In Utah, dispensaries are referred to as pharmacies, and the method of which patients must apply for and obtain cannabis medicine differs. While the state of Utah is home to over three million people, only 15 pharmacies and eight cultivators are allowed to legally operate there.

Pharmacists are essential to the structure of Utah’s medical cannabis program, as they are legally the only way that medical cannabis patients can obtain cannabis products. Beehive Farmacy’s Pharmacist in Charge, Mindy Madeo, has been a pharmacist for over 20 years, but found a new calling to enter the cannabis industry after the state of Utah legalized medical cannabis. Madeo attended the University of Maryland School of Pharmacy’s cannabis program, which she will soon be graduating with a Masters of Science in Medical Cannabis Science and Therapeutics. It’s currently the only pharmacy school in the U.S. to offer such a degree, and furthermore, Madeo is one of the only people in Utah to have earned such a distinction.

Madeo took time to chat with High Times about what sets Utah apart from other states’ medical cannabis programs, the influence of the Church of Jesus Christ of Latter-day Saints (LDS), and what the future holds for patients.

The Essential Pharmacist

When Madeo began her entrance into the cannabis industry, she helped one of the pharmacies, called Wholesome, open up shop. While that pharmacy was a bit more business-focused, Madeo then moved on to Beehive Farmacy where she currently works as Pharmacist in Charge. Beehive Farmacy has two locations out of the total 15 that are allowed statewide, one in Salt Lake City and another in Brigham City. “It’s been really amazing,” Madeo said of her role. “The work I do every day is really like my dream. I’ve been doing it for two years and I still say I would do it even if I wasn’t getting paid.”

Madeo explained how Utah’s medical cannabis program works for patients. Similarly to other states, patients must go to a doctor and obtain a recommendation for a cannabis card—but new patients can’t just go to a pharmacy to pick up their medicine right away. “It is required by law that every single patient that’s new to the cannabis program, has to sit down and have a consultation with the pharmacist. And that’s the unique thing. That’s the thing that no other state does,” Madeo explained. “And it’s expensive to run as a business to do that, but the results are just phenomenal.”

These consultations only take an average of 30 minutes, during which pharmacists like Madeo will ask their patient which medications they currently take. “I’ve noticed as I was doing this that it’s not just the pain pills,” she shared. “It’s stimulants, like the Adderall and Ritalin in the morning that people can come off of. It’s the sleeping pills at night. It’s the antidepressants. It’s the stomach meds. I’ve even had I’ve even had quite a few patients come off of blood pressure medications.” After identifying their patient’s needs, pharmacists recommend various cannabinoid combination products, or different cultivars or terpene profiles, to use as a treatment.

Madeo also notes the importance of teaching new patients how to control their dosage, what to do if they consumed a bit too much, and for regular consumers, how to reset tolerance or reassess their current medication. “So I think giving patients control of their pain, control of their health, where they’re able to increase or decrease or try different products is very empowering for people. And I wish more medicine would be like that.”

The LDS Church

Aside from regular curious customers, Madeo has also witnessed the shift in perspective by the Church of Jesus Christ of Latter-day Saints (LDS) and its members. “In Utah, it’s amazing because the LDS church, at first was not on board. There was a lot of controversy,” she said of the church’s initial stance on cannabis. “And then they changed some policy saying like ‘You can’t have cannabis.’ And then they changed it again and saying ‘It’s fine if it’s with a doctor.’ So currently, it’s 100% fine as long as the doctor recommends it. And I am seeing so many old people, so many people that come in [and] you can tell [that] they’re Mormon, they’re wearing CTR rings. Their minds are changing. And to me, that in itself is just an amazing thing to watch.”

Expanding Legislation in Utah

Utah initially passed its medical cannabis legislation when former Gov. Gary Hubert signed House Bill 195 into law in March 2018, which allows patients the “right to try” cannabis as a treatment if they are terminally ill. Later in November 2018, Utah voters approved Proposition 2, which created the foundation for the state’s current medical cannabis program. The state’s program launched in March 2020, and now there are an estimated 41,000 medical cannabis patients in the state, as of January 2022.

