The Corridor Paper

The ‘Weeding’ of the Corridor

The Other Green Movement

Some changes happen quickly.

Others evolve over long periods, even centuries.

Anthropologist have determined that cannabis (also known as marijuana) was used to treat physical and mental afflictions as long as 3000 years ago.

Fast forward to November 8, 2016. The voters of Florida, in a historic referendum on Amendment 2, approved Florida’s Medical Marijuana Initiative by a margin of 71.1% to 28.7%. This was followed by the passage of SB8A and SB6A in the Florida Legislature. These acts implemented Article X, section 29 of the Florida Constitution and defined “debilitating medical conditions” that may benefit from cannabinoids. These include nausea and vomiting (often post chemotherapy), HIV/AIDS, chronic pain, neurological problems, post-traumatic stress disorder (PTSD) and several other physical and mental conditions.

Clearly, given the stigma of its past, the use of cannabis in any form is fraught with controversy and concerns about side effects, including societal ones. But as of today, therapeutic prescription of cannabis derivatives is legal in Florida. And certain pre-qualifications are included in the law to assure controlled use and discourage abuse.

Dr. Robert Brueck MD FACS, a  physician and board-certified plastic surgeon with more than 33 years of practice in Lee and Charlotte counties became interested in cannabis as a palliative when research on the subject began to surface and his post-operative patients started commenting to him that cannabis therapy was helping them deal with pain.

“Many of my patients, who had experienced post-operative pain, reported to me that they were using cannabis to alleviate their discomfort. I became curious enough to investigate the literature about cannabis research. Unfortunately, there was not much to read because cannabis is a Schedule 1 controlled substance, which restricted it from funding the kind of clinical research Schedule 2 drugs can receive.”

Dr. Brueck also related a story of woman who was diagnosed with a tumor in her lungs that was too massive to be operated on. She was given 6 months to live. “After 3 months of cannabis (CBD/THC) therapy, a new x-ray revealed the size of the tumor had shrunk enough to allow surgery to remove it. She is now 7 years post-op and cancer free. Of course, such stories are widespread and seldom quantified.”

Not to get too deeply into the “weeds” here (pun intended), this writer must disclose that he is neither a doctor, medically-trained, or a user of cannabis. In fact, my sole experience with the subject is as a very small investor in a Canadian company that produces and sells medical cannabis in Canada, where its medical use has been legalized in every province.

Moreover, nothing in this article is intended as medical advice, which the writer is not qualified to offer or provide.

Fort Myers, and specifically the area covered by the Corridor, has at least one facility to counsel potential patients and assist them in determining if they are qualified for cannabis therapy. Dr. Brueck is the medical director at Liberate Physician Centers on Gladiolus Drive.

At this time, Florida law does not permit smoking marijuana as a legal use, even as a medical use. It is also recommended that cannabis not be used during pregnancy. The effect of cannabis use by children is unclear and appears not to
have been studied, which may be why the American Academy of Pediatrics opposed its legalization for medical use.

Permitted uses include capsules, lozenges, oils, tinctures, skin patches, oral sprays, edibles and vaporizing.

According to studies, the main differences between the ways of administering the medication are the rates at which the the dosage becomes effective. Methods that include metabolizing cannabinoid through the liver significantly slow down the rate of transmission to pain centers in the brain.

Cannabis is generally considered to have two main components. THC (delta-9-tetrahydrocannabinol) is believed to be the compound that is psychoactive and creates euphoric reactions. Delta-8-tetrahydrocannibinol, cannabiniol (CBD), cannabinol (CBN) appear to have little or no psychotropic effect, but play a role in overall effect.

There is considerable technical data available for anyone interested in more information, including about possible side effects such as dizziness, fatigue, vomiting and hallucinations. Clinics such as Liberate can also provide in-depth information.

Dr. Brueck says that the mission of his center is “to provide medical evaluations that will assist patients to determine qualification and, if qualified, become certified for possession of a Florida Medical Marijuana Card.” This includes registration in the Florida Office of Medical Marijuana Use Registry.

Currently, the registration costs $75, a fee set by the State of Florida. According to Dr. Brueck, an initial visit to a doctor certified to process an application costs $150. A follow-up visit, if necessary, runs about $100 to $150. If the patient has his or her medical records, a second visit may not be required, only a later follow-up to make sure there are no complications.

At this time, health insurance does not cover these  costs. After submission of an application, it typically takes between 17 days (online) and 23 days (paper application) to have it processed. The resulting Florida Marijuana Card and Registration is valid for one year.

Dr. Gregory Sonn, DO, is another Fort Myers/Corridor area doctor who counsels patients from his Iona office on McGregor Boulevard concerning the use of medical versions of cannabis to to treat and relieve chronic pain

and other afflictions. He is quoted as observing, “The idea of medical cannabis as an alternative medicine fits in very well with what I do and what I preach and think. I am focused on making this a significant part of my practice.”

The State Department of Health is required to have rules for the medical use of marijuana established this month (July). While many doctors have taken steps to qualify as Medical Marijuana doctors (there is a list by city/county at the Florida Office of Medical Marijuana Use), most doctors are wary of proceeding too fast, since it is still a Schedule 1 drug nationally. “It (cannabis) is an experimental drug,” says Sonn. “What ever the government tells me to do, I’m going to do.”

According to the News-Press, Lee Health, which we featured in the Corridor last month, has decided to wait until this summer to decide whether or not to create a medical cannabis policy of its own. All this caution appears to be warranted. Even though medical marijuana is legal in Florida, it remains a Schedule 1 drug on the federal level. Until its status nationally is clarified, marijuana prescribers and dispensers face some risk. Still, our neighbor to the north, Canada, appears to be on track to legalize the substance in all provinces, which may be an omen for the US.

As a final note, it is interesting that the interest in medical marijuana has arisen at the same time concern about opioid addiction has spiked. Opioids often are prescribed to alleviate pain. Unfortunately, the addictive qualities of opioids appear to frequently lead to overdoses and death. Whether or not cannabis-based treatment can replace opioids to treat chronic pain, we leave to experts with more knowledge and medical training.

 

We truly live in interesting times.

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