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Updates

February 19, 2018
Attention all Medical Cannabis Physicians:
Please contact Executive Director Ron Watson with your questions and/or concerns regarding the registry. Ron will soon be meeting with the  Department of Health’s Office of Medical Marijuana Use  (OMMU) leadership to share FLSCP member ideas for improvement in the present registry. If you are not a member, please join now so your input will be heard by the OMMU!
The newest numbers from the OMMU show that over 100 new physicians were qualified to make patient certifications within the week of Feb. 9-16! The new physician total is 1146.
Other new numbers include:

 

  • Patients in the Registry: 78,929*
  • Patients added since last update: 2,411
  • Approved ID Card Applications: 52,619*
  • Card applications approved since last update: 1,569
  • Applications in Processing: 3,000
  • Amount of Medical Marijuana Dispensed This Week (Feb. 12-16): 9,765,782 mgs
  • Amount of Low-THC Cannabis Dispensed This Week (Feb. 12-16): 668,076 mgs
*Note, not all patients entered into the medical marijuana use registry apply for medical marijuana use identification cards.
The OMMU has made changes to the Medical Marijuana Use Registry that eliminate the need for patients to submit a passport-style photograph if they have a Florida issued driver’s license or identification card. Instead, when a qualified ordering physician enters a patient into the registry it automatically accesses the patient’s Florida Driver’s License or Florida identification card photograph directly from the Department of Highway Safety and Motor Vehicles (HSMV) system. Their photo is then populated in the patient’s online identification card application. Passport-style photographs will still need to be submitted for those applicants who are not in the HSMV system.
December 18, 2017
The Florida Department of Health, Office of Medical Marijuana Use, is now releasing weekly updates. The December 15 report can be found here. Some of the highlights include:
  • Just under 61,000 patients entered into the registry
  • Just under 1300 qualified physicians
  • 4200 patient applications being processed
  • New physician location tool on DOH website (found here)
  • Patient ID card program outsourced to Veritic
  • DOH creates new site specifically for qualifying physicians (found here)

December 8, 2017

 

The Florida Department of Health (DOH) Office of Medical Marijuana Use (OMMU) is now releasing a weekly update. Click HERE for the most recent update.

 

The latest report highlights a new web site
specifically for qualified physicians that can be found HERE.
This web page includes a direct link to the required two hour CE course that all qualified physicians must take. As a reminder, any physician who took the original eight hour course under the old law must take the new course within 90 days of it becoming available. The deadline is December 26; please make sure you have completed the new course by the day after Christmas.
December 1, 2017
FLSCP Testifies
On behalf of the FLSCP, Executive Director Ron Watson testified before the Boards of Medicine and Osteopathic Medicine’s Joint Committee on Medical Marijuana and the Physician Certification Pattern Review Panel in Orlando on Thursday Nov. 30th. Mr. Watson explained the mission of the FLSCP and encouraged board members to utilize the Society as a resource moving forward.  Additionally, he asked several questions and a detailed report will soon be available to FLSCP members on our website.

 

December 26 is the Deadline to take the new CE course
The Florida Legislature, in SB 8A, required all certifying physicians who took the former 8 hour CE course to take the new 2 hour course within 90 days of it being available to continue to certify new patients. December 26 is the end of that 90 day period. As a reminder, the new course costs $250 and can be found here. (Don’t shoot the messenger!)

Department of Health OMMU on House Committee Agenda again
Christian Bax, the Director of the Office of Medical Marijuana Use, is set to testify before the House Health Quality Subcommittee for a third time on Wednesday, Dec. 6 from 8:00 am – 10:30 am ET.
Please consider becoming a member of the FLSCP , so we can continue advocating on your behalf.
November 21, 2017
Post-Committee Meeting Updates
The Florida Legislature held another round of committee meetings last week. Mr. Christian Bax, the Director of the Office of Medical Marijuana, gave another update to the House Health Quality Subcommittee on the status of SB 8A implementation on Wednesday, Nov. 15.  Mr. Bax begins his presentation at 27:30-ish on the time bar.  His presentation materials can be found here.

The Boards of Medicine and Osteopathic Medicine’s Joint Committee on Medical Marijuana announces a public meeting to which all persons are invited.
DATE AND TIME:

Thursday, November 30, 2017, beginning at 1:00 PM or soon thereafter. PLACE: Rosen Plaza Hotel, 9700 International Drive, Orlando, Florida 32819. The hotel phone # (407) 996-9700.

GENERAL SUBJECT MATTER TO BE CONSIDERED:
General business of the Committee. T Committee meetings may be cancelled prior to the meeting date. Please check the Board Web Site at www.FLBoardofMedicine.govfor cancellations or changes to meeting dates or call the Board of Medicine at (850) 245-4131 for information. The hotel’s public block deadline is Wednesday, November 29, 2017 and at a rate of $130.29 per night. A copy of the agenda may be obtained by contacting: Board of Medicine (BOM) Meeting Materials at BOM.MeetingMaterials@flhealth.gov or call (850)245-4131.

The Boards of Medicine and Osteopathic Medicine’s Physician Certification Pattern Review Panel announces a public meeting to which all persons are invited.
DATE AND TIME:
Thursday, November 30, 2017, immediately following the Boards of Medicine and Osteopathic Medicine’s Joint Committee on Medical Marijuana Meeting or soon thereafter. PLACE: Rosen Plaza Hotel, 9700 International Drive, Orlando, Florida 32819. Hotel phone: (407) 996-9700.
GENERAL SUBJECT MATTER TO BE CONSIDERED:
An organizational meeting will be held to create the Physician Certification Pattern Review Panel required under section 381.986, (4)(g), Florida Statutes.
October 26, 2017
Department Issues New Rule for “Other Condition” Form
SUMMARY: The proposed emergency rule incorporates the form which must be utilized by qualified physicians who issue physician certifications for medical marijuana to patients with comparable medical conditions.
THE PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS: Claudia Kemp, J.D., Executive Director, Board of Medicine/MQA, 4052 Bald Cypress Way, Bin # C03, Tallahassee, Florida 32399-3253.
THE FULL TEXT OF THE EMERGENCY RULE IS:
64B8ER17-3 Documentation Required Under Section 381.986(4)(b), Florida Statutes.
Pursuant to Section 381.986, F.S., qualified physicians who issue physician certifications for patients with medical conditions of the same kind or class as or comparable to: cancer; epilepsy; glaucoma; positive status for human immunodeficiency virus; acquired immune deficiency syndrome; post-traumatic stress disorder; amyotrophic lateral sclerosis; Crohn’s disease; Parkinson’s disease; or multiple sclerosis, are required to submit form DOH-MQA-5027 (10/17), entitled “Documentation Required Under Section 381.986(4)(b), Florida Statutes,” which is hereby incorporated by reference and available from the Board’s website at http://www.flboardofmedicine.gov/forms/statutorily-required-documentation.pdf. Said form must be submitted within 14 days after issuing the physician certification.
Rulemaking Authority 381.986 FS. Law Implemented 381.986 FS. History-New 10-24-17.
THIS RULE TAKES EFFECT UPON BEING FILED WITH THE DEPARTMENT OF STATE UNLESS A LATER TIME AND DATE IS SPECIFIED IN THE RULE.
EFFECTIVE DATE: October 24, 2017
 
