Last week, I attended Portland’s Hemp CBD Connex, an annual event that highlights the vast potential of hemp and CBD.

Of interest to me–because my practice focuses on the regulatory framework of CBD products–was a panel entitled “Weeding Through the CBD Jungle: How to Grow, Run and Be Successful.” This panel was led by two experienced industry leaders: Stuart Bennett, VP of Contract Manufacturing for Canopy Growth, and Alex Rullo, Executive VP of Strength of Hope. Both panelists discussed the dos and don’ts of selling and distributing CBD products in interstate commerce and stressed the importance of complying with the CBD laws of each state in which a product is sold. This was music to my ears!

As you already know if you follow our blog, the Food and Drug Administration (“FDA”) has taken the position that CBD-infused foods and dietary supplements cannot be lawfully sold or marketed in the United States. Yet, states have adopted their own approaches to regulating CBD products that are not necessarily consistent with the FDA’s current position.

Some states, including Colorado and Oregon, allow the manufacture and sale of all CBD products, including food, dietary supplements, smokable products, and cosmetic products. Other states, like Idaho, strictly prohibit the production and/or sale of any such products. A handful of other states, including California, have banned certain categories of CBD products (usually food and dietary supplements) but seem to take no issue with the sale of other products, such as CBD cosmetics.

In addition, some states that have legalized the sale of Hemp CBD products impose their own regulations, including but not limited to labeling and testing requirements.

As we previously discussed, CBD manufacturers and distributors selling their products in interstate commerce should familiarize themselves with labeling and marketing laws in each state where they plan on placing their products. As a rule of thumb, companies should adopt the most stringent rules, such as those imposed by Indiana, Texas and Utah, to ensure compliance across state lines.

While it’s impossible to cover all state labeling and marketing laws in one blog post, I thought I would provide a brief overview of the label components that have become standard in the industry:

The FDA’s General Labeling Requirements

Every state that authorizes the sale of CBD products also mandates, in one way or another, that the labels of CBD products sold within their borders be labeled in accordance with the Food, Drug and Cosmetic Act (“FDCA”). Under the FDCA, the labels of any product sold in the United States must contain four basic elements:

(1) An identity statement, which indicates what the product is;
(2) A net weight statement;
(3) A list of all ingredients, which in states like New Mexico and Colorado, must clearly identify hemp and CBD. This requirement makes it difficult for companies that are steering clear from using the term “CBD” in an attempt to mitigate the risk of enforcement action. For more information on this issue, please read here; and
(4) The name and address of the manufacturer, packer or distributor along with their street address.

Scannable Bar Code or QR Code

A growing number of states are mandating the use or a scannable bar code, QR code link or web address linked to a document containing information, pertaining to:

• the batch identification number;
• the product name;
• the batch date;
• the expiration date, which in some states like Indiana, must be not more than two (2) years from the date of manufacture;
• the batch size;
• the total quantity produced;
• the ingredients used; and
•  certificate of analysis.

FDA Warning Statement

States like Colorado require that the following statement appear on CBD product labels: “FDA has not evaluated this product for safety or efficacy.”

No Medical or Health Claims

As we have discussed at length, the FDA has limited its enforcement actions against CBD companies that make outrageous and unfounded health claims about the therapeutic values of their products. Nevertheless, many states demand that the labels of CBD products sold within their borders be free of any health claims. It’s important to understand that drug claims don’t need to be explicit. If a company implies that its product can be used to treat a disease, the FDA and local authorities may conclude that the product is a drug.  Consequently, if a CBD company makes any medical, disease, or bodily structure or functional claims or implications about its products, the FDA will likely conclude that the company is marketing unapproved drugs in violation of the FDCA.

Ensuring compliance with the labeling and marketing laws (and policies) of each state in which a CBD product is sold can be challenging, yet it is a crucial step in mitigating the risks of enforcement action by federal and state agencies.

