Florida first legalized medical cannabis in 2014 when the Legislature passed the Compassionate Use Act allowing patients suffering from cancer and epilepsy to access low-THC cannabis. This program grew in 2016 under the Right to Try Act which permitted full strength cannabis to patients with a terminal illness.
On November 8, 2016 Florida voters passed Amendment 2 with a 71.3% majority (in every single county!), allowing for an expanded medical cannabis program, effective January 3, 2017. While operational, the program existed in a legal grey area until June when Governor Rick Scott signed Senate Bill 8A into law, removing the dreaded "90 day wait" and establishing operational guidelines to meet the requirements of Amendment 2.
Cannabis has long been called a viable treatment alternative to relieve symptoms of ALS, but the most astonishing results have come from many ALS sufferers that have managed to slow the progression of the disease through regular, controlled doses of cannabis oil.
Bob Strider began experiencing the symptoms of ALS in 1998, specifically the loss of function in his right arm and problems swallowing. An avid cannabis enthusiast, he had used cannabis heavily for decades, which he considers has kept the development of his illness slow but steady. In 2012, Strider began manufacturing his own cannabis oils, dosing himself with about a gram per day for 60 days. Within 10 days of his routine, he regained control of his right arm and managed to stop using opiates to handle his pain.
Cannabis contains at least 85 distinct kinds of cannabinoids, the active compounds that produce drug-like effects throughout the body. The effects of these cannabinoids in treating cancer symptoms and the side effects of cancer treatments is so beneficial, cannabinoids are synthesized for legal, prescription usage. Dronabinol and Nabilone/Cesamet, two synthetic pill forms of THC, are FDA-approved and now being used to treat nausea and nausea associated with chemo. Cannabidiol (CBD) is proven to relieve pain, lower inflammation, and lessen anxiety with no "high" of THC, the major psychoactive ingredient in cannabis. In Canada, a cannabis extract containing THC and CBD named Nabiximols/Sativex is approved for pain relief in patients with advanced cancer and multiple sclerosis. According to the U.S. government's National Cancer Institute, other effects of cannabinoids include anti inflammatory action, blocking cell growth, preventing the development of blood vessels that supply tumors, fighting viruses, and relieving muscle spasms.
Florida Health officials say many medical marijuana users report substantial reductions in pain. More than 60 percent of the more than 2,200 patients surveyed by the state report gains from using marijuana in inhaled or pill forms during the first five weeks after Florida approved cannabis to treat pain. The poll also found that 43 percent of physicians observed medical marijuana with a positive impact on patients. Approximately 10 percent of patients reported no benefit, while as much as 40 percent experienced mild side effects like fogginess or fatigue. At least one patient decided that the positive effects of cannabis were just temporary.About 10 percent of patients reported no benefit, while as much as 40 percent experienced mild side effects like fogginess or fatigue. At least one patient decided that the positive effects of cannabis were only temporary. The report surveyed patients who used cannabis in 2016 for the first time to deal with chronic pain. "It is heartening to see that this fairly large percentage achieved that level of decrease in their pain evaluation score," said Dr. Tom Arneson, research director for the office of medical cannabis.
Over 350 patients involved in the analysis originally reported using opioid painkillers. Almost 63 percent reported decreased or removed opioid usage after six months of using medical cannabis. "We need further research into the potential value of medical cannabis in pain management, particularly as our communities grapple with the damaging consequences of opioids and other drugs now in use for this function," Arneson said.
One especially interesting therapeutic application of the ECS (Endocannabinoid System) is its effect on the immune system, or what some scientists refer to as "immuno-cannabinoid" modulation. Simply stated, the ECS will help modulate or change the properties, tone, and overall function of the immune system. Although the immunomodulatory effects of the ECS haven't been fully elucidated, here is what we do know. Cannabidiol is particularly potent in this respect.
Secondly, cannabinoids have been demonstrated to play a role in modulating neurogenesis and neurodegeneration. By way of instance, evidence from numerous studies demonstrates beneficial effects of cannabinoids on animal models of stroke, head injury, cerebral ischemia, in addition to beta-amyloid induced tau protein phosphorylation (tauopathy). It has been established that the immune system plays a critical role in many of these neurodegenerative and neuroinflammatory conditions.
GW Pharmaceuticals group conducted a stage 3 multi-center, randomized, double-blind, placebo-controlled trial globally, aiming to evaluate the effectiveness and safety of 2 distinct CBD doses and compare them to a placebo. They included the CBD and placebo doses into regimens of conventional antiepileptic medication prescribed to treat "fall" seizures in patients with the rare but severe Lennox--Gastaut syndrome form of epilepsy.
