by Jenet Jacob Erickson
This last week, Utah signed into law what some have called “the best-designed” medical marijuana law in the country. Crafting that law was not easy. In just a few years marijuana has become a key political issue across the nation. Utah was no exception. In June of 2017, medical marijuana advocates in Utah began a campaign to obtain the number of signatures needed to put a medical marijuana initiative on the ballot in 2018, ending up with nearly 154,000 signatures. Many of those signatures represented conscientious citizens who are concerned about individuals with severe and difficult medical challenges that may be alleviated by the use of medical marijuana. But the language of the initiative and the funding behind it ultimately represented something different than the stated goal of enabling “medical patients to have access to medical cannabis for very specific medical needs.”
Marijuana Policy Project – the money behind lax Cannabis law
In fact, Marijuana Policy Project, the national lobbying arm of the marijuana industry was the major funder and crafter of Utah’s medical marijuana initiative. They likely saw Utah’s compassionate response to suffering patients as fertile ground for fulfilling their motto, “We Change Laws!” in their unequivocal mission to legalize recreational marijuana across the United States. It should be no surprise that the “medical” marijuana initiative they helped craft for Utah was not actually “medical.” Unlike other medical treatments used for serious medical conditions, doctors would not prescribe it and pharmacies would not dispense it. Instead, the “medicine” of marijuana would be purchased at dispensaries where “budtenders” (with or without medical training) would recommend marijuana-infused cookies, candy, sodas, and other marijuana infused products, including free samples. Some Utahns would even be allowed to grow this “medicine” in their own yard.
The fact that Utah’s medical marijuana initiative did not treat marijuana as a medicine and that it lacked the regulations essential to mitigating opportunities for abuse of the law raised concerns. Ultimately the governor and other leaders concluded that the initiative’s lack of safeguards over the production and utilization of marijuana had serious flaws that compromised the health and safety of Utah communities and opened the door for marijuana’s recreational use.
Marijuana – a serious drug with serious risks
They knew what those risks could mean. Multiple studies suggest that marijuana is a “gateway drug” that precedes use of and addiction to other licit and illicit substances. Marijuana use is consistently linked to alcohol abuse, and other substance abuse including nicotine addiction. In studies using rats, marijuana exposure appears to “prime” the brain for addiction by increasing the brain’s responsiveness to other drugs as well as marijuana. These findings are consistent with multiple epidemiological studies linking marijuana use in adolescence to addiction to other substances later in life.
But that isn’t the only potential risk. States that have legalized marijuana for recreational use provide a case study for other unintended consequences of legalizing marijuana. In Colorado, for example, the prevalence of marijuana use increased from 21% to 31% among young adults and from 5% to 14% among adults after legalization. But there was not just a dramatic increase in the “legal” use of marijuana.
Colorado also became a “haven” for criminals who hope to make millions exporting the marijuana they grow. In Colorado, law enforcement agencies have faced an increase of 380% in arrests for the production of black market marijuana, as well as a dramatic increase in arrests for illegal manufacturing of marijuana laced products, and for illegal marijuana growth in large, hidden operations. Between 2012 and 2017, organized marijuana crime case filings went from 31 to 119, and the number of seizures for Colorado-sourced marijuana increased more than 250%.
In addition, the number of traffic fatalities where a driver tested positive for any cannabinoid increased 200% between 2013 and 2017. Hospitalization due to possible marijuana exposure increased from 803 to 2,696 (per 100,000) between 2001 and 2015. And marijuana was the most common reason for school expulsions and law enforcement referrals among youth in the 2016-2017 year, the first year when marijuana was reported separately as a reason for disciplinary action.
Common sense cannabis legalization – balancing needs and risks
Given these risks, Utah knew it had to find a way to balance strong patient access to marijuana for medical help with regulations that could mitigate opportunities for abuse and strengthen law enforcement’s ability to monitor recreational use. In the end opposing sides came together create compromise legislation that effectively helps alleviate suffering while shoring up protections for public health and safety. In doing so, Utah’s compromise legislation provides a model for other states to follow.