As I wrote in a prior blog post, Utah’s cannabis market has special characteristics that you are unlikely to find in other states. This is due in large part to Utah’s hardworking, predominantly conservative, and compassionate culture. Marry those qualities together and the parameters and developments of the Utah medical cannabis and hemp marketplaces make perfect sense. Overall, 2019 was a banner year for Utah’s cannabis marketplaces as it ramped up for 2020. Here’s the overview on 2019 and looking forward in 2020.

Medical Cannabis

Utah’s medical cannabis marketplace is slated to launch this year, with qualified patients receiving medical cards by March 1, 2020 or possibly sooner. After the voter approved initiative passed in November 2018 and was modified by the legislature in December 2018, Utah’s divided proponents of medical marijuana ended up with a medical program that is both patient-centric and internally seen as socially responsible.

Utah’s voters, with the intervening pen of its legislators, approved a non-smokable medical cannabis marketplace with significant government oversight and involvement instead of a full-scale adult-use/recreational market. Questions such as the following were central to the discussion: (a) What are the most efficient delivery systems for medical cannabis? and (b) Which of those delivery systems is most likely to provide health benefits to the consumer without producing negative externalities? (For instance, marijuana smoke can be noxious to those in the near vicinity to the consumer, but eating chocolates, softgels, or gummy bears or rubbing oil on your body is less likely to infringe on others’ comfort and health.)

On September 16, 2019, the Utah Senate passed SB1002, which amended the Utah Medical Cannabis Act. Among those changes were: (a) the number of available medical cannabis pharmacy licenses increased from seven to 14; (b) the division of the state into at least four geographic regions for license issuance purposes; (c) a mandate that Utah Department of Health (“UDOH”) issue pharmacy licenses by July 1, 2020; (d) the state central patient portal will allow patients to submit orders online for medical cannabis; (e) the UDOH may authorize home delivery by medical cannabis pharmacies, which may use medical cannabis couriers for delivery; (f) patients will be permitted to purchase a month’s supply of medical cannabis regardless of the distance they live from a medical cannabis pharmacy; and (g) cultivators are permitted to grow cannabis indoors and outdoors.

Utah cultivator licensing is currently closed at this stage, with only eight cultivators that received licenses out of 81 applications, although the legislature authorized 10 licenses. Seven of the cultivation sites are in rural areas and one is in an urban area. Licensees include both Utah companies and out-of-state companies with Utah ties. Processor licensing opened August 23, 2019 and remains open through August 2024, with an unlimited number of licenses available in two tiers. The application to become an independent cannabis testing laboratory remains open: the criteria can be found here. On January 3, 2020, the Utah Department of Health announced the companies that would receive the 14 medical cannabis pharmacy licenses. Eight of the locations may be open as early as March, with the remaining open as early as July. You can see the pharmacy map here.

Hemp

The Agricultural Improvement Act of 2018 (“2018 Farm Bill”) legalized industrial hemp, and Utah responded by amending its Hemp and Cannabinoid Act on May 14, 2019. Amendments included referring to cannabinoid products rather than only cannabidiol (“CBD”) products and requiring the Utah Department of Agriculture and Food to establish requirements for a license to cultivate, process, or market industrial hemp. Utah is currently drafting a state hemp plan to submit to the USDA in accordance with the 2018 Farm Bill. Currently Utah has approximately 175 licensed hemp growers, approximately 30 licensed hemp processors, and over 700 registered hemp products.

But You Can’t Smoke It

Utah has some unique twists to its cannabis marketplace. Smoking cannabis and hemp is not permitted, even with a doctor’s authorization to use cannabis, but diffusing is. Why? As I wrote in two prior blog posts (see here and here), two dominant global essential oil companies are headquartered in Utah: Young Living Essential Oils and doTERRA. Popular ways to use essential oils include ingesting, including in food and beverages, topical application, and diffusion into the air by use of a diffuser. And because Utah is also the epicenter of natural products, especially dietary supplements, ingestion of hemp products (like hemp-derived CBD) by tablet and capsule top the list of the definitions of approved “Medicinal Dosage Forms.”