Patients taking a daily high dose (20 mg of CBD per kilogram of body weight; e.g., about 1,600mg daily for a 180-pound adult) of the CBD medication while continuing their traditional antiepileptic regimen experienced a median 41.9% percent decrease in seizures after 28 days. Participants taking a lower dose of CBD (10mg per kilogram of body weight) experienced a 37.2percent reduction. Patients in a placebo group experienced a 17.2% drop in seizures. Results were statistically significant.
Going back to the 1970s, studies have shown that cannabinoids can alleviate glaucoma-related symptoms since they lower the intraocular pressure (IOP) and have neuroprotective actions. By way of example, in 1971, among the first studies of its kind found ingestion of cannabis lowers IOP by 25 to 30 percent.
Regardless of the findings from early research, hardly any ophthalmologists support using medical marijuana in patients with premature to mid-stage glaucoma. The main issue ophthalmologists have with cannabis is that the potential adverse effects -- particularly smoking cannabis -- outweigh the short term benefits. For example, smoking can result in unstable intraocular pressure, thereby increasing risk of permanent vision loss.
Further, because its therapeutic effects on glaucoma are short-term, patients would need to consume cannabis frequently -- once every few hours. Doctors assert that because glaucoma has to be treated 24 hours per day, patients would need to consume cannabis six to eight times over the course of a day to achieve consistently lowered IOP levels. Such frequency is not easy to maintain and could increase the chance of developing a cannabis use disorder.
Even the current success of combination therapy--that, by keeping HIV in check, has changed AIDS from a terminal illness to a chronic disorder--has a downside. The very drugs that give individuals with HIV a future can make their daily life miserable. As this 41-year-old Virginia theater technician told the IOM team.
Thirteen years ago I found out that I was HIV-positive. These medications have two things in common: they gave me hope and they also made me ill. Nausea, diarrhea, fatigue, vomiting, and loss of appetite became a lifestyle for me. After three years of these side effects ruling my life, a doctor suggested a simple and effective means to manage many of them. This remedy kept me from slowly starving to death, as I had seen many of my friends do. It helped me rejoin the human race as a responsible, productive citizen. Additionally, it made me a criminal, something I have never been before.
Like this man, increasing numbers of AIDS patients appear to be using marijuana to counteract the side effects of prescribed medicines as well as to treat disease symptoms. Specifically, those who take exceptionally effective antiviral drugs known as protease inhibitors often suffer from nausea and vomiting like that experienced by cancer patients during chemotherapy. Just how effectively marijuana and cannabinoids reduce the nausea and vomiting brought on by AIDS drugs remains to be determined in the clinic. Research on marijuana's antinausea properties has focused on chemotherapy-induced emesis (vomiting) in cancer patients and is discussed in depth in the next chapter. A number of distinct kinds of antiemetic drugs (including substituted benzamides, serotonin receptor antagonists, and corticosteroids) have been used successfully by both AIDS patients and cancer patients, so there is reason to believe that cannabinoids could help both groups. On the other hand, clinical trials suggest that marijuana and THC do not control nausea and vomiting as efficiently as do other drugs.
Since a wide array of factors affect emesis and each person responds to them differently, it is possible that patients would get better relief from marijuana-based medications than from conventional treatments. In the meantime, some people with AIDS who take THC in the form of dronabinol (Marinol) to fight weight loss may also find that it reduces their feelings of nausea. AIDS patients who took the drug in a four-week clinical study showed a trend toward decreased nausea compared with those who took a placebo, as well as a substantial increase in appetite.
Based on a 2005 "gold-standard" trial of whole-plant cannabis-based extract (oromucosal spray containing 1:1 THC:CBD), cannabis-based medication was twice as effective as placebo to treat pain, and three times more effective for sleep. Neural tissue inflammation is common as the body's immune cells attack the central nervous system. The (well established) anti-inflammatory effects of cannabis can help MS sufferers. A 2014 systematic review provided high-quality evidence that cannabis-based medicines were highly effective in treating muscle spasms. Many scientists consider cannabinoids help control gut reaction and modulate gastrointestinal issues. According to a survey conducted by Scottish researcher Roger Pertwee, 51-60 percent of respondents reported a decrease in defecation urgency, a 44% reduction in incontinence, and 30% had less constipation. Many MS patients will experience depression or at least persistent mood issues. Pertwee's survey discovered that more than 90% of the MS sufferers reported botanical cannabis as improving mood.