The bad news is that presently this form can only be snail-mailed to the Board office. However, it is anticipated in the future, that this form should be able to be electronically sent.  We remain in the grey area of new law requirements in place but regulatory systems trying to catch up.
The good news is that for the 12 specifically listed conditions in SB 8A , justification to the Boards is not required. The justification form only applies to the “medical conditions of the same kind or class as or comparable to those enumerated.. “.

 

The conditions not requiring justification to the Board(s) are:

1.  Cancer

2.  Epilepsy

3.  Glaucoma

4.  HIV

5.  AIDS

6.  PTSD

7.  ALS

8.  Crohn’s

9.  Parkinson’s

10.    MS

11.    Terminal condition (die within one year)

12.  Chronic nonmalignant pain ( means pain that is caused by a qualifying medical condition or that originates from a qualifying medical condition and persists beyond the usual course of that qualifying medical condition.)

October 18, 2017
Recap:  The House Health Quality 
Subcommittee Meeting in Tallahassee
The House Health Quality Subcommittee met last week in Tallahassee and received an update from Christian Bax, Director of the Office of Medical Marijuana Use. If interested in watching the meeting video, it lasts about two hours.
Florida Society of Cannabis Physicians (FLSCP) Executive Director Ron Watson testifies on behalf of the FLSCP near the very end of the video. Mr. Watson lets the House committee know that the FLSCP is here to help educate physicians and to speak on their behalf moving forward.
The Senate Health Policy Committee, which meets on Tuesday, October 24 from 9-10:30, has just released their schedule for next week’s committee meetings. That agenda also includes an update from Mr. Bax. It will most likely be very similar to the House presentation , but there may be some new additional information.
The FLSCP is here to fight on your behalf, but we need physicians to join so we can continue to do so. Please help us, help you, by joining the FLSCP today!
October 5, 2017
Board of Medicine Consent Form and Disciplinary Guidelines
The Boards of Medicine and Osteopathic Medicine released two new rules today developed by the Joint committee with respect to medical cannabis. They address a newly required uniform patient consent form as well as disciplinary guidelines for the respective Boards for improper patient certifications.  Both rules became effective immediately on October 4. Make sure you start using these new consent forms today!
We are still waiting on Board rules creating a form for the “or other” conditions, which must be turned into the respective Boards within 14 days of making a patient certification for a condition not specifically listed in SB 8A. (See page 9 of SB 8A for conditions)
New rules released:
64B8ER17-1 Mandatory Standardized Informed Consent for Medical Marijuana.  Pursuant to Section 381.986, F.S., the Board has approved form DOH-MQA-5026 (8/17), entitled “Medical Marijuana Consent Form,” which is hereby incorporated by reference and available from the Board’s website at http://www.flboardofmedicine.gov/forms/medical-marijuana-consent-form.pdf, as the mandatory standardized informed consent form that a qualified physician must use each time the qualified physician issues a certification for medical marijuana to a patient he or she has diagnosed with at least one qualifying medical condition.
Rulemaking Authority 381.986 FS. Law Implemented 381.986 FS. History-New.
64B8ER17-2 (64B8-8.001) Disciplinary Guidelines.
(1) No change.
(2) Violations and Range of Penalties. In imposing discipline upon applicants and licensees, in proceedings pursuant to Sections 120.57(1) and (2), F.S., the Board shall act in accordance with the following disciplinary guidelines and shall impose a penalty within the range corresponding to the violations set forth below. The verbal identification of offenses are descriptive only; the full language of each statutory provision cited must be consulted in order to determine the conduct included.
RECOMMENDED RANGE OF PENALTY
VIOLATION
FIRST OFFENSE
SECOND OFFENSE
THIRD OFFENSE
(a) through (sss) No change.
(ttt)  Issuing a physician certification, as defined in Section 381.986, F.S., in a manner out of compliance with the requirements of that section and the rules adopted thereunder.
(Section 458.331(1)(uu), F.S.
From probation to revocation or denial of the license and an administrative fine ranging from $1,000,00 to $5,000.00.
From suspension to revocation or denial of the license and an administrative fine ranging from $5,000.00 to $10,000.00.
(3) through (7) No change.
64B15ER17-2 (64B15-19.002) Violations and Penalties. In imposing discipline upon applicants and licensees, the board shall act in accordance with the following disciplinary guidelines and shall impose a penalty within the range corresponding to the violations set forth below. The statutory language is intended to provide a description of the violation and is not a complete statement of the violation; the complete statement may be found in the statutory provision cited directly under each violation description.
MINIMUM
MAXIMUM
(1)  through (81)  No change.
(82) Issuing a physician certification as defined in Section 381.986, F.S., in a manner out of compliance with the requirements of that section and the rules adopted thereunder.
(Section 459.015(1)(ww), F.S.
FIRST OFFENSE:
denial or probation and an administrative fine of $1,000.00.
denial or revocation and an administrative fine of $5,000.00.
SECOND OFFENSE:
denial or suspension and an administrative fine of $5,000.00.
denial or revocation and an administrative fine of $10,000.00.
September 29, 2017
Newly Required 2-Hour Physician Training Course Released
The Florida Medical Association (FMA) has just released the newly required 2-hr course for physicians to become “Qualified physicians” who can make “Physician certifications” for “Qualified patients”.  The old law required an 8-hr course which cost $1,000. The new law, (see SB 8A language below), requires a 2-hr course which could have cost physicians up to $500.
The good news is the FMA has set the price at $250. The bad news, as required by the law below, is that every physician who took the old 8-hr course must take the new course within 90 days of today. The FMA will most likely have to update this course when the Department of Health releases more detailed rules. According to the FMA, physicians will not be required to retake the updated course, but will have access to the new course once updated again, if the physician so chooses. However, the new law does say physicians must take the 2-hr course before each license renewal.
SB 8A language:
(a)    Before being approved as a qualified physician, as defined in paragraph (1)(m), and before each license renewal, a physician must successfully complete a 2-hour course and subsequent examination offered by the Florida Medical Association or the Florida Osteopathic Medical Association which encompass the requirements of this section and any rules adopted hereunder. The course and examination shall be administered at least annually and may be offered in a distance learning format, including an electronic, online format that is available upon request. The price of the course may not exceed $500. A physician who has met the physician education requirements of former s. 381.986(4), Florida Statutes 2016, before the effective date of this section, shall be deemed to be in compliance with this paragraph from the effective date of this act until 90 days after the course and examination required by this paragraph become available.
