The Florida Legislature will have its hands full the next several months determining regulations for Amendment 2, which, despite garnering 71 percent of voters’ approval, is a bit wobbly in the knees.
Although the amendment expanding the parameters of medical marijuana made its constitutional debut Tuesday, the state’s Department of Health has a minimum of six months to define those boundaries. The awkward time lapse between the law’s effective date and its determined infrastructure is riling up uncertainty, to say the least.
“Right now it’s like, yeah, it’s passed, but what next?” said Adrian Long, a doctor at Crescent Beach Care, a walk-in health care clinic and family practice based in St. Johns County.
Just last week, Long completed the required eight-hour, $1,000 course and examination registering him in the Compassionate Use Registry database.
He can now recommend medical marijuana to patients meeting the qualifications of Amendment 2. But without guidelines officiated by the state, he has more questions than answers.
“As far as the next steps, I’m kind of lost in that aspect, as well,” Long said. “Hundreds of patients ask about it.”
Long said under current laws, established in 2014, doctors may order non-euphoric marijuana for patients with chronic muscle spasms or cancer and full-strength marijuana for terminally ill patients. The patients must be registered in the Compassionate Use Registry database and establish a 90-day relationship with a physician before receiving a recommendation.
But under Amendment 2, treatment has been expanded to patients diagnosed with epilepsy, glaucoma, HIV/AIDS, post-traumatic stress disorder, ALS, Crohn’s and Parkinson’s disease and multiple sclerosis.
Physicians can also certify patients by diagnosing them with “some other debilitating medical conditions” comparable to defined ailments.
Until the state sets regulations concerning identification cards, standards for caregivers and registered medical marijuana treatment centers, physicians are trapped in a gray zone.
“It’s difficult because as a doctor, you want to do what’s best for your patient,” Long said.
When building, a foundation must first be laid.
Richard Blau, head of the GrayRobinson Regulated Products Group, knows this best of all. His statewide group counsels clients through compliance issues in regulated industries and represents a Florida marijuana dispensary.
“It’s tough to go from zero, which is where this was in 2014, a product that was basically illegal for almost a century and had no real presence as a lawful industry, to a full-blown, properly regulated, functioning and effectively operating industry,” Blau said. “That just doesn’t happen overnight.”
As of now, Blau admits there are many open-ended questions in regards to the new amendment, such as how products will supply tax revenue, how dispensaries will be regulated and what infrastructure is needed for physicians. But he added it takes time and patience. Amendment 2 is only in the second stage of a several-step process requiring intricate and appropriate planning.
“At the end of the day, it’s in our public interest for things to be done right,” Blau said. “There are so many things that most people don’t think about that really need to be carefully considered and defined before you can go forward.”
The Legislature will have to determine who is eligible to dispense and where the dispensaries can be placed within the state. There must be regulations, forms and rules to maintain consistency across dispensaries, ensuring patients receive a valid product and physicians can be comfortable making recommendations.
Although Amendment 2 doesn’t grant local governments authority to deny dispensaries, Blau said many will choose to regulate them through zoning oridinances.
“What they can do is severely restrict where it can be grown, processed or sold and dispensed and when those activities can occur,” he said.
The Associated Press reports dispensaries haved opened in Tallahassee, Clearwater and Tampa. According to the Florida League of Cities, 55 cities statewide have zoning moratoriums in place either banning or restricting dispensaries. Most moratoriums are temporary as local officials anticipate the regulations of Amendment 2.
Only a handful of dispensaries have been authorized to distribute medical marijuana, none of which are located in St. Johns County. Once the patient registry reaches 250,000, an additional three licenses will be available statewide.
Blau said there is a divergence in opinion concerning how the industry’s market will grow. One side supports a free market, which will encourage entrepreneurship and creativity, so long as businesses meet basic safety and regulation standards. Others believe the stringent rules structurized by the Charlotte’s Web rules — those put in place in 2014 — should continue into Amendment 2. It is still up in the air whether entities will split into sects, divided into the production, dispensing or regulating of medical marijuana based on demand.
Until regulations are established, Blau urges physicians and patients to practice patience and caution. The limited dispensaries will also have to determine how to handle business regarding Amendment 2 patients.
“They will have to determine whether they will move forward with their constitutional authority to dispense the product or whether they will decline and instead wait until regulations tell them specifically what records to keep and what to dispense,” Blau said.
The state has already established some structure in previous years.
