FREQUENTLY ASKED QUESTIONS
*videos are also on our YouTube Channel with the complete script in the comment section so you can read and follow along.
How can we help?
Take a look at all the pages on this website which explains the science, the medicine, and the public policy information you need to know as a Medical Marijuana Patient. Recorded videos can be viewed on our YouTube Channel at https://www.youtube.com/channel/UCkIG9oBJg6wrv2UGkoqYm4A
If you are interested in scheduling an appointment or for additional information, please reach out to our medical providers via phone at (772) 218-7262 or Contact us (sends an email) through our HIPAA-secure messaging portal. Afterwards, a ‘Welcome e-mail’ will outline the next steps with simple instructions. Given high call volumes we do prefer communications via email.
We ensure that you are receiving affordable services with market comparisons, in addition to compassionate and informative medical evaluations. Everyone’s time is very valuable. Our business process is designed to minimize costs to patients by maximizing efficiencies.
Your privacy is very important to us; it’s 100% confidential!
Take caution with other companies that advertise similar services. We pride ourselves in a committed patient-doctor relationship and there is a lot more to the process than getting an application. We go above-and-beyond providing important education about how to find the right medication for you and the next legal steps to obtain it. Southern Comfort is a family-run company with patient’s interests prioritized and we believe in such transparency.
We want you to feel well cared for and safe when choosing Southern Comfort Marijuana Clinic. We offer individualized services, so if your questions are still unanswered, please ask so we can share more FAQs for other patients to learn.
*** Who Qualifies? What are the next legal steps? ***
Our Physicians are certifying that our patients really have a debilitating condition, having tried previous therapies without success, and that the use of medical marijuana outweighs the health risks. Because of this tremendous professional responsibility, our Physicians may have to turn patients away who have not yet met criteria or are missing documentation.
By definition, debilitating, adj: something that seriously affects strength or ability to carry on with regular activities.
As per Amendment 2, included in the list of debilitating conditions are;
Amyotrophic lateral sclerosis (ALS),
or other debilitating medical conditions of the same kind or class as or comparable.”
Next Legal Steps:
1.) Get medical records. This can be your Doctor’s last office visit note. You can submit any records in advance for the physician to review and if it is not sufficient or not qualifying, you will not be charge for such consult.
2.) See the Physician (you cannot be certified by meeting with any other staff alone). Unlike other offices, we want you to have success, so we provide extra levels of education for the use of cannabis with safe and effective strategies, as well as up-to-date information about Dispensaries. We can provide trouble-shooting/Consult appointments throughout the year if you need additional help finding the right dosage program.
3.) Finish the Application. The Physician certifies medical approval, the State certifies identity. The State application is the second step after the physician issues an ID#. Most offices will discuss the Paper application which needs to be snail-mailed; which not only may take more time for approval, but also in our experience has a higher risk of rejection. We will walk you through the Electronic application process for the ID Card, which can take 5 or 10 minutes to complete for most people on the OMMUR Patient portal.
4.) Buy your Medicine from a MMTC/Dispensary. The State will send an approval email (2-3 weeks) which allows you to start your Cannabis Medicine! The ID Card will come in the mail afterward.
5). Followup appointments * Our office will place orders/certify for the next 6 months. We are available for consult visits if you need to be seen sooner. Other clinics will have different policy about followup times, but the LEGAL requirement is twice a year if you want to be able to purchase medication for the full year. This followup has to be in-person with a physician and State consent forms signed. Be careful if other physicians want to see you sooner for extra fees or advertise that certifications are for the year (which isn’t possible).
What Products are allowed? Can I just smoke it?
Forms : Vaping oils or herbal vape, smoking herbal, sublingual drops, nasal sprays, creams/lotions, transdermal patches, oils to ingest/cook, capsules, suppositories
Inhalation methods are excellent methods as they provide immediate benefit, great for crisis/breakthrough control of symtpoms, but don’t last but a few hours so not the best for maintenance control of the disease process. Vaping is healthier than smoking, as it occurs at a lower temperature, which means no combustion or inhalation of tars or carbon monoxide. Also, theres less risk of inhaling byproducts of butane lighters or plant material into the lungs. Some liquid vape extracts are “healthier” as they are pure cannabis oils, other dispensaries may cut product with MCT oils (ex. olive oil, safflower oil). FLOWER FOR SMOKE orders became approved by the Dept of Health March 2019. Additonal paperwork is required so this must be requested at the time of the appointment to avoid the need for a visit to make the changes. We still suggest trials of healthier methods prior to or in addition to smoking.