Please consider becoming a member of the FLSCP , so we can keep fighting on your behalf. See the article from the FMA below, with a link to the course.
The new mandatory CME course for physicians who seek to certify patients for medical marijuana in Florida is now available in the FMA’s online education catalog. This two-hour course, which is provided by the FMA and FOMA, meets the educational requirements under state law for physicians to certify patient eligibility for medical marijuana in Florida. Doctors who intend to do so must complete the course every two years. Click here to take the Florida Physician Medical Marijuana Course. If you have questions, contact the FMA Education Department at education@flmedical.org or (800) 762-0233.
September 22, 2017
Post Irma Update
On behalf of the FLSCP, we hope everyone is doing well after Hurricane Irma left our state bruised and battered. Storms can bring out the best and occasionally the worst in people, but they present an opportunity to remember what is really important in life. Let’s all count our blessings as we recover and rebuild.
So where are we now? Much has happened since our last update. We encourage members to send any and all comments or concerns to FLSCP.
Department of Health (DOH) releases new rules for applicants on September 20
The DOH released “some” of the long awaited rulesfor medical marijuana after passage of SB 8A. However, these rules deal mainly with new applicants wanting to become Medical Marijuana Treatment Centers (MMTC) and not issues specific to physician certifications. Rules must still be promulgated to define a patient daily dose limit with forms for exceptions, medical director and the Coalition for Medical Marijuana Research and Education details, to name a few.
The emergency rules, which became effective when filed on Sept. 20, include definitions, a new applicant scoring system and specific application instructions; however, the window of time for applicants to submit these applications is still up in the air. The DOH will publish the new MMTC application time frames at a later date.
Board of Medicine/Osteopathic Medicine Joint Committee Rules
The Board of Medicine and Osteopathic Medicine’s Joint Committee on Medical Marijuana met on August 25. (See minutes) The Joint committee has put forward proposed rules dealing with physician discipline, a uniform patient consent form and a form for justification of the “other” conditions not listed in Amendment 2.  However, the Joint committees proposed rules must be approved by both the Boards before becoming effective. The Board of Osteopathic Medicine has already approved the rules, but the Board of Medicine’s meeting on September 7 was cancelled due to the storm. The next scheduled Board of Medicine meeting is on October 13. Depending on the Board of Medicine deliberations, look for these rules to be printed by October 16. The FLSCP will provide members a detailed summary when completed.
Telehealth bill filed for 2018 session prohibits medical marijuana
SB 280 has been filed for the 2018 legislative session. This bill attempts to formally regulate the practice of “Telehealth” or Telemedicine. The bill has been around for many years and keeps dying because of two main issues, out-of-state licensure and pay parity. There is also a task force studying this issue and will make recommendations to the Legislature that may or may not change this bill.
However, this year’s bill specifically excludes certified physicians from utilizing this practice for MMJ clients. We are not surprised as SB 8A requires a physician to conduct “a physical examination while physically present in the same room as the patient and a full assessment of the medical history of the patient.”
Language in SB 280:
“(d) A telehealth provider who is authorized to prescribe a controlled substance named or described in Schedules I through V of s. 893.03 may use telehealth to prescribe a controlled substance, except that telehealth may not be used to prescribe a controlled substance to treat chronic nonmalignant pain as defined in s. 458.3265(1)(a) or to issue a physician certification for marijuana pursuant to s. 381.986. This paragraph does not prohibit a physician from using telehealth to order a controlled substance for an inpatient admitted to a facility licensed under chapter 395 or a patient of a hospice licensed under chapter 400.”
August 23, 2017
Friday, August 25, 2017 – Joint Committee Meeting of Florida’s Boards of Medicine and Osteopathic Medicine – Orlando, Florida
This Friday, August 25, 2017, beginning at 8 AM ET,  the Joint Committee of Florida’s Boards of Medicine and Osteopathic Medicine will host a meeting on Medical Marijuana at the Doubletree Hilton Orlando Airport.
This special meeting will provide a public forum for discussion focused on two legal forms: 1) Medical Use of Marijuana Consent Form and 2) Documentation of Comparable Conditions Form. Pursuant to Section 381.986 (4)(b), Florida Statutes (2017), one or both of these forms must be completed by a qualified physician and submitted to the appropriate board within 14 days after issuing physician certification.
(b) If a qualified physician issues a physician certification for a qualified patient diagnosed with a qualifying medical condition pursuant to paragraph (2)(k), the physician must submit the following to the applicable board within 14 days after issuing the physician certification:
  1. Documentation supporting the qualified physician’s opinion that the medical condition is of the same kind or class as the conditions in paragraphs (2)(a)-(j).
  2. Documentation that establishes the efficacy of marijuana as treatment for the condition.
  3. Documentation supporting the qualified physician’s opinion that the benefits of medical use of marijuana would likely outweigh the potential health risks for the patient.
  4. Any other documentation as required by board rule.
In preparation for Friday’s meeting, the Boards Joint Committee has released a 1287 pg PDF “Book” on its website containing an array of materials from emails to clinical case studies.  For ease of reference, we have compiled the following index for the “Book”:
To access any of the meeting materials listed above (Release Forms or Joint Committee Book), please visit http://flscp.org/marijuana-updates/ within the “membership-only” section of the FLSCP.org website.
Emails to Crystal Sanford, Department of Health, Programs Operations Administrator re. consent forms
Pg. 2-398
Draft Forms ** to be discussed on 8/25/17
Pg. 399-408
What has research over the past two decades revealed about the adverse health effects of recreational cannabis use?
Pg. 409-425
Cannabidiol in Inflammatory Bowel Diseases: A Brief Overview
Pg. 426-429
Cannabis Induces a Clinical Response in Patients with Crohn’s Disease: A Prospective Placebo-Controlled Study
Pg. 430-432
Adverse Health Effects of Marijuana Use
Pg. 433-441
NIDA Review Summarizes research on marijuana’s negative health effects
Pg. 442-445
8/3/17 Joint Committee Meeting Materials
Pg. 446-552
7/14/17 Joint Committee Meeting Materials
Pg. 553-714
Medical Cannabis Update by Jeffery Scott, Esq.
Pg. 715-718
Physician Recommendation of Medical Cannabis
Pg. 719-729
Malpractice Liability and Medical Marijuana
Pg. 730-769
The Advisability & Feasability of Developing USP Standards for Medical Cannabis – Abstract
Pg. 770-779
State Medical Marijuana Laws
Pg. 780-788
Is Marijuana Addictive?
Pg. 789-790
CV – Dr. Sasha Noe
Pg. 791-798
Misc. Links
Pg. 799-800
Health Effects of Cannabis & Cannabinoids
Pg. 801-1287

