As medical marijuana becomes available to more patients in the state of Florida, many questions arise. Below, we've put together answers to some commonly asked questions.
Low-THC cannabis means a plant of the genus Cannabis, the dried flowers of which contain 0.8 percent or less of tetrahydrocannabinol and more than 10 percent of cannabidiol weight for weight; the seeds thereof; the resin extracted from any part of such plant; or any compound, manufacture, salt, derivative, mixture, or preparation of such plant or its seeds or resin that is dispensed only from a dispensing organization. Low-THC cannabis contains very low amounts of the psychoactive compound THC, and typically does not result in the "high" often associated with medical cannabis.
Medical cannabis means all parts of any plant of the genus Cannabis, whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, sale, derivative, mixture, or preparation of the plant or its seeds or resin that is dispensed only from a dispensing organization for medical use by an eligible patient as defined in s. 499.0295. Medical cannabis contains significant levels of the cannabinoid THC, and can result in the euphoric "high" sensation.
Patients suffering from cancer or a physical medical condition that chronically produces symptoms of seizures or severe and persistent muscle spasms may be eligible for non-euphoric, low-THC cannabis.
Beginning January 3, 2017, patients suffering from the following conditions will be eligible to receive recommendations for medical marijuana:
Medical cannabis has numerous applications for neurological, muscular and chronic debilitating conditions as well as cancer. The plant produces several substances that are present in the products consumed for medical conditions. THC is what causes the "high" and binds to receptors in certain areas of the brain. We recommend products that may or may not cause this "high" based upon the issue we are treating. Terpenes are also present and we are unsure of their medical benefit, but we know they need to be available in order to achieve the best results. The medical "magic" comes from the cannabinoids the plant produces.
A qualified physician may only order medical cannabis for a patient with a terminal condition that is attested to by the patient’s physician and confirmed by a second independent evaluation by a board-certified physician in an appropriate specialty for that condition. Patient is defined in section 499.0295, Florida Statutes.
Florida law defines a terminal condition as a “progressive disease or medical or surgical condition that causes significant functional impairment, is not considered by a treating physician to be reversible even with the administration of available treatment options currently approved by the United States Food and Drug Administration, and, without the administration of life-sustaining procedures, will result in death within one year after diagnosis if the condition runs its normal course.”
Florida state law has several requirements for patients to be eligible to receive low-THC cannabis or medical cannabis.
Before discussing how cannabinoids work, first we must understand the endocannabinoid system. Each person produces their own cannabinoids, we know of 2 and suspect there are 4. The cannabinoid anandimide is widely present in the central nervous system and the other cannabinoid 2AG is in the body. There is belief that the depletion of these cannabinoids is associated with some disease process. When consuming the plant’s cannabinoids, it prevents the enzyme FAAH from breaking down the cannabinoids produced in your body, effectively elevating the anandimide and 2AG levels. In the endocannabinoid system humans have more receptors for cannabinoids in the brain than any other neurotransmitter, more than dopamine, serotonin, epinephrine, etc. When cannabinoids bind to the receptors, it has a very unique reaction. If it needs to excite it does and if it needs to relax it does, no other neurotransmitter can make this claim. This is how it works on neurologic and muscular conditions. It also has receptors on pain pathways and this is why it is effective with chronic pain. There are no receptors for cannabinoids in the breathing center of the brain and this is why it’s impossible to overdose on cannabis (unlike opioids which kill 49 people in the US every day).
As far as cancer is concerned, cancer cells also have receptors for cannabinoids. When bound to these receptors it does three different things. First it turns on the cell’s genes to kill the cancer, this is called apoptosis, so the cancer cell commits suicide. Second it decreases the development of blood vessels to the cancer cells, effectively cutting of the nutrient supply to cancer cells. Third it decreases the likelihood of metastasis (spread) of the cancer.
Yes. A physician may only order low-THC cannabis or medical cannabis if he or she holds an active, unrestricted license as a physician under Chapter 458, Florida Statutes or an osteopathic physician under Chapter 459, Florida Statutes.
Additionally, a qualifying physician must have successfully completed an 8-hour continuing education course and examination. Renewal of the 8-hour course and subsequent examination is required each time the physician renews his or her medical license.
A medical director must hold an active, unrestricted license as a physician under Chapter 458, Florida Statutes or as an osteopathic physician under Chapter 459, Florida Statutes. They must also complete a 2-hour continuing education course and examination.
Florida currently has six authorized dispensing organizations: CHT Medical (Chestnut Hill Tree Farm), The Green Solution (San Felasco Nurseries), Trulieve (Hackney Nursery), Surterra Therapeutics (Alpha Foliage, Inc.), Modern Health Concepts (Costa Nursery Farms), and Knox Medical (Knox Nursery)
A qualified patient must first seek treatment from a qualified physician for at least three months immediately preceding their order for low-THC or medical cannabis. Once the ordering physician inputs the patient’s information and the order information into the Compassionate Use Patient Registry, the patient or the patient’s legal representative will then be able to contact one of the six licensed dispensing organizations and fill the order.
Dispensing organizations may only provide low-THC cannabis, medical cannabis or a cannabis delivery device to a qualified patient or a qualified patient’s legal representative.
A legal representative is a qualified patient's parent, legal guardian acting pursuant to a court's authorization as required under section 744.3215(4), Florida Statutes health care surrogate acting pursuant to the qualified patient's written consent or a court's authorization as required under section 765.113, Florida Statutes or an individual who is authorized under a power of attorney to make healthcare decisions on behalf of the qualified patient.
No. Physicians may only order low-THC cannabis or medical cannabis for patients diagnosed with one of the qualifying conditions outlined in FAQs 3 and 4.
Qualifying physicians can order no more than a 45-day supply and a cannabis delivery device needed by the patient for the medical use of low-THC cannabis or medical cannabis.
Yes. Low-THC cannabis and medical cannabis must be processed within an enclosed structure away from other plants and products. Dispensing organizations are required to test the processed low-THC cannabis and medical cannabis before they are dispensed. The results must be verified and signed by two employees of the dispensary. The dispensing organization must reserve two processed samples from each batch and retain them for at least nine months.
Cannabis test results must indicate that low-THC cannabis meets the definition of low-THC cannabis and that all medical and low-THC cannabis is safe for human consumption and free from contaminants.
The dispensing organization must also contract with an independent testing laboratory to perform audits on the dispensing organization’s standard operating procedures, testing records and samples.
Packaging of low-THC and medical cannabis should be in compliance with the United States Poison Prevention Packaging Act of 1970 (15 U.S.C. ss. 1471 et seq.) They should be packaged in a receptacle that has a firmly affixed and legible label with the following information: