Medical Marijuana: The Debate Comes To South Florida

Photo Credit: Shutterstock

In the year and a half since Florida became the 26th state to legalize medical marijuana, a new breed of doctors and “ganjapreneurs” has emerged to meet patient demands. Despite the drug’s illegal status at the federal level—and what some see as a blurry line between recreational use and medicinal necessity—many patients say medical marijuana has not only improved their lives but also helped them kick traditional pharmaceuticals to the curb.

José Hidalgo isn’t naïve. As the founder and CEO of Miami-based Knox Medical—one of 13 medical marijuana treatment centers (MMTC) licensed to grow, process, transport and sell medical marijuana across Florida—he admits that recreation could be the name of the game for some of his company’s nearly 12,000 customers. But what infuriates him, he says, is when people assume most of the patients who flock to his dispensaries are just looking to get high. “It’s insulting. If you’ve bought into that notion, you should come and take a look at our dispensary waiting rooms,” he says. “We’re dealing with a very sick population of people.”

But before sick patients can get access to the medicines Knox and other licensed MMTCs are selling, a doctor certified by Florida’s Office of Medical Marijuana Use must first determine whether marijuana could have therapeutic benefits targeted to patients’ ailments.

To help patients in South Florida connect with qualified doctors, Jake Greenbaum started a patient-doctor network called 877weed123. Don’t let the name of Greenbaum’s company fool you: he says that 99 percent of the patients he refers to doctors are seeking marijuana as a legitimate medicine. He says for his patients, a recreational high is the last thing on their minds—or their wallets, pointing to the high costs of doctor visits, state registry fees and non-reimbursed medicine prices that are de rigueur for medical marijuana users.

“Marijuana is plentiful on the black market in Florida,” Greenbaum explains. “People who just want to use it recreationally aren’t taking the time to come to a doctor. They’re not shelling out the amount of money medical marijuana costs, which is not covered by insurance. People who are willing to break the bank like that tend to be part of a very debilitated population. They’re wheelchair-bound with shooting pains in their limbs, they’re stage 4 cancer patients,” he says. “Some of these patients are in the kind of situations you don’t even want to believe exist.”

Hidalgo says it’s these kinds of patients Knox and other entrepreneurs who work in Florida’s new medical marijuana industry are hoping to serve. “Lives are being changed by our medicines,” he says.

Marijuana comes from all parts of cannabis, a plant comprised of a key group of chemicals known as cannabinoids. The two main chemicals used in the medicinal application of marijuana are Tetrahydrocannabinol (THC)—the psychoactive compound that produces the high—and Cannabidiol (CBD)—which does not produce psychoactive effects.

In Florida, marijuana produced for medicinal purposes is tracked from seed to sale. It is grown in highly sophisticated facilities that are monitored to assure no foreign chemicals are introduced, with lighting and watering systems that control how plants are raised. Independent laboratories test each harvest to ensure the product is free from fungal or bacterial infections, and that it contains the requisite ratio of THC to CBD.

A medical marijuana user from Martin County—we’ll call Margaret—is a patient who uses medical marijuana. She doesn’t want her full name used for fear of backlash in her community, but she does want to share her message: medical marijuana has not only changed her life; it has saved it.

Margaret had her first seizure in 2005. Doctors subsequently diagnosed her with epilepsy and wrote her a prescription. “I figured I’d take a pill twice a day, and that would be that,” Margaret recalls. But that pill was not the answer Margaret had hoped it would be; nor were the other 23 medications she tried under the care of a world-class epileptologist at Johns Hopkins Hospital in Baltimore, Maryland. For the next 10 years, Margaret says she experienced at least five seizures a month—between 600 and 700 seizures in all—while struggling to function due to debilitating pharmaceutical side-effects. In 2014, Margaret turned to a 24th medication to treat her intractable epilepsy: marijuana. Today she is seizure free.

Dr. Anne Morgan, M.D., a family medicine practitioner and chief medical officer at MMJ Health in West Palm Beach, says Margaret’s results are not as extraordinary as you might think. “Cannabis drastically reduces the number of seizures many epilepsy patients suffer, without the nasty side effects that come along with most seizure disorder drugs,” Morgan says.