 

 

 

August 14, 2017

 

Patients Added to the Medical Marijuana Use Registry
More than 10,000 patients have been added to the Medical Marijuana Use Registry since SB 8-A passed on June 7-a 60% increase from previous counts in just two months.  This brings the total number of qualified medical marijuana patients to nearly 27,000.
Patients and caregivers must be added to the Medical Marijuana Use Registry and obtain a registry identification card in order to receive their orders of medical marijuana.  The card must be kept handy and available for presentation any time a patient or caregiver is consuming, possessing, or transporting medical marijuana.  Qualified ordering physicians, law enforcement officers, and medical marijuana treatment centers all have access to the registry in order to ensure lawful use.   Physicians licensed to prescribe other prescription drugs also have access to the registry to determine possible drug interactions.  The Office of Medical Marijuana Use is currently experiencing some delay in processing registry identification cards due to the influx of qualified patient applications.
At medical marijuana treatment centers, employees verify patients and their recommended dosage in the registry, and only permit patients to purchase the amount shown.  Some medical marijuana treatment centers go so far to only allow registered patients and caregivers into the room with the medical marijuana products.  All others must wait in a waiting room.
Dovetailing with increasing patient counts, 957 physicians are now qualified to order medical marijuana.  Additionally, the Office of Medical Marijuana Use has licensed 12 medical marijuana treatment centers, and five more will be licensed by October.  After October, the industry grows as the patient count grows-once the patient count reaches 100,000, four more medical marijuana treatment centers will be licensed, and an additional four more will be licensed per each subsequent 100,000 patient increase.  The existing medical marijuana treatment centers have opened up retail outlets all across the state and more are opening nearly every week.  Some treatment centers also offer a delivery service for patients without access to the retail stores.
The Florida medical marijuana industry is expected to grow rapidly, due to Florida’s large population size generally and large elderly population size in particular.   Also adding to the growth is the change in policy concerning seasonal residents.  After SB 8-A, seasonal qualified patients (provided they spend at least 31 consecutive days in Florida and maintain a temporary residence in Florida) are able to receive Florida medical marijuana.  Before, medical marijuana was only accessible for permanent Florida residents.  This provision could have a large impact in patient counts, especially in areas of the state with a large retirement community.
With increasing patient sizes come new concerns, and new rules.  The Society is advocating on behalf of its members for effective and efficient rules in a changing healthcare industry.
August 7, 2018
New Businesses in Response to Medical Marijuana
29 states and the District of Columbia have now legalized marijuana in some form.  Medical marijuana legalization has been evolving in Florida over the past several years and made significant headway in voter initiated constitutional amendments.  Just this summer, the Florida legislature passed legislation implementing the more expansive constitutional amendments that was passed last November.  The nascent medical marijuana industry is poised to become a multi-billion dollar industry, due to Florida’s large overall population size and specifically its large population of elderly patients.  As a result, new businesses and jobs are flocking to Florida to both spark and keep up with demand.  
 
