Utah Medical Cannabis Bill Passes Out of Senate, Onto House

In a 17-12 vote, SB 73, Utah’s whole-plant medical cannabis bill was advanced in third reading out of the senate and onto the House of Representatives. It will be read three times in the House, and if passed, land on Gov. Gary Herbert’s desk March 11 to be signed into law. If he signs, Utah will become the 24^th state to legalize safe access to medical cannabis and the first to progress from a restrictive cannabidiol (CBD)-only policy to whole-plant access.

During the second day of debates Monday, Utah State Senator Mark Benson Madsen (R-Saratoga Springs) broke down in tears on the Senate floor during the second reading debates on SB 73, The Medical Cannabis Act.

“We owe it to our constituents and to our fellow Utahns in need to do something now,” Madsen said. “Currently throughout Utah, thousands of our sick and suffering are forced to choose to either use cannabis here, although it’s against the law, to continue to suffer, or to flee their home state, leaving [behind] friends, family and support systems. We are better than that and we need to be better that.”

Madsen has faced an uphill battle trying to fill the information gap for senators unfamiliar with cannabis. He had met each concern from his colleagues with a binder full of hundreds of peer-reviewed credible studies, although he lamented most senators hadn’t bothered to read it.

“I can go study for study with everyone. What is relevant is whether we think these people should be put in jail or have their children removed. I have gotten to know many of these patients, too many have become medical refugees. The other bill [SB 89] doesn’t address that at all. Our bill will bring the refugees home,” Madsen said.

The medical cannabis debate — which has been ongoing since the surprise defeat of Madsen’s bill last year — has heated up in Utah and now threatens to alter the identity of that state’s politics. A growing body of patients and activists have obtained the support of wealthy financial backers and announced they will be running a much less restrictive ballot referendum. Political commentators on both sides have noted that medical cannabis on the ballot in Utah would bring out a whole new electorate and could easily unseat a handful of Republicans.

As the bill gained support, the Church of Jesus Christ of Latter-day Saints, which is based in Salt Lake City, issued two statements in opposition to Sen. Madsen’s bill and in support of the competing bill, SB 89, which would slightly expand the state’s current restrictive CBD-only medical cannabis legislation. With the Church’s disapproval in Utah — where 80 percent of the legislature is Mormon — the bill seemed all but dead, again.

In 2015, Madsen introduced SB 259, a bill that would have legalized whole-plant botanical cannabis with no arbitrary cannabinoid restrictions and establish in-state licensing, production, manufacturing and distribution of cannabis and cannabis medicines to patients with a list of conditions that includes cancer, AIDS, epilepsy, autoimmune diseases, PTSD and chronic pain, among others. The bill was defeated by one flipped vote in the Senate, despite public polling indicating overwhelming support from over two-thirds of Utahns, including Republicans, Mormons and senior citizens.

Since the bill’s defeat, a growing wave of patients have come forward and “outed” themselves to local media — many of them conservative and Mormon — including Sen. Madsen himself. Public support has mounted, with most major newspapers endorsing Madsen’s proposal and new polling indicating support for medical cannabis in Utah has gone up since the defeat of SB 259.

The result has become three pieces of legislation; one bill, SB 89, would expand on the state’s existing CBD-only medical cannabis policy; the second, SB 73, would make Utah the 24^th state to legalize safe access, and the third is a resolution asking the federal government to reschedule cannabis in order to pave the way for more studies. The resolution passed unanimously out of the Senate earlier this week.

On Friday, Feb. 19, the Senate was packed as patients and media gathered to hear SB 89 and SB 73 debated head-to-head on the floor. The arguments for and against both bills repeatedly harkened the need for a federal resolution.

“I guess we can call this weed day on the hill,” joked Sen. Evan Vickers (R-Cedar City), the sponsor of SB 89. He has since been criticized for making light of the issue while also decreeing the harms of marijuana.

Vickers was a vocal opponent to Madsen’s bill last year, along with Senators Brian Shiozawa (R-Salt Lake City) and Todd Weiler (R-Woods Cross).  Shiozawa is sponsoring the senate resolution to ask the federal government to reschedule cannabis to Schedule II, which he says would bring relief to suffering patients “within months”. Vickers and Shiozawa are pushing SB 89 in place of SB 73, despite the vast majority of patient support falling behind Madsen’s proposal.

