2017-06-15 / Top News

Lawmakers OK medical marijuana program

BY EVAN WILLIAMS

On the Tuesday after Memorial Day, Dr. Barry Gordon stayed busy seeing patients who qualified or might qualify to use medical marijuana under Florida’s new program. A former ER doctor from Ohio, he and his wife, Patricia, and their business partner, Patrick DeLuca, opened the Compassionate Cannabis Clinic in Venice five months ago.

The practice is one of the first in Florida dedicated to ordering marijuana-based medicines for people with a variety of ailments defined by state law as “debilitating.” Business has boomed, says Mr. DeLuca, who as executive director runs the clinic’s business side, with about 650 qualifying patients so far.

Back in November, more than 71 percent of Florida voters approved Amendment 2 to the state’s constitution, paving the way for expansion of the use of medical marijuana in the Sunshine State. On June 9, the last day of the special legislative session, the House and Senate approved the bill, which now goes to Gov. Rick Scott for his signature. The legislation allows patients who suffer chronic pain related to 10 qualifying conditions to receive either low-THC cannabis or full-strength medical marijuana. THC is the compound that gives marijuana users a high.


Dr. Barry Gordon, chief physician, and his wife Patricia Gordon at their Compassionate Cannabis Clinic in Venice. 
EVAN WILLIAMS / FLORIDA WEEKLY Dr. Barry Gordon, chief physician, and his wife Patricia Gordon at their Compassionate Cannabis Clinic in Venice. EVAN WILLIAMS / FLORIDA WEEKLY It’s still not legal to smoke marijuana/ cannabis buds in Florida, even as a medicine. But any licensed physician who has taken the eight-hour course on cannabis required by the Florida Department of Health’s Office of Compassionate Use can prescribe — or technically, as a matter of legal semantics, “recommend” — marijuana medicines for their patients to ingest, including by vaporizing oil (vaping) and taking the medication orally such as in pill form. The Office of Compassionate Use is in charge of keeping a registry of all doctors and patients who use medical marijuana and making it available to law enforcement, among other duties, such as providing patients with Florida medical marijuana ID cards.

So far, more than 800 Florida physicians have taken the course required to recommend marijuana.

Like other advocates, Dr. Gordon of the Compassionate Cannabis Clinic in Venice calls marijuana an “exit drug” that can help patients get off sometimes dangerous opioid pain medications, not a “gateway” drug to harsher ones, as it has often been portrayed.

“Nobody is coming to see me to get high,” he says. “People are coming in to try to get well and feel better. It’s not to take more drugs, it’s to take less drugs.”

Dr. Dareld Morris, a long-time Fort Myers physician with a family practice and owner of Morris Medical Center, predicts that more physicians will take the state’s cannabis course after “the stigma calms down in the next few years” and people start to associate marijuana with medicine instead of with whatever experiences they’ve had with it or whatever they’ve heard about it in the past.

“Why would your doctor not want another tool in his toolbox?” Dr. Morris says. “That’s the simplest way to explain it … It’s not prescribed for everybody, nor is it going to help everybody.”

He has ordered marijuana meds for his patients primarily for multiple sclerosis, seizures and cancer.

One patient’s story

David C., a 65-year-old West Palm Beach resident and Vietnam War Army veteran who suffers from Parkinson’s disease and post-traumatic stress disorder, started using a no-TCH marijuana medicine in March to control his symptoms. David uses a vaporizer pen to inhale marijuana’s CBD compound (cannabidiol, which doctors and patients have found can relieve inflammation, pain and other symptoms without getting the user high). He calls the result “life changing.”

It controls his shaking due to Parkinson’s, has brought his daily level of pain down from an eight or nine out of 10 to a two or three, and allowed him to “cut way back” on his pharmaceutical medicine, Carbidopa, he says. “I used to take it every two hours to control (shaking). Now I take it when I wake up and that’s it.”

His cannabis medicine also helps with the PTSD that has dogged him since his experiences in battle when he was a teenager, now almost five decades ago.

“Those things stay with me, you don’t lose it,” he says. “I don’t want to say they’re totally gone, but they’re not there as much in the moment.”

His wife, Eileen, and their children and grandchildren have also noticed a positive change in David since he started using medical marijuana. “The whole family has noticed it seems when he’s here, he’s in the moment, he’s with us again,” she said.

In Florida, getting a marijuana recommendation requires you’re your doctor has determined you suffer from one of the qualifying ailments now listed in the state constitution: cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, “or other debilitating medical conditions … for which a physician believes that the medical use of marijuana would likely outweigh the potential health risks for a patient.”

