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.)
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.
The implications from being categorized as a Schedule I drug are many:
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.
What 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.)
In 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.
Why 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.
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.
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:
So that in a nutshell is the process…easy right? Hardly.
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:
And 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.
A strange thing happened on the way to the series of attempts to repeal and replace the Republican-hated policy known as “Obamacare.” Fundamental attitudes about health care began to change–and in an unanticipated direction.
The Affordable Care Act (aka “Obamacare”) has been an excellent example of how perceptual screens affect attitudes. Polling indicated that when people were asked about the policy called “Obamacare” it received less support than if it was called the “Affordable Care Act.” But even more, polling reveals that partisanship functions as a perceptual screen when making such judgments—Democrats support Obamacare/the ACA more than do Republicans. This was true when it was first passed and remains somewhat true today—but oddly enough, some attitudes on health care have shifted to bring Democrats and Republicans closer to each other. (Could we have the beginnings of an emerging bipartisan consensus?)
The latest polling indicates that a substantial majority of Americans (over 60%) now believe that health care is a right rather than a privilege. (Substantially less than a majority had this belief as recently as 2014). And while there is still a modest partisan divide, lower income Republicans now agree with Democrats of all income levels that health care is a right. The strongest support for the view that health care is a privilege and government should not play a role is isolated among relatively well-to-do Republicans.
Ironically, the catalyst that has produced this change has been the controversy that has been sparked by the various aborted attempts in Congress to repeal Obamacare. Republicans, hoping to kill the Affordable Care Act have instead helped build support for not just the ACA, but for even greater government involvement in health care.
Specific provisions that arose during the debate also helped to solidify public opinion and narrow the partisan divide on the issue. Now, an over-whelming majority of Americans (over 70%) want health care to be guaranteed to people with pre-existing conditions. Further, even a substantial number of Republicans (66%) want insurance policies to provide a minimum package of benefits and a vast majority of Americans of all political persuasions want coverage to extend to children up to age 26 (on their parents’ plan). These are significant changes in attitudes from just a few years ago.
Sociologist Robert Merton first identified the “law of unintended consequences” in 1936 when examining decisions policy-makers make in complex social systems. While he identified a number of reasons for this phenomenon (including stupidity and relying upon short-term interests over long-term interests) he also noted that it was difficult to effectively adopt policies which went against the grain of fundamental underlying values and beliefs. That may now be the dilemma the Republicans face when they try—yet again as they no doubt will—to repeal and replace Obamacare. If Republicans in Congress continue to pursue health care reform in a partisan fashion they may find that their constituents, both Republicans and Democrats, may rebel.
As a political scientist, I view the controversy over the NFL players kneeling during the national anthem as grounded in two related questions:
1) How did football (and just about every other sport) become a forum for displays of patriotism?
2) Why is the kneeling of a player during the playing of the national anthem viewed as an insult to veterans in particular?
So, in answer to #1, there is really no good reason why sports have been aligned with militarism. Some have theorized that joining the two connects nationalism with aggression; or winning with patriotism. “We (meaning the US) are Number 1!” But the history of this conjoining of (male) sports teams with national patriotism has its origins in WWI and this grew stronger during WWII. During the fighting of the world war, it was viewed as unseemly that while other men engaged in international warfare to save the country and indeed the world, professional athletic males in the United States were playing their sports rather than engaging in true warfare. Sporting events were also an opportunity to mobilize much needed public support. Thus, patriotic moments were injected into the games: the playing of the national anthem or patriotic songs, the presence of the American flag, flybys or honor guards by the military, and the recognition of war veterans. But this association continued far beyond the world war years. It is now seen as part and parcel of what it means to be engaged in athletic competition. As a result, displays of patriotism infuses football, baseball, soccer, hockey, and so on.
But think about it…this is a social construct that survived its time. This was a nationalistic practice that originated as a way of defending why able-bodied males should continue to play competitive (and lucrative) games during a time of war. The national symbolism has continued throughout the decades although it is now disconnected from the original purpose it served.
In answer to #2, I can understand that some people may be offended by NFL players who kneel in protest during the national anthem. But why is this form of symbolic speech interpreted as an insult to veterans in particular?
This protest began last football season (2016) by Colin Kaepernick. Because it was a silent form of protest, in later interviews he had to articulate the meaning in words. His explanation was that the physical gesture was a sign of protest about the troubling incidences of black men shot by police officers who were not punished by the legal system. Kneeling was chosen a “respectful,” peaceful, and silent protest about racial inequality in the country.
So how exactly does this implicate veterans?
It doesn’t. The protest is an indictment of the American legal system, law enforcement system, and systemic racism within the culture. But it is not in any way aimed at those who have served in the military.
Why? Because the flag, the national anthem, the Constitution, and patriotism at large does not belong to veterans exclusively. Yes, the nation should thank veterans for their service and should provide them in turn with respect and concrete resources to integrate them back to civilian lives (e.g., imagine a VA that is efficient and responsive and generous). However, criticisms about the nation, no matter how cutting, are not aimed at veterans. They are directed at society at large. Although symbolic speech, these actions invite reflection and conversation. Are they pointed and sometimes painful critiques? Yes, they are. But does kneeling constitute treason or an attack on veterans in particular; I’d say not. Political protest is and should be a protected right. That is necessary in any society that aspires to be democratic. Dissent should be met with conversation, not misdefined or misaligned as attacks on veterans or unpatriotic expressions in need of punishment.
It is a bit ironic that this sensitivity to the feelings of veterans as the victims of the NFL protests is taking place during a time when conservative commentators have been unforgiving in their criticisms of college and university policies designed to protect student “snowflakes” from upsetting speech, topics, or situations. Veterans, who have been redefined in recent years as heroes, are now being constructed as victims in need of protection from kneeling athletes. And so, in the words of Pres. Trump, a protesting athlete is a “son of bitch” who should be fired.
Some might say that political protests are unwarranted given the time and place consideration that these occur during sports contests, not political events. But, as I wrote earlier, the infusion of symbols of patriotism during athletic competitions is an odd coupling to begin with. If patriotic displays are embraced during games, one can expect, and one is expected to tolerate, differing views in response.
While humans scanned the skies for the path of Irma
I weathered my own crisis here on terra firma.
A whirling dervish who bites, chews, and pees
His name is Koda, a little Cuban Havanese.
A mini me, but don’t assume I’m his mother
My humans informed me: he’s my new “brother.”
I thought at first he was a storm victim, a guest,
But he’s here to stay, the shark-like pest.
He hangs from my tail, and eats from my bowl,
Over elimination, he has no control.
He squeals like a pig when he’s left alone
And smells like urine eau de cologne.
But he’s willing to play and likes tug-of-war
My place is the sofa, he likes the floor.
And the boy’s got style when he copies me.
So he’s my Wingman, Dawg, BFF, Homie.
But wait…what is this fresh hell?
Says his name’s Sir Charles of Taywater Dell!
Not another young pup to guide all lifelong!
Whew! Not ours, but belongs to Cat Armstrong.