The other preferred method is Sublingual drops. Along with inhalation both of these methods go straight to the blood stream, so you keep more millgrams ingested (more cost effective) and controllable in dosing due to ease of separate milligrams per dose. Since drops can last 6-8hours we suggest using this method for maintenance or disease control to bring baseline symptoms down. It can also be used for breakthrough but onset is slower than inhalation.
Oral Medications which you swallow are a little more cautionary, as they go through the liver and change the chemical compounds, meaning less predictable and greater risk for unpleasant side effects. For some, it may work great and provide 12+ hours of relief.
FINAL NOTE ON ORDERS: Please review your patient portal at https://mmuregistry.flhealth.gov to review your orders.
See the Department of Health Office of Medical Marijuana Use (OMMU) website https://knowthefactsmmj.com for any other FAQs.
What are some other legal considerations?
REGARDINSouthern Comfort Marijuana Clinic is not a legal attorney group and all information below should be verified by independent consult with your attorney. Below are the interpretations of the current laws by citizens. As the legislation in the State of Florida continue to evolve regarding medical marijuana, information below may become quickly outdated; but we try to continue to revise as new publications are reviewed.
FREEDOM FOR DOCTORS TO DISCUSS MEDICAL RISKS/BENEFITS:
We would like to bring attention to the legal case Conant v. Walters, 2002, with the decision from the Ninth Circuit Court of Appeals (does not include FL but sets precedence), stating that the federal government could not even threaten to punish a doctor for discussions about the therapeutic benefits of medical marijuana, given protection under the First Amendment of Free Speech. To this end, Southern Comfort providers give patient’s documented consults and recommendations, not prescriptions, for the use of medical marijuana. The clinic is not involved in the procurement or sale of marijuana or cannabis products.
REGARDING CBD OVER-THE-COUNTER:
Some businesses online and at smoke shops advertise CBD oils for sale (these are coming from Hemp plants). We want you to consider the following technicalities before you invest in products that may be unsafe or put you in legal jeopardy. First, medical CBD is still a Schedule I chemical designated by the DEA and therefore Federally illegal to possess as a medicine, and there has been a few but limited persecutions of this law. It slides by when CBD is marketed as a nutritional supplement, but note still at users risk as not regulated for quality in any way compared to the Florida CBD coming from Marijuana plants.
Take extreme caution when purchasing or transporting these products across state lines as even with an ID card you may not be immune to Federal enforcement and each state has their own laws about marijuana use. Be respectful and use responsible, not near public facilities.
Case law has upheld that a registered Marijuana User will fail the ATF 4473 form questioning illicit drug use, and be can be denied purchase of a firearm. Concealed carry is a per-state law system and Florida has yet to set precedence. In fact, view the links below to see what would technically disqualify someone from their Concealed Carry permit and a statement from the Florida’s Agriculture Commissioner, Nikki Fried:
Can You Have Both A CWFL And Medical Marijuana Card
Nikki Fried [Florida’s Agriculture Commissioner] Interviewed on The Marijuana Solution:
Possible Reasons for Ineligibility
The Science Behind Cannabis
Various studies, anecdotal reports, and scientific literature summaries have been reviewed to the best of the Physician’s ability. Given that the FDA will not approve medical marijuana or its extracts for traditional pharmaceutical use, we are obligated to share the warning that this therapy option is not a guarantee, and is not indicated as a cure, preventative measure, diagnostic tool, or means to mitigate a medical condition. We must keep in mind that some studies are more subjective in comparisons; conclusions of “some benefit” may mean that while the study did not find it statistically significant, while others may still benefit. The best type of study is a randomized clinical trial with humans, but research is banned basically in the US except for special programs; therefore, much data is brought from international sources, in vitro or with animal research.
All this being said, with our philosophy to support a patient’s choice in a setting that minimizes risks/harms, we intend to educate based on the science available and provide recommendations. As new data is revealed about the potential benefits of medical marijuana or the risk of side effects, the information below will be updated so that you and your physician can make the best healthcare decisions together. Studies have primarily been done with patients having a terminal condition, and now we are realizing the benefits can also relate to other more common conditions, as long as the correct ratio of CBD and THC are used. Finally, while there is a lot of evidence that medical marijuana can be help numerous conditions, we keep entertain the science with an open mind but will comply with the regulations foremost related to Amendment 2.
