By MICHAEL PATTERSON

In February 2020, the Florida Supreme Court will review a petition from a group called “Regulate Florida,” to be placed on the ballot in November 2020 to legalize the use and cultivation (home grow) of cannabis to adults over 21. There is a second petition for cannabis legalization gaining signatures for 2020 from a group called “Make it Legal Florida.”  Their petition does not include the ability to grow cannabis at home (home grow). Either way, it seems that all of us will be voting on some sort of full cannabis legalization next year. 

If legal cannabis becomes a reality in the Sunshine State in 2020, what will happen to the state’s Medical Marijuana program?  A lot of physicians have been asking me this question lately, and there is some good news for physicians who write MMJ recommendations and bad news. 

Let’s start with the bad news. Based on other states like Colorado who legalized adult-use cannabis in 2012, the medical cannabis patient numbers will consistently and steadily decline commencing at the passage of adult-use.  At its peak, Colorado had over 100,000 medical cannabis patients in the system.  As of 2019, the patient numbers are approximately 30,000 and declining. 

Now, let’s discuss the good news.  If adult-use cannabis is legalized in 2020, depending on how the eventual law is written, it would not go into effect until January 2022.  In 2016, 71 percent of Florida voted in favor of legalizing medical marijuana.  In 2017 the Florida legislature passed legislation on how to implement this new constitutional amendment, and it was signed into law by former Governor Rick Scott.  However, some parts of the law have still not been implemented as of today due to the bureaucracy that is our state legislative system. So, if you are a physician currently recommending MMJ or looking to get into the industry, there are still potentially more than two years left in a pure medical cannabis system.  You have time to begin thinking about options to adjust to a new legal market. 

Also, adult-use cannabis will have a tax, medical cannabis currently has no tax (that is not expected to change with adult-use legalization).  By having a tax on recreational cannabis, it will cause customers to pay more (sometimes 30 percent more) without a medical card.  This will encourage your patients to stay in the medical system for longer due to the fact the #1 most common complaint about medical cannabis is cost.

If you are looking to evolve your business model with the introduction of recreational/adult-use cannabis, consider the following:

• Preserve your patient base through the development of TRUST. Start educating your patients and the public now about medical cannabis and the benefits. I know that may sound extremely obvious, but ensure you have a complete education strategy.  The more you can gain your patients’ ultimate trust and the public’s trust that you are a professional physician/group they can visit to explore the use of cannabis as a medicine (and not be judged or shamed), the better your retention rate.  Once adult-use comes and is implemented, these people who trust you and your team will stick with you longer than running to the recreational market right away. 

• Get into medical cannabis research studies- Network with current licensed medical marijuana companies in Florida to be involved in medical cannabis research studies. The more “pharmaceutically based” you can make your practice in dealing with medical cannabis, the better your chances to attract new patients (over the next 2 years) and keep patients if adult-use is legalized.

• Develop a new pricing model around WELLNESS - The $300-$350 per visit fees for a physician MMJ recommendation are numbered. You must begin looking at your long-term pricing strategy focused on wellness and value.  Look at services you can offer in conjunction with a MMJ recommendation visit that adult-use stores cannot. Focus on combining MMJ recommendations into a “wellness” visit where you incorporate an entire list of services to give the patient tools to a healthy life (blood work, BMI, nutrition counseling, DNA testing to determine the best cannabis medicine for each patient, hormone replacement, stem cell treatment, CBD counseling, extensive review of all current prescription meds, etc.)   The average age for a MMJ patient in Florida is approximately 50 years old.  Most of the people who will start using cannabis for medical purposes are not using it currently. 

• Focus on VALUE- When, not if, cannabis is legalized for adult-use there will be millions of people in Florida who want to try cannabis to help a medical ailment (primarily senior citizens). There are projected to be over 2 million monthly cannabis users in Florida 3-5 years after full adult-use legalization. Currently, 40 percent of people who use recreational cannabis use it for medical reasons (problems with sleep being the most commonly cited medical condition).  However, these new users will be too scared to go into a store “blind” not knowing anything.  Keep in mind the “reefer-madness” ideology for over 80 years has really created fear in the use of cannabis (in any form) by senior citizens across the country.  But at same time, seniors are tired of all of the side effects of their current prescription medications and are open to trying cannabis (with physician oversight).

• Fight to have a seat at the 2021 legislative “table”- when the law is written to implement legal adult-use cannabis (if it passes in 2020), have representation to implement changes in the current law for MMJ recommendations to make it easier to receive a MMJ recommendation.
  1. Allow full telehealth for MMJ recommendation visits via digital devices for all required visits.
  2. Allow ARNPs and PAs to recommend MMJ, not just MDs or DOs.
  3. Increase the list of qualifying diagnoses to receive MMJ or remove the list all together.
  4. Allow Florida doctors to recommend MMJ for any condition they feel would provide more benefit than harm (which is currently the Oklahoma MMJ law)
  5. Eliminate the mandatory state-wide MMJ patient registry. People don’t like being on “lists.” It seems too much like “big-brother.” Edit the law to allow the Department of Health to collect de-identified data (for future research) but not personal information.

The one constant in healthcare is change. Medical Marijuana is no different. The industry in Florida is evolving rapidly and providing opportunity for groups who can provide value and trust for their patients.

Michael C. Patterson, founder and CEO of U.S. Cannabis Pharmaceutical Research & Development of Melbourne, is a consultant for the development of the medical marijuana industry nationwide and in Florida. He serves as a consultant to Gerson Lehrman Group, New York and helps educate GLG partners on specific investment strategies and public policy regarding Medical Marijuana in the U.S. and Internationally. He can be reached at mpatterson@uscprd.com