FLORIDA'S WEED WOES: State of Confusion
Feb 04, 2019 05:23PM
If Floridians are confused about how medical marijuana works in their state, it’s no wonder. After all, the legalization of this natural drug has been a two steps forward, one step back process.
First, medical marijuana was made legal in Florida for a relatively small subset of severe chronic health conditions, such as HIV/AIDS and cancer. Then last year, Florida voters okayed its use for a broader range of “like” conditions—that is, the sort of physical and emotional symptoms, such as chronic pain and anxiety, that often accompany those severe health conditions.
Now, under the new law, medically qualified patients can get a referral that enables them to purchase medical marijuana products at a state-approved dispensary.
And there are so many products! You can ingest them, vape them, rub them on your skin, smoke them … oh, sorry, you can’t smoke them. First, you could, but now you can’t; Florida’s legislature wrote that restriction into the new law. But Gov. Ron DeSantis just announced that if the restriction isn’t lifted by March, he’ll drop the appeal preventing that from happening.
So the state law is still being hashed out, and meanwhile, Floridians who are interested in trying medical marijuana—a potentially life-changing treatment—are asking lots of questions.
Like, is it really OK to use medical marijuana if federal law still prohibits it? What happens if I test positive for it at work? Can I use it and not get high? What’s the difference between medical marijuana and CBD? And why do I have to go to a dispensary for some CBD products, when I just saw a bunch of them at the gas station down the street?
Then there are the logistical questions, about time, cost and process. And, of course, there’s the most important question of all: Can medical marijuana help me?
With input from three local providers who offer medical marijuana referrals, we found some answers.
Who can use medical marijuana?
To get a medical marijuana card, you must be diagnosed with a qualifying medical condition by an M.D. who’s approved to make medical marijuana referrals. Qualifying conditions include cancer, epilepsy, glaucoma, HIV/AIDS, post-traumatic stress disorder (PTSD), amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, multiple sclerosis (MS); medical conditions similar or comparable to any of those conditions; chronic pain related to one of those conditions; or a terminal condition diagnosed by a physician other than the one making the medical marijuana referral.
What’s the process?
“If you try to figure it out on your own, it can seem complicated, but any doctor’s office that does these things can make it pretty simple,” says Kevin Hogan, D.C., owner of East Hill Medical Group.
Some practices, like East Hill, request that patients wanting a medical marijuana referral bring in medical records showing that they’ve been treated for a qualifying condition. Other practices will diagnose first-time patients before making a referral.
While the time spent on consultation and follow-up varies from one practice to another, the referring doctor generally talks with the patient about the various types of products and intake options (edible, topical, etc.), as well as the dispensary process, before uploading the referral—indicating dosage amount and often intake type—to the Florida Health Department Office of Medical Marijuana Use (OMMU).
Within minutes, the patient will receive an email from the state with instructions to submit a passport photo and $75. About 10 days later, the patient will receive an email notification that he or she is registered in the state system and can purchase medical marijuana from a dispensary. An official medical marijuana card will be issued within a few weeks.
The card must be renewed via medical referral every seven months. During that time, the referring physician can issue certifications for three 70-day supplies of product.
How much does it cost?
There’s the cost of the doctor’s visit, the cost of the medical marijuana card and then the cost of the products themselves. Kim Hawkes, senior manager of government and public relations at Surterra Wellness, a dispensary based in Tallahassee, says products cost between $25 and $150 each, depending on the delivery device.
Currently, insurance doesn’t cover the office visit unless the referring physician is also the patient’s primary care doctor for the qualifying condition, and it’s a regular visit. Patients should check with the referring physician about this.
Felipe Muñoz, mindfulness and meditation coach for Empathic Practice, a Pensacola clinic that offers medical marijuana referrals, says the issue of insurance has been confusing for patients. He often has to explain that insurance doesn’t cover medical marijuana products because they’re still federally illegal.
Then again, many prescription medications are pricey even with insurance. If medical marijuana is a good or better substitute, with fewer side effects, it could be well worth the out-of-pocket expense.
Kent Beams, M.D., owner of Releaf Medical Marijuana Clinics, says that medical marijuana “is so often effective with pain management that many of our patients have decreased or completely stopped all of their prescription medications.”
What are the different types of marijuana products?
