Panel eyes small number of doctors making pot approvals

By Christine Sexton, The News Service of Florida

TALLAHASSEE — As the number of Floridians allowed to use medical marijuana continues to grow, new data shows that a relative handful of doctors have been responsible for a majority of the patients approved for pot.

Florida had 168,810 patient “certifications” for medical marijuana between Oct. 1 and March 31, and more than half of them came from 89 doctors, according to a new draft state report on medical marijuana.

The data has alarmed members of a special panel of doctors charged with keeping tabs on the ordering patterns of physicians who can authorize patients to take medical marijuana. Panel members fear that if left unabated, medical marijuana will become the state’s next public-health problem.

“To me, I look at this data and say this is just another form of a pill mill.” Sarvam TerKonda, a Jacksonville medical doctor and member of the joint review panel, said last week after reviewing the six-month draft report.

But members of the Physician Certification Pattern Review Panel of the Board of Medicine and the Board of Osteopathic Medicine were hazy about what sort of recommendations they should submit to the Legislature in a final report due in January.

“It feels like the 800-pound gorilla in the room,” board member Michelle Mendez, an osteopathic physician from Jacksonville and member of the panel, said.

“What is the Legislature’s expectations of the recommendations that we make?,” she asked. “ … What are they expecting to hear from us?”

The panel, created in state law, is responsible for reviewing the data for patterns and annually submitting a report with recommendations to the Legislature.

Sandra Schwemmer, an osteopathic physician from Tavernier who chairs the joint review panel, asked staff members to reach out to the Office of Medical Marijuana Use at the Florida Department of Health to get â€œguidelines.”

The concerns stemmed from data showing that 1,207 physicians had active medical- marijuana certifications during the six-month review period, but just 89 of them were responsible for 94,850 of certifications.

Put another way, 7 percent of the physicians were responsible for 56 percent of the medical marijuana certifications.

Florida voters in 2016 passed a constitutional amendment that legalized medical marijuana for patients with a broad range of conditions. That came after lawmakers earlier had legalized non-euphoric “low-THC” cannabis for limited conditions.

Under the system, physicians must ensure that patients have conditions that qualify for using medical marijuana and certify the patients.

The draft report included patient certifications for non-euphoric and full-strength medical marijuana and five different administration modes: inhalation, oral, topical, suppository and under the tongue. 

It does not include data on smoking medical marijuana, which wasn’t legal until lawmakers and Gov. Ron DeSantis approved a bill in March.

Data for the draft report was taken from two sources: the state’s physician-licensure database program and the statewide medical-marijuana use registry, which houses a variety of information about issues such as physician certifications, qualifying medical conditions and average maximum daily doses ordered.

And while the draft report contains nearly 500 pages of data and charts, it does not track all the counties where physicians are practicing.

That’s because physicians are only required to list their primary office addresses with the state and not the counties where they work.

Twelve specific diseases or disorders can qualify patients for medical marijuana certification, as well as a broadly written 13th category that captures “medical conditions of the same kind or class” as the other 12 conditions or diseases.

Chronic non-malignant pain was the No. 1 qualifying condition for medical marijuana certifications, accounting for nearly 34 percent of diagnoses in the draft report, followed by “medical conditions of the same kind or class” and post-traumatic stress disorder, which each accounted for roughly 26 percent of the certifications.

Joel Rose, a Tampa-based osteopathic physician and review panel member, asked whether the state was taking a close look at the diagnoses to ensure that physicians are following the law.

For instance, Rose noted that while patients with non-malignant chronic pain qualify for medical marijuana, that pain must stem from one of the underlying qualifying medical conditions, such as cancer, epilepsy, or glaucoma. The non-malignant chronic pain cannot stem from an acute injury. 

“I’m wondering is anyone looking at the quality of the data,” he said, adding he also had concerns with the broadly written “same kind or class” diagnoses.

The report also contains data on patients who are using medical marijuana.

The draft report shows there were 157,854 individual patients with active certifications, and the overwhelming majority — or 147,843 patients — had one active certification.

Patients also can have more than one certification. Of the 10,011 patients with more than one certification, only 25 percent of them were certified by two different doctors. Meanwhile, 23 patients had three different physicians issuing certifications.

During the six-month span, 60 patients had four certifications, but the report doesn’t specify how many physicians those patients were seeing.

A medical marijuana certification period can extend upward of 210 days under the law and can include three consecutive orders. Patients can purchase products until the total supply ordered by the physician has been reached.