“The government has worked really hard to put together a system under the Charlotte’s Web regime and expanded it in 2015 for terminally ill patients,” he explained. “That system is in place and those rules are still there and functioning today under Amendment 2.”
Blau said despite the majority of Floridians favoring Amendment 2, opposition from individuals and organizations abounds, placing even more pressure on Legislature to implement structure.
“Most people live somewhere in the middle,” Blau said. “Whether they like it or don’t like it, they want to see it done responsibly and with integrity for the safety and welfare of their community.”
The Great Divide
Roby Baird is sick and tired of pharmaceuticals.
He’s tired of taking a pill in the morning. He’s tired of taking a pill at night.
“I want to be at the point where I’m not taking these medicines, these chemicals every day,” he said.
So a couple days after Amendment 2’s effective date, the St. Augustine resident called one of three physicians in St. Johns County licensed to recommend medical marijuana.
But Baird, who suffers with epilepsy resulting from a brain tumor several years ago, was promptly put on a wait list.
“They aren’t taking on new clients right now because the regulations aren’t set yet … ,” he said.
His theory on the delay isn’t based on the government’s strategic planning process, but on the possible influence of pharmaceutical companies.
“I truly believe the control aspect of it — the laws that are set in place, some of them are for the good — but some of them might be saying ‘we’ve got to make sure the drug companies are going to get some kickback in this before it’s set in motion,’” he said. “That’s ultimately the reason marijuana has been so illegal all along.”
Kevin Thompson, a family physician based in St. Augustine, doesn’t see the point in rushing.
“That’s the frustrating thing from a physician’s standpoint,” Thompson said. “You have these laws that come out and the public starts to interpret them as ‘it’s good for everything.’ That’s not the case.”
Six months ago, Thompson admits she was adamantly against medical marijuana. Since then, the family practioner has cautiously come around to the idea, although she still harbors doubt on the drug’s “cure all” potential.
Like any good doctor, Thompson believes any unproven treatment option needs thorough research, and medical marijuana hasn’t received enough of it.
“I think it’s a promising area for research. We’re kind of stuck, we want to give help to our patients and we’re seeing good responses, but we’re not seeing any big research saying ‘yes, it’s safe,’” Thompson said.
She’s also worried patients prescribed medical marijuana could sell or abuse the drug for recreational purposes or that doctors will recommend medical marijuana too frequently, inadvertently creating drug-related car accidents, crimes and addictions.
“There are going to be practitioners who are more lenient and just like we’ve had an enormous issue with pain medication management, I imagine that could potentially be a problem, as well,” she said, adding: “What’s to say that’s not going to happen with this too, and it will fall into the hands of people who don’t really need it?”
That’s a concern that fueled Lynnette Horwath, coordinator of PACT Coalition Prevention, to speak at a recent St. Augustine City Commission meeting.
She said she’s worried it’s too late for commissioners to enact zoning regulations preventing or limiting dispensaries from rooting in town. In her mind, Amendment 2 is simply setting the stage for marijuana’s recreational passage.
“We certainly don’t object to the people who need the medical marijuana use, it’s just kind of a Pandora’s box and allowing other things to creep in,” Horwath said.
There are already four zoning ordinances regulating the cultivation, sale and manufacture of legally available marijuana, among other things in St. Augustine. The move was made by commissioners in 2014 in anticipation of impending rules regarding low-THC cannabis (Charlotte’s Web). As for St. Augustine Beach, the City Commission has discussed regulating medical marijuana sales the same way the city regulates liquor stores, which are allowed if they have an area of less than 8,000 square feet within a shopping center having greater than 15,000 square feet under roof.
Isaiah Abenchuchan, a strong supporter of the medical marijuana movement, also spoke at the meeting and encouraged commissioners to move forward with the industry. He said under the commission’s proposed zoning ordinance, only one location will qualify under the restrictions for the beach.
Those limitations, he said, defeat the purpose of Amendment 2’s existence.
“It’s important for the people, who overwhelmingly supported the amendment, to have access to the medicine they would like to have,” Abenchuchan said.
He holds hope that Legislature will provide the framework needed to ease the minds of local government platforms. Medical marijuana is an area in which, if done properly, the Sunshine State could really shine.
“Florida has a chance to set a golden standard, because there are a lot of states [that] have done this. Some have done it better than others, but there isn’t that golden standard in the industry,” he said. “Florida has the chance to set these high-water bench marks so this is something that’s done well and responsibly.”