Dr. Bone and Tim were connected through Shawn Hammond, the grower for Zion Pharmaceuticals (check out our interview with Shawn here.) When Tim began to get involved in the cannabis scene in Utah, Shawn encouraged Tim to reach out to Dr. Bone.
Dr. Bone, based out of West Palm Beach, Florida, is an expert in cannabis and speaks internationally on the subject.
Florida medical providers do not have patient caps. However, patients do have a daily milligram cap on THC. Clinicians can prescribe a certain number of milligrams of CBD and a certain number of milligrams of THC that the patient may purchase for 70 days.
Dr. Bone found that there are Florida patients who order as little as one to two hundred milligrams of THC a day, up to 10,000 milligrams a day.
Utah patients are restricted to 20 grams (or 20,000 milligrams) per month.
Dr. Bone believes that the Florida program provides robust options for patients. However, one of the challenges she has experienced is with seniors.
The Florida Medical Marijuana program requires either a driver’s license or Florida state photo ID. However, older seniors may not have had a driver’s license for years. Also, for seniors who are in severe pain, it can be difficult for them to get to a location where they can obtain a state ID. Utah faces the same challenge, as the EVS system requires a state ID.
One difference between the Utah and Florida Medical Marijuana programs is the amount of flower that can be possessed . Utah allows patients to obtain four ounces of flower per month, versus only two and a half ounces every 35 days in Florida.
Another difference between the two states is how they handle out-of-state Medical Marijuana cards. In Florida, you must meet all residency, ID, and health qualification requirements to obtain a card, even if you have obtained a card in another state. This is especially problematic for seasonal residents, who may not have a permanent residence in the state.
In Utah, out-of-state Medical Marijuana cards cannot be used. However, a temporary card may be issued with an out-of-state license.
In Florida, every caregiver has to register and pay an annual fee to be able to administer Medical Marijuana for their patients. They also have to complete a course and pass a five-question quiz, which can be intimidating to some people.
These hurdles were created in Florida to prevent anyone from claiming they are a caregiver so that they can easily obtain Medical Marijuana.
This caregiver issue is very similar in Utah. In Utah, anyone under 21 who uses Medical Marijuana must have a caregiver. Caregivers are required to pay an additional fee and have a background check.
Dr. Bone works in a memory care unit, a locked unit for patients with all types of dementia, including later-stage dementia. Because the unit is funded with healthcare dollars from Medicare and Medicaid, they are unable to treat patients with THC products. They are able to see some success with CBD for anxiety, hyperactivity, agitation, and combative behavior. However, she also sees success with her private practice patients that are prescribed THC.
Her approach with THC and dementia is to start with a full spectrum or low THC product and assess the results. Then, if necessary, she will increase dosages and CBD/THC ratios until the patient sees results.
There are no dispensary limits in Florida. However, it is very expensive to start a dispensary. This is because dispensaries require “full vertical integration”, which means you have to grow cannabis, harvest it, process it, package it, and bottle it in your retail facilities. Dr. Bone estimates that dispensaries will require an investment of up to $60 million to get started.
In Utah, there are eight grow licenses and 14 dispensary licenses. Unlike Florida, Utah dispensaries are not required to also grow their own product. This allows growers and dispensaries to focus on what they do best.
In Florida, patients must have a face-to-face consultation and physical examination with a medical provider. This requirement was not waived during the COVID-19 pandemic.
There are no specific parameters for what the physical examination consists of. Providers are just required to provide a basic examination and review the patient’s medical history.
If the patient has one of the 12 qualified medical conditions, they can be given a Medical Marijuana card. After approval, it typically takes 14 days for them to receive a card.
The patient’s medical marijuana certification is good for 70 days. Providers can set this to automatically re-certify after 70 days. However, providers in Florida are required to see the patient every 210 days.
In Florida, patients applying for Medical Marijuana use with a non-qualified medical condition requires a letter to the state in which the physician says why the patient would benefit from cannabis, documented with medical literature to support their opinion (called a “similar diagnosis”). For example, anxiety is not an approved diagnosis. A provider would have to say it is “similar” to PTSD, which is an approved diagnosis.
In Utah, applications for Medical Marijuana use with a non-qualified medical condition require approval from the state’s Compassionate Use Board, a board of seven physicians.
As of the recording of this podcast, Dr. Bone believes there are ~400,000 patients in Florida.
Dr. Bone’s child went to an outdoor wilderness therapy program in the Uinta mountains in Utah. Her other connection to the state is as a breast cancer survivor and speaker. Specifically, she spoke on behalf of Myriad Genetics — a company in Utah.
You can learn more about Dr. Bone on her website, drmelaniebone.com. On the site, you can contact Dr. Bone and learn more about her mentoring program for doctors.