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PATIENT GUIDE.

REGISTRY USER GUIDE FOR PATIENTS AND CAREGIVERS.

What is medical marijuana?

Florida law defines medical marijuana as all parts of any plant of the genus Cannabis, whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant or its seeds or resin, including low-THC cannabis, which are dispensed from a medical marijuana treatment center for medical use by a qualified patient.

In Florida, medical marijuana is distinct from low-THC cannabis in that it can contain significant amounts of tetrahydrocannabinol (THC). THC is the chemical compound that causes the “high” commonly associated with cannabis. Unlike low-THC cannabis, the consumption of medical marijuana can lead to potent psychoactive effects in patients.

Who qualifies for medical marijuana?

A qualified physician may only order medical marijuana for a patient with a qualifying condition that is diagnosed by the patient's physician.

Qualifying conditions include:

  • Cancer
  • Epilepsy
  • Glaucoma
  • HIV
  • AIDS
  • Post-traumatic stress disorder (PTSD)
  • Amyotrophic lateral sclerosis (ALS)
  • Crohn’s disease
  • Parkinson’s disease
  • Multiple sclerosis (MS)
  • Medical conditions of the same kind or class as or comparable to those above
  • A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification
  • Chronic nonmalignant pain 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

The medical use of medical marijuana does NOT include the following:

  • The possession, use or administration of medical marijuana by smoking.
  • The transfer of medical marijuana to a person other than the qualified patient for whom it was ordered or their legal representative.
  • The use or administration of medical marijuana on any form of public transportation, in any public place, in a qualified patient's place of employment, if restricted by his or her employer, in a state correctional institution, on the grounds of a preschool, primary school, or secondary school or any school bus or vehicle.

The medical use of medical marijuana does NOT include the following as stated in Section 381.986(1)(j), F.S.:

  • Possession, use, or administration of marijuana that was not purchased or acquired from a medical marijuana treatment center.
  • Possession, use, or administration of marijuana in a form for smoking, in the form of commercially produced food items other than edibles, or of marijuana seeds or flower, except for flower in a sealed, tamper-proof receptacle for vaping.
  • Use or administration of any form or amount of marijuana in a manner that is inconsistent with the qualified physician’s directions or physician certification.
  • Transfer of marijuana to a person other than the qualified patient for whom it was authorized or the qualified patient’s caregiver on behalf of the qualified patient.
  • Use or administration of marijuana in the following locations:
    -On any form of public transportation, except for low-THC cannabis.
    -In any public place, except for low-THC cannabis.
    -In a qualified patient’s place of employment, except when permitted by his or her employer.
    -In a state correctional institution, as defined in s. 944.02, or a correctional institution, as defined in s. 944.241.
    -On the grounds of a preschool, primary school, or secondary school, except as provided in s. 1006.062.
    -In a school bus, a vehicle, an aircraft, or a motorboat, except for low-THC cannabis

What is low-THC cannabis?

In Florida, low-THC cannabis is distinct from medical marijuana in that it contains very low amounts of the psychoactive component tetrahydrocannabinol (THC). Because of its low-THC content, it does not have the euphoric properties that full-potency marijuana has.

In order to qualify as low-THC, the flowers, seeds, resin, and any other product derived from the cannabis plant must contain 0.8 percent or less of THC and more than 10 percent of cannabidiol (CBD) weight for weight.

Who qualifies for low-THC cannabis?

Qualified physicians may order low-THC cannabis for a qualified patient conditions enumerated in section 381.986, Florida Statutes.

 What is a qualified physician?

  • An active, unrestricted license under 458 or 459
  • Complies with education requirements of 381.986(3)

 How to become a qualified physician:

  • Have an active and unrestricted license as a medical doctor or osteopathic physician in Florida.
  • Take the 2-hour course and examination offered by the Florida Medical Association or Florida Osteopathic Medical Association, depending on your license type.
  • If a physician took the previously offered course, they must take the 2-hour course on or before December 26, 2017, in order to remain a qualified physician.
  • You must re-take this course each time you renew your license if you wish to remain a physician qualified to order medical marijuana and low-THC cannabis.

Physicians ineligible to be qualified physicians:

  • Physicians holding a restricted license
  • Physicians that are employed by an MMTC or Marijuana Testing Laboratory, including physicians that are a medical director for those companies
  • Physicians that have a direct economic interest in an MMTC or Marijuana Testing Laboratory
  • Physicians that have any indirect economic interest in an MMTC or Marijuana Testing Laboratory

The Office of Medical Marijuana Use will publish a list of all physicians meeting these qualifications on its website as required under 381.986(10)(e). This list is published regardless of whether the physician has a profile in the Medical Marijuana Use Registry or has placed, or intends to place, any orders.