Cannabis isn’t the only medical treatment that legislators are contemplating when it comes to access. In the 2022 legislative session, Utah legislators passed House Bill 167, also called the Mental Illness Psychotherapy Drug Task Force, which will review studies about psychedelic substances being used as a treatment for medical patients. Substances such as psilocybin therapy, or even the use of MDMA, are being used to treat certain medical conditions.

Ultimately, Madeo sees a bright future for the medical patients of Utah, and those who aren’t currently patients but are becoming curious about how cannabis can help. However, there are still many hurdles to overcome. “In Utah, and probably in the whole country is, right now we sit and we differentiate between medical use and recreation[al] use, right? That word ‘recreation’ is a terrible word. We should be calling it ‘adult-use.’ But we still use “rec.” To me, that’s such a judgment call, and I don’t think there’s much of a difference between the two.”

Madeo commented on the judgmental attitude of laws in Utah, from limitations on advertisements or restriction on anything that is Rastafarian inspired, such as colors or designs. “To me, they’re trying to whitewash the plant that we’ve been using forever,” she said.

But this judgement also extends to consumers as well. “We’re somehow like targeting this culture that we think we’re judging them and we’re saying, ‘You have dreadlocks, you are using concentrate … you’re using too high of a dose, so you’re a rec patient.’ That person could have anxiety, they could have cancer. Give me five minutes with someone who you say is rec and I’ll find a medical reason why they’re using it.”

Brazil is moving forward on medical cannabis reform. At the beginning of the month, the National Health Surveillance Agency approved two new medical products. This will bring the number of approved medical cannabis products to 18. The majority of those available are still only CBD—ten out of the total are extracts made from cannabidiol. All of them must be bought in pharmacies and drug stores.

That is the state of cannabis reform du jour in Brazil, a place where even this victory has been hard fought. Indeed, the current (right wing) leader, President Jair Bolsonaro, has repeatedly quashed attempts at any forward steps, despite whole cities defying him.

Enter the 2022 Brazilian Presidential elections.

Tragically, there are a lot of fence-sitters. Then again, given the current political climate, even one step forward represents progress—even of the tortoise variety.

The Political Can to be Kicked Down the Road

CNN questioned all of the pre-candidates about their stance on reform. Here are some of the broader takeaways from the seven men in the ring.

Two candidates, plus the sitting president, Bolsonaro, did not answer. However, nobody needs him to. Bolsonaro’s track record on legalization is very clear. He even publicly mocked the last legislative effort to regulate the industry.

The other four all spoke in favor of medical use—but none support recreational reform.

Will Canada Remain the Only Recreational Reform Country in The American Hemisphere?

The U.S. has sadly had a great deal of influence in both Central and South America when it comes to the topic of drug policy. This is clearly showing up in Brazil right now. This includes any and all threats to access the American banking system (which were used to slow down dispensation in places like Uruguay).

Given the struggle that is going on at the federal level in the U.S. at this point, sticking to the medical side of the equation is a safe political bet.

Brazil is not the only country facing its Prohibition past and trying to figure out the next steps forward.

The positive news, of course, is that this is a serious question at the national level—and so is full reform.

The Great Medical vs. Recreational Divide

The scenario playing out in Brazil is by now a familiar one, especially to the global industry but the issues involved in this debate have not really hit the United States so far outside of California. Namely, how far should a federal government go when beginning to legalize a recreational market?

In the U.S., the issue of states’ rights has clouded the topic in a way unseen in Europe or other countries.

There are several models so far. The first is Holland, which has allowed an illicit market to survive based on the grey exceptions in the law. Spain is similar. In both countries right now, there are attempts to formalize both markets and figure out how the two should work together (or if there should be any overlap).