Expected new businesses include the medical marijuana treatment centers.  The state currently has licensed nine entities that can legally grow, process, and distribute medical marijuana, and must license an additional eight more by October.  Several retail dispensaries have opened throughout the state, and many more are expected to open quickly as local governments lift their temporary moratoriums on the product.  There, patients are purchasing pre-packaged products that just eight months ago were completely illegal, such as cannabis-derived oils and vape cartridges.
Other new businesses are growing as well.  One example is the medical marijuana clinics – entire clinics, with licensed physicians conducting exams, focused on helping patients access medical marijuana.  These clinics are there to help patients navigate the changing rules and to educate them on proper procedure and their qualifying condition. The clinics do not distribute medical marijuana-as per state regulation, only licensed medical marijuana treatment centers can dispense medical marijuana products.  One example of this type of business is Tetra Health Care, a California-based chain that has expanded into Florida.  Tetra Health Care’s founder ventured into the medical marijuana scene after her husband was diagnosed with stage four throat cancer.  Though impressed by the relief medical marijuana brought her husband, she was disappointed with the patient care he received.  These clinics are patient-centered and aim to provide a high level of comfort and care.
Tetra is not the only business coming in from other states.  Businesses from Arizona, Colorado, and even Canada, to name a few, are partnering with license holders and finding a niche for themselves in the new industry.  Florida has the benefit of learning from other states while keeping the experience patient-focused.  The industry is also creating jobs dealing with secure delivery of its products, accounting, and education.
71% of Florida voters voted for medical marijuana, indicating the overall consensus in the benefit medical marijuana can provide.  With a huge population, Florida’s industry is expected to surpass veteran medical marijuana states very quickly. The Society will be monitoring these changes to the industry and helping create a collaborative network keeping the focus on patients and physicians.
August 4, 2017
Local Governments Handle Preemption Requirement
After Amendment 2 was passed, local governments across the state enacted temporary moratoriums on medical marijuana treatment centers to wait for legislative guidance.  Many of these moratoriums are set to expire soonand per the new law, local governments now must make a choice: to ban dispensaries within city limits, or permit dispensaries and regulate them the same way as pharmacies.
Some cities, like New Port Richey, unhappy with their lack of ability to zone, have decided to go with an alternate option: regulate medical marijuana dispensaries the way they want, and change the way pharmacies are regulated to conform.  Under New Port Richey’s proposed ordinance, medical marijuana dispensaries will be permitted in nearly all parts of the city, except for in residential districts or the downtown district.  To do this, the ordinance also includes a provision banning pharmacies in those districts.  Presumably, existing pharmacies would be grandfathered in.  This ordinance has already passed its first reading, and is set to be heard again on August 15.
Much of this zoning concern has to do with the idea of a “pot shop on the street corner” and the potential for recreational marijuana use.  However, the most common way of ingesting recreational marijuana-smoking-is currently illegal in Florida, and dispensaries cannot sell the whole marijuana flower as a result.  The law also tightly prescribes which conditions can qualify a patient for medical marijuana.  Physicians concerned about a qualified patient wanting to use marijuana recreationally have options when making their recommendation, such as recommending low-THC strains or limiting dosage.  At the dispensaries, employees are very careful to confirm patient identity in the medical marijuana use registry and only permit the patient to purchase what is recommended in the registry.
Another concern is local cohesion. If surrounding municipalities enact bans, local governments seem more likely to enact a ban of their own as to not become a haven for banned dispensaries.  It is important to remember, however, that the state tightly regulates how many dispensaries each medical marijuana treatment center can open throughout the state, and how many total dispensaries can open in a region.  Further, competition in a localized area pushes down the prices for patients.  This is very important for patient access because insurance does not cover medical marijuana.  Considering most of the qualifying conditions are conditions associated with increasing age, and Florida has a substantial elderly population, patient access and affordability is crucial.
Additionally, in practice, Florida’s medical marijuana dispensaries are a far cry from “pot shops.”  The dispensaries are sleek, clean, and modern, on point with current wellness trends.  Many visitors compare the experience to visiting a doctor’s office.  Employees are helpful and knowledgeable about their product, and safety is the ultimate concern.
71% of Florida voters voted for medical marijuana.  The Society is committed to local government lobbying efforts for appropriate zoning to ensure patients have the access they need.
August 1, 2017
Disciplinary Guidelines Proposed
Strict disciplinary rules for physicians who improperly certify patients for medical marijuana have been proposed by the Joint Committee of Medical Marijuana.  This committee is composed of members of the Board of Medicine and the Board of Osteopathic Medicine.
The Boards are given rulemaking authority under SB 8-A and are currently operating under emergency rulemaking procedure.  The relevant rules needing to be developed include a standard consent form and disciplinary guidelines for physicians.  On a July 14 conference call, the joint committee met to develop these rules.
Under the proposed rule, for a first offense of improperly certifying patients for medical marijuana, physicians face probation, a revocation or denial (in the case of first time applicants) of their license, and/or a fine ranging from $1,000 to $5,000.  For a second offense, physicians face suspension, revocation or denial of their license and/or a fine ranging from $5,000 to $10,000. Other possible sanctions, such as corrective actions or letters of concerns, are not included as punishment options.
Some physicians argue that the disciplinary guidelines for improperly certifying medical marijuana should be the same as improperly prescribing other drugs, since medical marijuana can be an alternative to other drugs.  Consistent with this viewpoint is the statutory provision that local governments cannot regulate medical marijuana treatment centers any more than they regulate pharmacies.
However, for a first offense of improperly prescribing medicinal drugs or controlled substances, medical doctors face a one year probation, revocation or denial of their license and/or a fine ranging from $1,000 to $10,000.  For a second offense, medical doctors face suspension, probation, revocation or denial of their license, and/or a fine ranging from $5,000 to $10,000.  Though these disciplinary rules are similar to the proposed rules concerning medical marijuana, they do contain a few key differences.  First, the range of fines is broader (and higher) for a physician who improperly prescribes medicinal drugs as compared to a physician who improperly certifies a patient for medical marijuana. Second, probation time for a first offense of improperly prescribing medicinal drugs is limited to one year, while there is no limit on the probation time of improperly certifying a patient for medical marijuana.  Depending on the nature of the offense and the ultimate way the Boards choose to discipline, physicians could be impacted very differently from these two similar rules involving similar practices.
These disciplinary guidelines send a message that the Boards take very seriously any violation of the certifying process, consistent with the overall medical marijuana scheme in the state.  Even with these penalties and uncertainties, as of July 28, 948 physicians have taken the required course to certify patients.
The joint committee will meet again on August 3 in Miami. The rules will then be presented to the full Board of Medicine for approval at their meeting on August 4, and to the Board of Osteopathic Medicine for approval at their meeting on August 25.
Education and training is needed to ensure physicians are complying with statutory provisions and Department or Board rules at all times in a quickly changing legal environment.  The Society will be monitoring issues in the changing landscape on behalf of its members.  By joining the Society, you can help advance the interest of physicians affected by not only this rule, but also other rules in effect now and rules to be made in the future.

 

July 19, 2017

Some Florida Municipalities Look to Ban Medical Marijuana  
The new medical marijuana law preempts local government regulation of medical marijuana to the state. Local governments may choose to ban medical marijuana treatment centers (MMTCs) from within their boundaries, but, if they choose not to ban, MMTCs cannot be regulated any more strictly than pharmacies. (The notable exception is MMTCs cannot be located within 500 feet of a school.) Most municipal or county ordinances regulate pharmacies simply; for example, designating pharmacies a permissible use for commercial zones. Some proposed ordinances for MMTCs included language that restricts the number of MMTCs permitted in the city or county, or language that limits their location from schools, worship centers, and each other. These ordinances are no longer permitted per SB 8-A.
As a result, local governments essentially have a choice: ban MMTCs outright, or allow them nearly unrestricted. However, it is important to remember that though local governments cannot regulate MMTCs, the entities are highly regulated by the state. Some local governments have proposed amending their pharmacy zoning ordinances to restrict pharmacies the same way they would want to restrict MMTCs, but those plans have not yet been well developed.
So far, the following municipalities have proposed or adopted an outright ban of MMTCs within their limits:
1.) Collier County
2.) Gulf Breeze
3.) Indian River County
4.) Naples
5.) Orlando
6.) Sarasota
7.) Winter Garden
8.) Winter Park
9.) Winter Springs
Many other municipalities have passed moratoriums on MMTCS, essentially enacting temporary bans on MMTC activity within their boundaries. These moratoriums are set to expire in the next few months, requiring the local government to make the choice between permitting and outright banning.
These bans, if passed, will have significant effects on the medical marijuana industry, including on patients and physicians.
The Society is committed to local government lobbying efforts ensure passage of favorable ordinances allowing MMTCs so that complying physicians are able to practice in their chosen field in the place they live and work.