There are risks and benefits associated with using cannabis for those who have Parkinson’s Disease. Benefits include a potential improvement in stress, pain control, sleep disorder, weight loss and nausea. Potential adverse consequences include: impaired cognition (impairment in executive function), dizziness, blurred vision, mood and behavioral changes, loss of equilibrium and hallucinations. Chronic use of marijuana can increase risk of mood disorders and lung cancer.
One investigator of PTSD and cannabis is the Multidisciplinary Association for Psychedelic Studies (MAPS). Martin Lee is a MAPS affiliate and director of Project CBD, and has analyzed PTSD and cannabinoids in depth. "Researchers found that people with PTSD had lower levels of anandamide, an endogenous cannabinoid compound, compared to those who didn't show signs of PTSD," Lee wrote,"Innate to all mammals, anandamide (our inner cannabis, so to speak) triggers the same receptors that are activated by THC and other components of the marijuana plant."
To put it differently, one pillar of PTSD is an endocannabinoid deficiency: the body stops producing enough endocannabinoids to fill receptor sites, and this is where the cannabinoids found in marijuana play a therapeutic role. By replenishing these missing endocannabinoids with those found in cannabis, researchers think marijuana pharmaceuticals might bring PTSD patients relief from their own memories.
One of the strongest arguments for medical marijuana and terminal illness is for treating nausea, vomiting and loss of appetite. Cancer patients which are undergoing chemotherapy have profited greatly from the availability of FDA approved medical marijuana. It's known to reduce nausea and vomiting, often when more traditional medical treatments for the symptoms don't produce important results. Nausea and Vomiting can occur with several terminal illnesses such as cancer and AIDS -- related illness.
Cancer and AIDS may also lead to loss of appetite. It is expected at the very end of life that appetite decreases until it's nonexistent in many cases. However, it's often great for patients to consume as much as you can until it becomes impossible. In actuality, the hunger-inducing effects of medical marijuana are so well known that they are even known colloquially as"the munchies" from the recreational marijuana use neighborhood.
Medical marijuana's effects are felt soon after ingestion and almost immediately after inhalation. There's absolutely no guarantee it will alleviate depression, stress and suicidal ideas. However, it is beneficial for its fast-acting advantages. There's some research to suggest that medical marijuana can help some of the symptoms related to depression, especially difficulty sleeping, but it's still an under-researched area of medical care.
A study, published in the medical journal Psychopharmacology, found that those who use cannabis daily or nearly daily had a blunted pressure reaction when subjected to a high-stress scenario after a period of abstinence from marijuana. While non-cannabis users reported feeling stressed and experienced elevated levels of the stress hormone cortisol when stressed, chronic cannabis users reported reduced levels of stress, and their cortisol levels remained the same under high strain as they they were under no pressure. The study included 40 people who had used cannabis chronically over the past year and 42 people who had used cannabis no longer than 10 times in their lives and not at all in the prior year.
CBD has also been proven to exert a chemopreventive effect at a mouse model of colon cancer. In this experimental system, azoxymethane increased premalignant and malignant lesions in the mouse colon. Animals treated with azoxymethane and CBD concurrently were protected from developing premalignant and malignant lesions. In in vitro experiments between colorectal cancer cell lines, the researchers found that CBD protected DNA from oxidative damage, increased endocannabinoid levels, and reduced cell proliferation. In another study, the investigators found that the antiproliferative effect of CBD was counteracted by selective CB1 but not CB2 receptor antagonists, suggesting an involvement of CB1 receptors.
Another research to the antitumor effects of CBD examined the role of intercellular adhesion molecule-1 (ICAM-1). ICAM-1 expression was reported to be negatively correlated with cancer metastasis. In lung cancer cell lines, CBD upregulated ICAM-1, resulting in decreased cancer cell invasiveness.
One especially interesting therapeutic application of cannabis is that the endocannabinoid system, or ECS, is the impact on the immune system, or what some scientists refer to as "immuno-cannabinoid" modulation. Simply stated, the ECS will help modulate or change the properties, tone, and general function of the immune system. Even though the immunomodulatory effects of the ECS haven't been fully elucidated, here is what we do know. Cannabidiol is very potent in this respect.
Secondly, cannabinoids have been demonstrated to play a role in regulating neurogenesis and neurodegeneration. By way of instance, evidence from numerous studies demonstrates beneficial effects of cannabinoids on animal models of stroke, head trauma, cerebral ischemia, in addition to beta-amyloid induced tau protein phosphorylation (tauopathy). It's been demonstrated that the immune system plays a vital role in many of these neurodegenerative and neuroinflammatory conditions.