- Pain: relief from severe pain caused by neuropathies or visceral/somatic pains from cancers, by itself or as adjunct with opiate medications (which have cardiopulmonary and GI risk issues not found with medical marijuana.)
- Muscle Spasm: studies showed good benefit for patients with Multiple Sclerosis when in ratio of 1:1 THC and CBD in studies using mucosal doses and capsules
- Nausea: calming of nausea to prevent vomiting associated with chemotherapy, through indirect activation of 5HT91a receptors in dorsal raphe nucleus, though studies report variability in benefit
- Anorexia: studies with dronabinol (synthetic THC) were of smaller doses with statistically neutral effects, used most commonly in patients with HIV/AIDS to prevent wasting
- Cancer: no clinical data yet to suggest direct anti-cancer effects (replication is independent of CB1 and CB2 receptors), however an abundance of pre-clinical data suggest an anti-proliferative and pro-apoptotic (self destruction counter attack) that affects cell migration, adhesion, and invasion. The animal tissues studied so far included cancers like breast, brain gliomas, lymphoma/leukemia, lung, prostate, and colon cancer.
- Seizure: anticonvulsant proprieties have long been known of medical marijuana but the mechanism is still under investigation. Early studies showed that high dose THC could actually increase seizure activity but the CBD component provides better results and safety profile. It’s believed that CBD affects many transporter receptors such as the ENT, GPR55, TRPV1, 5HT1a, a3 and a1 glycine receptors to work directly on the nerves to reduce the excitability and transmission of signals, as well as through anti-inflammatory paths TNFa or affecting adenosine uptake to prevent seizure potentials. Many participants or parents of children who were included in these studies using cannabis extract also reported improvement in developmental skills (motor, language), alertness or sleep, and mood.
- Psychiatry: acts on limbic system to help regulate mood (borderline personality, PTSD, anxiety more than depression, affective disorders), stress, and reward. It may be used as therapy for dystonia, a side effect of some psychotropic medications. For those with sleep disorders these studies showed medical marijuana was weakly beneficial.
- Anti-inflammatory – decreased TNFa. Very high doses would not be good for an immunocompromised patient.
- Neuroprotective – possible mechanisms include prevention of oxidative damage, moreso than would Vit C or E. Additional theories suggest an increase cerebral blood flow, with potential for improved stroke recovery.
- Immunomodulatory- the CB2 receptors in skin have shown such autoimmune conditions like psoriasis, as well as mice having less joint destruction from similar rheumatoid disease.
- Glaucoma – potential to reduce the optic pressures moderately, benefit with protection of the nerves of the eyes
- Metabolic – surveys of regular medical marijuana users revealed that they were actually less likely to develop Metabolic Syndrome, meaning lower BMIs, and subsequently less incidence of diabetes (less insulin resistance) and cholesterol issues (with better HDL). The biological pathways are yet to be discovered.
- Other- the Florida Medical Association Certification course for Physicians also detailed some emerging science yet to be validated in human studies, but these include to potential to increase blood flow to the heart after a heart attack (increased perfusion in mice) or after stroke (less MCA infarct volume). The serotonin system may have a role in this process.
We keep up with Cannabis science, and have a database of articles related to the condition we will be addressing. This is a legal requirement to provide to the State if we certify based on an “other condition.”
Here are some other websites that are very good for education:
www.healer.com (Dr Sulak @ Integr8Health)
https://www.green-flower.com/ Green Flower Media
More about the plant and your natural Endocannabinoid System
Your body has it’s own cannabinoid system, with two receptors called CB1 and CB2 and two ligands called anadamine and 2-AG, plus regulatory enzymes. This system has a role in pain, appetite, mood, memory, inflammation, insulin sensitivity, metabolism, etc. The CB1 receptors are all throughout the brain/nervous system, gastrointestinal tract, reproductive system, adrenals, heart, lung, and bladder tissues. CB2 receptors are primarily found in the immune system. The marijuana plant has >100 phytocannabinoids, which are chemicals that mimic our own system. The glandular structure of the plant, called the trichome, produces resin phytocannabinoids including terpenes, which give the plant its characteristic smell.
THC – aka Delta-9-tetrahydrocannabinol
Works by activating mostly CB1, but also CB2 receptors and others not mentioned. Therefore, medicinally it can be used for its psychotropic features, anti-inflammatory, anti-cancer, analgesic, muscle relaxant/anti-spasmotic, and antioxidant with neuroprotective properties.
