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Originally written by: Jennifer Graham at the Deseret News

Is marijuana medicine? Twenty-eight states say yes. But the Utah Medical Association and the American Academy of Pediatrics insist that it isn’t, and federal law says it has “no currently accepted medical use.”

So far, Utah lawmakers have declined to make marijuana legal, except for cases of severe epilepsy. However, the issue still hovers like smoke, and it gained oxygen in the November election when three states legalized pot’s use as medicine and another three authorized recreational use.

The Utah Legislature announced Friday it will not consider legalizing medical marijuana this year, but will instead push bills that allow research and create infrastructure for production and distribution in the case of later legalization.

Proponents around the country include people who use marijuana to treat chronic pain, like a New Jersey nurse who says it has made her a better mother, and those who say marijuana is more comparable to alcohol than to other banned drugs like heroin and LSD. Others argue that legalization will allow for much-needed study on dosage, efficacy and driver impairment.

Opponents say legalization, even for medical use, gives marijuana an aura of government sanction and results in more use among adolescents, whose developing brains are most likely to be harmed by heavy use.

As Utahns continue to mull what it will do, the rapid spread of legalization across the U.S. offers evidence of the best — and worst — practices, how legalization could work here and how it could change Utah.

Getting past the stigma

When Jessie Gill injured her neck and shoulder at work, she thought the pain would go away after physical therapy and a course of muscle relaxers and pain pills.

It didn’t.

A year later, after exhausting Workers’ Compensation benefits and losing her job, Gill found herself taking 10 to 15 pills a day, including opiates, muscle relaxers, benzodiazepines and an antidepressant, in addition to laxatives and anti-nausea medicine to combat the side effects of the drugs.

The routine unnerved her, even though her insurance covered the cost. For one thing, the pills didn’t work — she still suffered pain. And their side effects, and the risk of addiction, made her nervous about how she was performing her most important job: raising a 9-year-old son and a 19-year-old daughter.

Gill, 36, is a registered nurse who lives in Colonia, New Jersey, about 30 minutes from New York. When friends and her mother suggested that she try marijuana, Gill resisted, in large part because of the stigma she assigned to pot.

“I thought it was something people did to get high. I thought, if this is really the miracle drug people are raving about, we would have known about it hundreds of years ago,” she said. “I was misinformed.”

Desperate for relief, Gill found that she qualified for medical marijuana under New Jersey law. She paid the $200 fee to apply for the identification card that allows her to make purchases from a state dispensary, and when the ID arrived, her parents drove her to get her first dose, since she can’t drive because of her injury.

Jessie Gill is a nurse, a writer and a mom in Colonia, New Jersey. This is her ID to participate in the state medical marijuana program. | Jim Anness, for the Deseret News

For Gill, it was worth the trouble.

“I took one puff from the vaporizer, and instantly the wrenched up muscle spasms in my neck, arm and throat began to release,” she said. “After a few puffs, calm washed over me. For the first time in years, my damaged, contorted muscles felt normal, at least for a little while. I was surprised, and I knew right then that this medication was something amazing.”

Fourteen months later, Gill uses marijuana daily to manage her pain. She doesn’t smoke it — “you expose your body to carcinogens in the smoke” — but mostly uses a vaporizer, which heats the plant’s flower and converts its active ingredients into a vapor she inhales. She says she “micro-doses,” using a tiny amount every 60 to 90 minutes to manage her muscle spasms and nerve pain.

She keeps the marijuana locked in a box, and doesn’t allow her children to see her use it. It costs her about $600 a month and is not covered by insurance since although New Jersey allows it, marijuana is a Schedule I drug, prohibited in the U.S.

Gill said she does not support legalizing marijuana for recreational use, like seven states and Washington, D.C., already have, and she believes strict regulation, as in New Jersey, is important for states that allow it for medical use. Ultimately, however, she believes marijuana is more benign than painkillers like Percocet, which is a Schedule II drug. It needs to be kept away from children, like over-the-counter drugs, and parents need to educate their children about the dangers, she said.

Jessie Gill uses $600 worth of marijuana each month to treat chronic pain after suffering a spinal injury at work. She keeps her marijuana in a lockbox. | Jim Anness, For the Deseret News

“But, as a mom, I think it’s much safer to have in the house than all the other drugs I was taking,” she said.

The effect on kids

Despite the best efforts of conscientious parents like Gill, many adolescents are getting marijuana anyway, which is a particular concern in Colorado, which has been called “the Silicon Valley of marijuana.”

According to federal statistics for the years 2014-2015, 11.1 percent of Colorado children aged 12 to 17 use marijuana monthly. That’s more than twice the rate of Utah, where teen use is 4.5 percent, according to Christine L. Miller, a pharmacologist who works with the advocacy group Parents Opposed to Pot.