Cannabidiol (CBD) is proven to relieve pain, lower inflammation, and lessen anxiety with no "high" of THC, the major psychoactive ingredient in cannabis. In Canada, a cannabis extract containing THC and CBD called Nabiximols/Sativex is approved for pain relief in patients with advanced cancer and multiple sclerosis. According to the U.S. government's National Cancer Institute, other effects of cannabinoids include anti-inflammatory activity, blocking cell growth, preventing the growth of blood vessels that supply tumors, fighting viruses, and relieving muscle spasms.
Cannabinoid receptors have a coordinated dance with specific neurons in the brain known as proopiomelanocortin (or POMC neurons), which are located in the hypothalamus. These neurons control appetite stimulation (as well as other base instincts, such assexual stimulation and alertness -- this explains so much). The POMC neurons are also responsible for sending a chemical signal to the brain to stop eating when the man or woman is full.
However, this study made the correlation that when cannabinoids are introduced to the system, a receptor within the POMC neuron is activated, causing a change from signaling that the individual is full to making endorphins, a neurotransmitter that increases appetite. Tamas Horvath, the lead writer (who has also authored numerous scientific studies on cannabinoids and eating behavior, as well as endocannabinoids and their role in body fat regulation), likened the compound influence to switching your foot by a gentle tap of the brakes to quickly accelerating instead. It fools your brain's central feeding system and you feel ravenous, even if you've only eaten. This explains a lot of the standard chemical reactions we often experience with the introduction of cannabis -- euphoria, stimulation, appetite.
Medical Marijuana (MMJ) was commonly used as a folk remedy throughout the world to treat inflammation and pain, among a number of other disorders. Only, in the last century, has the use of MMJ been discouraged. In America, up until the 1930's, Medical Cannabis products were prescribed as a pharmaceutical for many ailments, including GI. Over the last couple of decades, many research studies and clinical trials worldwide have overwhelming revealed that MMJ is a powerful drug, useful in the treatment of many conditions including Gastrointestinal Disorders.
Not only does cannabis reduce symptoms and side effects, it has also shown some promise as an inhibitor of HIV/AIDS development. One study, observed a marijuana constituent named Denbinobin slow down the replication of HIV. Though this mechanism requires further study, it opens up intriguing possibilities for improved HIV/AIDS therapies.
Medical marijuana for inflammation is effective at reducing inflammatory-related pain and chronic inflammation due to its two primary cannabinoids, CBD (cannabidiol) and THC (tetrahydrocannabinol).
During a 2008 study, researchers examined mice with swollen paws. The researchers gave the mice oral beta-caryophyllene doses that resulted in a 70 percent reduction in inflammation. Mice that didn't have CB2 receptors did not show any improvement. Both CBD and THC not only work to cure and prevent inflammation, but they also demonstrate efficacy in reducing both the creation and release of pro-inflammatory cytokines. They also cut LPS-induced STAT 1 transcription factor activation that contributes to specific inflammatory processes. Since researchers find that CBD is the most effective in tackling inflammation, CBD-rich bud for inflammation breeds can be helpful for individuals with extreme inflammation.
A recent study looked at the potential benefits of medical marijuana for those suffering from Huntington's disease, a disease that produces symptoms similar to those found in a patient with Parkinson's Disease. In this animal study, a mutant strain of hamsters that demonstrated that the symptoms of dystonia, a sub-group of disorders that share similar traits to Huntington's disease, were given a synthetic cannabinoid that activates the exact same cellular receptors as THC.
The hamsters showed symptoms of dystonia that included rapid jerky movements or slow, repetitive motions, like Huntington's disease victims. The hamsters showed a marked reduction of symptoms when under the effect of the synthetic cannabinoid, suggesting that medical marijuana could be beneficial to those with Huntington's Disease. Since dystonia is also sometimes a symptom of Parkinson's, the study suggests medical marijuana can also be beneficial to individuals with Parkinson's.
A couple of studies have been done on how medical cannabis can help minimize the side-effects due to certain medicines for Parkinson's disease. One study, from 2001, looked at the function cannabinoids play in reducing dyskinesia due to levodopa. The results of the study indicated that nabilone, a cannabinoid receptor agonist, could minimize the involuntary movements associated with levodopa use.
Cannabinoids have been shown to play a role in modulating neurogenesis and neurodegeneration. For example, evidence from numerous studies demonstrates beneficial effects of cannabinoids on animal models of stroke, head injury, cerebral ischemia, as well as beta-amyloid induced tau protein phosphorylation (tauopathy). It has been established that the immune system plays a critical role in many of these neurodegenerative and neuroinflammatory conditions.
