Inside the mind of a medicinal cannabis pharmacist in Utah

In Utah, pharmacies are referred to as pharmacies, and the method by which patients must apply for and receive cannabis medication varies. While more than three million people live in the state of Utah, only 15 pharmacies and eight farmers are legally allowed to operate there.

Pharmacists are critical to the structure of Utah’s medical cannabis program as they are legally the only way for medical cannabis patients to obtain cannabis products. Beehive Farmacy’s lead pharmacist, Mindy Madeo, has been a pharmacist for over 20 years but found a new calling entering the cannabis industry after the state of Utah legalized medicinal cannabis. Madeo attended the University of Maryland School of Pharmacy’s cannabis program, from which she will soon graduate with a Masters of Science degree in Medical Cannabis Science and Therapeutics. It is currently the only pharmacy school in the US to offer such a degree, and in addition, Madeo is one of the few people in Utah to have received such an award.

Madeo took time out to speak with High Times about what sets Utah apart from other states’ medical cannabis programs, the influence of The Church of Jesus Christ of Latter-day Saints (LDS), and what the future holds for patients.

Courtesy of Mindy Madeo

The Essential Apothecary

When Madeo started her career in the cannabis industry, she helped one of the dispensaries called Wholesome start a business. While that pharmacy was a bit more business oriented, Madeo then moved to Beehive Farmacy where she currently works as the Pharmacist in Charge. Beehive Farmacy has two locations out of a total of 15 licensed nationwide, one in Salt Lake City and one in Brigham City. “It was really amazing,” Madeo said of her role. “The work I do every day is really like my dream. I’ve been doing it for two years and I still say I would do it even if I didn’t get paid.”

Madeo explained how Utah’s medical cannabis program works for patients. Similar to other states, patients must go to a doctor and get a referral for a cannabis ID card — but new patients can’t just walk into a pharmacy to pick up their medication right away. “By law, every single patient who is newly admitted to the cannabis program must sit down and consult with the pharmacist. And that’s what’s unique. This is something that no other state is doing,” Madeo explained. “And it’s expensive to run a business for it, but the results are just phenomenal.”

These consultations last an average of just 30 minutes, during which pharmacists like Madeo ask their patients what medication they are currently taking. “It struck me that it’s not just the painkillers,” she shared. “It’s stimulants like Adderall and Ritalin in the morning that people can get off of. It’s the sleeping pills for the night. It’s the antidepressants. It’s the stomach pills. I’ve even had a few patients who went off blood pressure medication.” After determining their patient’s needs, pharmacists recommend different cannabinoid combination products or different strains or terpene profiles for treatment.

Madeo also notes the importance of teaching new patients how to control their dosage, what to do if they’ve consumed a little too much, and for regular users how to reset their tolerance or change their current medication can rate. “So I think it’s very empowering for people to give patients control over their pain and their health, where they’re able to increase or decrease or try different products. And I wish more medicine was like that.”

The LDS Church

Aside from regular inquisitive customers, Madeo has also witnessed the change in perspective of The Church of Jesus Christ of Latter-day Saints (LDS) and its members. “It’s amazing in Utah because the LDS Church wasn’t on board initially. There was a lot of controversy,” she said of the church’s initial stance on cannabis. “And then they changed some policies that said like, ‘You can’t have cannabis.’ And then they changed it again and said, “It’s okay if it’s with a doctor.” So currently it’s 100% fine as long as the doctor recommends it. And I see so many old people, so many people coming in [and] you can say [that] they’re Mormons, they wear CTR rings. Your mind changes. And to me that in itself is an amazing thing to watch.”

Extend legislation in Utah

Utah first passed its medical cannabis laws when former Gov. Gary Hubert signed House Bill 195 in March 2018, which gives patients the “right to try cannabis as a treatment” when they are terminally ill. Later in November 2018, Utah voters approved Proposition 2, which laid the basis for the state’s current medicinal cannabis program. The state program started in March 2020 and there are now an estimated 41,000 medicinal cannabis patients in the state (as of January 2022).

Cannabis isn’t the only medical treatment lawmakers are considering when it comes to access. In the 2022 legislature, the Utah House Legislature passed Bill 167, also called the Task Force on Psychotherapy for Mental Illness, which will review studies of psychedelic substances used to treat medical patients. Substances like psilocybin therapy or even the use of MDMA are used to treat certain medical conditions.

Ultimately, Madeo sees a bright future for Utah’s medical patients and those who are not currently patients but are becoming curious about how cannabis can help. However, there are still many hurdles to be overcome. “In Utah, and probably across the country, right now we’re sitting here making a distinction between medical use and recreation[al] use, right? The word “recovery” is a terrible word. We should call it “adult use”. But we still use “rec”. To me, that’s such an assessment and I don’t think there’s much of a difference between the two.”

Madeo commented on the judgmental stance of Utah laws on restrictions on advertising or restrictions on anything Rastafarian-inspired, like colors or designs. “For me, they’re trying to whitewash the plant that we’ve been using for ages,” she said.

But that judgment extends to consumers as well. “We’re kind of targeting this culture that we think we’re judging, and we’re like, ‘You’ve got dreadlocks, you’re using concentrate … you’re using too much of a dose, so you’re a rec patient.’ This person might be afraid they might have cancer. Give me five minutes with someone you say is over the counter and I’ll find a medical reason for them using it.”