It’s that last part, giving physicians discretion to decide if a patient has some other condition that marijuana would help, that could open the door for doctors to order the drug for a much broader range of ailments. Depending on the interpretation, that could also mean millions more dollars flowing through a burgeoning industry in the third most populous state in the country.

With the drug being relatively safe, Mr. DeLuca of the Compassionate Cannabis Clinic argues, “It’s very easy to make the case that the benefits outweigh the risk.”

He points out the well-known fact that marijuana overdoses are virtually unheard of, although it has also been known to be addictive, cause anxiety, short-term memory loss and have other side effects. Gold-standard “double blind, peer reviewed” research on cannabis has been stymied in the United States because of its federal status as illegal in any form. Even as states like Florida say it can be a medicine, cannabis is considered a Schedule I drug by the U.S. Drug Enforcement Administration that has “no currently accepted medical use.”

Mr. DeLuca believes that lawmakers ultimately will not keep doctors from ordering the drug for a wider range of conditions because of the money at stake.

“You tell me how they’re going to stuff the cat back in the bag,” he says. “It’s not going to happen. There’s too much money involved.”

A growing market

Arcview Market Research, often cited for its reports on the cannabis industry, estimates that 1.8 million Floridians use marijuana of some sort on a monthly basis, and that the medical cannabis market will grow to a $1.3 billion market by 2021 if doctors are granted more latitude to recommend the drug and other restrictions are loosened, including granting more licenses to companies to grow, process and sell cannabis meds. Now, only seven companies can do that.

As of the end of May, there were close to 15,600 patients in the state registry who have qualified for medical cannabis. The Department of Health projects that number could grow to 1.5 to 2.5 percent of the population, or up to about 250,000 people, under current guidelines. Others predict the numbers could be at least double that depending on factors such as the status of marijuana changing at the federal level, and how much discretion doctors have in interpreting whether the benefits of marijuana would outweigh “the potential health risks.”

“Cannabis is a marvelously wonderful drug for treating pain, anxiety, depression, inflammatory diseases, seizure disorders, muscle spasms and life-ending issues,” says Dr. Thomas Ashton, a surgeon and owner of Grassroots Holistic Centers in Palm Beach Gardens. He has about 100 patients who use medical cannabis, including veteran David in this story. Just as it has helped David cut back on prescription pills for his Parkinson’s and PTSD, Dr. Ashton believes it could help people get off opioid pain medications and addictions, which cause thousands of deaths every year in Florida and elsewhere.

“My most dependable evidence for this is my own clinical experience with my patients,” he says. “I treat terminal cancer patients with cannabis preparations according to the laws of the state of Florida. Many of those cancer patients are addicted to opioid medication because they’re in constant pain.”

With marijuana, those doses of opioid-based medications have been reduced 60 to 70 percent in six to eight months and even eliminated in some cases, he says.

One of the complications resulting from marijuana being illegal at the federal level is that insurance doesn’t cover any of it. In addition to the cost of the medication, for instance, David paid $250 for an initial doctor visit to qualify and still pays $150 for a required checkup to get refills every 45 days. Each time he gets a delivery of medication, that’s another $25.

Meanwhile, the number of patients who qualify for various types of medical cannabis continues to grow.

“I think there are going to be somewhere around 250,000-plus, maybe as many as 1 million people in five years in Florida that will qualify for some of these conditions,” says José Hidalgo, founder and CEO of Knox Medical, one of the seven companies so far that the state has licensed to grow, process and sell marijuana medicines. Mr. Knox has a nursery where the plants are harvested before the oil that contains different types of drugs such as THC and CBD is extracted.

“The raw concentrated oil is what gets ultimately put into various medicines that we offer,” Mr. Hidalgo says.

Because of its federal status, the safety and quality of cannabis medicines is regulated by state rules and not the FDA. But Knox Medical is acting and preparing as if the FDA will regulate it, as Mr. Hidalgo believes it ultimately will. “We certainly strive to be a pharmaceutical grade company,” he says, adding his projection that Knox could provide medicine for up to 75,000 patients.

While many South Florida cities and counties have temporarily banned medical marijuana dispensaries amid uncertainty as to how medical cannabis will be regulated in the state, doctors can still order the drugs and patients can either drive to a dispensary or have them delivered. In South Florida, there are dispensaries in Tampa and Miami. Knox Medical has dispensaries in Gainesville and Orlando with plans to open more in Tallahassee, Lake Worth, Jacksonville and St. Petersburg. ¦

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