What’s Turning Heads?

In 2019, Young Living Essential Oils acquired Colorado-based Nature’s Ultra, and now Nature’s Ultra’s ads are prevalent on the digital billboards on I-15 and I-215 in Salt Lake County. Recently, a self-proclaimed “Farmer & Chemist” company began advertising on the I-15 corridor. On December 30, 2019, Nevada’s West Wendover opened its first recreational marijuana dispensary just under two hours west of Salt Lake City. Looking ahead, UtahCann, the primary cannabis trade group in Utah, is preparing to hold its third annual Business Conference and Expo on April 25-26.

The Utah cannabis marketplace will continue to develop with uniquely Utah characteristics. We will keep you updated as the markets mature. I predict that Utah will begin to flex its unique international business connections before too long, especially on the back of its behemoth multi-level-marketing (direct sales) companies.

I recently attended Utah’s annual securities law workshop with some heavy-hitting headliners: Ben McAdams from Utah’s Congressional delegation; the chief accountant for the SEC’s enforcement division; and the head of Utah’s Division of Securities, Tom Brady (the slightly less famous one). Mr. Brady confirmed for me that Utah has more than its fair share of fraud and that the fraud has a particular Utah flavor, with confidence schemes dominating the landscape, often perpetuated by fraudsters who work their church, neighborhood, and family connections in a state that rivals China for its interconnectedness (in Chinese it’s called guanxi (gwon shee) – 关系). Many of Mr. Brady’s examples of fraud perpetuated in Utah began with a hot tip provided by a well-regarded businessperson who was extremely likeable and therefore seemed trustworthy. Utah has a very trusting population, and it also has a growing elderly population, both of which are vulnerable to fraud. Although it is currently only appearing as an intermittent blip on the radar of Utah’s Division of Securities, the Utah cannabis scene is ripe for fraud opportunities. Caveat investor.

Utah is on the cusp of rolling out its medical marijuana program. The Utah Department of Health will begin issuing medical marijuana cards no later than March 1, 2020. Even before Utah voters passed the ballot initiative on November 6, 2018, the green rush had already started in Utah, with would-be investors looking at getting in on the ground floor in Utah’s new marijuana marketplace. Heavy cannabis investments are happening in all the states where we have attorneys: Washington, Oregon, California, and Utah, which means that bogus investments (not just bad investments) are also being shopped to would-be investors as an alternative to the evergreen oil-and-gas venture fraud in the West. How can prospective investors in a Utah cannabis venture avoid losing their money in a fraudulent scheme? It helps to ask the right questions and to know what the right answers sound like.

Is the company or individual raising funds using a law firm to help with the transaction? Does that law firm know both securities and cannabis?

These questions are partially self-serving, but I put this point first because you do not want to dabble in securities law, whether you are a company, an individual businessperson, an investor, or a lawyer. Whatever your role in business, if money is changing hands between investors and a business venture, the investor is investing in securities being offered by the company. Even if it is “just” a promissory note or you are “just” loaning some funds to a friend or family member, unless you do not care about getting your money back, make sure there is a qualified securities attorney involved. There are a lot of great attorneys in Utah. There are at least two good cannabis attorneys in Utah. I am not aware of any other lawyers in Utah who know both securities and cannabis. You need good securities attorneys representing the company and each investor.

If the company is using an intermediary to solicit investments, is that intermediary licensed to solicit investments? Are they registered with the SEC, FINRA, or the State of Utah? Has the intermediary been disciplined by any of these entities?

Intermediaries or “finders” are (by definition) not involved with the day-to-day operations of the company that is soliciting investment, and they must be registered with state and federal regulators because they are in the trusted position of soliciting funds for investment. If the intermediary is not registered as a broker or investment advisor, they should not be soliciting investments unless they have a direct and substantial role with the company. If the company thinks the intermediary is registered but the intermediary is not registered, you should think twice about investing with the company. If the company does not know that their intermediary needs to be registered, you should also think twice about investing with the company.