 

 

July 7, 2017

Lawsuit Filed over Smoking Ban

Tallahassee—On July 6, Orlando attorney John Morgan filed his much anticipated law suit addressing the no smoking provision in the new medical cannabis law. The law expressly prohibits smoking cannabis as a lawful medicinal use, and prohibits the sale of the whole cannabis flower accordingly. The suit names the State of Florida, the Board of Medicine, the Board of Osteopathic Medicine, the Department of Health, the Office of Compassionate Use, and all of their respective chairs as defendants. The suit seeks a declaration from the court that smoking medical cannabis is lawful use under Amendment 2.

The Amendment, passed by 71% of Florida voters, included a provision that smoking could be prohibited in public places. Morgan argues that this implies smoking is legal in private places, saying this is “first-grade logic.” He also argues that Florida voters assumed smoking would be permitted as a common way to consume the drug, pointing to an intent statement distributed to voters as evidence. Further, Morgan argues that the definition of cannabis in amendment 2 included all parts of the cannabis plant—including the flower—and claims that politicians are restricting patients constitutional rights  by these bans.

Morgan held a press conference in Tallahassee the morning the suit was filed wherein he criticized legislators for inserting their opinions over the opinions of physicians and said that he trusts Florida’s doctors to make the best decision for their patients.

Supporters of the ban argue that you don’t smoke medicine and to treat cannabis like medicine means banning smoking. They point to health issues of smoking, the difficulty of controlling dosage, and that allowing smoking creates a path to recreational cannabis use. Opponents of the ban, like Morgan, argue that people with terminal illnesses or other life-threatening disease don’t care about potential future health issues from smoking. They also argue that dosage is always difficult to control when patients administer their own medicine; and that recreational users of cannabis vape and consume edibles, which the law permits. He also criticized House Majority Leader Ray Rodrigues (R-Estero), a vocal supporter of the ban, saying that if Rodrigues truly cared about smoking, he would have worked on taxing cigarettes. By going against the will of the people, Morgan argues, the legislature has “kicked the door wide open” to a recreational cannabis initiative.

Morgan is using the hashtag #NoSmokeIsAJoke on social media to raise awareness. Politicians also weighed in on twitter during the press conference. Representative Frank White (R-Pensacola) tweeted “we care that the patient gets the proper dosage- unlike vaping, edibles, pills, etc, it’s impossible to control dosage with smoking.” Senator Rob Bradley (R-Fleming Island) tweeted an old ad for “Fresh Cigarettes” and called it “Exhibit ‘A’ to @JohnMorganESQ lawsuit” comparing the tobacco industry lawsuits to the medical cannabis industry ones.  On the opposite side of the aisle, Representative Carlos Smith (D-Orlando) tweeted “I said it before, who are WE to tell legit patients they can’t smoke their cannabis?”

The case is pending in Leon County Circuit Court.

 

July 6, 2017

Florida Department of Health Adopts Placeholder Rules 

On Monday, July 3, the Department of Health Office of Medical Marijuana Use’s newest rules (noticed on June 16) became effective. SB 8-A, the medical marijuana bill passed in last month’s special session, requires that the Department promulgate a host of rules implementing medical marijuana legislation. The Department has been given a huge task to implement provisions relating to nearly every stage of medical marijuana, from cultivation to after patient use.

The new rules primarily define terms to accord with the new legislation and set out a general procedure for future regulations. They almost certainly will need to be amended or clarified in the next few weeks, as they are not fully consistent with SB 8-A and they contain few specifics to practical issues. For example, SB 8-A includes terminology changes: “dispensing organizations” and “the Compassionate Use Registry” are now known as “medical marijuana treatment centers” and “the Medical Marijuana Use Registry” respectively.  The June 16 rules make the change when they refer to medical marijuana treatment centers, but they also continue to refer to the Compassionate Use Registry.  Additionally, the rules include vague language for important provisions. For example, SB 8-A only allows physicians to issue a certification for three 70-day supply limits of marijuana, calculated from a daily dose as defined by the Department of Health. However, the Department rule relating to his provision does not define a daily dose and instead defines the 70-day supply limit as simply an “adequate supply”, offering little practical guidance to physicians, patients, law enforcement, and medical marijuana treatment centers. New rules are likely to be forthcoming shortly, and we will be working to ensure they effectively serve physician’s interests and efficiently get medical marijuana to the patients that need it.

The Florida Medical Association has issued an update relating to SB 8-A. It reads the new law very conservatively in a way that is not altogether favorable for physicians wanting to recommend medical marijuana, set against the context of the limited existing Department of Health rules. However, given the likelihood of future rule changes, the new medical marijuana laws can be interpreted very favorably for physicians, especially with effective advocates working to amend and fine tune the rules.

 

June 26, 2017

Governor Scott signs Medical Cannabis bill

On Friday, June 23, Governor Rick Scott signed SB 8-A into law. The law is an effort to implement amendment 2, passed overwhelmingly by Floridians in last November’s election, and to amend previous statutes relating to medical cannabis. The law expands medical cannabis access to millions of patients and begins a plan for growth of the industry.

It requires that 10 more medical cannabis treatment centers are licensed by October 3, and gives an outline of who those licenses will be.  5 of the 10 will go to companies that applied in 2015 but were not selected and at least 1 will go to a member of the Black Farmers and Agriculturalists Association. Additionally, for up to two of the licenses, preference will be given to applicants that formally were part of the citrus industry and will convert those facilities for cannabis processing.  Once the patient registry reaches 100,000, 4 more applicants will be licensed, bringing the total up to 21 licensed medical cannabis treatment centers. For each additional 100,000 patients after that, another 4 applicants will be licensed.

