State plays catch-up as marijuana surges

Cultivation technicians Josh Masanow and Ofilia Rangel defoliate marijuana plants to prepare them for harvest at Liberty Health Sciences medical marijuana nursery in Alachua.

As Florida’s medical marijuana market hits new highs, the state’s still considering how best to regulate it. Three years after a law took effect broadly legalizing medical marijuana, and a surge in use, research remains limited and the state Legislature is working out possible kinks in the system. Nearly 300,000 Floridians currently have an active medical marijuana ID card. Only about 170,000 had them at the start of 2019. That growth has trickled into the tri-county area, where physicians ordered approximately 6,289 pounds of cannabis for patients from Oct. 1, 2018, through Sept. 30, 2019. During that period, 48 tri-county physicians issued 11,984 certifications for medical marijuana and low-THC cannabis, which has less tetrahydrocannabinol, the “high”-causing compound, according to a recent report by the Florida boards of medicine and osteopathic medicine.

A certification to receive medical marijuana is given for each condition, so one patient can have multiple certifications. Local patients predominantly sought treatment for chronic pain and post-traumatic stress disorder.

The tri-county area had only 3,675 certifications from Jan. 1 through Sept. 30, 2018.

Sumter County experienced the largest increase from 18 to 4,208 certifications.

Florida’s surge in use has outpaced research on health benefits, said Almut Winterstein, chair of Pharmaceutical Outcomes and Policy at the University of Florida College of Pharmacy and director of a statewide consortium studying health outcomes related to medical marijuana.

For most conditions, she said there is no solid evidence it has any effect.

“I personally find this more concerning than recreational use,” Winterstein said. “The reason why is this is a particularly vulnerable patient population.”

Marijuana is still federally illegal, which has limited research on its uses.

Most patients have shown improvement in research that has been conducted, but with lack of a control group, it could be the placebo effect, Winterstein said.

But there is evidence medical cannabis alleviates symptoms of pain and nausea, she added.

Dr. Bob Goethe, a Citrus County medical marijuana physician who treats patients from The Villages, said the medical community as a whole hasn’t embraced the potential of medical marijuana.

He said he has seen many patients improve. About half of his patients seek relief from chronic pain, said Goethe, who has offices in Summerfield and Crystal River.

“It helps the pain patients a lot because it enables them to get off their narcotics,” Goethe said.

Patient Use

Still, a stigma persists for some patients.

Baby boomers who once used it recreationally may be starting to use it again medicinally and could be leery about public perceptions, said JoVanna Eisenbarth, a nurse anesthetist who has presented on best practices for anesthesia providers to use with patients who use cannabis to the American Association of Nurse Anesthetists.

“I think some of them may still have some thoughts of hiding their usage,” Eisenbarth said, adding it’s important for patients to be open with their medical providers to ensure they get the best care.

The price of medical marijuana, which is not covered by insurance, remains a big concern, Goethe said.

Patients must spend $75 to apply for a medical marijuana identification card and additional hundreds to see a certified physician before they can get a certification. They have to return to that doctor every seven months to renew the recommendation, and some physicians take advantage of that, Goethe said.

“Patients complain about cost all of the time,” he said.

A set of bills that’s been filed in the upcoming legislative session aims to decrease those fees for one segment of the population.

Senate Bill 98 and House Bill 543 would prohibit the Florida Department of Health from charging a fee for the issuance, replacement or renewal of an identification card for service-disabled veterans.

Working out the kinks

Card fees are not the only medical marijuana issue under consideration. HB 149 would end the current model for license holders that limits license numbers and requires license holders to cultivate, distribute and sell the cannabis — a vertical integration system.

In July, Florida’s First District Court of Appeal upheld a ruling that the state’s vertical integration system conflicted with the constitutional amendment approved by voters in 2016. Gov. Ron DeSantis’ administration  appealed the decision.

It’s not the first time a lawsuit has claimed a regulation was unconstitutional.

Smokable medical cannabis was banned in the legislature’s original rules, but, after a court battle, began being dispensed last year.

And while edible forms were approved in those rules, companies are still awaiting guidelines from the state.

This delay is especially disappointing, Goethe said, because patients who are reluctant to start medical marijuana would be more willing to try it in edible form.

“When you get these older people who benefit so much from it, we need gummy bears and things like that,” he said.

As the legislature gets ready to discuss medical marijuana in the new session, which starts this month, regulations for another cannabis market recently came online.

Once a legal gray area, as of Jan. 1, the state is regulating CBD-based products.

CBD, or cannabidiol, is a non-euphoric compound that can be derived from hemp — cannabis plants with less than 0.3% THC.

Julian Timoner, leader of Naturally Get Rid of Pain, said hemp CBD helped him about four years ago after complications from surgery to repair a herniated disc.

The Village of Amelia resident said he is well-versed in alternatives to medication for relieving pain, such as acupuncture, massage and chiropractic.

Alternatives helped some, but he still had pain.

After researching, Timoner ordered CBD from an Arizona company.

“In four days all of the pain was gone,” he said.

Though he no longer uses CBD, he knows others do, and without oversight, companies can mislead consumers about their products’ CBD concentrations, he said.

So, Timoner said, regulating the industry is a good move.

Senior writer Ciara Varone can be reached at 352-753-1119, ext. 5395, or Information from News Service of Florida was used in this report.