What type of investment registration statement is the cannabis venture required to file?

The company either has to register its investment securities or qualify for an exemption from registration. If the company owners do not know what a securities offering is, you should think twice before investing with the company unless the company is willing to get competent advice from a securities lawyer. If the company or its attorney has not heard of Reg D, Rule 4(a)(2), or Rule 506, you should probably walk away or insist a qualified securities attorney get involved.

What parts of a cannabis business can be invested in, or what are the limits to the company’s business purpose?

Some states (like Arizona) allow full integration of marijuana business activities; others (like Washington) do not. If, for instance, the company seeking investment plans to develop a cannabis testing facility and have a fully integrated cannabis business (cultivate, manufacture, distribute/transport, and retail sales), but you know that the company can only do what its license permits, then you may want to look for another company to invest in. In Utah, only eight companies have been authorized to grow medical cannabis: Dragonfly Greenhouse, Harvest of Utah, Oakbridge Greenhouses, Standard Wellness Utah, True North of Utah, Tryke Companies Utah, Wholesome Ag, and Zion Cultivars. There will initially be only up to 14 privately-operated medical cannabis pharmacies licensed by the Utah Department of Health, but the RFP for applications has not yet been issued.

What can be found out about the principal owners and operators of the business by (1) word of mouth, (2) a simple Google search, and (3) checking with state and federal securities regulators?

I cannot tell you how many instances of investment fraud could have been avoided by doing a simple Google search. This was stressed recently in another conference I attended with the Washington State securities regulators. Do your homework or pay someone else to do your homework. In the legal world, that homework is called “due diligence,” which is a crucial part of any business transaction.

When it comes to investing in cannabis, know your counterparts, know their business, and know their flaws and weaknesses. Know all of this before you invest.

I recently attended two events in Utah headlined by the United Natural Products Alliance (“UNPA”) where its President, Loren Israelsen, discussed the voluminous public comments received by the FDA in response its latest round of questions regarding how over-the-counter cannabis extracts like CBD should be regulated. Israelsen provided numerous takeaways for UNPA members and their in-house attorneys regarding CBD and cannabis-derived products, and many cannabis businesses can also benefit from these insights.

As a nearly 40-year veteran of the dietary supplements industry, Israelsen knows his business. UNPA, led by Israelsen, was instrumental in helping pass the 1994 Dietary Supplement Health and Education Act (“DSHEA”), and the majority of UNPA’s calls in recent months have been from UNPA members who want to understand how natural products companies can dive into the CBD world. These inquiries culminated in UNPA reviewing the over 4,000 public comments to the FDA’s inquiries regarding cannabis regulation. In UNPA’s review of the FDA comments, UNPA identified several trends emerging that cannabis business owners should understand to help frame where UNPA believes the cannabis industry is heading in the next five years and beyond, including the intersection of cannabis-derived products appearing as foods, food supplements, drugs, and cosmetics. Those trends are summarized below.

The FDA Already Knows a Lot About CBD.

Epidiolex is a drug that was created by Cambridge, UK-based GW Pharmaceuticals and was approved by the FDA as a drug in 2018 to help relieve epilepsy-induced seizures. GW Pharmaceuticals has now done two decades’ worth of research on CBD and other cannabinoids and is responsible for putting CBD on the FDA’s radar many years ago. CBD’s involvement as an active ingredient in an FDA-approved drug precludes CBD from being marketed as a dietary supplement.

The Larger Battle is for Cannabinoids Generally, Not Just CBD.

