Earlier this month, Utah lawmakers impaneled the seven physicians who will be entrusted with evaluating the most complex patient requests for medical cannabis.
This entity, called the compassionate use board, will have the power to recommend cannabis for patients whose maladies aren’t on the legal list of qualifying ailments, or people who would otherwise be ineligible for the plant-based treatment. It will also review all applications by patients younger than 21 for an added layer of caution when using marijuana in pediatric cases.
And the board’s role as a backstop in the state’s marijuana program could expand even further in the future, potentially to accept appeals from patients whose personal physicians are uncomfortable making cannabis recommendations.
“There’s just concern out there amongst the medical community,” said Sen. Evan Vickers, a Cedar City pharmacist. “And so we’re trying to come up with some ways that the patient could still have access to medication, if their physician didn’t want to do it.”
This year, Vickers, the Republican majority leader, is readying legislation that could enable the compassionate use board to step in for these cases, so Utahns aren’t left shopping for doctors receptive to medicinal cannabis.
Patients across Utah have reported being in this situation. For several months after the state last year passed its medical marijuana law, Intermountain Healthcare, Utah’s largest health network, did not allow its providers to write letters recommending cannabis to patients. While Intermountain has lifted those restrictions, many individual doctors are still tentative when it comes to recommending the federally illegal plant, and advocates say this reluctance will create a significant bottleneck in the program if unaddressed.
“There are so many doctors that I speak to that are just afraid,” said Desiree Hennessy, executive director of the Utah Patients Coalition. “There’s a lot of stigma that’s been built up for years about this plant, and now they’re just supposed to erase it with the passing of an initiative. And that’s not really going to happen.”
That’s why it’s so important to let patients appeal to the compassionate use board, she said.
Andrew Talbott, a Park City pain specialist, said this approach would cause more problems and believes there is a simpler solution: allowing physicians to treat an unlimited number of cannabis patients.
The Utah Medical Cannabis Act — which was approved by state lawmakers in a December special session and supplanted the medical marijuana initiative passed by voters — caps regular physicians to 175 cannabis patients at a time. Certain specialists can treat up to 300 patients at a time with medical marijuana, according to the law.
Those limits were included to prevent a handful of “cannabis doctors” from handling the bulk of the marijuana recommendations, Vickers said, adding that the Utah Medical Association wanted a broader base of physicians for the state’s program.
Talbott doesn’t see the harm in allowing cannabis-focused practices.
“We need specialists who practice almost exclusively cannabis medicine, who are experts in this field,” he said.
While the state hasn’t yet started issuing medical cannabis cards, physicians have been able to write letters of recommendation that afford patients some legal protection if they’re caught with cannabis. The caps don’t apply during this interim period, and Talbott said he’s written well over 300 letters for patients who have been turned away by their regular physicians.
But he won’t be able to keep all those patients once the card system is up and running.
“As of right now, I have people coming in from every corner of the state,” said Talbott, who unsuccessfully applied to serve on the compassionate use board. (He suspects his involvement in suing the state over the medical cannabis law wasn’t to his advantage in the selection process.)
Christine Stenquist, founder of Together for Responsible Use and Cannabis Education (TRUCE), agrees with Talbott, who serves on her group’s board. Saddling the compassionate use board with more duties will probably just lengthen wait times for patients applying to the panel for help, she said.
“It sounds like a bunch of malarkey,” she said, going on to argue that the law passed in December is fundamentally flawed. “I know that they’re trying but they screwed it up so bad to begin with, it’s putting a Band-Aid over a hemorrhage.”
TRUCE and other advocates are suing the state in an attempt to repeal the cannabis act and go back to Proposition 2, the medical cannabis initiative passed by voters. Prop 2 did not set patient caps, Talbott notes.
Ed Redd, a former state lawmaker and member of the compassionate use board, said he hopes most qualifying cannabis patients will be able to work with their personal doctors without having to turn to his panel.
“If I were going to recommend cannabis, I would want to spend enough time with the patient,” the Logan physician said.
Talbott estimates he needs a minimum of 45 minutes to consult with a new patient.
Vickers said his proposal is still in a conceptual phase and he and other drafters are still figuring out how it would function and how to deal with any added workload for the compassionate use board.
Connor Boyack, a cannabis advocate and founder of the libertarian Libertas Institute, is collaborating with Vickers on the bill and said the physician board’s structure might ultimately have to change in light of its broadened role.
“Over time, we may find that we need to expand the board or structure it in a way that allows them to adequately review all the applications they’ve received,” he said.
Serving on the board with Redd will be Joel Ehrenkranz, an internal medicine specialist and expert in medical cannabis; Angelo Giardino, pediatrician and pediatrics department chair at the University of Utah School of Medicine; Nicholas Whipple, specialist in pediatric hematology-oncology at the University of Utah; Meghan Ward, an Intermountain Healthcare specialist in neurology and epilepsy; Richard Segal, a psychiatrist; and Colleen Marty, a pediatrician and expert in hospice and palliative medicine.
Three of the board members will serve an initial two-year term, and the remaining four members will serve four years apiece.
