application, you pay your fee, and then wait for your card to arrive electronically.
If you are still unsure, learn a little bit more about Olivia Newton-John and her brave battle against cancer. Being a cancer patient for some 30 years, she had plenty of insight to offer. We could all learn from her inspiring story.
Olivia Newton-John’s passing has had a profound impact on a lot of people. Those of us in the cannabis community can draw inspiration from her story and example. Her life was proof that Medical Cannabis is something to be celebrated rather than kept hidden in the shadows.
Israeli researchers recently published the results of a study looking at the effectiveness of aerosolized THC as a treatment for chronic pain. Though the study is considered small scale, its results were what many expected: patients reported less pain and a higher quality of life after inhaling microdoses of THC with a specialized inhaler.
What makes the results of this study so encouraging is the fact that the researchers could use such small amounts of THC and still achieve positive results. The amount of THC delivered via their aerosolized inhaler are “a fraction of the amount of MC [medical cannabis] compared with other modes of delivery by inhalation,” according to the published report accompanying the study.
Researchers enrolled 143 patients between the ages of 17 and 62; 54% were male and 46% were female. All were diagnosed with chronic neuropathic pain. The neuropathic pain qualifier is important because of the nature of this type of pain. Neuropathic pain is the result of nerve damage caused by trauma, disease, or an underlying health condition.
Participants were provided with the inhaler and medicine and instructed to use it over several months. Some patients reported mild side effects during the initial stages of the study, but those side effects subsided over time. As the months passed, patients gradually reported less pain and a higher quality of life.
The results led researchers to speculate that low-dose THC delivered via an aerosolized inhaler could offer long term pain relief for chronic pain patients. As in most other cases, the researchers were quick to point out the small scale of their study indicated the need for more research to verify their findings.
The implications of this research are important on many levels. Right off the top is the difference between aerosolized THC and cannabis smoke. Here in Utah, smoking Medical Cannabis is illegal. Plant material can only be used as a medicine by dry heating it or using it to make edibles at home.
Dry heating is the process of heating plant material in a specialized vaporizer in order to decarboxylate it. Decarboxylation activates cannabinoids and releases them from plant material. In order for this delivery method to work, the plant material needs to get hot enough to release cannabinoids – but not hot enough to combust.
In an aerosol environment, THC and other cannabinoids are suspended in a pressurized liquid. Forcing that liquid through a nozzle upon release transforms it into an aerosol that can be inhaled. The process is similar to forcing liquid window cleaner through a small nozzle to create a mist.
The main benefit to this sort of delivery method is that there is absolutely no risk of inadvertently creating toxic chemicals that could be inhaled along with the THC. Patients are getting just the medicine they need and nothing more.
We are excited to hear about this research out of Israel. It could ultimately lead to an entirely new delivery method for the future. Giving patients yet another choice allows them the ability to find the delivery method that works best for them. We are fully on-board with that.
Here’s hoping future research shows similar effectiveness of low-dose THC via aerosolized inhalers. If we can help patients find the relief they need with the lowest possible doses of THC, we will be advancing the cause of Medical Cannabis as an effective treatment for chronic pain. That can only be a good thing for pain patients in the long run.