Vickers, a pharmacist by trade who has taken much criticism for his opposition to medical cannabis, insisted he is trying to help patients but stressed the need for incrementalism. He said he made an exploratory trip to Colorado and was put off by the “bud masters” with tattoos behind the counters. He added an amendment requiring all employees dispensing CBD medicines be required to wear white lab coats.

Vickers lamented that getting educated about cannabis has been stressful and there are groups getting behind the whole-plant bill who are simply “trying to legalize marijuana.”

“We recognize our path is slower and we don’t have a problem with that,” Vickers said. “If people would just be patient with the process, the science will catch up.”

Madsen was directly asked Monday if his bill was the first step towards full legalization in Utah.

“If there are activists thinking this is the first step, they are going to be really disappointed — this is Utah. This isn’t inevitable. Again, I think even now the people of this state understand this,” Madsen said.

Vickers went on to address the criticism that he is a pharmacist who owns two pharmacies and that his motives aren’t directed at helping patients, but instead at personal profit and defense of the pharmaceutical industry.

“Don’t let the facts and truth get in the way of a good accusation,” Vickers said.

Vickers said his primary concern is about the efficacy and safety of dosing with an herbal medicine like cannabis, that for medicine to be properly practiced it must have measurable and traceable consistent dosage every time, the way pharmaceutical drugs work. He went on to add that if a patient needs THC—the demonized cannabinoid once thought to be the only active ingredient in cannabis that SB 89 seeks to prohibit—they should simply get a prescription for Marinol (dronabinol).

Marinol is a Schedule III drug approved by the FDA in 1985 to treat cancer, AIDS and wasting. At the time, patients with these ailments had begun to find smoking whole-plant cannabis was mitigating their symptoms, extending their lives and in some cases giving them relief enough to be considered remission. Because cannabis is a Schedule I drug considered by the FDA and DEA to have “no accepted medical uses”, a pharmaceutical option would seemingly preempt that change.

Marinol is a synthetic isolated version of Δ9-tetrahydrocannabinol (THC), the controversial cannabinoid at the center of the debate. THC is responsible for the euphoria and other psychotropic effects characteristic of the cannabis “high”. Patients have found the effects of isolated THC to be wildly unpleasant and often dysphoric because the THC is unmitigated by the hundreds of other naturally occurring chemicals found in botanical whole-plant cannabis. Israeli researchers, led Dr. Raphael Mechoulam, identified this phenomenon and described it in the early 1990s through research on the “entourage effect”, meaning what is known about medical cannabis is that it is most effective in its naturally occurring formulations rather than as isolated cannabinoids.

Sen. Madsen pointed out both the effects of Marinol were not desired by the patient and the cost, approximately $300 per month, was an unnecessary financial burden when a cheaper and more effective option—cannabis—is already available on the black market everywhere and legally regulated in nearby states.

But the Utah Senate—and most state legislators—have very little knowledge about medical cannabis and the available research. Support for SB 89 (CBD-only) and SB 73 (whole plant) has largely fallen more along ideological lines than scientific ones. Concern for patients getting “high” on THC from whole plant cannabis has crippled SB 73 — which underwent a series of amendments Friday before being circled and the vote pushed to Monday.

Vickers estimates his bill will help bring relief to an estimated 10-20,000 patients, a notion supporters of SB 73 and Sen. Madsen rebuke. He reiterated that patients support his bill, although none were present to support it. Despite that, SB 89 is expected to easily pass into law because it has the support of the LDS Church.

Sen. Luz Escamilla (D-Salt Lake City), a vocal proponent of medical cannabis, spoke out against more CBD-only legislation and in favor of un-amended passage of Sen. Madsen’s whole-plant bill. Escamilla, along with a handful of other senators supporting SB 73, had a patient constituent sitting behind her on the senate floor as she spoke.

“The people who do benefit from THC will not be able to access anything at this point, so what is the answer for desperate patients? [Are we] giving them a time frame of 5, 10, 20 years? When is it that we move to the next level in your [Sen. Vickers] scenario, in your version of the bill?” Escamilla asked.

“We don’t put a time frame on it, we don’t put a time frame on science,” Vickers replied. “I realize this is incrementalism, incrementalism isn’t a bad thing.”

Madsen insisted the available research be discussed.

