The Utah cannabis bill as drafted would exclude hundreds of medical providers from recommending cannabis. Will lawmakers change it?

(Francisco Kjolseth | The Salt Lake Tribune) District Attorney Sim Gill holds a press conference at the State Capitol to announce a new patient initiative supporting medical cannabis as patients relay their difficult stories. Medical cannabis patients, each representing a different condition covered under Senator Madsen's bill, openly admit having violated Utah's marijuana laws out of medical necessity. District Attorney Sim Gill is advocating in support of changing policy to ensure that patients are not treated as criminals.

David Cromar says while living in St. George, it was difficult to find clinical specialists in general, let alone ones who were open to the medical cannabis treatments that control his son’s seizures.

When speaking about medicinal marijuana, “the reaction we would get from the pediatrician was kind of an eye roll,” he recalls, adding that his family would drive several hours to Provo to seek medical care for his son.

Utah’s shortage of physicians and the reluctance of some doctors to explore cannabis treatments has caused some anxiety to patient advocates as the state works toward establishing a marijuana program. But further heightening this concern, the bill lawmakers will consider in Monday’s special session would exclude hundreds of medical providers — nurse practitioners and physician assistants — from the ability to recommend cannabis to patients.

Advocates say this provision could lengthen wait times and restrict access for sick people seeking cannabis treatment, especially in sparsely populated parts of the state where physicians are few and far between. Two Utah counties, Rich and Daggett, don’t have any primary care doctors at all, according to state data.

“Those rural communities aren’t going to be serviced,” Christine Stenquist, president of the patient advocacy group TRUCE, said. “The [legislators] are hurting their people.”

As the clock winds down to Monday’s special session, House Speaker Greg Hughes said lawmakers have heard loud and clear that patients want the Utah Medical Cannabis Act to have a more expansive list of eligible health providers.

“Where this has really resonated is patient access in rural areas. I think there’s just such a strong role for nurse practitioners and physician assistants in rural Utah. That’s been a very good point and one that’s been heard,” Hughes said Friday.

Hughes said he’s hopeful the final version of the bill will include this change.

Proposition 2, the ballot initiative approved by voters earlier this month, would empower a broader range of medical professionals to treat cannabis patients. Providers authorized to prescribed Schedule II drugs, including OxyContin or fentanyl, would’ve been qualified to recommend cannabis, under the proposition. Nurse practitioners and physician assistants with the appropriate licensing would fit the bill.

But these two types of providers were excluded from the replacement legislation because of an ongoing turf war in the medical community, Hughes has said.

The Utah Medical Association, which helped shape the replacement bill, has insisted that physicians alone should guide patients in exploring medical cannabis treatments.

"The medical conditions for which cannabis might be recommended are complicated. As such, UMA feels that those allowed to recommend it should have the highest levels of education on these conditions," Michelle McOmber, CEO of UMA, said in a prepared statement.

However, Utah Rep. Ray Ward, himself a physician, said doctors aren’t on a higher plane when it comes to medical cannabis.

“This is one issue where, right now, physicians cannot claim to have any more training than nurse practitioners or PAs because, right now, nobody in the state can do this,” Ward, R-Bountiful, said.

Doctor shortages are already a problem Utah, which ranks near the bottom in the nation for its physician supply. But rural areas would most acutely feel the decision to exclude the state’s roughly 2,225 nurse practitioners and 1,400 physician assistants from the medical cannabis program.

The state’s physicians are largely concentrated along the Wasatch Front, with Salt Lake County boasting one primary care provider for every 880 residents. Kane County, on the other hand, has two primary care physicians, or one per 3,600 people, according to data collected by the Utah Office of Primary Care and Rural Health.

“There are over 1,000 practicing PAs [physician assistants] in the state. If legislation blocks some of these types of providers ... you are limiting access to care,” Brad Pace, executive director of the Utah Academy of Physician Assistants, said in a prepared statement.

And the state’s populations centers would suffer, too, Ward said.

Practices typically have a mix of physicians, nurse practitioners and physician assistants and could opt out of medical cannabis wholesale if some staff members are prohibited from recommending it.

"It's very difficult for an office to have one part be able to do something and another part not be able to do it," Ward said. "So there will be fewer doctors willing to prescribe it if their colleagues are forbidden from being able to recommend it."

Utah Rep. Christine Watkins, who lives in Price, said the restriction will disadvantage her constituents in rural parts of eastern Utah. Many people in her neck of the woods see nurse practitioners when they go in for a checkup, and medical centers tend to have few doctors on staff, she said.

The pool of qualified doctors might dry up even further, since not everyone will feel comfortable recommending cannabis to patients, she said.

But seeking medical care in more populous areas would also be difficult. During the winter, many people in her district are reluctant to cross snowy mountain passes for a doctor’s appointment. And then there’s the expense of finding a new provider, she said.

It's not that policymakers are trying to disenfranchise certain patients, "but they don't have to live in the world that we live in here," she said.

Watkins said she plans to submit a substitute bill that would include physician assistants and nurse practitioners in the medical cannabis program.

Connor Boyack, a medical marijuana advocate who helped negotiate the cannabis bill, said he shares these concerns over the lack of access for patients, especially those who live in remote areas. However, even if the final version of the cannabis act doesn’t include nurse practitioners or physicians assistants, advocates will return in 2020 to lobby for the change, he said.

“Because in our perspective there’s no legitimate public policy justification to prohibit these medical practitioners, who are competent and on the front lines and prescribing opioids, from recommending cannabis,” he said.