October 2019 - Volume 16 - Issue 4 | Thursday October 17, 2019

Medical Marijuana Doctors Choose Optimism Despite Warning Signs

The medical marijuana / cannabis (MMJ) legalization process has begun in Florida with exaggerated hesitancy and over-regulation. Physicians are steering clear of MMJ altogether because, in addition to the plant’s controversial reputation, the steps necessary to prescribe it combined with legal complexity are simply not worth the hassle for most.

Florida passed the Compassionate Medical Cannabis Act in 2014, but more than two years later there are only two dispensaries with operational storefronts. Meanwhile the others growers, in spite of mammoth investments and startup costs, are still trudging through red tape to obtain licenses to process or dispense MMJ.
Patients have fared little better in terms of navigating the MMJ process. As a physician with my own Florida practice (Florida Marijuana Doctors, www.FMD.green) that focuses on conditions treatable with MMJ, I have yet to speak with a patient who has a clear understanding of the current MMJ laws. The whole process has proven confusing and has left many feeling betrayed and angered.
Patients are upset, for one, that there is a mandatory 90-day waiting period before they are eligible to obtain a ‘prescription’ for MMJ and placed on the FLDOH’s Compassionate Use Registry.
This 90-day wait is unique for patients seeking medical relief, and is inarguably cruel to a large percentage of the population that qualifies for MMJ treatment, none more so than the terminally ill. These patients have been diagnosed as having less than one year to live, and our legislators are making them wait a minimum of three months to receive what should be considered palliative care.
As a physician licensed to prescribe MMJ in Florida with considerable medical experience in California and other states, this is the most complicated and cumbersome medical process that I have ever encountered.
Involving myself at the forefront of the Florida MMJ circus has been intimidating and confusing. The simplest part of the process was becoming credentialed to ‘prescribe’ MMJ. While the course itself was informative and similar in content to other CME courses, after completing it in 2015, I was displeased to realize that the State still had not made MMJ available, and yet I would have to renew my credentials (and pay again) upon my next medical licensing cycle.
We physicians find it difficult to understand the new laws and their nuances, and how to apply them to actual patients. For instance, out of the four primary medical categories that qualify patients to use MMJ – terminally ill diagnosis, cancer symptoms, seizure disorders, and severe muscle spasms, the latter condition has the broadest interpretation. Chronic (and painful) spasms are difficult to separate from ‘chronic pain’, which is pointedly not a qualifying condition; neither is ‘chronic pain’ included in the proposed Amendment 2 that would broaden application of MMJ for patients and allow full potency MMJ to be used for a wider range of medical conditions. Currently, only terminally ill patients qualify for full potency MMJ.
While the Florida Office of Compassionate Use has provided a physician liaison, I have sent questions through email and have either received no answer or confusing legal jargon that carefully avoids answering the actual questions and fails to offer concrete directives.
Physicians are already bogged down by today’s medical bureaucracy. Adding additional patient disclosures, documentation, and reporting requirements to prescribe MMJ only multiplies the inefficiency of the system. All of this in addition to shouldering the onus for interpretation and application of the law has produced an MMJ environment where physicians choose not to participate for fear of making a costly misstep.
Since few physicians feel comfortable prescribing MMJ, even in states with much more liberal laws, why would we bother prescribing medical marijuana in Florida?
The answer is clear: MMJ has legitimate medicinal qualities, and the response from patients has been overwhelmingly positive and gracious. Patient narratives of enduring chronic illnesses and painful conditions are compelling and real, and their sheer gratitude for being given the opportunity to try MMJ as an approved medication is our catalyst to stick to our ideals, however challenging.
As the topic of MMJ continues to become more prevalent, physicians should recognize that many of their patients feel very strongly about the right to use marijuana as medicine. Thus, medical practitioners should either consider becoming a licensed prescriber themselves, or they should refer patients to a doctor who is licensed to prescribe MMJ and has the knowledge and background to effectively oversee this treatment option.
While Florida’s MMJ “r”evolution has thus far left patients, growers, investors, and physicians feeling frustrated, mistreated, and abandoned by Florida legislators, we reflect on the relative progress we have achieved, and continue to forge ahead with great hope and optimism. And with marijuana’s excellent safety profile and proven efficacy in treating a wide array of serious medical conditions, physicians, even if not prescribing MMJ themselves, should be supportive of their patients who wish to use MMJ and should keep an open mind about its use as a viable medical option.

Dr. Justin C.K. Davis or ‘Doc Davis’, is a native Floridian, a pioneer in integrative and alternative medicine delivery, and a longtime advocate of patient rights in the use of Medical Marijuana. His former boutique practice, The House Doctor (www.TheHouseDoctor.com), specialized in housecalls in the greater San Francisco bay area before he moved back to Florida to be closer to family. His new practice, Florida Marijuana Doctors (www.FMD.green) is Florida's first holistic medicine practice that specializes in conditions that can be successfully treated with marijuana / cannabis. He can be reached directly at DrDavis@FMD.green and is always happy to answer both physician and patient questions about MMJ.

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