Then there is Canada, which allowed patient groups and collectives to be the starting point for a commercial medical and then recreational market. Funky financing and certification issues notwithstanding, this has been the model that has also forwarded, in its own strange way, reform elsewhere. Namely being the first country outside of the Netherlands to provide Germany with product for its medical market that started in 2017.

Finally, there is Germany which is now on track to pass some kind of recreational reform by the end of 2022. The transition here is likely to be bumpy too, but for different reasons. Namely, it is highly likely that the first movers in this market will be required to have EU-GMP certification.

This will mean that the first products in the recreational market will have to have a much higher bar to cross to hit the market, even if the transition to a less stringent standard is inevitable.

Regardless, there will be plenty of fireworks and drama if the cultivation and distribution bids were anything to go by—starting with challenging the inherent unfairness of the status quo. That said, it is hard to expect anything different since the Health Minister is the go-to guy on crafting the new recreational reform legislation per the actions of the Bundestag.

Legalization is not easy anywhere.

Just ask Joe Biden.

The Massachusetts House of Representatives overwhelmingly voted on Wednesday to approve a bill amending the state’s weed laws, including significant social equity investments and the addition of cannabis consumption cafes to the state’s roster of regulated pot businesses. Lawmakers in the House voted 153-2 to approve the bill, which is nearly identical to a measure passed by the Massachusetts Senate in April.

House Speaker Ron Mariano issued a statement quoted by the Boston Globe, saying the bill aims “to create a fair and successful cannabis industry, fostering equitable opportunities to those disproportionately impacted by the systemic racism of historic drug policy.”

The bill makes several changes to existing cannabis laws in Massachusetts, where voters approved a ballot measure to legalize cannabis for use by adults in 2016. Since then, recreational pot retailers in the state have sold more than $3 billion in weed products, according to a report from the Massachusetts Cannabis Control Commission that was released the same day the bill was approved in the House.

Adam Fine, a partner with the cannabis law firm Vicente Sederberg, says that the “legislation marks the House of Representatives’ first significant movement on cannabis since adult-use legalization.”

“Components of the bill address some of the concerns that have been identified over the past five years, particularly around social equity, host community agreements and movement towards allowing social consumption sites,” Fine wrote in an email to High Times. “The proposal creates the Social Equity Trust fund for social equity operators and provides a mechanism for money to be raised to help applicants enter the cannabis space.”

New Investments in Social Equity

Under the bill, 20% of the pot taxes collected in the state will be dedicated to investments in cannabis social equity businesses. The share of revenue is higher than the 15% detailed in an earlier version of the bill and double the 10% included in the Senate bill.

The increased funding would be substantial. From July 2021 through April of this year, Massachusetts has collected $124.5 million in recreational cannabis excise taxes. Under the House version of the bill, that amount of revenue would equate to more than $25 million in funding for social equity cannabis businesses in the state.

Under the state’s current social equity program, only 23 of the state’s 253 licensed cannabis businesses are owned by entrepreneurs qualified for the economic empowerment and social equity programs administered by the Cannabis Control Commission. Shanel Lindsay, the co-founder of the advocacy group Equitable Opportunities Now, praised lawmakers in the House for the change and urged senators to retain the higher percentage in a compromise version of the bill.

“Without this funding, our equity goals are just hollow promises,” Lindsay said.

Both versions of the bill require local governments to consider social equity factors when issuing local permits. The House bill also simplifies the expungement process for past weed convictions and arrests by making more offenses eligible for relief. The legislation also directs judges to approve all eligible petitions for expungement, removing much of their discretion to deny requests without explanation.

“We mean it when we say our residents have the right to keep these records from following them around for life,” said state Representative Michael Day.

Massachusetts Bill Reforms Host Community Agreements

Another provision of the legislation would reform the contracts cannabis businesses sign with local governments to obtain local licensing approval known as host community agreements. Cannabis operators and applicants for licenses have argued that community impact fees included in such agreements by local governments exceed the cannabis industry’s negative effects on the community.