First of all, there are the various strains of marijuana, which are categorized into three main types that produce different effects. Indica strains, which help with pain and insomnia, promote deep relaxation. Sativa strains, which help with depression, anxiety, pain and low energy associated with ALS, tend to improve mood. The hybrid strains combine qualities of both.
Then there are the various delivery systems. The one Americans are most familiar with—smoking—is self-explanatory but currently illegal in Florida. The closest legal equivalent is vaping, where the marijuana is heated (but not ignited) to release the active ingredients, which are inhaled as vapor.
There are edibles, whose appearance is strictly regulated so children won’t be attracted to them (no cute shapes); capsules, for folks who like their drugs in pill form; and tinctures—basically concentrated drops you put under your tongue. And then there are topicals—marijuana-infused creams and lotions absorbed by the skin.
William Haas, M.D., owner and medical director of Empathic Practice, notes that different people respond to marijuana in different ways, depending on their physiology, so consultation and follow-up with the referring doctor is key to ensuring that the patient achieves the best results possible.
“Each person is unique, and their response to any product needs to be carefully observed and customized,” Haas says. “What works for your friend may be wrong for you.”
Will medical marijuana makes me useless, dangerous, or illegal at work?
That’s a complicated question.
First, it’s important to note that medical marijuana is designed and intended to be used like a pharmaceutical drug—that is, responsibly and precisely, for a specific condition.
Second, different strains of marijuana have different effects on different people (see above). Some strains might make you sleepy, while others might actually serve as pick-me-ups. The best doctors will help you figure out what strain works best with your physiology and lifestyle.
Third, there are certain things, like driving a vehicle, that you should never do if you feel buzzed—whether the buzz comes from alcohol, prescription medication or medical marijuana.
Fourth, it’s possible to use medical marijuana and not get high, through a technique called microdosing. Muñoz explains in our sidebar, below.
Fifth, as Hogan points out, some employers, especially those with ties to the federal government, might not consider medical marijuana a legal drug—card or no card. He advises concerned patients to check with their HR department.
Speaking of illegal, how does that work?
Florida and federal law contradict each other and it’s a weird dynamic, for sure. The OMMU’s website states it pretty clearly (if not grammatically correctly): “Medical marijuana is available in Florida, however, remains illegal under federal law.”
The fact is, since last fall’s election, 30 states and Washington, D.C., have legalized medical marijuana to some extent, and the federal government has shown little appetite for fighting what appears to be a losing battle in the court of public opinion.
At the state level, especially in Florida, the general attitude seems to be “Proceed with caution.” That is, develop strict protocols and regulate heavily.
There are bugs to be worked out in Florida, but so far, so good.
How does CBD fit into the picture?
This has been a little confusing, because there are two types of CBD. The kind you saw at the gas station down the street (and lots of other places) is legal everywhere in the country. It’s derived from hemp, so it contains only trace amounts of THC (the compound in marijuana responsible for its psychotropic effects). It won’t make you high.
Hemp-derived CBD has been marketed as something of a miracle drug, and while some people have reported that they’ve experienced the sort of health benefits medical marijuana provides, there’s no record of evidence that it is a reliably effective medical treatment. It’s also important to note that hemp-derived CBD products aren’t regulated by the U.S. Food and Drug Administration.
“These products suffer the same problems as any other herbal medication,” Muñoz says. “You’re buying something that might be mislabeled, that’s not strictly regulated … we just advise a lot of care where you purchase your product, whatever that is, and be cautious with the research behind it.”
CBD products sold through dispensaries, on the other hand, are FDA regulated. They are derived from marijuana, so they contain higher levels of THC, but they still won’t make you high.
“I recommend CBD products that are derived from marijuana only,” Beams says. “This is the most reliable source of CBD that is a good alternative to prescription and over-the-counter anti-inflammatory medications. The conditions for which patients seek medical marijuana often involve chronic conditions that are significantly helped with CBD.”
Wait, you didn’t answer my question!
We tried to hit the high spots—see what we did there?—but this is a complex topic. The OMMU has an exhaustive Q&A on its webpage (under FloridaHealth.gov). There’s more great info at EmpoweringWellness.org, from the nonprofit that’s helped steer the national debate on the issue by advocating for smart medical marijuana policies.
More from your local Medical Marijuana Providers
East Hill Medical Group A Healthier Alternative
Dr. Kevin Hogan isn’t shy about expanding his practice to meet his patients’ needs. That’s how his chiropractic practice grew into a health and wellness “one-stop shop,” East Hill Medical Group.
