FL: No Easy Path To Obtain Medical Cannabis

Photo Credit: Brad McClenny

Over-the-counter pain medication had become an enemy for Chris Breyfogle before the Marine veteran met Dr. Justin Davis.

The 1,600 milligrams of ibuprofen he took daily led to Barrett’s esophagus, a condition in which the esophagus lining thins, and diverticulosis, a condition that causes small, bulging pouches to develop in the digestive tract.

The alcohol Breyfole used to numb the memories of two combat tours in Iraq made everything worse.

In March, Breyfogle, like more than 2 million other Americans, decided that he was tired of waiting for answers and made the decision to seek medical cannabis to provide relief from years of pain caused by his grocery list of medical disorders.

“I have lived with chronic pain, PTSD and anxiety for quite some time,” Breyfogle said. “And I’ve medicated with alcohol. I’ve medicated with a never-ending litany of NSAIDS and other pills that have, frankly, destroyed my body.”

It took Breyfogle hours of Google searching, he said, to find a doctor in Gainesville that could help.

The Florida Department of Health lists 20 doctors in Alachua County who are qualified to order medical cannabis for their patients, but they aren’t necessarily easy to find. And, of those, only 12 are accepting new patients.

“It’s not like you Google ‘medical marijuana doctor’ and they just pop out at you,” he joked.

Florida Marijuana Doctors, Davis’ private practice, is the one Breyfogle felt most comfortable trusting.

It wasn’t an easy decision to seek the help, but he said he knew it had to be done.

“I had to come to a decision that, OK, I am now on these medications because I was on all of these other medications. This is a problem. This is something that we need to look at. I literally had to have a conversation with myself because there is a stigma in just showing up at the door,” Breyfogle said.

Getting to the doctor’s door

After years of working in family medicine, Davis was ready for something different.

Davis, a board-certified family practice doctor, grew up in Archer and went to the University of Florida for undergraduate and medical school.

He once ran a house-call practice in San Francisco, where his patients would either come to his home or he’d go to theirs. He called it an “off the beaten path” entrepreneurial endeavor — something he’d always been interested in.

So, when he came back to Florida in 2016, around the time voters in the state approved a more liberal constitutional amendment for medical cannabis, he took a $1,000 test to become certified to recommend it — the first doctor in Gainesville to do so.

“I was familiar with marijuana legislation from when I was in California, and it seemed like an interesting avenue,” Davis said. “I knew it was something that helped patients quite a lot and I felt like I could be on the cutting edge of helping people here by heralding in medical marijuana.”

After Breyfogle found Davis’ website, he searched how to schedule an appointment. To his surprise, the amount of patient vetting done before the appointment is impressive, he said.

In Davis’ practice and similar to other practices, patients seeking medical cannabis first fill out an online form with basic information like their name, address, phone number, Social Security number and birth date. The form also requires the patient to list current and past medical problems, allergens and medications, and then attach medical record files that support each medical condition or diagnosis.

Breyfogle said because of the extent of his medical history and medications, the process took him hours to complete.

But he’s an organized person, he said, and knew his way around records systems.

For those patients without medical records on-hand or knowledge of how to get them, Breyfogle said he could see it making for a complicated screening process, leading to longer wait times for appointments.

He had to wait about two weeks.

Davis said the vetting process is so strict because of the demand for service and cost, which varies from doctor to doctor, he said. Health insurance doesn’t cover any of it.

For an initial visit with Davis, patients pay a $300 fee, which includes a patient-evaluation exam, a physical exam and a medical cannabis order, which details the strength and milligrams of cannabis appropriate for the patient. The order is valid for seven months under current Florida law. Every seven months, patients must go see their doctor again — a $250 fee at Davis’ office.

His office also enters the patient into the Compassionate Use Registry so they can apply for a mandatory state identification card. The card costs $75.

Breyfogle said once he got in Davis’ office to meet with him, it was an easy, simple appointment.

However, he argued that the cost of getting approved for medical cannabis is just as taxing as the weeks-long process.

“You have to have some resources upfront to be able to do this,” he said. “Florida did not make this easy.”

First appointment

Walking in to his first appointment, Breyfogle said he noticed he was the youngest patient in the waiting room.

“I was surprised because I’m pushing 40,” he said.

Also to his surprise, the people there had severe conditions like he did.