The body’s own internal cannabinoid system, called the endocannabinoid system (ECS), is one of our most important physiological systems. Nearly every aspect of our health — including inflammation, immune response, neuroprotection, pain modulation — are all dependent on the ECS. Given the vital role of the ECS, particularly in neuroprotection and inflammation, many scientists believe the development of cannabinoid-based medications could be immensely useful in treating (and preventing) glaucoma.
A study, published in the medical journal Psychopharmacology, found that those who use cannabis daily or nearly daily had a blunted stress reaction when subjected to some high-stress situation after a period of abstinence from marijuana. While non-cannabis users reported feeling stressed and experienced elevated levels of the stress hormone cortisol when stressed, chronic cannabis users reported reduced levels of stress, and their cortisol levels remained the same under high strain since they were under no anxiety. The study included 40 people who had used cannabis chronically over the past year and 42 people who had used cannabis no longer than 10 times in their lives and not at all in the prior year.
"According to our findings, the possible effects of cannabis on anxiety do seem to extend beyond the period of intoxication," Dr. Carrie Cuttler, a researcher and clinical assistant professor at Washington State University and co-author of this analysis. "But," she cautions,"We are not yet comfortable saying if that muted stress reaction is a great thing or a bad thing."
Orrin Devinsky's team conducted a stage 3 multicenter, randomized, double-blind, placebo-controlled trial globally, aiming to evaluate the efficacy and safety of two distinct CBD doses and compare them to a placebo. They included the CBD and placebo doses into regimens of conventional antiepileptic medication prescribed to treat "fall" seizures in patients with the rare but severe Lennox--Gastaut syndrome form of epilepsy.
Patients taking a daily high dose (20 mg of CBD per kilogram of body weight; e.g., about 1,600mg per day for a 180-pound adult) of the CBD medication while continuing their conventional antiepileptic regimen experienced a median 41.9% percent decrease in seizures after 28 days. Participants taking a lower dose of CBD (10mg per kilogram of body weight) experienced a 37.2percent reduction. Patients in a placebo group experienced a 17.2% drop in seizures. Results were statistically significant.
Among the strongest arguments for medical marijuana and terminal illness is for the treatment of nausea, vomiting and loss of appetite. Cancer patients that are undergoing chemotherapy have benefited greatly from the availability of FDA approved medical marijuana. It's known to decrease nausea and vomiting, often when more conventional medical treatments for the symptoms don't produce significant results. Nausea and Vomiting can occur with different terminal illnesses like cancer and AIDS -- related illness.
Standard therapy for AIDS wasting focuses on stimulating the patient's appetite, usually with the medication megestrol acetate (Megace). Although approved for this purpose, Marinol is prescribed much less often. Clinical studies indicate that Megace stimulates weight gain more efficiently than Marinol and that patients get no additional benefit by making use of the drugs in combination. People who take Megace generally increase their food intake by about 30 percent, but gain mainly obese, rather than lean muscle or tissue mass. Like Megace, Marinol reverses starvation but has no impact on cachexia.
Up to now, THC is the only cannabinoid that's been evaluated in the clinic for its ability to stimulate appetite and thereby counteract AIDS wasting. In short-term (six weeks) and long-term (one year) studies, patients who received THC in the form of Marinol tended to experience increased appetite while maintaining a stable weight. Moreover, five patients in a preliminary study gained an average of 1 percent body fat after taking the medication for five weeks.
This category allows doctors to certify patients who have symptoms or medical conditions that are both debilitating and similar in nature to the medical conditions that are explicitly named in the law.
For a physical or mental health condition to be debilitating it must interfere with or limit the patient's life activities. So what does this look like? Does the patient miss work or other comittments due to symptoms? Does the condition interfere with their ability to sustain relationships, get around/drive/walk, perform manual tasks, concentrate, think, or communicate? Does the patient require medications or other treatments for their symptoms? If the answer is yes to any of these questions, it's likely the condition qualifies as debilitating.
In our practice we certify patients for medical cannabis treatment with a wide variety of health concerns. While it's impossible for us to provide you with a comprehensive list of conditions that may qualify, we can specify some of the most common qualifying classes and symptoms. If the condition you would like to treat with medical cannabis shares any of the below, it may likely qualify.
The first step in becoming a legal medical cannabis patient is seeing a qualified physician for a certification exam. We are currently accepting patients in all of our Local Offices here in Florida.
In our office we do require that you provide us with medical records verifying your condition(s). Having these available at the time of your appointment will assist with your certification, but we understand this isn't always possible. If you have any questions about obtaining/or providing your medical records please let us know.