Both the Senate and House versions of the bill limit impact fees by requiring local governments to detail any negative impact and set commensurate fees. State regulators would have the authority to reject plans that require excessive payments.

“Without enforcement, we’ve seen some communities push the bounds further than allowed by law, this legislation will make local permitting straightforward and allow more social equity applicants to move through the local process,” said Fine.

The House version ends impact fees once a weed business has been open five years and gives the Cannabis Control Commission 45 days to review local agreements, while the Senate bill allows up to 120 days.

“The municipality literally has the upper hand in these negotiations, and many have used it to a fault,” said state Representative Daniel Donahue. He added that the legislation would help create a “legal, fair, and honest” cannabis industry in Massachusetts.

The Massachusetts Municipal Association of local governments opposed the change, saying the changes to impact fees were a way for cannabis operators to keep more profit for themselves at the expense of local communities.

“The key issues for cities and towns include making certain that the final version of legislation doesn’t interfere with existing host community agreements, and making sure that communities can collect adequate community impact fees going forward,” said Geoff Beckwith, the associate director of the group.

Beckwith added that reducing or eliminating the impact fees “could be a disincentive for additional communities to accept cannabis establishments.”

Massachusetts Cannabis Business Association president David O’Brien praised the changes to the state’s cannabis laws included in the legislation.

“By providing start-up capital, empowering the [cannabis commission] with proper oversight of greedy municipalities, and allowing cannabis operators to deduct normal business expenses,” O’Brien said, “entrepreneurs now will be able to pursue their dreams of starting a small business with fewer barriers in their way.”

Before the legislation can become law, a conference committee will have to rectify the differences between the House and Senate versions of the bill. Both bodies would then have to vote in favor of a final bill before sending it to Governor Charlie Baker for approval.

A new study published on May 9 in the Journal of Adolescent Health shows evidence that cannabis legalization has brought down the consumption of alcohol and cigarettes in youth consumers. Entitled “Trends in Alcohol, Cigarette, E-Cigarette, and Nonprescribed Pain Reliever Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis,” the study includes the analysis of six waves of survey data collected between 2014 and 2019. Researchers from the University of Washington reviewed data which covered approximately 12,500 adolescents.

“Prevalence of past-month alcohol use, heavy episodic drinking (HED), and cigarette use and prevalence of past-year pain reliever misuse decreased, while the prevalence of past-month e-cigarette use increased since 2016 (the first year assessed),” researchers wrote about the results. “Across years and age groups, the prevalence of substance use other than cannabis was higher among occasional and frequent cannabis users compared to cannabis nonusers.”

As the years continued and more states began working on legalization programs, many of these consumption habits began to decrease over time. “However, associations between both occasional (1–19 days in the prior month) and frequent (20+ days) cannabis use and pain reliever misuse and between frequent cannabis use and HED weakened over time among individuals ages 21–25.”

“Contrary to concerns about spillover effects, implementation of legalized nonmedical cannabis coincided with decreases in alcohol and cigarette use and pain reliever misuse,” researchers concluded.

However, it is commonly recommended that more studies be conducted to better understand the effects of legalization on youth consumption. “The weakening association of cannabis use with the use of other substances among individuals ages 21–25 requires further research but may suggest increased importance of cannabis-specific prevention and treatment efforts,” researchers wrote.

Many other studies have evaluated the influence of cannabis on young adults from a variety of perspectives. A study published earlier this week questioned the effect of cannabis being portrayed positively on TikTok as a concern for the youth who frequently use the app.

In March 2022, a policy paper released by the Coalition for Cannabis Policy, Education and Regulation (CPEAR) analyzed youth cannabis consumption as well, and also reported that youth cannabis consumption hasn’t increased since legalization began. Results claim that continued work in creating a federal framework to help curb cannabis misuse by youth in the U.S. is essential and recommended a focus on eliminating access to illegal cannabis in the process.

