FUZZY FUTURE
Despite legalization, state’s professional groups and governments remain anxious
Florida voters last November took a leap of faith and passed state constitutional Amendment 2, expanding access to medical marijuana by a 71 percent majority. But the waters remain murky. Doctors and patients must be willing to plunge in knowing that institutions have thrown up the equivalent of “No lifeguard on duty” signs.
Last November, Florida voters took a leap of faith and passed state constitutional Amendment 2, expanding access to medical marijuana by a 71 percent majority. Lorraine Fierro cheered. A physical therapist from Fort Myers, she assumed that relief was on the way for thousands of people. A few years ago, Fierro had surgery on her neck “and it didn’t turn out well,” she says. “I was on three or four medications the doctors gave me.”
Popping pills did nothing for her pain and inflammation. She went to visit her daughter, a nurse in Colorado, and was clearly in pain. “She looked at me and said, ‘I’m not taking you to the E.R.; I’m taking you to the dispensary,’” Fierro says. “You knock on the door and give them your driver’s license. There’s security guard. They let you in a locked door. And here are guys who look like computer techs standing around the counter. They gave me [cannabis] oil. Within a few hours my inflammation subsided―and that was the problem.”
Fierro stayed with her daughter, stopped taking anti-inflammatories and Percocet and used the oil―placed under her tongue―until she was healed. “It tasted horrible,” she says, but it worked.
Now she’d like to open a clinic in Estero. But Estero, among other municipalities, has placed a moratorium on them as they―and patients, doctors and everyone else―wait to see what regulations the state Legislature puts in place this month, when they are due.
Local doctors say medical marijuana in its many forms offers relief to their patients as well, including those suffering from seizures, anxiety and nausea. “Everything I do is really a vitamin, a supplement, a natural technique,” says Dr. Gregory Sonn, a local physician who is certified to recommend medical pot. “I consider what’s natural first. To me, marijuana is simply a nat ural medicine.”
But regarding endorsement by medical establishments and local govern-
ments, the waters remain murky. Doctors and patients must be willing to plunge in knowing that institutions have thrown up the equivalent of “No lifeguard on duty” signs.
While a child in the care of Hope Hospice gets relief from seizures and symptom relief is claimed by patients of local doctors Paul Arnold, Gregory Sonn―and at press time 19 others in Lee County who have been certified to recommend medical marijuana―medical and governmental institutions remain reluctant to embrace it. Medical doctors and doctors of osteopathy who have paid $995 and taken the state’s educational course can recommend oil, vapor, pill or other cannabis forms (not prescribe, since patients obtain cannabis through distributors not pharmacies). Doctors and patients say they have seen relief of pain, spasticity and nausea―among other symptoms of serious illness―but use of the non-psychoactive cannabidiol (CBD) and/or psychoactive THC separately or in combination remains a “swim at your own risk” proposition.
Not an attractive proposition, either, to opponents like Publix supermarket heiress Carol Jenkins Barnett, who coughed up $800,000 for Drug Free Florida, the lobbying group that shouted the loudest against Amendment 2. The group worried out loud about children getting a hold of “pot candy, up to 20 times stronger than it once was” and “pot shops” setting up across the state.
But it also would have been difficult not to hear the endorsement of medical marijuana advocate and attorney John Morgan—whose radio spots claiming it was a godsend to his brother after a tragic accident—aired far and wide.
Under Amendment 2, patients must establish a 90-day relation-
ship with a qualifying doctor to eventually buy medical marijuana. Neither the office visits nor the product is covered by insurance.
At Iona Health & Wellness Center, also called Iona Cannabis Clinic, Sonn charges $175 for a first visit, when a patient meets with him for a simple checkup and determination about his eligibility for medical marijuana. If the patient is eligible―nearly all of them are, Sonn says―the patient pays $85 for each of two follow-up visits (or $55 if done by telemedicine). Sonn registers the patient with two government sites and his own database, and the patient sends a check for $75 to the Office of Compassionate Use and gets an ID card in the mail.
Obtaining medical marijuana is not like filling a prescription. A doctor writes a recommendation on a paper or electronic form and the patient orders what the doctor suggested from the dispensary. There’s no requirement that the substances ordered match what the doctor recommended, although most of the time they do.
Consequently, “I’ve seen fabulous results,” says Sonn. “It’s very personal. I’ve had extraordinary results with just the CBD oil, for folks who don’t want a psychoactive component.”
“One patient, a 9-year-old boy, was having three seizures a day,” says Paul Arnold, a graduate of Kirksville College of Osteopathic Medicine in Missouri who has practiced in the U.S. Army, Navy and Marines Corps as well as in private practice. “I put him on the lowest dose and [two months later] he was having just one a month. And I know it relieves pain and works on anxiety.”
Perhaps no one was more surprised by the amendment’s passage than Sonn. He grew up in Fort Myers and graduated from Cypress Lake High School. A graduate of Kansas City University’s College of Osteopathic Medicine, Sonn is certified in family medicine and palliative medicine. He stressed that he runs a wellness practice, which is different from primary care. “I point people to non-medicine first,” he says. “Everything I do is really a vitamin, a supplement, a natural technique. I consider what’s natural first. To me, marijuana is simply a natural medicine.
