Cannabis Care

As a pediatrician and hospice and palliative medicine specialist Benjamin Moresco, MD, sees young patients living with rare diseases who are often experiencing debilitating pain that traditional medicine can’t touch. Many of these children at Salt Lake City’s Primary Children’s Hospital will only live into their teens.

Moresco, who’s also a qualified medical provider, or health care professional licensed by the state of Utah to prescribe medical cannabis, has found success in using medical cannabis to ease some of his patients’ pain—sometimes with fewer side effects.

While Utah law prohibits medical cannabis for people ages 20 and younger—and the American Academy of Pediatrics opposes its use in people under age 21—the law recognizes that marijuana may currently be an option for cannabinoid administration for children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate. Parents can apply to Utah’s Compassionate Use Board for an exception when standard treatments for their child fail. Of the fewer than 10 patients Moresco has enrolled in the program, most are cancer patients, including one with relapsed osteosarcoma.

“Getting through therapy or treatment relies on good symptom management and for patients to be able to tolerate the medications they need to take to have a chance at remission,” Moresco said. “Medical cannabis can help with the pain or the nausea related to treatment.”

Along with helping his patients, Moresco has also eased parents’ concerns about the legality of children taking medical cannabis. But, like many Utah providers, at the same time he’s left with lingering questions about the therapy. For example, what does research conclude is the appropriate dose to give, how exactly does medical cannabis interact with other drugs patients are taking, and what is the best way to evaluate its benefits? These are questions that researchers and experts at the University of Utah’s newly launched Center for Medical Cannabis Research (CMCR) are seeking to answer.

“We’re still really in the beginning stages of understanding some of the long-term outcomes of medical cannabis,” said Valerie Ahanonu, BS ’09, the center’s senior manager, who brings her background in pharmaceutical research to her new role. “We’re hoping the center will help to make it easier for providers to have these conversations about medical cannabis with their patients and to give better guidance about what they’re recommending.”

Five years after lawmakers passed the Utah Medical Cannabis Act in 2018—joining over a dozen states that allow medical marijuana use only—in 2023 lawmakers agreed on H.B. 230, legislation that established the University of Utah’s Center for Medical Cannabis Research.

The center’s goal? To advance research on the safety and effectiveness of medical cannabis at a time when clinicians still have little precise data on its efficacy as a therapy. The center aims to educate clinicians, pharmacy medical providers, and medical cannabis patients about the therapy, plus shape evidence-based guidance for treatment. Lawmakers gave an initial $650,000 to the initiative.

Since then, the number of people in Utah carrying medical marijuana cards has grown dramatically. By the end of September 2024, more than 89,000 people in the state held medical marijuana cards, representing a 23% year-over-year increase.

“In Utah, we have a lot of really determined patients who want access to medical cannabis that doesn’t exacerbate their symptoms or create any other problems,” said Ahanonu. “We also have an industry that’s very interested in research and in creating more quality products for patients, and a great collective of researchers.”

“In Utah, we have a lot of really determined patients who want access to medical cannabis that doesn’t exacerbate their symptoms or create any other problems.”

“Being on the forefront of a new class of medication puts Utah on the map, and it brings good researchers and people to the state.”

Ahanonu envisions the center as a place where all stakeholders can come together as a collaborative group to help patients ultimately gain more trust in the quality and effectiveness of the medical cannabis products they take.

Along with the center’s interim director, Jerry Cochran, MSW ’05, PhD, who’s also director of research for the Program on Addiction Research, Clinical Care, Knowledge, and Advocacy within the Division of Epidemiology, Ahanonu has been hard at work in the center’s early days to establish a strong foundation upon which future research will be built.

“My vision is for a multidisciplinary center that answers important questions from a variety of perspectives and promotes safe and effective use of medical cannabis,” said Cochran. “I think most providers who are engaged in the medical cannabis program do believe that it really does help some of their patients, but they’re not exactly sure how—and under what circumstances—their patients are being helped.”

One center project that’s come to fruition is a series of educational videos for providers to use when talking with their patients about medical cannabis and for patients to discuss cannabis with pharmacists. Last year, the center also awarded its first round of annual seed grants for medical cannabis-related research.

Grants are focused on collaborative projects that seek to further the translational potential of cannabis and deepen understanding of its impact on public health. The 2024 seed grant competition drew nine applications, and four researchers across Utah’s academic institutions received $50,000 each.

Projects funded by the grants include a study that will investigate the effects of cannabis legalization on illicit drug use, drug-related crime, and jail and prison populations, and another that aims to compare oral and vaporized cannabis pharmacokinetics and their effects on the endocannabinoid system.