In March 2021, another study was published, with an analysis of 46 states and data collected between 1991-2015. “This study found no evidence between 1991 and 2015 of increases in adolescents reporting past 30-day marijuana use or heavy marijuana use associated with state MML (medical marijuana law) enactment or operational MML dispensaries,” the authors wrote in their abstract.

Back in 2020, yet another study explored the effects of legalization, and found that there was little impact on youth specifically in California. “Contrary to the claims of many legalization opponents, changes in states’ marijuana policies have not led to any significant rise in cannabis use among young people,” NORML Deputy Director Paul Armentano said about the study. “Overall, most voters believe that these adult-use policies are operating as intended, which is why no state that has legalized the use of cannabis for either medical or adult-use purposes has ever repealed their law.”

These studies go back to the earlier years of adult-use legalization, as seen in published findings from 2016 from the Colorado Health Department who found teens saying that four out of five high school students “say they don’t use marijuana, even occasionally.”

While these studies help show that youth cannabis consumption has not increased, there is still the question of how cannabis consumption affects young adults’ minds. Some studies claim that cigarettes cause the decline of grades more than cannabis does, according to a 2016 study. However, in 2018 a study found evidence that kid’s cognitive development can be affected, followed by another study in 2019 that found no link between adolescent cannabis consumption and adult brain structure. Due to the conflicting information, more studies are necessary in order to learn more about how cannabis affects adolescents.

The Campaign for Sensible Cannabis Laws is a nonpartisan organization that is striving to “reform Iowa’s medical and recreational cannabis laws based on fairness, financial prudence, and common sense.”

The group recently launched its newest campaign, which is led by Bradley Knott and Pete D’Alessandro. Recently, Knott authored an article about their drive to get Iowa up to speed with other states that have legalized cannabis. “Cannabis reform is sweeping the country. From ruby red South Dakota and Montana to perpetually blue New York and New Jersey, majorities from across the political spectrum are voting for reform. In some states it’s a stronger medical program,” Knott wrote. “In other states voters have gone all in for both medical and recreational cannabis. In Iowa, we don’t have a choice. We don’t even have a voice.”

Knott explains how tax revenue of Iowa’s neighboring states have been invested back into the community in ways of education, health care, and other beneficial services. He also refers to a poll from 2021, which found that eight of out 10 Iowans supported a stronger medical cannabis program, and 71% of state residents under age 35 supported adult-use legalization (with 56% of those between 35-54 also supporting adult-use as well).

Despite this positive data, many legislators in Iowa are not on board with the idea. When Illinois legalized cannabis, Iowa Gov. Kim Reynolds expressed very clearly that she doesn’t support the cause. “I do not support recreational marijuana. I don’t. I won’t be the governor to do that,” she told The Gazette in June 2019. She shared her belief that cannabis is a gateway drug that leads to the use of other drugs.

Knott elaborates that state legislators should listen to the people, who should be able to vote on the topic. “Iowans are sensible people. They are proud of their state and have compassion toward others in need. And Iowa’s current cannabis laws make no sense,” he states plainly. “They make no sense if you want to capture lost tax dollars going to Illinois and Colorado. Or you want to build on and diversify Iowa’s excellence in agriculture, or stop the brain drain and keep the young folks here. Iowa’s cannabis laws make no sense if you want to help people who suffer from, or care for someone with, chronic pain, autism, cancer, or seizures. They make no sense if you believe in equal treatment or wise use of public safety dollars and keeping nonviolent offenders from crowding jails.”

There are a few Iowa legislators who support legalization though, as seen with the recently proposed Senate Joint Resolution 2003, which would have amended the Iowa constitution to legalize adult-use cannabis. However, it did not garner enough attention to proceed as law, which The Gazette states is due to the Republican-controlled House and Senate. Legislators like Senate Minority Leader Zach Wahls believe that legalization is “long past due” though. “Democrats support legalization and Republicans oppose legalization, [and] Iowans who want legal cannabis need to vote for Democrats this election,” Wahls said.