GW Pharmaceuticals describes itself as having “established a world leading position in the development of plant-derived cannabinoid therapeutics through its proven drug discovery and development processes, intellectual property portfolio and regulatory and manufacturing expertise.” In its 23-page comment submitted to the FDA, GW Pharmaceuticals provided its well-reasoned argument as to why cannabis research should be led by pharmaceutical companies instead of business leaders (a health care professional-driven market instead of consumer-driven). Even though CBD is driving the current cannabinoid craze, companies like GW Pharmaceuticals are looking beyond CBD to the dozens of other cannabis-derived cannabinoids.

This is a Battle Among the Food and Beverage Industry, the Nutraceutical Industry, and Pharma/BioTech.

GW Pharmaceuticals made it clear that if the FDA allows cannabinoid products to be ingested in food, drinks, or dietary supplements, then pharmaceutical companies have zero incentive to spend millions or billions of dollars on R&D to develop new drug compounds to address diseases. It is highly unlikely that the current CBD market structure will extend beyond CBD to other cannabinoids because the FDA will want to maintain R&D incentives for pharmaceutical and biotech companies.

Big Pharma and BioTech are Much Farther Along than the Food and Beverage Industry and the Nutraceutical Industry.

Based on GW Pharmaceutical’s submitted comments, it is clear that the company has spent decades and many dollars on its research, and it likely knows more about cannabinoids than any other pharmaceutical or cannabis company in the world. In the broader industry, at least 10 cannabinoids are currently under research, and companies are manufacturing synthetic cannabinoids and researching cannabinoids derived from non-cannabis sources. Established food and beverage companies and nutraceutical companies have been slowly wading into the CBD world, but they are lagging behind these pharmaceutical companies.

Dosage/Acceptable Daily Intake Will Vary by the Individual.

The observable negative effects of CBD vary by individual factors such as height and weight, and what dosage is “well-tolerated” is not yet widely understood or implemented in the marketplace. That will change. Israelsen believes that the dosage will look something like this: the number of milligrams of CBD per kilogram of person, with special attention to vulnerable populations (children and pregnant/nursing women) and animals.

Everyone is Starting to Lawyer/Lobbyist Up.

During this interim period where the FDA has not yet issued its final rules, the lawmakers and regulators in Washington D.C. are regularly being contacted by trade groups, trade associations, constituents back home, and lawyers and lobbyists. The current political base is focused on how the cannabis industry is helping disenfranchised rural farmers. These hemp farmers are the ones to hitch your wagon to, especially in states that are not saturated with overcapacity. And if the FDA determines that it does not have enough guidance, it will kick the can back up the road to Congress.

UNPA Wants to Join Forces with Cannabis Businesses and Trade/Interest Groups.

UNPA recognizes that there are many cannabis interest groups and that both existing natural products companies (and trade alliances like UNPA) and new natural products companies (aka cannabis businesses and trade alliances) should collaborate to learn from each other and find commonalities. The natural products companies excel in quality control systems and analytical practices. There may be good opportunities to share expertise, resources, and legal strategies. Israelsen said the nutraceutical industry needs to get to know the cannabis farmers and marijuana-related business groups.

Product Liability Insurance was Not Discussed in the FDA Comments But is Critical.

No one likes to talk about insurance except insurance agents and lawyers. Israelsen stressed the importance of insurance for all companies engaging in the cannabis industry, and it underscores this prior blog post about product liability insurance.

The next several months will provide significant insight into these issues and how they will affect the intersecting paths of companies in the pharmaceutical, biotech, nutraceutical, food and beverage, and cosmetics industries. I believe we will see more strategic alliances, partnerships, and mergers and acquisition activities across industries.

Recently I wrote about the two dominant global MLM essential oil companies based in Utah: Young Living and doTERRA. Last month Young Living announced it is entering the CBD oil market, but doTERRA publicly stated on its website that it will not (yet) follow suit, even though everyone and their dog are clamoring for CBD oil and CBD oil-derived products. doTERRA only hints that it may produce CBD oil if it can be produced according to doTERRA’s rigorous standards for its products, but “Right now, it is not possible to deliver a CBD oil that meets [doTERRA’s] CPTG^® standards.”