“Let’s talk about the research,” Sen. Madsen said. “As far as I can see… we passed the CBD bill [in 2014] based on a CNN article, so I am wondering about the science that would exist that makes you [Vickers] believe CBD alone will be effective for the conditions listed in your bill [SB 89]? Why do you believe the conditions in the bill would be treated at all with CBD? What is the science that backs that up?”

In 50 years of medical cannabis research, both in the United States and abroad, the vast majority of studies and anecdotal success stories have been on inhaled whole-plant cannabis with naturally occurring (higher) levels of THC. The medical potential of CBD is a relatively new phenomenon that has been propelled in recent years after it was featured on CNN chief medical correspondent’s Sanjay Gupta’s groundbreaking documentary “Weed.”

When Madsen prompted Vickers to cite the research that is the basis of SB 89, Vickers said he has spoken to researchers at the University of Utah and said he stands behind their recommendations.

Madsen continued on the offensive.

“You have conceded if the government hadn’t screwed the policy up years ago [researching cannabis] we wouldn’t be here and the patients would be obtaining relief. Because government screwed it up before, why do the patients have to continue to suffer while government sorts it out? Why is it government’s place in the first place to tell people what they can and can’t take when they are ill?” Madsen asked.

“I know your feelings about government, senator,” Vickers quipped. Madsen is a libertarian-leaning Republican known for voting along those principles.

A vote was taken on SB 89 and it was passed 26-3 into the House of Representatives. Sen. Madsen was one of the three senators who voted in opposition. The debate then shifted to SB 73.

Madsen made a passionate plea to his colleagues. He opened by talking about how moved he had become meeting the epileptic children and their families who were pushing for passage of HB 105, Utah’s current CBD-only legislation, in 2014.

Under HB 105, patients with intractable epilepsy can pay $400 a year to enroll in the Hemp Extracts Registry. This allows them to possess extracts of cannabis high in CBD and low enough in THC to be arbitrarily classified as industrial hemp. There is no mechanism for in-state production and distribution, meaning the medicine must cross state lines, which is federally illegal. In essence, patients must break the current law to comply with it.

“These children were here as collateral damage of the War on Drugs… Many of these families found they needed more THC. Now they break the law,” Madsen said. “They see people in other states getting relief from their conditions. This is not a question of science—we [legislators] are not qualified to review the hundreds of studies — this is really a question of criminal justice. Is it right to put sick people in jail? To me the answer is clear… CBD-only is a placebo masking as a panacea and the only thing it will ease is our conscience.”

One by one, Madsen introduced amendments to SB 73, each were approved and most were minor changes. By the time Madsen got to amendment seven, to remove access to whole plant cannabis flowers, his demeanor changed.

“This hurts,” he says. “The low cost option has always been the availability of the whole plant. [Patients] are bleeding money and I want to keep the costs to the families as low as possible. I have heard the concerns that people will take it home and smoke it… these are sick people. I don’t want to let this go—it’s an important part of the bill for a lot of people. This is what made patients throw up their hands and say they want to go another route [on the ballot].”

Madsen continued:

“The greatest feeling I have now is that I don’t want to let these people down. I tried to make them available to you so you would understand.

“I think that principles matter. Are we about the 99 or are we about the one? Do we believe in our founders’ principals that the individual was given the right to control their lives by God? When that agency is interfered with, that is not righteous.

“I know some very powerful political interests have been working against the bill and the people of this state recognize this issue, better than we do in here. They are willing to take this in their hands if we don’t do it right. Before we got into the substance of this issue we have had to dispel a lot of myths, it’s been an interesting experience… but I have never been more sure about a bill than this one.

“This, as you know, is a personal issue to me—although I am one of many and don’t suffer as much as others do. Each of you, as you cast your vote today; have an impact on my personal situation. The law will either force me to take medicine everyone has cleared a path for me to take [opiates]—it helps but it also killed me and I am fortunate to have been revived. But, is it right that the government should force me to take that substance that killed me? That my kids have to live with that over their heads? That I could still die when we know there is something better? Is it your role to make the decision for me and my children what I can take into my body to best treat the conditions I am struggling with in my life? We will see how that question is answered.”

Sen. Madsen suffers from chronic back pain and was almost killed by an accidental overdose of opiate pain medications. He traveled to Colorado last winter to try medical cannabis before introducing the bill.

The bill will begin hearings in the House of Representatives early next week.

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