Morgan is licensed by the state of Florida to recommend medical marijuana to patients, and she serves on the board of directors for the American Academy of Cannabinoid Medicine. Six years ago, however, she says she didn’t know the first thing about marijuana’s medical applications. When several of her patients who had relocated to South Florida—from states where medical marijuana was already legal—told her how marijuana had helped with ailments like PTSD, chronic pain, cancer and epilepsy, Morgan was intrigued. “It was a wakeup call for me as a clinician to do my own research,” she says.

Morgan spent the next several years learning all she could about medical marijuana and its effect on the human endocannabinoid system that emerging science shows is responsible for maintaining optimal balance in the body, also known as homeostasis. Armed with her new knowledge, Morgan became a vocal advocate for the drug’s legalization as a medicine in Florida. She was one of the first doctors approved to recommend it to patients after Florida Amendment 2 passed in 2016.

Although Morgan had witnessed marijuana’s effects on the health of her patients, she hadn’t experienced the drug herself until a traumatic horseback riding accident during this December left her with three brain hemorrhages, a shattered pelvis, a fractured wrist and seven broken ribs.

Doctors told her son, Marshall Morgan, that his mother—who was flown by helicopter to a trauma center and placed in a weeklong, medically induced coma—had a 40 percent chance of dying from her injuries. If she survived, they said, she’d have a 20 percent chance of permanent brain damage.

Because he had worked in the medical marijuana industry in California and Washington, Marshall Morgan knew about the drug’s neuroprotective properties. The Morgan family had recently acquired some CBD oil for their terminally ill dog, and Marshall Morgan figured giving some of it to his mother couldn’t hurt. Without consulting her doctors, he put drops of CBD oil under her tongue twice a day. After his mother emerged from the coma—spending more than a month in the hospital and a rehabilitation center—follow-up CT scans showed a remarkable rate of healing, with no residual brain damage.

“I wouldn’t be here talking to you if my son hadn’t given me that CBD,” Morgan says. “I am 100 percent certain that’s why I have no speech defects, no visual defects, no permanent brain damage.”

Now fully recovered and back at work treating patients, Morgan says her first-hand experience with medical marijuana’s healing powers continues to fuel her advocacy for the drug’s ability to change patients’ lives. “That’s why I have fought and will continue to fight to get these medicines into the hands of patients who need them here in Florida,” she says. “I’m not out to get high. None of my patients are either. We just want to use the medicines that work for the ailments we’ve got.”

“I’m not out to get high. None of my patients are either. We just want to use the medicines that work for the ailments we’ve got.” – Dr. Anne Morgan

When Margaret turned to medical marijuana to treat her epilepsy in 2014, the drug was still illegal in Florida. Undaunted, she located “a friend of a friend” to make a purchase from a street dealer on her behalf.

Because she didn’t want the high associated with smoking marijuana, Margaret decided to use the drug orally. After getting her epileptologist’s cautious approval, she watched YouTube videos on how to grind marijuana and pack it into empty capsules (which she purchased via Amazon). To her disbelief, that first test was a success: she was seizure free for the first time in almost a decade.

But the marijuana she bought off the street wasn’t consistent in supply or effect. “It worked for me, but I never knew exactly what I might be getting,” Margaret explains. Today she can legally access the marijuana medicines she uses to manage her epilepsy, anxiety and insomnia.

Margaret and other proponents of Florida’s medical marijuana program say that’s one of the reasons why legalizing the drug for medical use has been so key for patients: The state’s role in regulating MMTCs provides a source of reliable medication that is no different from traditional pharmaceuticals. “It’s totally different from what you get on the street market,” Morgan says of the marijuana she recommends to her patients. “What all the dispensaries are selling today is a clean and reliable product.”