The Department of Health Office of Medical Marijuana (formally the Office of Compassionate Use, amended by this new law) is under emergency rulemaking procedure to quickly implement the provisions of the new law and provide a process for licensing. In 2015, the department used a rank scoring process to distribute the licenses. Each application was grouped according to statutory region, and then the individual applications were ranked in fourteen different categories. For each category, the worst applicant would receive a score of 1, while the best would receive a score that equaled the total number of applicants in that region (i.e., if a region had 4 applicants, each application would receive a score of 1, 2, 3, or 4 for each category). 3 different people scored the applicants and then their scores were averaged to get a final score. This process had critics (notably, Administrative Law Judge John G, Van Landingham) because it arguably did not score the applicants as required and instead ranked them in a way that maximized small differences while minimized large differences. Regardless, the department will need to quickly begin receiving and scoring applications, as licenses should be issued by October 3.

New applicants must have been registered to do business in Florida for the previous 5 consecutive years with a certificate of registration issued by the Department of Agriculture. This amends the former requirement that every applicant had operated as a nursery for the previous 30 years. The law gives many factors and other requirements that the department should consider, including plans for diversity and financial ability.

Orlando attorney John Morgan plans to sue on the provision that bans smoking as a way to consume cannabis, tweeting “Thank you @FlGovScott for doing your part! I’ll be in Tally soon to file my suit.” Morgan had a large role in passing amendment 2 and is a vocal supporter of medical cannibis.

Though many supporters, like Morgan, take issue with parts of the law, most believe that it is a good first step in expanding access to medical cannabis to patients.

June 20, 2017

The Physician’s Certificate and SB 8-A

In the last two weeks, Florida lawmakers and Department of Health officials have passed a new bill and noticed new regulations relating to the medical cannabis. The bill becomes effective as soon as Governor Scott signs it, and the regulations will be finalized by July 3 and fully implemented by October. It is important that physicians understand and comply with state law in this quickly changing medical landscape, as medical cannabis outside the scope of the constitution and statute remains illegal under Florida law, and cannabis generally remains illegal under federal law.

To legally recommend medical cannabis to patients, qualified physicians must appropriately issue a physicians certificate to qualified patients.

Qualified Physicians

A physician seeking to recommend cannabis as a treatment must first become qualified to do so. This process is relatively simple: First, the physician must have an active, unrestricted license as either an allopathic or osteopathic physician; next, the physician must complete a 2 hour course and subsequent exam offered by the FOA or FOMA.

A qualified physician cannot be employed by or otherwise have economic interest in a medical cannabis treatment center or testing lab. This provision expands the former restriction that a qualified physician may not also serve as a medical director for a treatment center. If a qualified physician receives compensation from a medical cannabis treatment center related to the issuance of a physician certification, the physician is subject to disciplinary action.

If a physician was previously qualified under Florida Statute 381.986, the physician is considered qualified from the date the bill is signed to 90 days after the course becomes available.

Qualified Patients

SB 8-A no longer requires that the physician had treated the patient in the months preceding the authorization, but it does require that the physician conduct a physical exam while in the same room as the patient. A patient must be diagnosed with a qualifying medical condition in order to be treated with medical cannabis.

SB-8A expanded the number of conditions that qualify a patient for medical cannabis. A patient must be diagnosed with at least one of the following: cancer, epilepsy, glaucoma, PTSD, Crohn’s disease, Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, positive status for HIV, AIDS, or chronic nonmalignant pain as a result of one of these conditions. Additionally, other medical conditions of the same kind or class as those listed can qualify a patient for medical cannabis.  A different terminal condition can also qualify a patient for medical cannabis use, provided that the terminal condition is diagnosed by a physician other than the qualified physician authorizing the medical cannabis.

When deciding whether medical cannabis is the proper treatment, the bill requires that the physician also determine that the benefits of cannabis will outweigh any health risks, determine whether the patient is pregnant and not authorize the use if the patient is, and review the patient’s controlled drug prescription use.

It is important that the physician carefully diagnose the patient—it is a misdemeanor for a physician to authorize medical cannabis for a patient without a reasonable belief that the patient has one of the qualifying conditions.

Physician’s Certificate

Once a qualified physician has diagnosed a qualified patient, the physician  must issue a physician certificate that authorizes medical cannabis use.  The physician must register as the issuer in the medical cannabis use registry , and confirm that the patient does not have an active physician certification from another qualified physician.

In the registry, the physician must enter the patient’s qualifying condition, the dosage, the amount and forms of cannabis authorized for the patient, and any types of cannabis delivery devices needed by the patient. The physician must have the voluntary and informed written consent of the patient each time the physician issues a certification, to be kept in the patient’s medical record. The consent form should be a standard form adopted by the Board of Medicine and the Board of Osteopathic Medicine.

If there is any change made to the certification, the physician must update that change in the registry within 7 days. The physician must also deactivate the patient’s registration in the registry when the physician no longer recommends the medical use of cannabis for the patient.

 

These procedures show some of the responsibilities physicians have when recommending medical cannabis to a patient. Ultimately, all players in this industry – the physicians, patients, medical cannabis treatment centers, Department of Health, law enforcement, and others – have  different statutory responsibilities and must work together  to ensure a patient is lawfully receiving the medical cannabis he or she needs.

 

 

June 18, 2017

Changes to Medical Cannabis Law after SB 8-A

On June 9, state legislators passed Senate Bill 8-A, a medical cannabis bill amending a previous medical cannabis statute and implementing the state constitutional amendment passed by voters in 2016. This bill, which becomes law and takes effect upon Governor Scott’s signature, contains several key policy changes that impact physicians and others involved in the medical cannabis business.

Diagnosing and Recommending

                SB-8A tweaks the previous process for diagnosing patients and recommending cannabis for treatment. First, it amends the physician education requirement that all physicians must successfully complete before recommending cannabis from an eight hour course to a two hour course. It also expands the conditions that can be treated with cannabis to a list closely related to the constitutional amendment. Additionally, physicians are given some discretion in recommending cannabis for comparable conditions not otherwise enumerated in the bill.

SB 8-A no longer requires that the physician has treated the patient for three months preceding the patient’s registration in the medical marijuana use registry. However, it does require that the physician conduct an exam while in the same room as the patient, therefore not permitting medical cannabis recommendation through telemedicine. Both provisions have a number of supporters and opponents, and could potentially be subject to legal challenge or further clarification by the Department of Health rule making.

Qualified physicians cannot be employed by or hold any economic interest in a medical cannabis treatment center or medical cannabis laboratory, an expansion of a previous prohibition of qualified physicians also being employed as treatment center medical directors.