Instead, doTERRA has gone to great lengths to educate its distributors (wellness consultants) both about the medical and legal issues surrounding CBD oil. On its website in a post modestly titled Everything You Need to Know About CBD, doTERRA provides a part-medical part-legal treatise, complete with embedded video, a PowerPoint presentation, and 24 footnotes to medical journals and federal laws. Its thoroughness means that it is a beast to digest if you did not double major in pre-med and pre-law, but doTERRA makes some compelling points about the current unsettled state of CBD.

On the legal side, doTERRA takes a conservative approach:

• doTERRA advises its distributors to “remain cautious” against products that may not follow the Federal Food, Drug, and Cosmetics Act (the “FD&C Act”) that may put health and safety at risk. This point is well taken, as we mentioned in a prior blog post entitled Four Important Considerations for Any Hemp CBD Company.
• Relatively little medical and scientific research has been completed regarding CBD and its “perceived health benefits” (see FDA Says It Is Speeding Up The CBD Regulation Process). This point is also well taken with respect to U.S. regulators. Neither the FDA nor the USDA have issued implementing regulations yet regarding hemp-derived CBD.

Young Living is aware of these potential legal issues with the current state of CBD, and it has taken proactive steps to mitigate potential negative effects. In its acquisition of Colorado-based Nature’s Ultra that produces 0.0% CBD oil (no THC content), Young Living has opted to keep Nature’s Ultra as a separate operating company rather than integrating its operations within Young Living. Nature’s Ultra’s CBD oils can be purchased with Young Living’s essential oils blended into its products rather than the other way around.

On the medical side, doTERRA provides extensive information regarding cannabinoids:

• The human body has cannabinoid receptors that are broken down into two categories:
  • CB1 receptors – affect the brain and central nervous system (pleasure and reward) (more widely distributed throughout the body).
  • CB2 receptors – immune system (inflammatory system) (less widely distributed than CB1 receptors).
• THC works directly on both CB1 and CB2 receptors.
• CBD works indirectly on both CB1 and CB2 receptors by slowing down the work of an enzyme called fatty acid amide hydrolase (“FAAH”), which breaks down anandamide (your body’s naturally-produced cannabinoid as a response to strenuous exercise (runner’s high), stress (fight or flight), and other related stimuli (stepping on a pile of your kid’s Legos in the dark)), which is why anandamide is called an endocannabinoid).
  • A slower breakdown in anandamide means it is present in the body longer and continues to interact with the body’s CB1 and CB2 receptors.

Finally, in good competitive market fashion, doTERRA educates its distributors that it already has a superior product to CBD oil called Copaiba oil:

• Copaiba oil contains beta-caryophyllene (“BCP”), which is a cannabinoid and a sesquiterpene (delivers oxygen molecules to cells) found in hundreds of different plant species.
• Copaiba oil comes from distilling the oleoresin of varieties of copaiba trees, which are found in Brazil. The resin is harvested similar to the method used to extract maple sap from maple trees.
• BCP interacts directly with the body’s CB2 receptors (“no risk of psychoactive effects”), “soothing tissues and helping to manage healthy inflammatory responses.”
• doTERRA’s copaiba essential oil contains 55% BCP content, which is the “highest BCP content of any known oil.”
• Its efficacy means only “a drop or two” is needed for its BCP to start affecting the human body, so its price point is significantly lower than CBD oil per application (They can’t call it a “dose” because “These statements have not been evaluated by the Food and Drug Administration” and “This product is not intended to diagnose, treat, cure, or prevent any disease.”)
• Copaiba oil has been produced under doTERRA’s rigorous proprietary CPTG® standards.