What is a physician certification?

  • A qualified physician’s authorization for a qualified patient to receive medical marijuana and a medical marijuana delivery device from an approved MMTC.

How to know if a patient is qualified:

  • They are a resident of Florida
  • They are a seasonal resident of Florida (residing in Florida for at least 31 consecutive days each year, maintains a temporary residence in Florida, returns to the state in which they reside at least once per year, and is registered to vote or pays income tax in another state or jurisdiction)
  • The physician diagnoses the patient with a qualifying medical condition:
    -Cancer
    -Epilepsy
    -Glaucoma
    -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 qualifying physician and confirmed by a second physician
    -Chronic nonmalignant pain – pain caused by a qualifying medical condition, or that originates from a qualifying medical condition above and persists beyond the usual course of that qualifying medical condition.

 Prerequisites to physician certification:

  • Physical examination while present in the same room as the patient
  • Full assessment of patient’s medical history
  • Diagnose patient with a qualifying condition
  • Determine the medical use of marijuana likely outweighs health risks and document that in the record.
  • For patients under 18 years of age, have a second physician agree in writing that medical use of marijuana likely outweighs the health risks for that minor patient.
  • Determine if the patient is pregnant. If the patient is pregnant, it must be documented in that patient’s medical record and only low-THC cannabis certification can be given to that patient during the pregnancy.
  • Review the patient’s history in the PDMP database
  • Confirm the patient does not already have an active certification from another physician in the Medical Marijuana Use Registry.
  • Physician must register as the physician issuing the certification to that qualified patient in the registry.
  • Obtain voluntary and informed written consent each time a physician certification is provided to the patient and keep that with the patient’s medical record. The approved informed consent form containing all legal requirements is available from the Board of Medicine and Board of Osteopathic Medicine.

 How does a patient get issued a physician certification:

  • After the physician registers as the patient's certifying physician in the registry, the physician can enter the contents of the certification into the registry for that qualified patient.
     

What information does the qualified physician enter into the registry for the qualified patient?

  • The qualifying condition of the patient
  • Dosage of medical marijuana not to exceed the daily dose amount determined by Department rule
  • The amount of medical marijuana or low-THC cannabis authorized for the qualified patient
  • The form of medical marijuana or low-THC cannabis authorized for the qualified patient
  • The medical marijuana delivery devices the patient needs for the medical use of the physician’s certification
    The physician can place no more than 3 orders for a maximum of 70-days per order as part of a physician certification for the qualified patient. Thereafter, the physician must issue a new certification, complying with all of the initial certification requirements and additional requirements required by 381.986(4)(d).

What physicians must do after issuing the first physician certification:

  • If the physician wishes to make a change to the original certification for the patient, they must update the registry within 7 days of making that change.
  • For subsequent certifications for the qualified patient which must occur at least once every 30 weeks:
  • Conduct an in person physical exam while in the same room as the qualified patient
  • Determine if the patient still meets all the requirements to be issued a physician certification as the physician determined at the time of the first certification.
  • Identify and document in the medical record for the patient whether the patient experienced an adverse drug interaction with any prescription or nonprescription medication with medical marijuana.
  • Identify and document in the medical record for the patient whether the patient experienced a reduction in use of, or dependence on, other types of controlled substances.
  • Submit a report to the Department including the information obtained from the patient regarding adverse reactions or reduction in use or dependence on controlled substances as a result of the patient’s medical use of marijuana.
  • If the physician no longer recommends the medical use of marijuana for the patient, they must deactivate that patient’s registration and the registration of any caregiver for the patient.
  • Submit to the Board within 14 days after issuing the certification for the qualified patient documentation required under 381.986(4)(b). The Board of Medicine and the Board of Osteopathic Medicine have created a form that is available for qualified physicians to use and submit to the Boards containing all of the required documentation.

 Penalties for physicians operating outside of the requirements of 381.986:

  • A qualified physician who issues a physician certification for marijuana or a marijuana delivery device and receives compensation from a medical marijuana treatment center related to the issuance of a physician certification for marijuana or a marijuana delivery device is subject to disciplinary action under the applicable practice act and s. 456.072(1)(n).
  • First Degree Misdemeanor for physician to issue a certification for the medical use of marijuana for a patient without a reasonable belief that the patient is suffering from a qualifying medical condition.
  • Possession or manufacturing of a blank, forged, stolen, fictitious, fraudulent, counterfeit or unlawfully issued registry ID card is a Third Degree Felony.
  • Physicians must continue to meet the standard of care and refrain from violating provisions of Chapter 456, 458 and 459 in their practice as a qualified physician certifying patients for medical use of marijuana.
  • Physicians may also be subject to criminal penalties under Chapter 893 and other appropriate civil or administrative penalties if they violate section 381.986.