Of the 10 states with the highest teen use, all have legalized marijuana in some manner.

“You can expect medical marijuana to increase youth use,” Miller said.

That’s what happened in Colorado after the Justice Department said in 2009 that it would not prosecute people who use marijuana as medicine, and those who provide it to them, she said. After that memo was issued, the number of registered medical marijuana patients in Colorado went from less than 3,000 to more than 100,000, she said.

“And not all that increase was accounted by medical marijuana card holders; some of those users were youths,” Miller said. “We know that because in 2012 a research paper was published that showed 74 percent of teens who go into treatment (for marijuana addiction) were obtaining their marijuana from cardholders.”

The Colorado Department of Public Health and Environment says the rate of use among teens has not increased since recreational use became legal, and in fact, went down a percentage point. In a poll of 17,000 Colorado students, 4 out of 5 high school students said they don’t use marijuana at all, the department says.

A study published in December in the journal JAMA Pediatrics, however, found that use among 10th-graders in Washington state rose 4 percent after recreational use was legalized there. The researchers speculate that Colorado did not see a similar increase because marijuana had already been prevalent for years. In the decade during which marijuana was legalized and the government said it would not prosecute users and sellers, teen use in the state went from 7.6 percent to 11.1 percent.

Henny Lasley, a mother of three who lives in the suburbs of Denver, joined with several other parents to form Smart Colorado after the state made recreational use legal. The group aims to protect the “health, safety and well-being of Colorado youth” in a pot-soaked state where sales passed $1 billion in 2016 and where “pot tourism” is a growth industry.

Lasley said her group is not trying to repeal Colorado’s laws, but to make sure that the effects of them don’t worsen, a job she likens to “chipping away at an iceberg with a spatula.” The challenge is apparent at the Colorado State House, where Smart Colorado has one lobbyist to at least 18 registered with the marijuana industry, according to the lobbyist directory maintained by the Colorado secretary of state.

In an effort to help other states, the group put together a report called “Lessons Learned From Colorado’s Marijuana Experiment.” It recommends, among other things, that states legalizing pot give local communities power to opt out or set their own rules and to prioritize the protection of children, since one of the unintended consequences of legalization is the change of children’s attitudes toward the drug.

“Now that it’s being sanctioned by the state, there’s a disconnect, even with adults, that marijuana being sold in stores is safe. Our kids believe marijuana is harmless and benign and will solve any and all health concerns, from menstrual cramps to ADHD to anxiety,” Lasley said.

Mark Bolton, senior deputy legal counsel for the Colorado governor’s office, likened the state’s experience to building an airplane as you fly but said Colorado has worked hard to build a system that protects public health and keeps marijuana from youth.

Since the state had no data when marijuana sales began, it’s still building a baseline from which it can track the effect marijuana has had on the state. “To some extent, the picture is still forming for us,” Bolton said. The Legislature is still tweaking the laws, too, because of “surprises” that the state didn’t anticipate, such as the popularity of edibles.

Colorado had to ban marijuana-laced candies in the shape of people, animals and fruits, and last year required that edibles be stamped with the letters “T-H-C.” The state also stepped up its education efforts.

It’s also grappling with its lack of restrictions on growing marijuana plants, which has made the state attractive to criminal operations, Bolton said. Some states, like New Jersey, allow medical marijuana but don’t allow people to grow it; others, like Massachusetts, set a limit on the number of plants.

“It’s not ideal to be the first state to do it; it’s better to be a subsequent state so you can learn from everyone’s experience,” Bolton said.

Marijuana now and then

A 2014 report by the United Nations Office on Drugs and Crime said that worldwide, marijuana use has declined in Europe, while in the U.S., “the lower perceived risk of cannabis use has led to an increase in its use. At the same time, more people using cannabis are seeking treatment.”

According to research by Gallup, marijuana use has nearly doubled in the past three years. One in 8 Americans — that’s 13 percent — is using marijuana currently, and 43 percent have tried it, Gallup said.

In 2014, more than 22.2 million Americans reported using marijuana in the past 30 days. Ninety percent said they used it solely for recreation, 10 percent said they used it solely as medicine, 90 percent for recreation, according to the National Survey on Drug Use and Health.

Proponents of marijuana say that it is much less addictive than the opioids that are ravaging the nation. But federal health officials say that in 2014, more than 4 million people “abused or were dependent” on marijuana, and 138,000 entered treatment for marijuana use. That may surprise people who see marijuana as a feel-good thrill of the ’60s, but today’s marijuana is not what the hippies smoked then.

Marijuana, some people argue, is simply a plant, a God-given remedy not so different from aloe or witch-hazel. Like opium derived from the poppy, it is believed to have been used to mask pain and stimulate euphoria for thousands of years.