But at the end of the day, copaiba oil is not CBD oil. BCP is not CBD, even though it contains two of the same three letters and may be confusingly similar enough for doTERRA’s wellness advocates to have an opening in the conversation to educate the market about BCP’s benefits. doTERRA is hoeing a hard row right now, but there is a segment of the doTERRA and Young Living essential oil market that is hesitant to use products that have not been approved by the FDA or that have any trace of THC content, as I explained my prior blog post. If copaiba oil is as effective as and can be purchased at a fraction of the price of CBD oil, it may get some takers, but because it does not interact with the CB1 receptors, it may be a hard sell. And copaiba oil is not as cool or edgy as CBD oil. Will doTERRA eventually produce CBD oil? Almost certainly. Will doTERRA’s consultants be able to educate the market about copaiba and BCP and keep pace with Young Living’s sales of its CBD oil through Nature’s Ultra? Probably not. The developments over the next several months will be interesting as these two competitors continue to fight for market dominance.

Brian Stoll faced a dilemma as his wedding day approached. For more than a year, he had been smoking marijuana to treat severe back pain, but to remain in good standing with the Church of Jesus Christ of Latter-day Saints and get married in the temple, he had to stop using pot.

Since marijuana was illegal under Utah law, church leaders told him, it was forbidden. Stoll turned to an opioid painkiller and has continued using it since his marriage three years ago, despite unpleasant side effects and its inability to match the soothing qualities of marijuana.

“This was devastating … I had to choose between my health and my fiancee,” Stoll said recently. “It seemed asinine that if I lived in another state, I wouldn’t have to make such a difficult decision.”

Perhaps soon, Stoll said, that could all change for him and his fellow Mormons in Utah.

In November, voters here will consider a ballot measure to legalize medical marijuana and possibly join 30 others states that allow its use.

While opponents, including a group of Utah doctors, have characterized Proposition 2 as a clear and dangerous step on the path toward legalizing recreational pot in the state, supporters say the initiative is a move of compassion.

Dozens of parents of children with severe illnesses, including epilepsy, who say they rely on marijuana for treatment, have become the public faces for the campaign. The initiative, supporters argue, is also a necessary response to the opioid epidemic. Every year between 2013 and 2016, roughly 600 Utahns have fatally overdosed on opioids, according to a recent report from the Kaiser Family Foundation.

“We’re talking about medical marijuana, which science time and again has shown to have benefits for people in pain and suffering,” said DJ Schanz, a Mormon and the director of the campaign supporting the measure. “People are being prescribed pills but can’t use something natural.”

Among those gathering signatures to place the measure on the ballot was Stoll. The product of a devout Mormon home in the Salt Lake Valley, he started taking prescription opioids in 2012, after fracturing his back in a fall during his sophomore year at Brigham Young University.

The pills helped somewhat, but he hated the possibility of growing addicted. So at 24, Stoll bought a mini bong and some pot, and soon his life changed. The pain faded, and he could sit through church services and go on hikes. Fears of addiction no longer flooded his mind, and his mood improved.

But then came his engagement and his desire to be married in the temple. He now takes a tablet of Tramadol most mornings. The powerful opioid can cloud his mind and make him drowsy, but he said that without it, he couldn’t sit through the four-hour service at his Mormon meeting house. The gnawing pain in his back would turn to a throb.

One recent Sunday morning, Stoll gulped down the small, white pill as he rushed out the door and headed to his church.

Church leaders long remained silent on the marijuana initiative but eventually took a public stance, releasing a brief statement in April lauding a memo by the Utah Medical Assn., a group of doctors opposed to the measure. The church praised the association for “cautioning that the proposed Utah marijuana initiative would compromise the health and safety of Utah communities.” A month later, church leaders put out a document citing legal concerns, including “significant challenges for law enforcement.”

According to a recent Salt Lake Tribune-Hinckley Institute of Politics poll, two-thirds of voters in Utah, where more than 60% of the population identifies as Mormon, support the medical marijuana proposal.

The leaders of the church, whose membership tops 16 million worldwide, “have enormous sway in Utah,” said Philip Barlow, a professor of Mormon history at Utah State University. And yet, he noted, “Mormon conclusions are not monolithic.”

