2021 A R

Board of Medicine and Board of Osteopathic Medicine

Physician Certification Pattern Review 2021 Annual Report

Under section 381.986(4)(j), Florida Statutes, "The Board of Medicine and the Board of Osteopathic Medicine shall jointly create a physician certification pattern review panel that shall review all physician certifications submitted to the medical marijuana use registry. The panel shall track and report the number of physician certifications and the qualifying medical conditions, dosage, supply amount, and form of marijuana certified. The panel shall report the data both by individual qualified physician and in the aggregate, by county, and statewide."

The Physician Certification Pattern Review Panel (Panel) is responsible for reporting its findings and recommendations by January 1 of each year to the Governor, the President of the Senate, and the Speaker of the House of Representatives. This report analyzes data from October 1, 2019 through September 30, 2020.

Physician Certification Pattern Review Panel Chair and Vice Chair

Sandra Schwemmer, D.O., Chair Andre Perez, Consumer Member, Vice Chair Members Shailesh Gupta, M.D. Jorge J. Lopez, M.D. Michelle Mendez, D.O. Luz Pages, M.D. Joel B. Rose, D.O.

This report provides a summary of the data for the 2021 Annual Report, and comparisons between the data from the 2019 and 2020 Annual Reports. All physician certification data comes from the Medical Marijuana Use Registry (MMUR). Physician licensure information comes from the Division of Medical Quality Assurance (MQA) Licensure Database.

1. 2019 Annual Report: 9 months of data, January 1, 2018 through September 30, 2018.

2. 2020 Annual Report: 12 months of data, October 1, 2018 through September 30, 2019.

3. 2021 Annual Report: 12 months of data, October 1, 2019 through September 30, 2020.

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i. Overview of the 2021 Annual Report Contents

Date Range for 2021 Annual Report Data

October 1, 2019 through September 30, 2020

Purpose of the Panel

The Panel reviews physician certification patterns, produces an annual report with its recommendations, and reports the Panel's findings to the Governor, the President of the Senate, and the Speaker of the House of Representatives by January 1 of each year, pursuant to section 381.986(4)(j), Florida Statutes (F.S).

Highlights of Trends in Physician Certifications

1. From the 2019 report to the 2021 report, there have been steady increases in the number of physician certifications, the number of qualified patients, and qualified physicians. 292% in physician certifications, from 169,573 to 664,779. 232% in qualified patients with certifications, from 133,847 to 443,888. 56% in qualified physicians with certifications, from 1,039 to 1,625.

2. The greatest number of certifications were issued by a small percentage of qualified physicians. This ratio has been increasing. 2019: 41% of certifications were issued by 4% of qualified physicians. 2020: 61% of certifications were issued 9% of qualified physicians. 2021: 71% of certifications were issued by 12% of qualified physicians.

3. From the 2020 report to the 2021 report, when outliers for Maximum Daily Dose ordered were removed, the average daily dose of medical marijuana has been increasing.

4. Certifications with at least one order for smoking as a route of administration have increased steadily since this route became available in late March of 2019. There was a total of 242,141 certifications with at least one order for smoking from April to December in 2019, with a peak in July, when the MMUR was upgraded. From January through September in 2020,

there was a total of 472,418 certifications with at least one order for smoking.

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CONTENTS

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Physician Certification Pattern Review, 2021 Annual Report I. General Process for Medical Marijuana Certifications 1. Requirements for Qualified Physicians Physicians may only order low-THC cannabis or medical marijuana if they hold an active and unrestricted license as an allopathic physician under Chapter 458, Florida Statutes, or an osteopathic physician under Chapter 459, Florida Statutes. Physicians must also successfully complete an approved 2-hour Continuing Medical Education (CME) course and examination; the course and exam are repeated for each biennial renewal. Only qualified physicians may issue certifications and order low-THC cannabis or medical marijuana for qualified patients. In addition, under section 381.986(3)(b), F.S., a "qualified physician may not be employed by, or have any direct or indirect economic interest in, a medical marijuana treatment center (MMTC) or marijuana testing laboratory." 2. Requirements to Issue a Physician Certification Figure 1 illustrates the general process to issue a physician certification. A physician certification can be issued only if the qualified physician conducted a physical examination while physically present in the same room as the patient, completed a full assessment of the patient's medical history, and diagnosed the patient with at least one qualifying medical condition. The qualified physician is responsible for the determination that the medical use of marijuana would likely outweigh the potential health risks for the patient. Physicians must also discuss a standardized medical consent form adopted in rule by the Board of Medicine and the Board of Osteopathic Medicine. Patient consent forms and medical records remain with the physician. Additional details are in section 381.986(4)(a-g), F.S. Figure 1. General process for a qualified physician in determining if medical marijuana is an appropriate treatment for their patient and if so, issuing a certification.