Hidalgo says that instilling that kind of confidence in his company’s products is priority No. 1 at Knox. “We see ourselves as no different than a Pfizer or any other pharmaceutical company,” he says. “The worst thing that can happen is the medicine is working great for a patient, and then they have a different reaction to the same medicine in the next batch they purchase. That can be very dangerous.” He says Knox’s extraction methods ensure that the medicines have the same effects time after time. “We are homogenizing batches of the same strain, using the whole plant profile,” Hidalgo explains. “That strain is what gets made into oil and ultimately makes it into our medicines.”

For South Floridians, the medical marijuana Knox produces can be purchased at the company’s recently opened Lake Worth dispensary, where the only marijuana leaf in sight is on the company logo.

Knox’s 2,000-square-foot storefront sits on South Dixie Highway, just across the street from City Hall. Unlike the bong-filled head shops of popular imagination, Knox’s dispensary more closely resembles a high-tech medical spa where vials of cannabis-laced lotions, vape cartridges, suppositories and tinctures line sleek wood and glass display shelves.

The Lake Worth location was the first of its kind in Palm Beach County when it opened in November, and Hidalgo says business has been booming since day one. “It is by far our most successful dispensary in the state,” he says.

Knox’s dispensary is not alone in Palm Beach County. Curaleaf, another state-licensed MMTC, opened a dispensary just 12 blocks away in January. Miami-Dade County boasts three dispensaries. But due to moratoriums passed by cities and municipalities, neither Martin County nor Broward County has a dispensary yet.

If you think five dispensaries to serve population-dense South Florida seems like a mismatch between supply and demand, you’re right. Margaret says many of her fellow medical marijuana users frequently experience product shortages. She worries that supply is outstripping the state’s steadily growing demand. “I’ve weaned myself off of Klonopin and Temazepam. But what happens to me if the cannabis medicine I’ve replaced those drugs with is out of stock?” she asks. “The answer is I’d have to go back on pharmaceuticals I don’t want to be on. If you take my cannabis away, I don’t know when my next seizure will be the one that kills me.”

Still, while the popular opinions may be that Colorado or California is ground zero for marijuana, Hidalgo says Florida is playing a game of catch- up. Recent research from New Frontier Data backs his claims, projecting that Florida’s market will grow to $1.6 billion by 2020—making it half the size of California’s projected $2.6 billion market, and topping Colorado’s projected $1.5 billion medical marijuana market.

“Florida has the potential to be one of the largest medical markets in the country,” says Giadha Aguirre de Carcer, founder and CEO of New Frontier Data. “The state is home to the nation’s largest percentage of people ages 65 and older, a demographic for whom chronic pain and catastrophic illnesses are commonplace and expensive to treat. Amendment 2 gives this large patient pool access to legal cannabis as an alternative therapy to their diverse medical needs.”

If New Frontier’s projections are on target, by 2020 Florida could end up owning 7.5 percent of the total legal U.S. cannabis market and 14 percent of the medical marijuana market.  That’s a key year, since the state’s legislative control on production and distribution caps expires in 2020—caps that many patients like Margaret and doctors like Morgan say are stifling supply.

Until then, scaling up will only happen as new patients enter the state’s patient registry, which currently stands at just over 88,000 patients. Once that number tops 100,000, the state will award five more MMTC licenses, bringing the total from today’s 13 MMTCs to 18.

But new patients in the registry will mean more than just new MMTCs and increased supply. Margaret says she hopes that as the number of medical marijuana patients in Florida grows, so will acceptance and awareness on the part of both doctors and community members. “For me, cannabis was a last resort,” Margaret says. “But it shouldn’t be that way. For so many things it should be the first line of defense.”

Morgan agrees, saying that at this early stage in the state’s medical marijuana program, things are “still a little bit like pioneer medicine.” She says the more patients who come into the system, the more evidence doctors can gather to fuel future research.

In the end, Morgan says that regardless of numbers, it all comes down to helping patients in need. “If a patient who comes to me can be managed with a substance that’s safe and if they can avoid taking pharmacologic medications with debilitating side effects, they can lead much more useful lives,” she says. “That’s the goal.”

