This is the last of a series about cannabis medicines in Utah, from cultivation and production in highly regulated facilities and research and development for new applications of the drug to the process for patients of considering the option, finding a doctor, getting a card and shopping at state-licensed pharmacies.

The policy landscape for Utah’s medical cannabis program is constantly changing.

“We joke oftentimes that the medical cannabis program is a legislator’s permanent employment plan,” state Rep. Jennifer Dailey-Provost said with a laugh. “Bad actors find loopholes, and sometimes it turns into a whack-a-mole thing.”

She’s been at it since 2019.

While Utah’s program started after seeing other states fail aspects of their own markets — and they could somewhat “pick and choose” elements to incorporate — Utah’s own blend of constituents, representatives and businesses inevitably comes with challenges.

And as needs arise in the state-regulated industry, legislation is the only way to adjust.

Right now, costs and access remain two of the biggest shortcomings of the program, but other concerns rise to the surface as more people consider cannabis as medicine — so, more legislation will need to pass to fix them.

Such as, what kind of protections are there for patients and medical professionals in the program? That’s a question cannabis patient Francisco Maes and his wife, Erin, are asking in the weeks after he was fired from his job of six years for smelling like marijuana. 

“The laws haven’t changed to protect people in my situation,” said Francisco, who’s been a legal patient since 2021. He uses vape cartridge options to manage his diagnosed chronic pain. “Instead of showing that I was incapacitated in any way, shape or form, they just used the smell as a violation of their policy.”

But his employer’s drug policy, a dated one, didn’t even mention cannabis, said Erin, and there’s an addition that permits drug usage when prescribed by a physician and is used according to the prescription.

“When this happened — I’m the researcher — so I’m online, like, what are the laws? What is going on? Can they even do this?” Erin said. “As a private employer, according to what I saw online, they don’t have to give any real reason. It’s an at-will state. They can just fire you for whatever.”

Erin said she works for the state, and since it’s a public employer, she has more protections — her employer would have to prove unlawful use of the drug on the job and that she was impaired in some way to terminate employment for a drug policy violation.

“Why do I as a state employee have protection against that, but he doesn’t?” Erin said.

Francisco said it’s frustrating that his choice to use an alternative medicine has such a high cost. Would this kind of treatment happen if he’d been using opiates to treat his pain? Unlikely, he said. 

“If you look at it, all of the prescription drugs have the potential to be bad for you, and so where they were allowing everything else but me — I was just trying to survive and support my family and had done so for years without problems. It’s pretty hard,” he said.

Because Francisco was fired for a drug policy violation, his unemployment filing was denied, too. Erin said they’re planning to appeal the decision and are considering hiring legal help from a labor law firm, but that’s more money. How many other cannabis patients have experienced something similar?

“Employers, if this is really going to be an issue based off of a smell, then I think that they need to amend their drug policy to say what their stance is on a medical marijuana card,” Erin said. 

On the flip side, what about pharmacists and other medical providers who want to participate in the state’s cannabis program? One pharmacist, who asked to remain anonymous for fear of retribution, said if the objective is to find a medication that works for the complex needs of each individual patient, that’s just not happening.

They said that in reality, some pharmacies aren’t patient-first. And of the many customers they see in a day as a pharmacist, it’s clear there’s a lot of recreational users slipping into the program.

“When we get patients that come in, it’s the most rewarding job I’ve ever had. You get to help them with their pain or where the traditional pharmaceutical medicine may not be working the best for them,” they said. “But in the same regard, the majority of people that we have come in really aren’t there because they’re patients.”

These participants in the program ultimately distort the metrics, meaning more obscure, niche dosage forms and formulas get taken off the shelf in favor of high-THC products in “higher demand.” It also lessens incentive to research new forms of cannabis medication that may help a complex patient need. 

“You can talk all day about the quality of products, it tastes great, or whatever. At the end of the day, true patients want their medicine,” they said. “The 80-year-old grandma wants to be able to afford her pain meds, not because it tastes great or has all these other amazing things about it.”

When there’s a medical system that requires patients to experiment with what works for them, removing products from shelves can have a huge impact on the people seeking help from cannabis.

“We want this to be medical, and if you can’t provide a true medical patient with what they want and what they need, even after reaching out to the manufacturer, then we’re failing,” they said.

Without certain regulations, too, these educated pharmacists who care about their patients struggle to speak out against the way this business is run.

Ultimately, they said they want to stay in the cannabis industry because when it works, it’s more fulfilling work. But to make the right changes, they called for more patient feedback and more scientific studies.

The process for making changes lies, in part, with the Medical Cannabis Policy Advisory Board, staffed by Utah’s Department of Health and Human Services. That board comprises individuals from the industry, patient advocates, medical researchers and medical providers, said Richard Oborn, who directs the department’s Center for Medical Cannabis.

“They make recommendations to state lawmakers on changes that they feel need to be made to the statutes that run the program, and also they make recommendations to our agency and the Utah Department of Agriculture and Food on changes to rules that impact patients and medical providers and in the licensees that sell the medical cannabis and that manufacture it and cultivate it,” he said.

It’s meant to be collaborative, a collective shaping of a young program. But seven years in, is it still young? 

“We’ve realized that no one has all the answers. This is a field that’s emerging, that we’re learning a lot from research, and it’s important that we share information with each other as we learn it,” Oborn said.

As for growth, Brandon Forsyth, director of the cannabis center at the Utah Department of Agriculture and Food, said that while they’ve built the program to scale, they’re not focused on expanding but on fine tuning what’s already there.

“We’re really just seeking to meet the needs of the existing patients and anybody who would potentially be a patient,” he said.

