The Salt Life: Medical Marijuana in Florida (Part III: Blame the Feds for a Lack of Access) by Sasha

Here is a riddle:  How can some states legalize marijuana (for medical and/or recreational use) when the national government has declared marijuana an illegal drug?

The answer:  Federalism. (Thank James Madison for this one.)scaletowidth

Although the U.S. Constitution recognizes that the states retain “police powers” over the health, safety, and welfare of their citizens, Article I of the document gives Congress power over interstate commerce (a power that has been very broadly defined in subsequent U.S. Supreme Court cases.) The result is a grey area of shared powers with the result that the federal government can attempt to trump (no pun intended) the efforts of the states to decriminalize marijuana.

Under the federal Controlled Substances Act, the Drug Enforcement Administration is authorized to classify drugs. The DEA does so using a system of classification called schedules. Schedule I drugs are viewed as having the most potential for abuse while Schedule V the least.

Marijuana, along with heroin, LSD, and ecstacy are Schedule I drugs, defined as drugs with no currently accepted medical use and a high potential of abuse.

In contrast, Schedules II through Schedule V drugs are recognized as having medicinal purposes.

But take a look at this:  oxycodone, fentanyl, and cocaine are categorized as less dangerous Schedule II drugs. And FYI, Schedule III drugs include anabolic steroids, codeine, and testosterone; Schedule IV drugs include Ambien, Ativan, Valium, and Xanax; and Schedule V drugs include antidiarrheal, anitussive, and analgesic drugs.

If this classification system makes sense to you, I want what you’re smoking. As it stands, the federal government maintains that marijuana is akin to heroin, and because marijuana is more likely to be abused than opioids, fentanyl, and anabolic steroids, it is more dangerous than those drugs. I beg to differ since the death tolls, addictions, and physical harms from these Schedule II and III drugs argue otherwise.

Federalism-Marijuana

The implications from being categorized as a Schedule I drug are many:

  • It makes “medical marijuana” an oxymoron because the federal government states that marijuana has no medical use.
  • This makes it very difficult for researchers to study the medical effects of cannabis because it is so strictly regulated.
  • Evidence of the curative powers or symptom relieving powers of medical marijuana are therefore mostly anecdotal: patients say it helps. But for this to be recognized by the DEA, scientific studies must prove this—and this is not allowed for Schedule I drugs (a Catch-22).
  • This means that although some states have legalized the growth, distribution, and use of cannabis, these actions are still illegal under federal law.
  • Given this, physicians, clinics, and distributors may be understandably uneasy about becoming involved with medical marijuana.
  • Because of its illegal designation on the national level, cannabis businesses are hampered: the US Postal Service cannot ship this drug, national banks will not authorize accounts or credit cards to be used for these drugs, and health care insurance companies will not cover this drug.

So why isn’t the federal government enforcing its ban on marijuana by raiding those who are breaking federal law?

Each year since 2014, Congress has renewed the Rohrabacher-Blumenauer Amendment that disallows the U.S. Drug Enforcement Agency from using federal dollars to prosecute marijuana businesses operating in states that have legalized them. But this is a precarious protection that Congress has to renew each year.  Attorney General Jeff Sessions has asked Congress not to renew the Amendment this year so that he can enforce federal law. (So much for the Republican Party’s love of states rights.)

Therefore, as much as Florida seems reluctant to enact a process that respects the mandate from the passage of Amendment 2 legalizing medical marijuana, the real problem is the DEA and the classification of cannabis as a Schedule I drug. States like Florida may attempt to chip away at the federal law criminalizing marijuana, but it will take actions on the federal level to truly give patients access to medical cannabis.

cannabis_research_imageWhat is needed are studies to explore the medical purposes of marijuana, and to make this possible, marijuana should be recategorized as a Schedule II or Schedule III drug.

And there may be another way. Senator Orrin Hatch (R-UT) has introduced the MEDS (Marijuana Effective Drug Study) Act of 2017 that would allow more medical marijuana research to be conducted.

It’s high time. (Sorry about the pun.)

 

The Salt Life: Medical Marijuana in Florida (Part II: Smoke and Mirrors) by Sasha

Florida-1In Part I of this three part series, I outlined the process that a patient must follow to legally obtain medical marijuana. Here in Part II, I trace some of the absurdities and hypocrisies associated with this process. There are so many that a forthcoming Part III will be necessary.

So here are some follow-up questions regarding the process. I’ve tried to give a straight answer and then continue with my own snarky analysis.

What forms of medical marijuana can be dispensed?  Vape pens, dissolvable capsules, tinctures, and gels.