What is the difference between low-THC cannabis and medical?

  • Low-THC cannabis means a plant of the genus Cannabis, the dried flowers of which contain 0.8 percent or less of tetrahydrocannabinol and more than 10 percent of cannabidiol weight for weight; the seeds thereof; the resin extracted from any part of such plant; or any compound, manufacture, salt, derivative, mixture, or preparation of such plant or its seeds or resin that is dispensed only from a dispensing organization. Low-THC cannabis contains very low amounts of the psychoactive compound THC, and typically does not result in the “high” often associated with medical cannabis.
  • Medical marijuana means all parts of any plant of the genus Cannabis, whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, sale, derivative, mixture, or preparation of the plant or its seeds or resin that is dispensed only from a dispensing organization for medical use by an eligible patient. Medical marijuana contains significant levels of the cannabinoid THC, and can result in the euphoric "high" sensation.

 What is a marijuana delivery device?

  • A marijuana delivery device is an object used, intended for use, or designed for use in preparing, storing, ingesting, inhaling, or otherwise introducing marijuana into the human body, and which is dispensed from a medical marijuana treatment center for medical use by a qualified patient.

Are low-THC and medical marijuana products currently available in Florida?

  • Yes. Patients may find medical marijuana treatment centers in their area by clicking here. All medical marijuana treatment centers in Florida are authorized to deliver statewide. If you do not have a medical marijuana treatment center in your area, you may contact one of the businesses listed on the Department’s website to arrange for a delivery of low-THC cannabis, medical marijuana, or a marijuana delivery device.

 Who is eligible to receive an order for low-THC cannabis products?

Patients suffering from the following conditions:

  • Cancer
  • Epilepsy
  • Glaucoma
  • HIV
  • AIDS
  • Post-traumatic stress disorder (PTSD)
  • Amyotrophic lateral sclerosis (ALS)
  • Crohn's disease
  • Parkinson's disease
  • Multiple sclerosis (MS)
  • Medical conditions of the same kind or class as or comparable to those above
  • A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification
  • Chronic nonmalignant pain 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

 Who is eligible to receive an order for medical marijuana products?

Patients suffering from the following conditions:

  • Cancer
  • Epilepsy
  • Glaucoma
  • HIV
  • AIDS
  • Post-traumatic stress disorder (PTSD)
  • Amyotrophic lateral sclerosis (ALS)
  • Crohn's disease
  • Parkinson's disease
  • Multiple sclerosis (MS)
  • Medical conditions of the same kind or class as or comparable to those above
  • A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification
  • Chronic nonmalignant pain 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

 What are the requirements to become a qualifying patient?

  • Be diagnosed with a qualifying condition
  • Be entered into the Medical Marijuana Use Registry by a qualified physician
  • Obtain a Medical Marijuana Use Registry Identification Card
  • Be a Florida resident or a seasonal resident

How do patients find qualified physicians who can order low-THC cannabis, medical marijuana or cannabis delivery devices?

  • A list of physicians authorized to order low-THC cannabis, medical marijuana or marijuana delivery devices for patients is located on the Patient’s tab on the Office of Medical Marijuana Use website. That information can be found here.

Are there requirements for a Florida physician to qualify to order low-THC cannabis, medical marijuana or a cannabis delivery device?

  • Yes. A physician may only order low-THC cannabis or medical marijuana if he or she holds an active, unrestricted license as a physician under Chapter 458, Florida Statutes or an osteopathic physician under Chapter 459, Florida Statutes.
  • Additionally, a qualifying physician must have successfully completed a 2-hour continuing education course and examination. Renewal of the 2-hour course and subsequent examination is required each time the physician renews his or her medical license. A link to the course and examination is available on the Physician's tab located on the Office of Medical Marijuana Use website. This information can be found here.

What are the requirements for a Medical Director of a Dispensing Organization?

  • A medical director must hold an active, unrestricted license as a physician under Chapter 458, Florida Statutes or as an osteopathic physician under Chapter 459, Florida Statutes. They must also complete a 2-hour continuing education course and examination. A link to the course and examination is available on the For Physician's tab located on the Office of Medical Marijuana Use website.

Who can sell low-THC cannabis or medical marijuana?

  • Click here to access the list of approved medical marijuana treatment centers.

How can a patient purchase low-thc or medical marijuana?

