UT: Understanding The Medical Cannabis Debate

Photo Credit: Rappler

During those many years when she rarely felt well enough to leave the house, Christine Stenquist would frequently curl up in her bed, gaze out the window at the apple tree in her yard, and see an analogy for her life staring her in the face.

Stenquist, who rarely felt well enough to drive, had plenty of time to look out that window, seeing the seasons change and exert their will on the tree and its fruit.

“I spent lots of hours alone, lots and lots and lots of hours,” she recalls.

One winter, she remembers, a particularly stubborn apple “sort of shriveled at the top” but held onto its branch, even as winter came.

“I just watched it (as something) very visually relatable to me at that time. I would just sit there and watch it.”

Like the fruit on her tree, Stenquist was wilting, she said, but obstinately holding on.

Surviving: That’s what Stenquist says her life felt like for nearly two decades after being diagnosed with a rare inner ear tumor called an acoustic neuroma in 1996 at age 24. It was discovered after she collapsed while at her job at Lakeview Hospital in Bountiful.

“(My doctor) told me to get my affairs in order. He gave me a month,” she said during a recent interview with the Deseret News in her Kaysville home. “I had a 3-year-old and a 5-year-old at the time. I had to figure out who would take care of my kids.”

Surgery saved her life, but it also changed her life. And she needed a way to gain the strength to function. That’s when marijuana entered her life, and today she is one of the faces of a movement to legalize the medical use of the whole cannabis plant in Utah.

That effort has drawn a steady march of fellow supporters to testify at the Capitol and laid the groundwork for a ballot initiative that many support, yet others say goes too far without the science to back it up.

It has ignited prolonged and fervent debates among lawmakers and health officials who warn of a slippery slope between the medical use of marijuana and the recreational use of the plant, which Utah’s bordering states of Colorado and Nevada, as well as California, Oregon and Washington in the West, have made legal despite its conflict with federal law.

The federal government regulates drugs through the Controlled Substances Act, and cannabis remains classified as a Schedule 1 drug, just like cocaine and heroin, making it difficult to study for any medical benefit.

It sets the stage for a rigorous legislative debate, even while Stenquist credits marijuana for allowing her enough energy to put her efforts behind the cannabis movement in the first place.

“It transformed me — from a hermit to an advocate — because I could function.”

Understanding the issues

Popular support for legalizing medical marijuana appeared to hit a critical milestone last year when it was announced that a campaign called the Utah Patients Coalition would seek to put the issue on the November 2018 ballot for Utah voters to decide.

The director of that campaign, DJ Schanz, said there will be enough signatures to put medical cannabis on the ballot within “about three weeks,” well in advance of the official April 15 deadline.

“We’re getting about a thousand a day,” he said of the signatures.

Others are lining up to oppose making cannabis legal in Utah, citing that slippery slope.

Rep. Brad Daw, R-Orem, when asked what concerns he has about the initiative, responded: “How long do you have?”

Daw said he believes the ballot measure’s provisions are too broad to the point of allowing recreational use.

“On day one,” he says, “Utah becomes an instant recreational state.”

Daw is introducing a handful of bills in the upcoming legislative session that are related to cannabis access, including a “right to try” measure for patients on hospice, a bill allowing Utah farmers to grow industrial hemp for commercial use, and another allowing the state to grow full-strength cannabis on behalf of research.

But he is not a fan of the initiative, which he said would be prone to manipulation by those who are using the drug recreationally. Daw also believes there is a large deficiency in the initiative’s regulation restricting what proportion of patients can be prescribed medical marijuana by a particular doctor.

Ultimately, the Orem lawmaker said he’s repelled by what he sees as a lack of adequate existing research on the issue.

Daw said he was initially taken aback when a state-commissioned review board tasked with examining existing cannabis research concluded that the state could benefit if there were additional research into how much the drug benefits patients suffering from pain.

“There’s 25,000 cannabis-based studies out there. … You’re telling me that’s not getting us there?” he recalls asking them.

But after taking a closer look at the analysis of the research, Daw said he believes existing studies “give us a lot of indications, but they don’t measure up” to an unequivocal endorsement.

Schanz disputes that. In recent months, he has become suspicious that a state-funded study into cannabis’ effects on pain was a delay tactic and added that “the idea that Utah’s going to be on the forefront of any research is laughable.”

There are “literally thousands of clinically studied reports” from throughout the world on the medical benefits of cannabis, he said in November.

Gov. Gary Herbert is not nearly as convinced as advocates about just how much of a settled matter medical cannabis research is.

“I think, in time, if we get the science to back up the fact there is in fact a medicinal use for medical marijuana, that it actually does cure pain, it has an application as a medication — if the science justified that, I think it will become legalized,” Herbert said earlier this month. “And I have no reason to doubt the anecdotal story. We just need to make sure the science backs up the anecdotal story.”

He later added, “Does it help with the pain, (or) does it put us in a state of mind that we don’t care? What is the truth of the science? … Why don’t we, in fact, address it, find out if there’s a medicinal purpose for it, what the science is, and then direct policy based on science?”

