How Does Medical Marijuana Work?
Medical marijuana contains active chemical compounds called phytocannabinoids that interact with a distinct physiological system known as the Endocannabinoid System. This system is comprised of endogenous cannabinoids, cannabinoid receptors, and regulatory enzymes. The endogenous cannabinoids and their receptors are found throughout the body: primarily in the nervous system and the immune system, but also in the gastrointestinal, endocrine, hematopoetic systems and more. Human and animal studies demonstrate the role of the endocannabinoid system in a wide variety of physiologic processes and this ubiquity of the endocannabinoid system suggests the possibility of multiple therapeutic roles for medical marijuana.
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Frequently Asked Questions
Before being approved as a qualified physician, 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. Register for the course here – https://flmedical.inreachce.com/Details?groupId=43ad9de9-3183-41ad-8e84-21cd0b20f0b0
A physician who completed the 8-hour course required by the 2014 and 2016 legislation5 is deemed to be in compliance with the new educational requirement, effective on June 23, 2017, until 90 days after this course became available. However, the physician must have completed the 8-hour course prior to June 23, 2017. To be clear, if you took the 8-hour course on or after June 23, 2017, then you have to take the new 2-hour course before you can be approved as a qualified physician. If you took the 8-hour course prior to June 23, 2017, then you will be deemed a qualified physician until 90 days from September 28, 2017, at which point you will no longer be a qualified physician unless and until you take the new 2-hour course.
While physicians no longer need to wait 90 days to qualify a patient, the patient will still need to wait until the Office of Medical Marijuana Use approves their application before purchasing any products.
In order to qualify the patient, a physician must also have:
- Conducted a physical examination while physically present in the same room as the patient and a full assessment of the medical history of the patient.
- Diagnosed the patient with at least one qualifying medical condition.
- Determined that the medical use of marijuana would likely outweigh the potential health risks for the patient, and such determination must be documented in the patient’s medical record. If a patient is younger than 18 years of age, a second physician must concur with this determination, and such concurrence must be documented in the patient’s medical record.
- Determined whether the patient is pregnant and documented such determination in the patient’s medical record physician may not issue a physician certification, except for low-THC marijuana (CBD), to a patient who is pregnant.
- Reviewed the patient’s controlled drug prescription history in the prescription drug monitoring program database established pursuant to s. 893.055.
- Reviewed the medical marijuana use registry and confirmed that the patient does not have an active physician certification from another qualified physician.
- Registered as the issuer of the physician certification for the named qualified patient on the medical marijuana use registry in an electronic manner determined by the department, and:
a. Enters into the registry the contents of the physician certification, including the patient’s qualifying condition and the dosage not to exceed the daily dose amount determined by the department, the amount and forms of marijuana authorized for the patient, and any types of marijuana delivery devices needed by the patient for the medical use of marijuana.
b. Updates the registry within 7 days after any change is made to the original physician certification to reflect such change.
c. Deactivates the registration of the qualified patient and the patient’s caregiver when the physician no longer recommends the medical use of marijuana for the patient.
- Obtained voluntary and informed written consent of the patient for medical use of marijuana each time the qualified physician issues a physician certification for the patient, which shall be maintained in the patient’s medical record. The patient, or the patient’s parent or legal guardian if the patient is a minor, must sign the informed consent acknowledging that the qualified physician has sufficiently explained its content. The qualified physician must use a standardized informed consent form adopted in rule by the Board of Medicine and the Board of Osteopathic Medicine which shall be maintained in the patient’s medical record. The patient, or the patient’s parent or legal guardian if the patient is a minor, must sign the informed consent acknowledging that the qualified physician has sufficiently explained its content. The qualified physician must use a standardized informed consent form adopted in rule by the Board of Medicine and the Board of Osteopathic Medicine.
A patient must be diagnosed with at least one of the following conditions to qualify to receive marijuana or a marijuana delivery device:
- Positive status for human immunodeficiency virus.
- Acquired immune deficiency syndrome.
- Post-traumatic stress disorder.
- Amyotrophic lateral sclerosis.
- Crohn’s disease.
- Parkinson’s disease.
- Multiple sclerosis.
- Medical conditions of the same kind or class as or comparable to those listed above.
- A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification.
- Chronic nonmalignant pain. 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.
If a qualified physician issues a physician certification for a qualified patient diagnosed with a qualifying medical condition “of the same kind or class as or comparable to those listed above”, the physician must submit the following to the applicable board within 14 days after issuing the physician certification:
- Documentation supporting the qualified physician’s opinion that the medical condition is of the same kind or class as the conditions listed above.
- Documentation that establishes the efficacy of marijuana as a treatment for the condition.
- 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.
- Any other documentation as required by board rule. The department must submit such documentation to the Coalition for Medical Marijuana Research and Education established pursuant to s. 1004.4351.
A qualified physician may not issue a physician certification for more than three 70-day supply limits of marijuana. The department shall quantify by rule a daily dose amount with equivalent dose amounts for each allowable form of marijuana dispensed by a medical marijuana treatment center. The department shall use the daily dose amount to calculate a 70-day-supply.
- A qualified physician may request an exception to the daily dose amount limit. The request shall be made electronically on a form adopted by the department in rule and must include, at a minimum:
a. The qualified patient’s qualifying medical condition.
b. The dosage and route of administration that was insufficient to provide relief to the qualified patient.
c. A description of how the patient will benefit from an increased amount.
d. The minimum daily dose amount of marijuana that would be sufficient for the treatment of the qualified patient’s qualifying medical condition.
- A qualified physician must provide the qualified patient’s records upon the request of the department.
- The department shall approve or disapprove the request within 14 days after receipt of the complete documentation required by this paragraph. The request shall be deemed approved if the department fails to act within this time period.
A qualified physician must evaluate an existing qualified patient at least once every 30 weeks (210 days) before issuing a new physician certification. A physician must:
- Determine if the patient still meets the requirements to be issued a physician certification under paragraph (a).
- Identify and document in the qualified patient’s medical records whether the qualified patient experienced either of the following related to the medical use of marijuana:
- a. An adverse drug interaction with any prescription or nonprescription medication; or
- b. A reduction in the use of, or dependence on, other types of controlled substances as defined in s. 893.02.
- Submit a report with the findings required pursuant to subparagraph 2. (above) to the department. The department shall submit such reports to the Coalition for Medical Marijuana Research and Education established pursuant to s. 1004.4351.
An active order for low-THC marijuana (CBD) or medical marijuana issued pursuant to former s. 381.986, Florida Statutes 2016, and registered with the Medical Marijuana Use Registry before the effective date of this section, is deemed a physician certification, and all patients possessing such orders are deemed qualified patients until the department begins issuing medical marijuana use registry identification cards.