“Among the majority in the state who identify as LDS, a fair portion of these, as with all religions, are not robust or active in practicing their faith,” Barlow said. “They simply identify as Mormon, as opposed to Baptist or Muslim.”

The Mormon Church has a history of weighing in on social issues.

In 2008, church members helped bankroll a successful campaign in California for Proposition 8, which banned same-sex marriage in the state until it was struck down as unconstitutional. Last year in Utah, the church supported a successful effort by lawmakers to create the lowest blood-alcohol driving limit in the country — 0.05% — despite concerns from the state’s tourism industry.

While the church’s doctrine regarding health, referred to as the “Word of Wisdom,” does not directly address medical marijuana, it does ask members to abstain from alcohol, tobacco, coffee, tea and “illegal drugs.” In recent years, some church members, including Stoll, have sought clarity on what classifies as an illegal drug, especially as more and more states legalize marijuana for medical or recreational use.

The church declined to comment for this article.

Utah has a long history with pot. In the early 1900s, it was among the first states to ban cannabis, following the return of Mormon church members from missions in Mexico, where some historians have said they used pot, according to a reference handbook on marijuana by scholar David E. Newton.

During the state’s current battle, Gov. Gary Herbert, a Republican and a member of the Mormon church, has voiced his reservations about Proposition 2.

“I am concerned about this initiative because of the lack of medical science on the safety, efficacy and proper dosage for compounds found in cannabis,” Herbert said in an email. Referring to the Food and Drug Administration, he added, “We should have clinical studies — just like we do for any other FDA-approved medicine. We need to isolate what helps and heals from what harms.”

While traveling the state, Herbert said, he has met with Utahns recovering from addiction who have told him “that marijuana was their gateway drug to other more dangerous and addictive drugs.”

“To a person,” Herbert said, “they have argued against the legalization of marijuana.”

For Stoll, who works in digital marketing in this suburb south of Salt Lake City with views of the towering Wasatch Range, his pain has propelled his activism.

Two years ago, he testified before lawmakers about a bill that would have legalized pot for medical purposes. The measure died in the Republican-controlled Legislature. But lawmakers have passed laws over the years that, among other things, allow oils and creams made from the non-psychoactive component of cannabis.

Before Stoll, his wife and their infant daughter drove to the red-brick meeting house in West Jordan on a recent Sunday, he pulled out the green bong he’s kept in a cardboard box in his closet since his marriage in 2015.

He can’t help but think about how much pot helped him — about what his life would be like if he could give up the Tramadol.

But he fears losing his good standing within the church — a designation that allows him to attend temples, where Mormons marry, have baptisms and other major life ceremonies. At times, Stoll admits, he thinks about moving out of state to better treat his condition. Stoll said he knows Mormons in other states — where pot is legal — who use marijuana and are in good standing and have temple recommends with the church because sympathetic local church leaders have given their assent. He wants that for himself.

“This is something that if I drive east or west — to Colorado or Nevada — is 100% legal and helpful to my situation,” he said. “We’re not talking about recreational. This is simply for medical.”

His wife, Rachael, said her husband seemed healthier when he used cannabis.

“As a family, we need this to become law,” she said, holding their daughter, Everly. “We pray for this.”

But her stepfather, Hector Llamas, 63, disagrees, saying he foresees medical pot being sold on the black market.

“People buy it with a card and then turn around and sell it elsewhere is going to be a problem,” Llamas said as the family sat at the kitchen table before church.

Moments later, as the family got ready to head to the meeting house — one of several in this community where horses graze in backyards under the shade of pine trees — Stoll read a passage from the Book of Mormon:

And there were some who died with fevers, which at some seasons of the year were very frequent in the land — but not so much so with fevers, because of the excellent qualities of the many plants and roots which God had prepared to remove the cause of diseases, to which men were subject by the nature of the climate.

This, he said, reminded him of his current situation.

“Marijuana,” he said, “is a gift from God.”

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