Senate President Wayne Niederhauser is less persuaded than most Senate Republicans that the initiative will be approved by voters if it ends up on the ballot in November.

“There seems to be consensus in our group (that) it might pass. I’m not convinced of that yet,” Niederhauser, R-Sandy, said about the discussion surrounding the initiative during an all-day caucus of Senate Republicans.

Conservative think tank Sutherland Institute also has raised several concerns with the policies included in the initiative. Derek Monson, executive director of the organization, cautioned that moving too quickly to legalize a substance’s medical use can cause problems, citing the widely discussed epidemic of opioid addiction plaguing communities throughout the country.

“It’s akin basically to how the opioid epidemic started. We kind of rushed to find medications and medical approaches that would alleviate pain without fully comprehending the ramifications,” Monson said. “We didn’t really understand what was going on until it was too late, and now there are too many people getting addicted.

“I don’t know that it’s beneficial or really humane to really replace that problem with a similar problem, only under the guise of marijuana, where we don’t really know all the ramifications.”

Monson also questioned whether medical marijuana legalization could also have the unintended consequence of increasing children’s exposure to the drug.

“When things are legal such that adults can access them, we have a hard time keeping them out of the hands of children,” he said. “It does raise the question then of (how) is that going to play out in the case of marijuana if we legalize it.”

Unintended consequences

The Department of Public Safety also has raised concerns that there could be potentially unintended consequences of legalizing cannabis for medical use.

“While the Utah Department of Public Safety acknowledges that there is information supporting the clinical use of marijuana, DPS has some preliminary concerns regarding a more broadly defined medical use of marijuana in our state and the negative impact it could have on public safety,” the agency says in a statement on its website.

The department points to data from the National Highway Traffic Safety Administration showing there were 125 traffic deaths in Colorado where one of the involved drivers tested positive for marijuana in 2016, up from 65 in 2012, the year the legalization amendment passed in Colorado.

The agency also notes that states reporting the top 10 rates of youth using cannabis “are all medical-marijuana states.”

“DPS is concerned about increased general marijuana abuse in medical marijuana states,” the statement continues.

The Church of Jesus Christ of Latter-day Saints has also previously expressed concerns about legalizing medical marijuana, formally opposing a 2016 bill from former state Sen. Mark Madsen, R-Saratoga Springs, and saying in a June statement that there are “legitimate questions regarding the benefits and risks of legalizing a drug that has not gone through the well-established and rigorous process to prove its effectiveness and safety.”

The LDS Church’s statement, which was published two days after the ballot initiative paperwork was filed, also said at the time that “the difficulties of attempting to legalize a drug at the state level that is illegal under federal law cannot be overstated.”

“Accordingly, we believe that society is best served by requiring marijuana to go through further research and the FDA approval process that all other drugs most go through before they are prescribed to patients.”

The Utah Medical Association has also voiced opposition to legalizing cannabis for medical use in the state, with CEO Michelle McOmber telling the Deseret News in December that “there’s a difference between a drug, or a medical product, or approved drug.”

“If it’s (called) ‘medical,’ you would expect to know a dosage, you would expect to know what to prescribe, you would know who to prescribe it to, you would expect to know what to prescribe it for,” McOmber said at the time.

Voices of support

Stenquist, who works with the Utah Patients Coalition campaign frequently but isn’t considered a member of it, disputes that there is not good research on dosing.

“The pushback is we don’t know dosing. (But) the average dosing is 10 milligrams,” she said, though there are some who take more and some who take less.

Stenquist has never returned to the health of her youth since her tumor diagnosis all those years ago. The surgery that soon followed preserved her life, with 40 percent of the tumor removed.

But she was never quite the same.

“This was not in my five-year plan. It was a serious curveball,” she said.

Stenquist suffered a stroke during her procedure. She also became deaf in her left ear as a result of her tumor, and she developed a chronic nerve pain condition affecting her face called trigeminal neuralgia — something she describes as “like having a really bad ice cream headache that never goes away.”

Life gradually ground to a halt as Stenquist’s world became smaller and more claustrophobic.

“There’s just a finite amount of energy. I was overwhelmed. It was hard to do much of anything. I didn’t leave (the house); I just didn’t ever leave,” she said. “I missed out on the kids’ recitals (and their) baseball games.”

Stenquist said she did as much as she could to nullify the pain. At her peak, she was taking 100 or more pills of Percocet in a bad month. She also wore a patch that supplied her fetanyl, an opioid renowned for its potency.

“I was very worried about being addicted to pain medications. We had a frequent flyer’s list in the emergency room” where she worked. “Pharmaceuticals just became part of my life,” she said.

But her pain wouldn’t stop — or even subside to the point of making her more functional day to day.

“I spent most of my 20s and 30s raising my kids from a couch,” Stenquist said.

Using cannabis

In 2012, 18 years after Stenquist’s health took a dramatic nosedive, she resorted to another option to treat her suffering: cannabis. She made the decision after a nudge from her father, a narcotics police officer living in Florida.