“In palliative care I learned a ton about terminal disease and the use of cannabis for it,” Sonn says. “I just didn’t think it was a
They gave me [cannabis] oil. Within a few hours my inflammation subsided―and that was the problem. ―Lorraine Fierro, medical marijuana patient
possibility here. I thought we were way too conservative.”
On an institutional level, he may be right. Local governments in Bonita Springs, Estero, Naples and Sanibel all have banned the opening of medical marijuana dispensaries in their jurisdictions for time frames that range from six months to a year. Naples did so in 2014.
That’s when state voters originally legalized low-THC medical marijuana for very limited use by people who are terminally ill and expected to live less than a year. The Compassionate Medical Cannabis Act of 2014 became effective on Jan. 1, 2015.
Amendment 2 went into effect Jan. 3, 2017, broadening the list of ailments for which medical marijuana may be suggested and no longer restricting patients to only low-dose forms of THC, the substance that induces euphoria. Doctors say that higher THC has benefits to some patients independent of the “high,” particularly for pain relief. Much more frequently recommended is cannabis-derived CBD oil.
But the sale of cannabis is still illegal under federal law, even though the U.S. Department of Justice announced in October 2009 that federal prosecutors should not take issue with legal medical marijuana patients. Since that’s just a “look the other way” measure, some people are concerned that the department could change its position, particularly under the Trump administration.
Still unpopular with many doctors is the fact that the at- torney general has upheld the classification of cannabis as a Schedule I drug―one with high abuse pot ential and “no accepted medical use.” Allowable research is much more limited in the cases of Schedule I drugs, thought to be the most dangerous. While the American Medical Association supports governmental review of this classification, it stops short of endorsing medical marijuana. The American Academy of Neurology cites “strong to moderate evidence” that medical marijuana can improve some symptoms of multiple sclerosis. Its efficacy for other neurological conditions is yet “unknown,” the AAN says.
In its December 2013 “Position Statement on Marijuana as Medicine,” the American Psychiatric Association cited “no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder,” although it did encourage further research on efficacy as well as addiction potential.
However, the American Nurses Association and the American College of Physicians each gave the use of therapeutic marijuana, and additional research, its blessing in 2008.
Nearly all professional organizations have cited concerns over quality control and specific guidelines for physicians’ recommendations as well as rules for suppliers. Not only is the proportion of CBD to THC a medical variable, but also various strains of the plant have different organic proportions of the compounds as well. The National Institute on Drug Abuse
claims that already the availability of legal cannabis dispensaries may be going far to reduce the problem of opioid addiction. States with medical marijuana have cited “… reductions of 16 to 31 percent in mortality due to prescription opioid overdoses, and 28 to 35 percent in admissions for treatment of opioid addiction,” according to a government-sponsored study.
Hope Healthcare, the umbrella under which Hope Hospice operates, doesn’t rule out its use, according to CEO Samira Beck with .“Each person, and family, in Hope’s care has an intra-disciplinary team dedicated to providing physical, emotional, spiritual and practical comfort. Every option is considered― massage, counseling, physical and expressive therapies, medical equipment, and of course, medications― including THC,” she says .“In fact, a child in Hope’s care is currently prescribed cannabis under the ‘Low-THC and Palliative Care exemption’ and it has proven effective for the management of some of his symptoms.”
Despite that, Beckwith says, “Medical cannabis may not be a high priority for Hope Hospice because our experience demonstrates that there are many effective medications currently available to provide people in our care with optimum comfort.
“Unfortunately, many only have access to Hope Hospice care for just a matter of weeks. During this phase of life, the benefits of medical cannabis will not be as beneficial as medications we currently provide. If people have access to Hope earlier, we could provide more comforting care and stop needless suffering,” Beckwith adds.
Counter intuitive ly, a synthetic form of medical marijuana has been legally available in pill form in the U.S. for decades. Dronabinol (brand name Marinol) was approved by the FDA in 1985 to treat nausea in chemotherapy patients and in 1992 to counteract weight loss in AIDS patients. Patients on Dronabinol report a marijuana high that does not happen with the CBD-based types of medical marijuana.
Opinions vary on whether or not the 90-day doctor-patient relationship is unnecessarily restrictive. “I called the governor’s office and complained about this,” Arnold says. “When you have people dying over the pain … Two people had been patients for only one week, one 26-year-old mother and one 59-year-old woman with cancer, and both died.” Arnold said pain directly contributed to the former’s death and likely caused the latter to die by suicide. Pain doesn’t wait for red tape. Adding to the uncertainty on all sides is the fact that details of Florida’s law were still unclear at press time, as six possible implementation plans were being brought before the Legislature to meet the July deadline for a state plan. The amendment called for an implementation plan to be in place six months after it became law.
That’s one holdup groups have cited. “We are still waiting for the Legislature to pass its bill and the Department of Health to promulgate its rules on the dispensing of medical marijuana, so we can understand the circumstances in which it can be ordered,” says Lee Health spokeswoman Mary Briggs. “Once those rules are issued we will assess if policy or procedures changes are necessary to make sure the health system is in compliance.”
In other words, like the local municipalities, the health system isn’t touching it … yet.