He starts listing the practitioners who work there—nurse practitioners, medical doctor, pediatrician, massage therapists, electrologists, estheticians—and then trails off. “Oh my gosh, I have a lot of people in here doing a lot of different things.”
But his decision to offer medical marijuana was less about growing his practice than about finding a new way to do something it stopped doing years ago: pain management.
Traditional pain management involves the use of prescription drugs—typically opioids or other narcotics—to control chronic pain and give patients a better quality of life. The drugs generally work for the first goal, but not the second. In fact, it’s quite the opposite, Hogan says.
East Hill Medical Group once included a pain management specialist, but Hogan says he found it increasingly hard to make that referral.
“It was difficult seeing how patients’ health would deteriorate after they started taking all these different medications they were putting them on, even though it did help manage their pain,” he says. “So when medical marijuana became available here in Florida to a broader audience, that’s when I knew it was something I should offer.”
Now Hogan and referring physician Blake Sayre, M.D., are regularly thanked by patients grateful to be living comfortably without prescription medications.
“We get a lot of that,” Hogan says. “It’s made a huge difference in many people’s lives."
99 B, S. Alcaniz St., Pensacola, FL., 850-437-0035. EastHillMedicalGroup.com.
Empathic Practice A Holistic Approach
Empathic Practice takes a holistic approach to health, and to medical marijuana.
“We’re focused on wellness beyond medication,” says William Haas, M.D., owner and medical director. “We feel that mindfulness, not medication alone, is the right path for your journey to your best self.”
What that looks like in practice is thorough consultation and consistent follow-up, as well as mindfulness training—both to complement the marijuana’s effects and to empower patients to manage their pain, anxiety or other chronic problems with less reliance on marijuana (or any other substance).
Felipe Muñoz, mindfulness and meditation coach at Empathic Practice, says their medical marijuana referrals come with four guided group meditation sessions and a personal consultation to learn exercises for easing pain, stress and anxiety during the wait for state approval.
“Our patients have made the decision to take control of their wellness by any means possible. Mindfulness and medical marijuana is a potent combination for change,” Haas says.
Empathic Practice also places a strong focus on ensuring that the patient ends up with the right strain of medical marijuana. Different strains have different effects and therefore are better suited for certain conditions, Muñoz says, plus two people might react very differently to the same strain, depending on their physiology.
He says patients are offered genetic testing so they can avoid the expensive and time-consuming process of trial and error to find the best strain for them. They are also taught about microdosing—using small amounts of medical marijuana to get the health benefits without the buzz.
“We really think it’s good to go low and slow, because you don’t want to get high and crash,” Muñoz says. “This allows you to have a better experience overall.”
801 E. Cervantes St., Ste. C, Pensacola, FL. 850-777-3334. EmpathicPractice.us.
Releaf Medical Marijuana Clinics Promoting a Balanced Lifestyle
While Kent Beams, M.D., established Releaf Medical Marijuana Clinics for the sole purpose of helping qualifying Florida residents get their medical marijuana cards, he and his staff offer various treatments to address many medical and wellness issues.
“My practice philosophy has always been to help patients maximize their health and quality of life through natural supplementation of nutrients, hormones, dietary and lifestyle changes, and medical marijuana when needed,” Beams says. “For many people, medical marijuana is a component of several supplements necessary for a balanced lifestyle.”
At Releaf, patients are guided through the entire process of getting a medical card, he says. “We educate our new patients in how to begin the process of discovering their own best dosage relief of their symptoms. We are compliant with Florida laws and are committed to making sure patients understand and avoid confusion.”
Part of the education process is clearing up patients’ misconceptions about medical marijuana, he says. For example, most people using medical marijuana don’t gain weight or experience increased appetite, unless they’re underweight and normally have trouble eating enough.
He says many patients also don’t understand the qualifying conditions for medical marijuana, particularly PTSD, which can manifest itself in a variety of ways.
“If you have chronic pain, anxiety, depression or insomnia, you may be suffering symptoms of PTSD,” he says. “Please let us know, and we can refer you to a licensed professional who can provide a diagnosis.”
4300 Bayou Blvd., Ste. 27, Pensacola, FL., 850-361-2752. Releafmmc.com.