  • A qualified patient must first seek treatment from a qualified physician. A qualified physician must input the patient into the Medical Marijuana Use Registry. Once the physician inputs the patient’s information, the patient must apply and be approved for a medical marijuana use identification card. Once approved, patients must go to or seek delivery from an approved MMTC.

Who can purchase medical marijuana from an approved medical marijuana treatment center?

  • Medical marijuana treatment centers may only provide low-THC cannabis, medical marijuana or a marijuana delivery device to a qualified patient or a qualified patient's legal representative.

Who can be a qualified patient's caregiver?

  • Florida law defines a caregiver as a resident of Florida who has agreed to assist with a qualified patient’s medical use of marijuana, has a caregiver identification card, and meets all requirements under Florida law.

A caregiver must:

  • Be 21 years of age;
  • Agree in writing to assist with a qualified patient’s medical use of marijuana
  • Be registered in the medical marijuana use registry as a caregiver for no more than one qualified patient, unless exempted from this requirement by Section 381.986(6), F.S.; and
  • Meet all other requirements of Section 381.986(6), F.S.

A caregiver may not:

  • Be a qualified physician;
  • Be employed by or have an economic interest in a medical marijuana treatment center or a marijuana testing laboratory; or
  • Receive compensation, other than actual expenses incurred, for any services provided to the qualified patient.

Can patients obtain low-THC cannabis or medical marijuana if they do not have one of the qualifying conditions?

  • No. Physicians may only order low-THC cannabis or medical marijuana for patients diagnosed with one of the qualifying conditions or conditions of like kind and class.

Does the law allow qualifying patients to grow their own low-thc cannabis or medical marijuana?

  • No.

How much low-THC cannabis or medical marijuana can a qualifying physician order for a patient?

  • Qualifying physicians can order no more than a 70-day supply and a marijuana delivery device needed by the patient for the medical use of low-THC cannabis or medical marijuana.

Will low-THC cannabis and medical marijuana be inspected and tested?

  • Yes. Low-THC cannabis and medical marijuana must be processed within an enclosed structure away from other plants and products. Medical Marijuana Treatment Centers are required to test the processed low-THC cannabis and medical marijuana before they are dispensed. The results must be verified and signed by two employees of the MMTC. The MMTC must reserve two processed samples from each batch and retain them for at least nine months.
  • Cannabis test results must indicate that low-THC cannabis meets the definition of low-THC cannabis and that all medical and low-THC cannabis is safe for human consumption and free from contaminants.
  • The MMTC must also contract with an independent testing laboratory to perform audits on the MMTC’s standard operating procedures, testing records and samples.

What are the packaging requirements for low-THC cannabis or medical marijuana?

Packaging of the marijuana in compliance with the United States Poison Prevention Packaging Act of 1970, 15 U.S.C. ss. 1471 et seq. They should be packaged in a receptacle that has a firmly affixed and legible label stating the following information:

  • The marijuana or low-THC cannabis meets the requirements of the law.
  • The name of the medical marijuana treatment center from which the marijuana originates.
  • The batch number and harvest number from which the marijuana originates and the date dispensed.
  • The name of the physician who issued the physician certification.
  • The name of the patient.
  • The product name, if applicable, and dosage form, including concentration of tetrahydrocannabinol and cannabidiol. The product name may not contain wording commonly associated with products marketed by or to children.
  • The recommended dose.
  • A warning that it is illegal to transfer medical marijuana to another person.
  • A marijuana universal symbol developed by the department.

Do qualified physicians have to conduct an in-person physical examination or can they issue a certification for medical marijuana by telemedicine?

  • The law requires that qualified physicians may only issue a certification if they conduct a physical examination while physically present in the same room as the patient and a full assessment of the medical history. A certification may not be issued through telemedicine.

What Is a Marijuana Strain?

  • Cannabis plants have distinct characteristics that can be expressed based on a number of factors. These unique characteristics create a marijuana strain.
  • Natural techniques have allowed cannabis breeders to create different types of marijuana based on a variety of desires (e.g. short, tall, fast, slow) and then final consumable results (e.g. sleepy, speedy).
  • An easy Seed Finder search turns up eight different types of OG Kush being offered by cannabis seed breeders. At the very least a dispensary could offer eight different types of OG Kush that were grown from seeds from reputable seed breeders. Crazy, right? It wasn’t always this way.
  • Cannabis breeding has grown dramatically in the last few years because marketing has created some strains that are said to be worth millions. Charlotte’s Web has garnered plenty of praise for its ability to reduce seizures without making patients feel the typical, cerebral high.
  • Cannabis consumers need to educate themselves about marijuana strains. There are numerous marijuana review sites and people documenting their tokes on Tumblr and YouTube.