Marijuana Patients Say Florida's New Dose Limits Stifle Treatment

Photo by Elsa Olofsson via Flickr
Nearly six years after the legalization of medical marijuana in Florida, the state has imposed strict dosage limits for cannabis patients.

As of August 29, a new Florida Department of Health rule caps patients' dosage across all major categories of medicinal marijuana, including a 350 mg daily limit on THC from vaporizers and a 60 mg daily limit on THC from edibles. The rule prohibits doctors from prescribing a patient more than 24.5 grams of THC, a primary active ingredient in marijuana, within a 70-day period, excluding smoking products.

Kristina Risola, the director of operations of Florida Medical Cannabis Clinic, calls the dose limits "completely arbitrary numbers." She says the caps will prevent people from experimenting to find what products treat their condition best.

"Patients are using so many different types of medications, more THC, and higher tolerance builds from that," Risola, who also serves as a cannabis health coach, tells New Times. "I understand we have to have dosing limits. It is the law. But these are just so unreasonably low that it feels like an intentional attack on THC."

Jake, a 19-year-old from Lighthouse Point, says his medically recommended THC dose is much higher than the new limits. He opts for cannabis instead of pills to treat his anxiety because pharmaceutical drugs were turning him "into a robot," he says. (Jake asked to be identified only by his first name out of concerns for medical privacy.)

"I already had to go through so much just to get my milligrams [dose] to where it is and now two months later, they're changing it on me," he says.

Although the rule (embedded at the end of this article) is already in effect, it allows patients to fill their doctors' existing cannabis recommendations in excess of the daily limits until late March 2023.

Jake feels the dose restrictions are only going to make it more difficult and expensive for him to find the medication that works for him, leaving him no other choice than to rely on the black market once his current recommendation expires.

The new 70-day dosage limits for THC are: 4.2 grams from edibles; 24.5 grams from inhalation; 14 grams from oral tinctures or capsules; 13.65 grams from suppositories and 10.5 grams from topicals or creams.

Before the restrictions were implemented, there was already a purchasing cap on cannabis flower for smoking, which went by raw weight rather than THC content. Still in effect, that cap allows patients to buy up to 2.5 ounces of marijuana flower in a 35-day period.

THC dosing can vary considerably depending on patient tolerance, medical condition and mode of cannabis consumption. A severely ill cancer patient with a high THC tolerance may be prescribed an exponentially higher dose than a patient with a mild condition and no experience using cannabis would receive. Edible doses tend to be lower than inhalation doses on account of stronger psychoactive effects when THC is metabolized in the digestive system.

The new rule does permit physicians to apply for exceptions for patients who require a higher dose to treat grave medical conditions such as cancer or seizure disorders.

"What's critical here is that they are allowing doctors to make that decision as to what a patient may need, " cannabis attorney Sally Kent Peebles tells New Times. "The only thing I'm disappointed about in the whole rule is that [state officials] get 14 days to approve or deny that request for exception. If I'm terminal and I have a lot of pain from cancer, that 14 days is a long time."

Risola says she's concerned doctors will charge patients additional fees to file for the dose limit exception.

"There's just so many unknowns," Risola says. "There will be physicians who refuse because they don't want to risk everything that comes with it and probably others who absolutely take advantage and overcharge for it."

Cannabis dose limits have been a long time coming. After Floridians voted to legalize medicinal cannabis via a 2016 ballot initiative, the Florida legislature passed a codification of medical marijuana regulations, which called for "a daily dose amount for each allowable form of marijuana dispensed." The process of pinning down the dose limits involved public workshops and years of heated debate stretching back to 2017.

Florida's Office of Medical Marijuana Use (OMMU) announced the caps late Friday afternoon, leaving some patients confused and scrambling for answers from their doctors. Risola says that without advance notice, many cannabis-prescribing doctors found out about the new rule via a notification email a few hours before closing time.

Florida now joins states like Ohio that exercise tight control of maximum THC dosing. Other states, such as New Jersey, leave it to medical providers to determine patients' doses. (New Jersey does have a 3-ounce raw weight limit on how much cannabis product a patient is allowed to buy in a 30-day period.)

There are 745,259 qualified patients and 2,481 licensed physicians in Florida's medical marijuana program, according to OMMU's Aug. 26 data.

Patients across the state use medical cannabis to treat everything from psychological disorders to cancer pain to irritable bowel syndrome.

Charlie, who suffers from hidradenitis suppurativa, relies on THC-infused topicals and concentrates in place of the immunosuppressant drug Humira to treat the skin condition. The eighteen-year-old now may be forced to abandon one of his cannabis medications to meet the new restrictions. (Charlie requested that his last name not be published in light of the discussion of his medical condition.)

"My flares went from healing in a few weeks to a few days without any other drugs involved," he tells New Times. "The program has been great, and these new regulations come out and affect us pretty badly."

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Naomi Feinstein is a fellow at Miami New Times. She spent the last year in New York City getting her master’s degree at the Columbia School of Journalism. She is also a proud alum of the University of Miami.
Contact: Naomi Feinstein