In fact, the human body contains cannabinoid receptors that prime it to welcome the compounds in marijuana that affect the body and mind, said Dr. Damon Raskin, a California internist board-certified in addiction and chief medical adviser of Cliffside Malibu, a drug-addiction treatment center.

Those compounds include tetrahydrocannabinol, or THC, and cannabidiol, or CBD. Only THC, however, affects the mind.

The potency of marijuana depends on the percentage of THC, which was commonly 3 to 4 percent in the hand-rolled “joints” people smoked in the 1960s and ’70s, but now can range from 12 to 15 percent and even exceeds 50 percent in some varieties of oils, Raskin said.

Disparity in potency and effect figures into the issue of impaired driving, tragically illustrated in Vermont in October, when a driver said to have high levels of THC in his bloodstream drove the wrong way down a highway, colliding with a car full of teens on their way home from a concert. All five of the teenagers died.

In Vermont, it’s illegal to drive with any marijuana in your system. Some states, like New Mexico, are considering limits consistent with impairment by alcohol. Police chiefs in Massachusetts unsuccessfully tried to thwart passage of a recreational marijuana law last year by warning about the difficulties of detecting pot-addled drivers. And it’s not just drivers of cars that use pot: The engineer in a deadly Amtrack collision in Philadelphia last year tested positive for the substance, the National Transportation Safety Board said this week.

The lack of uniform guidelines for law enforcement is but one of the problems presented by the rapid changes in marijuana laws, said Lasley of Smart Colorado. “It has moved at lightning speed — before the science could catch up,” she said.

Although it’s often said that marijuana hasn’t been studied adequately because it’s illegal, there are dozens of studies that are ongoing, and hundreds that have already been done. However, researchers must apply for special licenses from the DEA and the FDA, in addition to state licensing boards, and, until recently, those using marijuana plants could only obtain them from growers at the University of Mississippi, with DEA approval. The rules are so complex and restrictive that one researcher has called them “byzantine.”

Still, the National Academies of Sciences, Medicine and Engineering recently published a 395-page report summarizing 24,000 papers written about marijuana. Its authors concluded that marijuana is effective in treating pain, nausea and some effects of multiple sclerosis, but may not help other conditions for which it is touted, including glaucoma and epilepsy.

The report said marijuana does not appear to cause fatal overdoses or increased mortality, but that it is associated with a greater risk of motor-vehicle accidents and with overdoses among children. It also said pregnant women who consume marijuana deliver babies with lower birth weights than normal.

Other research has found troubling evidence of marijuana’s effect on the adolescent brain. One study in New Zealand found lower IQs in young people who had smoked marijuana frequently as teens and young adults. Compared to people who had not smoked, the marijuana users had a deficit of 6 to 8 IQ points, Raskin said. Researchers aren’t sure why but speculate that marijuana interferes with neurons connecting. There is also evidence that implicates heavy marijuana use in the development of schizophrenia.

Where we go from here

The Trump administration is hinting that change is on the way, with talk of a moratorium on recreational use.

“I’d be really surprised if the new administration attempted to restrict access to medical marijuana. As for nonmedical marijuana, I have no idea what the administration will do,” said Beau Kilmer, co-director of the RAND Drug Policy Research Center, who has pointed to Canada’s “meaningful discussion” on the subject as something America could learn from.

The uncertainty on the federal level is hobbling state Sen. Evan Vickers, R-Cedar City, and his colleagues in the Utah Legislature who want the state to develop a thoughtful plan for allowing marijuana use for patients who can benefit from it.

Vickers hopes to see three bills emerge in the current session: one to allow limited research in Utah, one that would spell out a framework on how medical marijuana would work “from the ground to the patient” and one that would articulate a policy on who would qualify as a patient, prescriber and provider.

A pharmacist, Vickers said he and many of his constituents support a sensible policy with strict controls. “If it’s going to be a medicine, let’s treat it like medicine,” he said.

Utah Senate President Wayne Niederhauser, R-Sandy, concurred in a meeting with The Deseret News’ editorial board. “I don’t think we’re going to get really far until this is addressed federally,” he said.

“I know that there are medical properties to marijuana. I think the evidence is there to some degree,” he said. “But we don’t know the degree (like) we know with other drugs because we haven’t had the opportunity to process them like you do other things.”

Niederhauser said whatever proposal Utah considers should be based on scientific recommendations for dosing, and that marijuana should be distributed through a pharmacy, not dispensaries that only accept cash, as in other states.

“I’ve been to dispensaries in Arizona, Oregon and Colorado, and it wasn’t sick people lobbying about medical marijuana; it was dispensary owners,” Niederhauser said. “These are the elements that need to be addressed — one of them nationally, which is a long way away — before Utah jumps off that cliff.”


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