Industry Growth

SB 8-A also expands the medical cannabis industry as a whole. Currently, there are only seven authorized medical cannabis treatment centers. The current patient count and estimations of future growth vary wildly, but experts generally agree that patient demand will soon outgrow existing treatment centers and qualified physicians. SB 8-A requires that the Department of Health grandfather in the seven treatment centers, as well as license 10 more treatment centers by October 3, 2017.

Additionally, within six months of the patient count reaching 100,000 as documented in the medical cannabis use registry, the Department will license four more treatment centers.  At that point, it will continue to license four treatment centers per each additional 100,000 patients. Since some estimations put yearly growth of patient numbers well over 100,000, the state could be seeing a large increase in the number of treatment centers very quickly.  SB 8-A also declares cannabis and cannabis delivery devices tax exempt as a medicine.

Currently, each medical cannabis treatment center can only operate a maximum of 25 dispensing facilities across the state, but if the patient count reaches 100,000, they will be able to operate a maximum of 30.  Additionally, the state is divided into five regions, each of which can only host a certain number of dispensing facilities, calculated as a function of their population. Treatment centers can sell their dispensing facility slots to other authorized treatment centers, with notice to the Department of Health. All of these provisions relating to the number of dispensing facilities automatically expire on April 1, 2020, presumably to be amended after evaluation of the state of the industry at that time.

 

 

June 16, 2017

Potential Legal Challenges to the New Cannabis Bill

On June 9 in a special legislative session, Florida lawmakers passed SB 8-A, a new medical cannabis bill that amends Florida Statute 381.986 and implements the constitutional amendment passed by voters in 2016. This bill, which becomes effective upon Governor Scott’s signature, received considerable overall support in legislative chambers, and is the product of compromise after other medical cannabis bills could not pass in the regular session. Despite support among lawmakers, the bill contains several controversial provisions that have angered medical cannabis advocates, some of whom have already proposed testing the provisions in court.

Smoking

Like Florida Statutes 381.986, SB 8-A contains a restriction against smoking cannabis; namely, smoking cannabis or possessing cannabis in a form that can be smoked is not considered “medical use.” Therefore, smoking cannabis – even by a qualified patient issued a certificate by a qualified physician in the privacy of the patient’s home – remains illegal under both state and federal law.

Opponents of the smoking ban argue that it goes against the spirit of the Article X, Section 29 Amendment as Florida voters likely assumed smoking would be legal when voting; smoking is often seen as the most common way to ingest cannabis. They also argue that the Section 29 amendment has a provision that references smoking in public places, thereby implying that smoking is permitted privately.

Supporters of the ban argue that smoking itself is a health issue. As representative Ray Rodrigues, R-Estero, stated: “We don’t believe you smoke medicine.” Supporters argue that smoking has significant harms that do not justify the benefits. Further they argue since vaping is permitted and has many of the same benefits without the same harms, there is no legitimate purpose in allowing smoking.

Opponents then counter that vaping does not have the same effects as smoking. For example, some have proposed that smoking best provides a “cottonmouth” effect, a very important effect for patients with ALS who need to treat excess saliva. However, like nearly all the effects of cannabis, more research needs to be done to better evaluate those claims.

Access

SB 8-A might also face action relating to provisions that potentially limit its access to patients. The bill does not allow for patients to grow their own plants and instead only legalizes cannabis purchased from a registered medical cannabis treatment center.  Supporters of this wish to have more defined regulations of medical cannabis and to treat cannabis like a medicine without implying a recreational legality that comes with growing at home.

Opponents argue that this too goes against the spirit of medical cannabis laws—well known examples of California and Colorado have long permitted medical cannabis patients to grow a specified number of plants at home.  Further, they argue, that this provision in conjunction with the relatively low number of registered treatment centers limit access to medical cannabis for the patients who need it. Supporters, however, justify the low number of authorized treatment centers as representative of the low number of qualified patients, and point to parts of the bill that will increase the number of treatment centers with the addition of a defined number of patients to the registry.

Additionally, SB 8-A requires that physicians examine patients in person before recommending cannabis, eliminating telemedicine as an option. Opponents argue that telemedicine is a legitimate form of medicine, and the provision limits access for rural or bedridden patients. Supporters argue that an in-person diagnosis is the best way to protect patients and physicians while combating fraud that can come with this still semi-illicit substance.

Constitutional rights

SB 8-A also allows for cities and municipalities to ban dispensaries entirely if they choose. If dispensaries are not banned, cities can only regulate dispensaries in the same way they can a pharmacy. Supporters argue that this allows individual cities to make choices best suited to their constituents; opponents argue that this allows individual cities to selectively implement the state constitution.

Several other states with legalized medical cannabis have similar provisions allowing city banning. However, as opponents have pointed out, many of those states enacted medical cannabis statutes independent of their state constitution, while in Florida, the state constitution plays a crucial role in medical cannabis.

Regardless of the legal merit of some of these arguments, their discussion plays an important role in continuing to fine tune Florida’s medical cannabis policy to best provide for patients and physicians.

 

 

April 3, 2017

Senate makes a move toward adding more medical cannabis licenses

TALLAHASSEE, FLORIDA — In furtherance of the Senate’s aim to expand access to medical cannabis, new policies changes were implemented on April 3, 2017 that will expand the industry’s players and allow snowbirds to partake.

The most significant policy change is an amendment that would require state regulators to approve licenses for five new Medical Marijuana Treatment Centers, These would need to be implemented by October 3, according to the amendment.  The Health Policy committee also amended the bill (SB 406) in a way that would speed up the process for registering additional Medical Marijuana Treatment Centers.   For each additional 75,000 patients who register, four new licenses would need to be attained.

Opposition to expanding number of licenses

Senator Bill Montford, D-Tallahassee, feels strongly about not expanding the number of licenses.  He wonders whether there would be enough demand to support the businesses, arguing that for companies that have already invested in the industry based on the medical cannabis system created by lawmakers in 2014, it is unfair.  Others counter that they want to make sure that 20 million people have enough treatment options.

Amendment would allow snow birds and long-term Florida visitors to have access to medical cannabis

The legislation was also amended to allow long-term visitors who have access to medical cannabis in their own states to go through Florida to obtain medical cannabis.

The next step is to send the bill to the Senate Appropriations Subcommittee on Health and Human Services.