In December 2021, Iowa state senators Joe Bolkcom, Janet Petersen and Sarah Trone Garriott joined to push a constitutional amendment for adult-use legalization. Bolkcom called out opposing legislators who aren’t considering the will of the people. “This has become a mainstream issue. “The majority of Iowans support this,” Bolkcom said. “The Republicans are in the minority on this. That said, we need their help to move this constitutional amendment to voters so they can have their voices heard.”

The Campaign for Sensible Cannabis Laws welcomes Iowan support for the cause and offers a petition to be signed on its website, as well as opportunities to donate to the grassroots legalization effort.

A research study published in Drug and Alcohol Review found that cannabis consumption is mainly depicted as positive on TikTok. However, lead author on the study, Brienna Rutherford, explained the thought behind the study. 

“Social media is a big part of the modern world, with adolescents reporting that they spend an average of eight hours online every day,” said Rutherford, a PhD candidate with University of Queensland in Australia. “Despite this high volume of use, little is known about the potential risks exposure to social media content depicting substance use may have on viewers. However, before you can assess the effects of exposure, we need to know what content is out there and accessible.”

The study, entitled “Getting high for likes: Exploring cannabis-related content on TikTok,” establishes the intent of analyzing cannabis content on TikTok, which has over one billion users, one-third of which are under 14 years of age. An estimated 63% of users between ages 12-17 use TikTok daily.

Seven main categories were defined, including Humor/Entertainment (71.74%), Experiences (42.90%), Lifestyle Acceptability (24.63%), Informative/How-To (7.5%), Creativity (5.4%), and Warning (2.7%).

“‘Humour/Entertainment’ videos often used comedic skits or storytimes to portray cannabis use positively to viewers,” researchers wrote. “Videos frequently featured discussions of users’ personal cannabis ‘Experiences’ through storytimes, re-enactments, and videos taken during active use. ‘Lifestyle Acceptability’ was also promoted using hashtags associated with pro-cannabis use communities (e.g. #cannamom, #stonersoftiktok, #stonertok).”

Researchers estimate that 54.14% of videos (viewed collectively over 417 million times) were portrayed as positive. Also, most of the TikTok users on videos were Caucasian males between 25-50 years of age. Of the videos analyzed for this study, only 50 videos actually depicted consumption, such as smoking, vaping, or eating edibles).

“The main take-home point from this study is that there is a high number of cannabis-related videos on TikTok that are a) publicly accessible via links (even without accounts!), b) have no age restrictions or content warning banners, and c) are promoting use of cannabis to viewers,” Rutherford added. “While many countries are moving towards legalization, that doesn’t mean cannabis use is without risk and none of this content addresses the potential negative health consequences associated with use.”

Rutherford explained the next steps toward identifying the impact of cannabis-related videos on TikTok. “The next step is obviously to assess whether viewing this content has any impact on viewers’ attitudes, behaviors or risk/norms perceptions around substance use,” said Rutherford. “Exposure to text- or image-based substance use content on platforms like Facebook and Instagram have been shown to influence the likelihood of substance use, so it is likely that a more engaging platform and content type (such as TikTok’s short-form videos) may have an even larger influence.”

Researchers also concluded that TikTok takes extra precautions to warn viewers that a specific video contains cannabis. This is similarly done with violent videos, or videos that might portray false information. 

“TikTok has taken some additional steps to regulate the availability of substance related content by removing access to hashtags which explicitly reference substance use (e.g., #cannabis). However, the videos themselves remain accessible—they are just no longer stored under these hashtags,” Rutherford said. “Removing the content or hashtags may also not be an effective approach as creators subvert hashtag rules anyway (using numerical values instead of letters ‘#w33d’ to get around the explicit reference rules).”

Social media channels have become home to many unique cannabis creators, although many other services such as Facebook or Instagram have frequently banned users who create cannabis content. High profile content creators such as YouTuber Chrissy Harless, whose account once had 46,000 subscribers, was recently terminated without an explanation.