No smoke?!? No toke?!? No joke. Under Senate Bill 8A, a physician cannot recommend buds, joints, or any form of marijuana that can be smoked. John Morgan, of the law firm Morgan & Morgan and Chair of People United for Medical Marijuana, has filed a lawsuit challenging what he sees as the state’s undermining of Amendment’s 2 intent which was to allow physicians to decide which form of cannabis to recommend while also allowing a prohibition against smoking in public. I think he’s right and hope he wins.

Why can’t my own physician recommend medical marijuana for my treatment?  It’s by his or her choice.  To become state licensed, a physician needs only to hold a license from any medical discipline (e.g. a podiatrist), AND take a two hour online course that currently costs $250. That’s it.

I admit that I haven’t viewed the two hour online course, but this sure seems like a very low bar to meet in order to qualify. So why don’t more physicians who regularly treat people who suffer from the “qualifying conditions” have the state certification to recommend medical marijuana? I can think of several reasons. First, marijuana whether clinical or not still holds a stigma within our culture and physicians don’t want to be associated with it. Second, most physicians treating patients who have one of the “qualifying conditions” rely on traditional (and not coincidentally profit-enhancing) treatments like surgery, physical therapy, or prescription drugs recommended by Big Pharma. Third, physicians often claim that there is insufficient scientific evidence (as opposed to anecdotal evidence) of the curative effects of clinical marijuana–a claim that should be taken seriously except that the federal government has greatly curtailed such studies (and why will be discussed in Part III).

The result is that patients must attempt to find a recommending doctor on their own. From the people I’ve spoken with, this is daunting and can be downright frightening. Some physicians will not book an appointment until their consulting fee (ranging from $250-1,000) is paid either in half or in full. Some travel throughout the state and hold their consulting appointments in hotel rooms or other rented spaces. People are fearful that they are being ripped off or lured to a place where they will be endangered. Yet many go. It tells you something about the desperation and the uncomfortable position that the state regulations have placed them in.

Why are there so few medical marijuana dispensaries?  Florida has chosen to limit the number to 12.

But Florida has also chosen to treat dispensaries differently than other businesses that provide meds. So I’d like to question why providers of medical marijuana are called “dispensaries” and not “pharmacies.” Distinguished by different names, they can now be subjected to regulations that limit their number, limit their locations (heavens, not by a school!!!), and limit their suppliers (to those in the state). Imagine the same regulations applied to CVS, Walgreens, Publix, and every other pharmacy that prescribes opioids. It makes you question whether  lawmakers really believe that marijuana can be medicinal.

shutterstock_431649292Why all the hurdles for patients to jump? Florida has placed the obstacles in order to safeguard that medical marijuana is not abused, e.g., by making it available to those without medical needs approved by the state.

But to me this is disingenuous. These obstacles reach beyond that goal and this is by design, not accident. I think they are inspired by lawmakers’ rejection of what the people of Florida decided–that medical marijuana should be available to suffering patients.

As I pointed out in Part I, I would have an easier time legally obtaining a gun or oxycodine than I would legally obtaining medical marijuana. If I wanted a gun, I could buy one at a gun show and take it home today. If I needed a prescription for excruciating pain, I’m pretty certain I could have the meds within five days. But if I need medical marijuana to ease my pain or symptoms, it will take months to get it. I’ve first got to find a new qualifying physician and then wait for an appointment for the consult (and some people wait for weeks); then I need to apply for my FL medical marijuana card (that now takes the state 4-6 weeks to issue); then I have to find one of the few operating dispensaries and drive to it or wait until they can deliver my clinical marijuana.

Those patients who are willing to conquer the hurdles and wait to legally obtain clinical marijuana must ask themselves whether it would be more cost effective and time efficient to go to an illegal dealer instead. So the hurdles put in place by the state might in fact work to undermine the objective of giving patients access to LEGAL medical marijuana.

Why can’t I use a charge card to pay for clinical marijuana and its associated costs and why won’t insurance companies cover it? Because under federal law, medical marijuana is illegal.

Stay tuned for Part III as I explain this contradiction in law.

The Salt Life: Medical Marijuana in Florida. [Part I: How to Get It] (by Sasha)

Georgia-Medical-Marijuana

That it is easier in Florida to legally obtain a gun (even in the aftermath of mass shootings) or to obtain opioids (in the midst of an overdose epidemic) than it is to obtain medical marijuana speaks volumes.

In 2016, with “yes” votes totaling 71%, the citizens of Florida approved Amendment 2, the Florida Medical Marijuana Legalization Initiative. However, this overwhelming public support has not translated into the political will or the practical structure to follow this mandate. The result of this political intransigence is that although the law took effect in January 2017, medical marijuana is not readily accessible in Florida. The failure of politicians to abide by the will of the people is one major obstacle, but another is that there is a great deal of confusion about how to legally obtain medical marijuana.