“I said, ‘But Dad, it’s illegal here in Utah.”

Stenquist said she was desperate. She made the decision to give the leafy drug a try. The only problem was she had no idea how to go about finding someone to sell it to her.

She ultimately settled on posing an awkward question to her 19-year-old daughter that she wishes she never should have needed to ask: “Do any of your friends smoke cannabis?”

So Stenquist began using the substance for her pain. She wanted to be cautious that any benefit she received wasn’t fool’s gold, such as a placebo effect. She wanted to know: “Was it relief, really relief, or was I just disassociating?”

“(I spent) two weeks using cannabis through a pipe and documenting. I’m such a nerd,” Stenquist said with a self-deprecating laugh.

Because she was quickly able to move around more than she had in some time, it wasn’t long before Stenquist made the decision she would keep using. Now, she uses cannabis with the help of a small vaporizer.

“I was walking, using my cane going around the house a little bit,” she said. “I started to miss (opioid) doses.”

Before choosing to use cannabis long term, Stenquist wanted to take her decision to her children, so “we had a family talk,” she said. It was then that she committed to them: Mom is going to be breaking the law, but she’s also going to work to change the law.

“I felt like that was a better example to set for my children,” she said.

Pushing for change

By 2015, Stenquist was working with Sen. Madsen as he made his rounds at the Capitol trying to drum up support for his legislation that would legalize the whole cannabis plant for medicinal use.

“2015 was really us learning how to swim on this issue,” she said.

But Madsen’s legislation was narrowly defeated in the Senate. Then in 2016, it passed the Senate but failed to get past a committee that would have sent it to the House of Representatives for a vote.

Around the same time as Madsen’s bill was defeated for a second straight year, Stenquist and her fellow advocates created TRUCE — Together for Responsible Use and Cannabis Education. The organization started merely as a Facebook group and has since grown significantly in numbers, sophistication and ability to mobilize supporters.

For those fighting for their own treatment, or that of a family member, Stenquist said, the quest for legalization is “something totally different” from those who analyze what to do about the suffering from the outside.

But she’s conscientious not to oversell the medical benefits of cannabis, as she is of the conviction that doing so would diminish the number of people in positions of influence who would listen to her, and also because she’s committed to the idea of being “an honest broker,” she says.

“Cannabis is not a panacea. … All I’ve seen it do is mitigate symptoms,” Stenquist said. “But treating symptoms is huge. That’s what we’re doing with pharmaceuticals, right?”

Managing pain

Andrew Talbott, a pain management physician who practices in Park City, agrees that the drug’s documented effects on relieving people’s symptoms of discomfort is reason enough to increase access.

“Our understanding of it, at this point, is it’s a great symptomatic treatment … but it’s not a cure for anything,” Talbott said. “But neither are opioids.”

Talbott is a member of the Utah Medical Association, whose leadership’s vocal opposition to legalization is well-documented. But he says the organization’s public stance “doesn’t necessarily represent the viewpoints of every physician” belonging to it.

“That’s certainly not what the entire medical community believes,” Talbott said. “I cringe whenever I see or hear people say, ‘Well, UMA says this shouldn’t be done, so that’s the voice of medicine.'”

In fact, Talbott first met Stenquist out of a desire to say “there are physicians out there who are proponents of having this be an accessible medication for their patients,” he said.

A Utah Policy poll conducted with registered voters in November found that 73 percent of Utahns support legalizing medical marijuana in the state, including 61 percent of Latter-day Saints who self-identified as very active. The poll did not address the specifics of the initiative or any legislative bill, making it difficult to draw conclusions about just what Utahns will accept.

Democrats surveyed were the biggest supporters of the idea of medical marijuana, with 97 percent saying they were in favor of it.

But count Box Elder County Commissioner Stan Summers among the estimated 61 percent of Utahns who are loyally Republican and who also support legalization of the drug.

Summers, who often finds himself passionately on the conservative side of health care issues — he visited the White House last year to decry the shortcomings he sees in the Affordable Care Act — said it’s actually quite easy for people of divergent worldviews to agree when it comes to alleviating physical suffering.

“It’s not just one (group) saying yes and a couple people saying no,” he said. “There’s quite a bit of broad support of this stuff.”

Summers came in contact with the idea of cannabis because his son, Talon, suffers from a rare condition similar to multiple sclerosis called IgG4. He says Talon, 26, has also suffered from other significant health problems ever since he broke his back playing football when he was in high school.

“There’s probably 100,000 Talons in the state,” Summers said. “So are we going to push these kids to the wayside?”

Despite the severe and chronic pain his son lives with, Summers said, he has decided not to illegally use cannabis.

“He flat-out said, ‘Dad, I don’t want to get you in trouble, so no, I’m not going to do it,” Summers said.

He said he is disheartened that the Legislature failed to pass a medical marijuana law in recent years, and believes too much stock is placed in worries about people misusing cannabis intended for medicinal use.

That sets the stage for the legislative session, which begins Monday, bringing the national debate to state lawmakers and ultimately to Utah voters if the initiative ends up on the ballot.