CBD- aka Cannabidiol
Non-psychotropic, used as a “entourage compound” to reduce side effects of THC. The list of potential uses includes anti-anxiety or anti-psychotic, anti-emetic via modulation of central feeding behavior, anti-arthritic, anti-inflammatory, neuroprotection, and immunomodulation with additional anti-fungal and antibacterial properties. While additional research is needed, initial reports are that CBD is nontoxic to non-transformed cells.
Third most prevalent phytocannabinoid, it has properties beneficial as anti-inflammatory, sedative, analgesic, antifungal and antibacterial agent. Animal studies also suggest use as antidepressant.
CBG – aka Cannabigerol
This chemical weakly activates CB1 and CB2, but also antagonizes 5HT and allows GABA neurotransmitters to maintain function in the brain. Strong anti-inflammatory properties suggest use in IBD like Crohns Disease and colon cancers, use with glaucoma, and as a powerful antibacterial.
CBN – aka Cannabinol
Found in aged cannabis, is a product of THC breakdown with less CB1 and great CB2 affinity, therefore with less nervous system and psychotropic potential, but influence over the immune system, as anti-inflammatory and antibacterial.
THCA – aka Tetrahydrocannabolic acid
Found in raw, undried cannabis, Non-activated form of THC, with animal studies ongoing to show neuroprotective effects and benefit with nausea and vomiting, and anticancer benefits.
THCV – aka Tetrahydrocannabivarin
It can activate CB2 and block CB1, which allows for antioxidant and possible antipsychotic and anticonvulsant properties. In studies it shows promise to delay progression of Parkinsons symptoms.
THC vs CBD --- key to success: you need both, the experiment is finding the balance
This is a fun question to answer and very misunderstood! Both are chemical components of medical marijuana that can be used for therapeutic purposes. THC has more psychotropic properties (“the high”) but when used with CBD, together are more tolerable and therapeutic. Most people do not realize that you do not have to feel “high” to get the medical benefits of medical marijuana as CBD cancels those effects at understood ratios. Some conditions benefit from specific ratios of these chemicals. Recreational plants are grown to be high in THC, sometimes up to 20+%. And the synthetic 100% THC, such as the prescription Marinol/dronabinol can cause a lot of people unwanted side effects.
We will guide you on how to titrate (increase your dose) to find what amount works best for your symptoms- unlike pharmaceuticals there is no standard dose for any person or condition, and more doesn’t necessarily mean better. Our natural body has an Endocannabinoid system, discovered in 1993, that when it becomes deficient from chronic stress or illness, can be supplemented back with the plants’ equivalent Phytocannabonoids- specifically THC and CBD! More is explained on our YouTube Channel video, the “Science of Cannabis.”
Why not Hemp? Can't I just get CBD from the corner store?
CBD is a molecule that can come from Medical marijuana or Hemp, but it’s not exactly the same. First of all, hemp is legally defined as having less than 0.3% THC so these CBD products may miss the benefit of the Entourage effect of combining the chemicals. Second, hemp growers also are Federally limited so much that the majority of hemp products are still imported, and therefore not comparable to medical cannabis which requires independent lab testing to verify for contaminates and potency. CBD is under Schedule 1 drug classification similar to THC, technically therefore not approved for medical use and the hemp industry works around the legalities by claiming use as nutritional supplement rather than medicine. This is commonly advertised falsely and some States are taking punitive action.
Hemp is a Cannabis plant variant that has been specifically inbred to be used for industrial and food purposes, whereas medical marijuana is more medical use- and the science can be easily explained by the difference in the plant. Medical marijuana is a very oily plant, with glands called trichomes releasing resins that give the plant its smell and oil that can be extracted for medical properties. Hemp’s agricultural goal is for the seeds and fibers, so the plant is dry and fibrous; leading to extract processes that may be more harsh. Hemp agriculture also likely has a degree of pesticide exposure by farmers- but that’s not to say medical marijuana is without pesticides (in FL most do operate as organic with the use of beneficial bugs but also nurseries in FL are required to undergo bath testing for 14 possible contaminates, so that is product safety).
Cannabis plants are very good at cleansing the soil. Historically, up to 80% of hemp was imported, so those soils may contain high levels of lead, arsenic, etc and there have been reports of nationally renown CBD companies testing high in these contaminates. Due to lack of regulation on CBD products bought from corner stores, we cannot make any recommendations due to these product safety concerns and advise you get CBD from a dispensary where it is known to be grown and tested in Florida.