Changing stigma

Lingering negative views on cannabis majorly impacted the industry’s legislative goals to meet patients’ needs during Utah’s 2025 general session.

“We had a lot of opposition that really seemed outdated,” said Cole Fulmer, publisher of Salt Baked City magazine, which aims to inform Utahns about all-things cannabis in the state. “A few Utah groups were arguing against cannabis, but it was kind of in the way you would have back in the ’90s, where there’s not a whole lot of accurate information, we’ll put it that way, a lot of fear mongering and scare tactics.”

Fulmer attributed some of that attitude to the lingering effects of the “war on drugs,” the result of which left cannabis labeled a Schedule 1 drug with the likes of heroin and LSD. 

Dailey-Provost said people’s beliefs about the drug are often missing the truth.

“There’s still just so much opposition to medical cannabis in general, and there’s so many people that think of it as such a black-and-white issue, and it’s just not. It’s complex, and it’s nuanced,” she said. 

Dailey-Provost said the history of the drug — the good and the bad — is something that policymakers and industry people both need to keep in mind as they create a medical system revolved around the cannabis plant.

“Cannabis is a very, very old, deeply culturally entrenched universe, and we’re trying to fit a medical program into this landscape,” she said. “We have to stop pretending that it’s this ‘brand new thing we discovered called cannabis!’ That’s something that we really need to keep in mind when we’re trying to craft policy that threads a needle between safety and accountability and effectiveness for patients.”

Since state legal medical cannabis and now recreational programs began popping up, people in the industry say the negative stigma has notably lessened.

Luke Flood, an executive with the Curaleaf cannabis brand and former real estate agent, said that when he started in the industry a decade ago, things were different.

“Many, many moons ago, I think I was introduced by my family when we’d go to social activities as ‘the real estate guy,’ despite the fact I was full blown in the cannabis industry at that point in time,” he said with a laugh. “You used to mention you work in the cannabis industry, and then it was met with a little bit of a judgey sense. Now it inspires more questions, more ‘wow’ than anything.”

Another Curaleaf employee, Alan Roth, said that’s been his observation, too.

“People are usually more like, ‘Wow, what’s that like?’” he said. “I think we certainly at least moved beyond — I don’t look like I came from a back alley.”

Flood said even business relationships, even just banking, have gotten a lot easier.

“Back 10 years ago, it was quite challenging, next to impossible, to even get treasury services and deposit services to pick up our cash in the stores,” he said. “The sentiment is 100% changed for the better in the last 10 years, and it continues to each passing year continues to get more and more prominent.”

It could be better, though, said Dragonfly Wellness’ Chief Growth Officer Narith Panh. He said the decision to make the leap from corporate America to the cannabis industry when Utah’s medical market was legalized wasn’t easy. 

“I just had a 6-month daughter, and I think about the future that she has to grow up in,” Panh said. “Is she going to grow up being proud to tell her friends that her dad works in the cannabis space? Those are things that, for us, we’re just regular people looking for some level of dignity at that level, that type of respect for what we’re doing.”

They’re not dealers, they’re professionals, Panh said.

“We’re actually very passionate human beings that really care about what we do and the quality of product that we put in our communities.”

Fulmer added, “It’s going to be a long time before we undo that damage.”

That’s why so many people, like Fulmer, like Dailey-Provost, like Panh, are working to inform the public on the facts that impact how Utah’s medical program is structured. 

“I think we’ve all lived through the opiate epidemic. We understand what that has done and created to our community,” Panh said. “What we’re really trying to do is remove the stigma of cannabis, of what we’ve all been told, and really start to look at this as a plant as medicine and teach the science of how it actually impacts our bodies.”

Because part of changing the stigma for Utah isn’t just “good vs. bad,” it’s for people to think about cannabis as a medication that treats an illness, like ibuprofen for inflammation or an antacid for an upset stomach.

Taking the mystery out of the drug will also help address teenage use concerns, said Desiree Hennessey, executive director of Utah Patients Coalition and a mom herself.

“Talking to kids saying, ‘Look, this is a medication.’ And I think kids are getting it, in every state that has legalized cannabis, the teen usage goes down,” she said. “They’re like, ‘Oh, my grandma’s using that for back pain.’ And it takes the mystery out of it because the conversations start to happen. … Truth, we have found over and over, drastically reduces the need for teenagers to try medication.”

Hennessy acknowledged there will always be teenagers tempted to try new things, but it’s on the parents to start that open dialogue with them — and keep them from accessing harmful, unregulated products.

“They are seeking a high, they’re seeking an adventure, and it’s being served to them so easily on the black market. But it is laced with mold and heavy metals and pesticides and flame retardants,” she warned. “I wish to educate teenagers so they can turn around and hold the black market accountable. They’re not lab rats.” 

Right now, despite recreational uses, it’s a medicine that works for patients, Hennessy and Dailey-Provost said — that’s who matters.

“There is risk to every medication that everybody takes, no matter what, to the Tylenol that you take for a headache. I don’t want anybody to think that I think that this is the perfect medication and it’s going to fix everything. But we have to keep talking about it and insist that people understand that this is just one piece to an important puzzle that is the delivery of health care,” she said.

With a background in public health and a doctorate from the University of Utah, Dailey-Provost said she operates in policymaking with a patient-first mentality.

Changing the stigma is one step in that process because, with more accurately informed medical providers and patients and policymakers, the state will be able to move the needle toward a better program. 

“I sincerely think the good that’s accomplished with our medical cannabis program outweighs the risk,” Dailey-Provost said. “We just have to continue to be diligent and make sure that that doesn’t shift the other way.”