“I thought people would be in there like, ‘Ugh, my eye.’ No. It’s incredibly legitimate.”

Davis told The Sun by the time his patients arrive at the office, he already knows them, in a sense, because of the vetting process. The first visit, he said, serves to educate and to dispel any myths that might be lingering inside the patient’s head about medical cannabis.

“There’s been nearly 100 years of misconstruing (cannabis) and making it into a very polarized political issue,” Davis said. “It’s all about normalizing it and talking about it as a medicine.”

He then talks with the patient about their conditions to further determine if medical cannabis is appropriate. If it’s determined they don’t qualify, Davis refunds the appointment cost.

Florida law enumerates a list of debilitating conditions that make residents eligible for cannabis. The list includes cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, Amyotrophic lateral sclerosis, also known as ALS, Crohn’s disease, Parkinson’s disease or terminal illnesses. Davis said doctors also can use their own discretion to recommend cannabis to treat patients with chronic pain or anxiety.

Florida only permits medical use of oils derived from the cannabis plant. Currently, smoking cannabis itself is not permitted, although that’s being challenged in court.

Any one of Breyfogle’s conditions would have qualified him for medicinal cannabis, Davis said.

During his appointment, Breyfogle said Davis talked with him about his conditions and then tailored a recommendation for medical cannabis that fit his lifestyle.

Breyfogle has two children and works a day job, so Davis suggested he use a cannabinoid or THC oil that made him functional throughout the day, providing mild pain and anxiety relief. At night, Davis suggested a stronger strain of cannabis, like an inhalant with THC, to help with his more extreme nightime pain and PTSD.

Post-traumatic stress disorder is a reality for millions of Americans and at least 11 percent of all veterans, according to data available from the U.S. Department of Veteran Affairs. However, the condition was only recognized by the American Psychiatric Association in 1980.

Davis’ recommendation order for Breyfogle details the milligrams of cannabis liquid, which includes extracts, oils, and tinctures, alloted for the seven-month period.

“The first appointment with Dr. Davis was quick and painless,” Breyfogle said. “But then you leave the office and you’re left in limbo with the state.”

Waiting game

Florida Department of Health reports that there are about 120,000 patients now registered in its Compassionate Use Registry. As of Wednesday, about 3,200 patients had been added since June 8.

Nationally, there were 2,132,777 legal medical cannabis patients in the 26 states that allow it, as of May 17, according to procon.org.

For those patients with completed online or paper applications for medical cannabis use, it will take Veritec, a Jacksonville company outsourced by the DOH Office of Medical Marijuana Use to process the applications, up to 13 days to do so, according to the DOH’s June 15 update.

It had previously said it’d take up to 16 days.

The patients’ applications must be processed before they can receive their state-issued “medical marijuana use card,” which are used in a cannabis dispensary like a driver’s license to buy cannabis products.

As of Friday, the state has 2,614 applications being processed. The thought is, Davis said, as the number of doctors certified to recommend medicinal cannabis to their patients increases, the more applications will be backlogged, which could make wait times grow. Currently, there are close to 2,000 doctors qualified to recommend medical cannabis in Florida, according to the DOH.

“I think it’s criminal negligence on the part of the state,” Davis said. “I think the wait is intentional. Originally, it was transparent with the state’s (previous) three-month waiting period.

“I mean, I don’t want to compare the two but you can walk into a pain clinic and walk out the same day with an unlimited supply of opiates, depending on the doctor.”

Breyfogle shared Davis’ sentiment.

He said he understood that medical cannabis in Florida is in its infancy and there is a steep learning curve to catch up to other states with laws that make the medicine more accessible.

But he said he didn’t understand why he had to wait so long.

“I had to do a huge workup to the appointment and then had to wait two weeks to get an appointment,” Breyfogle said. “Then, when I called the state (after submitting my application), I was told they didn’t know when my application would be processed — basically that I’d have to take the sideline and wait like everyone else.”

Breyfogle added that despite his debilitating conditions, they’re not going to kill him, and it upsets him that because of wait times, people with terminal illnesses might not get the chance to use medical cannabis for pain relief in their final days.

DOH interim communications director Devin Galetta did not provide comment about the maximum time Veritec has to process applications or what the state is doing to improve wait times.

After a nearly six-week process, Breyfogle finally got his chance for relief.