Medical Marijuana Safety
There are numerous articles to compare the health effects, both good and bad, with use of medical marijuana. To summarize all would be difficult on our website, so please see the referenced links. Below are some good points.
Adverse Effects (*combined list for THC and CBD):
Changes in perception- visual, time
Dry mouth and associated dental issues, Reduced tear flow and blink rate
Sedations, Dizziness, Reduced coordination, Ataxia
Bradycardia, orthostatic hypotenison
Anxiety, Dysphoria (these are dependent on ratios of CBD:THC)
Reduced sperm count (decrease testosterone)
Prospective memory and executive function decline
Bronchitis (resolves after cessastion), Cough (side note: data suggests no long-term change to lung function, ie no increase risk COPD, and little evidence to correlate as cause for lung cancer)
Medical Cannabis is regarded as having a fairly positive safety profile. There is a low to moderate dependence potential. Compared to prescription drugs or illicit drugs, there is low likelihood of overdosing, and the dose needing to obtain medical value is far below lethal doses. It should not be used at time of acute psychosis. Relative contraindications include severe cardiovascular (potential risk for arrhythmia), immunological, liver, or kidney disease, or acute illness. Extraction products should also be avoided if there is risk of hypersensitivity; cannabis extracts are often mixed with oils, ie. safflower oil, and patients need to be mindful and contact the dispensary or their product inserts to avoid allergic reaction. It is also important to get your product from reputable, regulated companies, as there has been issues of pesticide and fungal/bacterial contamination pending on oversight of other jurisdictions.
Pregnancy / Lactation – given the limitation on studies in pregnancy and lactation, it cannot be recommended through our provider to use medical marijuana. Mixed studies showed decreased fetal growth but does not appear to cause congenital defect, and may lead to perterm birth. Heavy use may diminish the neurodevelopment leading to subtle delay in milestones and cognition. THC does cross through the placenta and can be found in breast milk. Dispensaries have recommended use of contraception for men and women up to three months after the discontinuation of use.
There has been demonstrated decrease in brain volume (medial orbitofrontal and inferior parietal lobe) in adolescent medical marijuana users. This can associate with poorer complex attention. When used under the age of 18 years old, the long-term result was lower IQ at subsequent testing 20 years later. They also may have an increase of psychosis symptoms later in life. Proclivity to dependency peaks at age 20-24yo. We require that along with the provider at Southern Comfort medical marijuana clinic, the pediatric patient has their other physician sign consent for trial of therapy, with shared decision making regarding weighing risks:benefits.
People already experience individual benefit of all pharmaceuticals due to psychological makeup; particularly, liver enzymes, ie. some people are sensitive to all medications seemingly and others are very “tolerable” and need higher dosing. Reliable medical companies like Medscape evaluate the studies on drug-medical marijuana interactions and develop databases to classify the risk of side effects. You can look up your medications on their website, which then provides explanations of why they would interact here. Obviously, no database will be completely inclusive, it hasn’t been tested on everything!
There are no endocannabinoid receptors in the brainstem, which is why people can’t die from excessive medical marijuana intake; but can expect an uncomfortable response when taking an excessively high dose regardless. Some other meds, like opioids and benzodiazepines, there is risk for overdose as the receptors in the brainstem become bonded by the medicine and suppress the heart or lung function. We will teach you how to use the medication correctly and handle any bad sensations, which might mean changes in titration the next time.
Predictions can be made and dosing should be mindful to use minimum doses and monitoring. Many chemotherapeutic, antiepileptic, or cardiac arrhythmic medications have a narrow window of dosing, meaning toxicity or subtherapeutic levels that can be risky if not closely monitored. When looking at the pharmacology of medications that are sympathomimetic, such as nervous system depressants (including alcohol, sleep aids, benzodiazepines, opiates, barbiturates antidepressants), and anticholinergics, we recommend caution when used with medical marijuana, maybe to avoid completely. It is a relative contradiction for patients with history of cardiac arrhythmias or atherosclerosis, severe immunological, liver, or kidney disease, or in setting of acute illness to be using medical marijuana.
Common sense wisdom – too much of a good thing can be a bad thing. But if you want to get technical …. some pharmaceuticals will compete with THC and CBD in the liver to break down the chemicals to metabolites. CBD is metabolized by CYP3A and CYP2C19, and as an inhibitor of CYP2D6 will increase concentration of drugs metabolized by this enzyme. THC is metabolized by CYP3A4 and CYP2C9, and can decrease other drugs’ concentration as a metabolized by CYP1A2 inducer.