The medical marijuana agreement that has brought together warring factions in the Proposition 2 debate could make Utah a national test case — the state itself would distribute the cannabis.

Sure, other governments have mulled such a system, but they’ve generally shied away from direct involvement in dispensing a substance illegal under federal law, said Karen O’Keefe, state policies director for the Marijuana Policy Project.

"Usually we talk them out of it," she said.

Gov. Gary Herbert, legislative leaders and advocates unveiled the proposed legislation Thursday that Utah lawmakers are expected to take up during a November special session. Herbert described it as a step toward establishing a medical marijuana program that Prop 2 opponents, such as The Church of Jesus Christ of Latter-day Saints, could stomach and pledged to put it before lawmakers next month whether or not the ballot initiative passes.

The consensus plan would create a centralized state pharmacy that would package individual medical cannabis orders and ship them to a local health department for pickup by patients who qualify. Up to five private “medical cannabis pharmacies” would also be allowed under the legislation, but the state-run system would act as an alternative for rural residents who live far from these locations, Sen. Evan Vickers, R-Cedar City, said.

“Is it unique? Yeah, it’s definitely a unique model,” he said, “and that’s why it could very well become the role model ... for the rest of the country."

Here’s how the state centralized system would work:

  • A physician would recommend cannabis for a patient with a qualifying ailment.
  • The patient could make a request for the drug either directly to the state pharmacy or through a doctor.
  • The order would be verified through a state electronic tracking system.
  • If a doctor hasn’t recommended a specific dosage, a qualified physician at the state central fill center would consult with the patient to determine the amount.
  • An agent at the state’s cannabis clearinghouse would review the order, process the patient’s payment and prepare the shipment.
  • The agent would also check the patient’s order history to make sure the requested medical marijuana wouldn’t put him or her over the legal limit, generally 56 grams of unprocessed cannabis products containing up to 10 grams of THC per 14-day period.
  • The state pharmacy would make sure the order arrives at the patient’s local health department within 24 hours of the original request.
  • A patient would pick up the medical cannabis at the health department after showing a government ID and valid medical cannabis card.

Alternatively, a patient could visit one of the five private medical cannabis pharmacies. A licensed pharmacist would have to be on hand during business hours to advise patients on dosing and the appropriate treatment.

Vickers, who is a pharmacist by profession and helped broker the cannabis accord, said he was comfortable that the state wouldn’t run afoul of federal law by getting involved in the distribution of a Schedule 1 drug. He said he vetted the idea with the Drug Enforcement Administration but wouldn’t disclose who he’d communicated with, saying the conversations were sensitive.

O’Keefe said the Marijuana Policy Project isn’t sure a state-run model will fly in Utah. The closest comparison for it is in Louisiana, where the state designated two public institutions, Louisiana State University and Southern University, as the only legal growers of marijuana plants. The Louisiana program isn’t running yet, she said.

But her advocacy group — which has dumped more than $210,000 into the campaign supporting Prop 2 — is satisfied that if Utah’s centralized system fails, the private cannabis pharmacies will keep patients supplied.

"It sounds like Utah is interested and willing to stand up for their rights to determine their own marijuana policy," O'Keefe said.

And, for the time being, the Department of Justice doesn’t have the funds to crack down on state medical marijuana programs, thanks to a budget rider that Congress has passed in recent years, she said.

Connor Boyack, founder of the libertarian Libertas Institute, said the state-run system was a hotly debated element in the medical cannabis plan. His group was unwilling to rely on the central fill pharmacy alone and insisted the bill allow private pharmacies as a backup.

“We don’t have high hopes for [the state-run system]," he said, “but to be fair and in good faith, we’re saying, go for it.”

The number of licenses for private medical marijuana pharmacies could increase incrementally from five to 10 if the state doesn’t meet certain deadlines for launching its own distribution center. If the state’s pharmacy isn’t operational by Jan. 1, 2021, two more licenses would become available, with two more potentially issued after July 1, 2021, and another one on Jan. 1, 2022.