Physicians are required to submit required documentation if necessary and maintain up to date certification information in the MMUR. In closing a certification, physicians are required to note adverse events or reductions in use or dependency of controlled drugs. To continue to use medical marijuana

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Physician Certification Pattern Review, 2021 Annual Report as treatment for the patient's medical condition(s), physicians and patients must complete the entire process for a new certification. 3. Requirements for Patients to Obtain Medical Marijuana Figure 2 illustrates the general process for patients to obtain medical marijuana. Once a qualified physician determines that the medical use of marijuana would likely outweigh the potential health risks for the patient, a certification is created for the patient. Certifications contain orders with a maximum duration of 35 to 70 days depending upon route of administration (Edibles, Inhalation, Oral, Smoking, Sublingual, Suppository, or Topical). Current certifications have a maximum duration of 210 days, or three consecutive 70-day orders (six consecutive 35-day orders for smoking). Patients are allowed one current (active) certification and one pending (future) certification. All orders have their own start and end dates. Physicians can modify current orders at any time. Once a physician certification has been issued, first-time qualified patients must obtain a Florida Medical Marijuana ID card. If medical marijuana as a treatment for the patient's medical condition is continued, the card must be renewed every 12 months. Orders can be filled at any MMTC in Florida. Figure 2. General process for Florida residents who are interested in obtaining certifications for medical marijuana.

4. Reporting Physician Certification Data New physician certification data for this report are collected biweekly throughout the reporting period for the Panel's Annual Report. The registry is a live system; access date affects reported counts. Physician primary practice locations (addresses physicians provide in the Practitioner Profile) are collected on October 1 each year from the MQA licensure database. Section 381.986(4(j), F.S. requires the Panel to report physician certification data "both by individual qualified physician and in the aggregate, by county, and statewide". Please see the "Data Tables for Physician Certification Pattern Review, 2021 Annual Report" for details.

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Physician Certification Pattern Review, 2021 Annual Report II. Trends in Physician Certifications

Table 1 and Figure 3 show the growth in number of physician certifications, individual patients, and qualified physicians. Patient counts reflect distinct individuals; patients may have more than one certification in each time period.

Table 1. Growth in physician certifications for medical marijuana use.

Certifications

2019 Report 9 months

January 1, 2018 through September 30, 2018

169,573

2020 Report 12 months

October 1, 2018 through September 30, 2019

460,469

Individual Patients

133,847

291,865

Qualified Physicians with

Certifications

1,039

1,487

All Qualified Physicians

1,838

2,556

2021 Report 12 months

October 1, 2019 through September 30, 2020

664,779 443,888

1,625

2,700

Percent Increase

(2019 to 2021)

292% 232%

56%

47%

Figure 3. Number of physician certifications and patient counts in the 2019 Annual Report, 2020 Annual Report, and the 2021 Annual Report.

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Physician Certification Pattern Review, 2021 Annual Report

Table 2 provides information on how certification counts can vary by qualified physician. Only qualified physicians who have issued physician certifications during the time periods for the three data sets are included. The number of certifications has increased more than the number of qualified physicians issuing certifications, as can be seen in the average number of certifications per physician and the range in number of certifications per physician. This is illustrated in the three pie charts in Figure 4.

Table 2. Number of certifications in each data set.

All Certifications Average number of

certifications per physician Range in number of

certifications per physician

Median

Mode

2019 Report 9 months

January 1, 2018 through September 30, 2018

169,573

163

2020 Report 12 months

October 1, 2018 through September 30, 2019

460,469

130

2021 Report 12 months

October 1, 2019 through September 30, 2020

664,779

410

1 to 4,849

1 to 8,838

1 to 16,604

33

50

59

1

1

1

All Patients

133,847

291,865

443,888

Figure 4. Trends in the percentage of physicians whose total number of certifications fall into one of four groups. Percentages are based on the number of physicians in each group divided by the total number of physicians in that data set. 2019 Annual Report: 9 months of data, January 1, 2018 through September 30, 2018. 2020 Annual Report: 12 months of data, October 1, 2018 through September 30, 2019. 2021 Annual Report: 12 months of data, October 1, 2019 through September 30, 2020.

2019 Annual Report (N=1,039)

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