In this blog entry (Part I), I’m going to explain the process. In upcoming entries (Parts II and III), I’ll highlight and analyze some of the quirks about Florida law regarding medical marijuana. Part I is intended to be instructive; Parts II and III may make you laugh or cry–but you will certainly groan.

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Brad Weinstock and Dr. Dan Stein at Fogartyville

My source for the details of the process is the presentation, “Medical Marijuana Q and A,” held at Fogartyville on Tuesday night (October 19). Dr. Dan Stein and Mr. Brad Weinstock of Neurology of Cannabis took questions from an audience of around 50 people about how patients can legally obtain medical marijuana. Neurology of Cannabis is a medical marijuana recommendation clinic that opened at 5602 Marquesas Circle, Sarasota, FL 34233. (941-600-9055)

So here is the process:

  1. Florida Residency.  In order to obtain a card that authorizes you to obtain medical marijuana, you must have proof that you are a resident of Florida (e.g., a passport, tax bill, driver’s license, etc.)
  2. “Qualifying Condition.” Patients must have a “qualifying condition” as recognized under Amendment 2 and the legislation that put it into effect. (These conditions are detailed below.)
  3. Physician Recommendation. Patients must meet with a physician who has been certified by Florida to “recommend,” rather than technically to “prescribe,” the use of medical marijuana. This recommendation is filed online with the Florida Department of Health. The physician charges for this consultation meeting and most require payment in cash. No insurance companies cover this cost. [My own observation is that prices range from $250 to $1000.]
  4. Medical Marijuana Card. The patient needs to apply for the medical marijuana card and pays the Florida Department of Health $75 for this application. In some cases, the recommending physician or clinic will help the patient apply. It takes 4 to 6 weeks for the State to issue the card although under the law it should be issued in 30 days.
  5. Dispensary. Once the patient has received the Medical Marijuana photo ID card, a 70-day supply of the recommended medical marijuana can be obtained but only through a state licensed grower at one of their dispensaries. Costs vary, but again, cash is usually required and there is no insurance coverage. Currently, Florida law allows for only 12 growers and so far ten have received state licenses. The location of dispensaries is a political football limited by city and county zoning laws. Currently, there is no dispensary in Sarasota. Some dispensaries will deliver the marijuana directly to the patient.
  6. Follow-Up. The recommending physician has to file an updated treatment plan for the patient every 70 days (roughly 5 times a year.) Dosages can be adjusted at this time. There is no state requirement for an in-person consultation until 210 days from the initial consultation with the physician. Again, there are differences among recommending physicians whether patients will be charged for each updated treatment plan filed or for the 210 day in-person consult.

So that in a nutshell is the process…easy right?  Hardly.howtoescapea

I’m sure you have a lot of remaining questions including: How to find a recommending physician? Why won’t your physician do this? How to find a dispensary? What forms of marijuana can be dispensed?  Why is cash required and why won’t insurance companies help with the costs? Why does the federal government still maintain this is illegal?

I’ll try to answer these and more in Parts II and III.

Meanwhile, here is the answer to one of the biggest questions: What is a “qualifying condition?” This information comes from the handout and comments provided by Neurology of Cannabis, and from some of the regulations and legislation that put Amendment 2 into effect. Qualifying conditions:

  • Cancer, Epilepsy, Glaucoma, HIV/AIDS, PTSD, ALA, Crohn’s disease, Parkinson’s disease, Multiple Sclerosis, myelopathy, spasticity.
  • Medical conditions of the same kind or class as or comparable to those above. [Note: This is more open to interpretation and could include conditions such as neuralgia, anxiety, insomnia, myospasm, movement disorders and colitis.]
  • A terminal condition diagnosed by a physician other than the qualifying physician who issues the recommendation.
  • Chronic nonmalignant pain caused by a qualifying medical condition or that originates from a qualifying medical condition and persists beyond the usual course of that qualifying condition. (Huh?)
  • Another possibility to consider: Endocannobinoid Deficiency Syndrome (i.e., conditions like migraines, irritable bowel, inflammation, and fibromyalgia that may be caused by cannobinoid deficiency, and therefore can be alleviated by clinical cannabis.)

medical-marijuana-san-diego-logoAnd here is a very intriguing gap in the law: there is no requirement that the patient provide the recommending physician with medical documents. You read that right. The recommendation can be based on what the patient tells the doctor during the consult, although the physician has the discretion to ask for more.

Next blog:  Medical Marijuana Part II: Smoke and Mirrors. Stay tuned and please feel free to repost.