The center also sponsored researchers accepted to present at the Research Society on Marijuana’s 8th Annual Scientific Meeting held in Toronto, Canada. University of Utah Health’s Alan Taylor Kelley, MD, MPH, MSc; Carter Reeves; Lirit Franks, PhD; Michael Incze, MD, MSEd; Adam J. Gordon, MD, MPH, FACP, DFASAM; and Gerald Cochran, MD, MSW—members of the Medical Cannabis Outcomes Research Evaluation team—presented on “Cutting Through the Haze: Bridging the Gap Between Regulators and Researchers to Inform Effective Cannabis Policy.”

The bulk of Ahanonu and Cochran’s time thus far, however, has been dedicated to helping overcome a major hurdle for cannabis research in the US: a limited supply of research-grade medical cannabis from sites that are approved by the Drug Enforcement Administration (DEA). Built into H.B. 230 is the center’s duty to support a licensed cannabis cultivation facility that provides medical-grade cannabis products for research.

To date, the University of Mississippi is the only academic institution in the United States with a licensed facility that provides cannabis products for research nationally. The University of Utah would be the second.

“Part of the hope is that by becoming an additional production facility, we would be able to introduce more high-quality products that can be used for medical cannabis research across the US,” Ahanonu said.

Having increased access to these types of high-quality, standardized products is essential for elevating medical cannabis research. More trusted products will give researchers added confidence in their study results. Meanwhile, more precise research could ultimately help medical cannabis companies to create products that better target specific health conditions.

“Getting a production facility up and running at the university is a complicated endeavor that will likely take several years to complete,” said Cochran. “It requires a very thoughtful interdisciplinary team to kick something like this off,” he said. “It’s the scaling up that’s a challenge and also meeting the various regulatory demands.”

In the meantime, Ahanonu and Cochran have started their search for a full-time, permanent center director while looking at overlapping research, how to build out the fastest road to standards, and what research topics are the best for collaboration. Standards to develop might include ones that address medical cannabis production measures and practices, formulation, quantification methods, and patient impact.

The CMCR also hosted its first annual Cannabis Research Symposium, bringing together researchers, public employees, and industry stakeholders to present a broad overview of cannabis research in Utah.

As a new member of the Association of Cannabis Research Centers, CMCR is establishing collaborations with medical cannabis centers throughout the US and Canada. By hosting keynote speakers from Johns Hopkins University’s Cannabis Science Laboratory and the Yale Center for the Science of Cannabis and Cannabinoids, they hope to establish partnerships that continue on to collaborative projects.

During the next legislative session, the center will also likely take over the responsibilities of the state’s Cannabis Research Review Board, which sets cannabis guidelines. Ahanonu and Cochran are working as well to dispel ongoing misconceptions about medical cannabis.

For example, some providers still see patients who express an interest in medical cannabis as drug-seeking. People in general also overestimate patients’ level of impairment when they take medical cannabis. There’s a perception, too, that it is a cure-all that can alleviate any ailment, which isn’t necessarily true.

“That can be detrimental for people,” Ahanonu said, “if it means they’re forgoing other types of care that might be beneficial for their condition. Research done through the center will hopefully help home in on the best-use cases,” she added.

Moresco said that some patients approach their provider having already tried medical cannabis that was prescribed to a friend or family member. Education and research through the center could help to encourage a safer path to the therapy.

“The big push for the center is standardized education and opportunities for people to have that trusted source of information about how this can be used successfully and safely,” he said.

Moresco hopes to see more research around cannabis terpenes, or the compounds that give the plant their aroma and taste, to see if they might have a larger role to play in patient care. Some research has suggested they could offer an alternative to pain relief without the adverse side effects of CBD or THC.

Looking ahead, the DEA’s completion of the process of rescheduling cannabis, or reclassifying it from a Schedule I to Schedule III drug under the Controlled Substances Act—if it ultimately comes to fruition—may mark an important milestone for the center.

“My hope is that it would give researchers a bit more freedom,” said Ahanonu, paving the way for new discoveries that can enhance patient care. “We’re still learning so much about the endocannabinoid system and how medical cannabis reacts with other medications,” she added. “There’s just so much that we don’t understand yet.”

Added Moresco, “Being on the forefront of a new class of medication puts Utah on the map, and it brings good researchers and people to the state. New therapies for symptom management are rare, and to work on the safe development of therapies that can really help patients is just a really exciting place to be.”