Florida Medical Marijuana by The Numbers:

Patients in the Registry: 88,154

Approved ID Card Applications: 60,958

Qualified Physicians: 1,225

Processing Time for Complete Paper Application: 24 days

Processing Time for Complete Online Application: 17 days

Approved Medical Marijuana Treatment Centers: 13

Approved Retail Dispensing Locations Statewide: 29

Approved Retail Dispensing Locations in South Florida: 5

Communities in Florida banning dispensaries: 100

Marijuana 101

Who can legally use medical marijuana in Florida?

Medical marijuana is a treatment option for Florida residents who have documented cases of Parkinson’s disease, PTSD, Crohn’s disease, glaucoma, AIDS/HIV, ALS, cancer, multiple sclerosis, epilepsy, chronic pain, seizure disorders, muscle spasms or any similar debilitating condition. It is also available to people suffering from any condition determined to be terminal by two physicians.

How do patients get a medical marijuana card?

People 18 or older must visit one of the more than 1,200 doctors who are permitted by the Florida Department of Health to recommend medical marijuana. Those under 18 are required to see two doctors. If a physician agrees that the use of medical marijuana has more benefits than risks, the patient is entered into the registry and can apply for an Office of Medical Marijuana Use ID card.  Once the initial certification is issued, patients must be reevaluated by their physician once every 30 weeks in order to be able to have their certification renewed.

Where is medical marijuana sold?

Registered patients in Florida can take their doctor’s recommendation on one of the 29 licensed medical marijuana retail dispensaries to make purchases. Patients are allowed to purchase up to a 70-day supply at one time.  Although federal law doesn’t allow marijuana to be sent through the mail, for patients who don’t live near a dispensary or can’t travel to one, most MMTCs deliver statewide.

How much does it cost?

An initial visit to a doctor to become certified generally costs around $200 with quarterly follow-up visits running at about $100. State ID cards from the Office of Medical Marijuana Use cost $75.

Depending on the amounts and varieties of medical marijuana a doctor may recommend, costs vary from patient to patient. At Knox’s dispensary, a 300-milligram vial of the sublingual drops costs $45, while 600 milligrams of a topical cream runs $120. Because cannabis isn’t covered by insurance, patients pay the entire amount out of pocket.

What forms of medical marijuana are available?

Florida patients can’t buy marijuana in what’s commonly known as “flower” form. Instead, medical marijuana is delivered through vaporizers, pills, creams, transdermal patches, suppositories, oral drops, edibles or nasal sprays. It’s illegal to smoke any form of marijuana—whether medical or recreational—in Florida.

Can people grow marijuana themselves?

With the exception of the state’s 13 licensed MMTCs, growing marijuana is illegal in Florida. Even a registered medical marijuana patient will be charged with a felony and could serve jail time for possession of a cannabis plant.

Is marijuana a legitimate medicine?

Because the Food and Drug Administration has not approved the use of marijuana for any medical condition—landing it in the Schedule 1 category along with heroin and LSD—it is tightly controlled, and studies on its efficacy are limited.

Current science supports the use of marijuana as a painkiller, anti-emetic, neuroprotectant and appetite stimulant. Ongoing research includes studies focused on pinpointing how it may affect certain body systems and disorders.

How does medical marijuana work in the human body?

The human body’s endocannabinoid system naturally makes marijuana-like chemicals that bind to receptors embedded in cell membranes in the liver, brain, lungs, kidneys, nervous system and immune system. When a patient uses medical marijuana, the chemicals in the drug are delivered to the blood through the lungs (when inhaled), the digestive system (when consumed), or the skin (when applied topically). When those chemicals interact with key endocannabinoid receptors, they can suppress signals such as pain, nausea and depression, while boosting signals of appetite and euphoria.

Is marijuana still illegal at the federal level?

Yes. However, the federal government hasn’t pursued criminal charges against people who sell or use medical marijuana within state registries. Because of the disconnect between federal and state laws, health insurance companies can’t cover medical marijuana, and doctors can’t prescribe it—they can only recommend it. Additionally, banks can’t accept deposits from MMTCs, so patients must pay cash when they make purchases at dispensaries. Employers are allowed to fire workers who test positive for marijuana, even if they consume the drug as a part of the state’s registry.