The following chart lays out some of the major changes between the original ballot initiative and the compromise bill that was finally adopted into law by more than a 2/3rds majority in the legislature. (Thank you to Family Policy Resource). These comparisons provide a guide for specific issues that should be considered when addressing the issue of medical marijuana.
| Proposition 2 | Utah’s Compromise Bill |
| A doctor, physician assistant, optometrist, podiatrist, dentist, nurse practitioner, or certified nurse midwife may recommend a Medical Cannabis Card.
“Qualifying conditions” are very broadly defined (e.g., any autoimmune disease, chronic pain, nausea, autism). |
Only a doctor – MD or DO – who has been treating a patient for a “qualifying condition” may recommend a Medical Cannabis Card. Only a doctor – MD or DO – may recommend a specific medicinal dosage. |
| Marijuana products dispensed at commercial dispensaries (stores) with 1 in every county, and up to 8 in Salt Lake County.
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Marijuana products must be purchased at a state-regulated Medical Marijuana Pharmacy, with seven pharmacies total permitted statewide, and a state central fill system with capacity to mail marijuana prescriptions to state health departments for patient pick up. |
| Marijuana products dispensed by a “budtender” with or without medical training. | Marijuana products can only be dispensed by a licensed pharmacist who receives ongoing training in medical cannabis dispensing. |
| Patients living more than 100 miles from a marijuana dispensary may grow up to six of their own marijuana plants. | Marijuana plants cannot be grown on an individual’s property. The size and number of marijuana growing facilities is limited and regulated by the state. |
| Teens can obtain medical marijuana cards without parental permission or awareness. The state has no remedy for sanctioning physicians who liberally dispense cannabis cards to patients as young as eighteen years old. | Patients under 21 years old must obtain approval for a medical cannabis card from the state-appointed Compassionate Use Board as well as from their physician. A parent or legal guardian must obtain a medical cannabis card for an eligible minor patient and the minor patient concurrently receives a provisional patient card. A minor is prohibited from entering a medical cannabis pharmacy. |
| Any practitioner who recommends marijuana is granted legal immunity from malpractice lawsuits or sanctions from state licensing boards. | Criminal penalties are imposed for improperly giving or selling medical cannabis. |
| Until July 2020, a person claiming a “qualifying condition” can use, possess, or manufacture marijuana products under the initiative’s affirmative defense provision, even if caught in possession of marijuana without a medical marijuana card.
After July 2020, those in possession of marijuana without a medical marijuana card have a maximum penalty of an infraction and $100 fine. Medical marijuana users will be able to possess ¼ lb. (160-220 joints) of marijuana in public, with no limit for the amount possessed in their residence. |
Possessed marijuana must be in medicinal dosage forms including certain dosages, labeling and childproof packaging and the possessor must have a “pre-existing relationship” with a doctor who indicated they could medically benefit from marijuana use. Utah’s Department of Agriculture and Food, the Department of Health, the Department of Public Safety, and the Department of Technology Services are required to create an electronic verification system to facilitate recommendation, dispensing, and record-keeping for medical cannabis transactions. |
| Marijuana-infused products can be sold at commercial dispensaries in any form including edibles that appeal to children (e.g., brownies, cookies, candy, soda, and ice cream).
Medical marijuana users may vape or smoke marijuana.
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Authorized forms of medical marijuana are limited to a “medical dosage forms” including tablets, capsules, concentrated oil, liquid suspension, skin patch, sublingual pill, and in limited circumstances a resin or wax. |
| Records on all medical cannabis users would be destroyed after months. | The medical records of medical cannabis users will be preserved like all other medical records.
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Utah’s compromise legislation demonstrates that there is a way to change the dynamics of medical marijuana, forging a compromise between the serious advocates of medicinal use and the conscientious medical, civic, and police associations opposed to its misuse. In the end patients, children, and communities can all benefit when we carefully craft legislation that balances the benefits of medical marijuana use against the risks of its abuse.
What can you do?
Marijuana has been legalized in some form in 33 states in the U.S. World-wide, 21 countries have legalized cannabis use either fully or partially. It is important to know the status of the nation and state in which you live and to stay informed regarding the consequences of lax marijuana laws, then act with other concerned citizens to pressure policy-makers to treat marijuana legalization responsibly. Cannabis has real potential to help those that suffer from serious medical conditions, but it also has serious potential risks – both to individuals and communities. Utah’s compromise bill proves that policy-makers can craft legislation that provides needed help while protecting families and society.