NEW PORT RICHEY
It was a typical ribbon-cutting ceremony for members of the West Pasco Chamber of Commerce gathered at Natural Clinic MD to welcome Dr. Tanmay Patel.
"We'll help you spread the word about the good work you are doing," said Chamber member Gary Scarsbrook.
A few potential patients perused pamphlets, while sampling a spread of Indian cuisine and cheese platters. Patel and his wife, Sonal, the office manager and a registered nurse, fielded questions about their medical marijuana practice.
"Can you drive with medical marijuana?" asked Gigi Evans, of Dynamic Title.
As with many medications, Patel told her, you shouldn't drive or operate machinery.
"But that's exactly what the (warnings on the) pain meds say," said Ginny Pearce, of Allpro Printing & Direct Marketing.
Medical marijuana can provide an alternative to pain medications — particularly opioids, Patel said. "But there is no dying from medical marijuana."
Medical marijuana has been legal in Florida since 2014, when legislators signed into law the "Compassionate Medical Cannabis Act," allowing low doses for patients with cancer or seizure conditions. In 2016, Floridians approved Amendment 2, which expanded the list of qualifying illnesses.
The December Chamber event was a step toward legitimacy for Patel and his burgeoning practice. Patel, who perscribed pain medications to patients in the past, was alarmed by what he calls the "vicious cycle of opioid use." He turned his focus to medical marijuana after hearing testimonies of patients at a medical conference. Since then, he said, he has seen remarkable results in his own practice.
One patient was an artist who gave up painting due to hand tremors caused by Parkinson's disease.
"After the medical marijuana, she can paint with a steady hand," Patel said. "Those are the stories that motivate me to move in this direction."
A board certified internist with 10 years of experience practicing in Florida, Patel is one of 20 physicians in Pasco County certified to order medical marijuana. Across the Tampa Bay area, physicians are being certified to order medical marijuana. There are 93 certified physicians in Hillsborough County, 89 in Pinellas County and 13 in Hernando County.
Patel sees about 515 patients at his clinic on Rowan Road and another office in Brevard County. About 10 to 15 new patients come in each week.
He built his business through advertising, word of mouth and people who stop in after seeing his marijuana leaf shingle from the street. Patel also sees patients referred by other physicians.
That was the case for Cindy and Mike Sarafino. They inquired about medical marijuana for their daughter after their neurologist referred them to Patel.
Dana Sarafino, 26, was born with cerebral palsy and has frequent epileptic seizures. She is wheelchair-bound and non-verbal, said her mother, who keeps a handwritten list of the 16 medications that have not worked, for the next time they end up in the emergency room.
"I don't even know if this will help her," Cindy Sarafino said. "I hope it will help her."
As of April 20 — the unofficial marijuana holiday — Florida had more than 100,000 people on its medical marijuana registry. Of those, more than 75,000 became legal patients by applying for and receiving a medical marijuana use identification card.
The number of Pasco County patients is unavailable because the registry is confidential, according to a spokesperson with the state's department of health.
Dr. Scott Gebhardt and Kristina Risola of Florida Medical Cannabis Clinic — with offices in Land O' Lakes and Spring Hill — hosted an event April 20 to connect with potential patients.
The function at the clothing-optional resort Caliente in Land O'Lakes opened with an informational presentation that about 30 people attended.
Over the next five hours, more people flocked to the event. They ate food from a 4/20-themed menu, listened to a Reggaeton band and met vendors.
Initially, Gebhardt said, he was skeptical of medical cannabis. He spent more than 20 years as a primary care physician. After treating a patient with Alzheimer's disease using Marinol, a synthetic form of tetrahydrocannabinol, or THC — a main ingredient in cannabis — he said he witnessed remarkable results. That's when he decided to dedicate his practice to medical marijuana.
The patient, who was severely agitated and experienced difficulty sleeping and eating, was a changed person by the next morning, Gebhardt said.
"It's really impressive — all the things (medical cannabis) can do," said Gebhardt, who has placed more than 350 patients on the state medical marijuana registry since the clinic opened in June 2017.
Risola, who once worked as a state vocational rehabilitation counselor for people with chronic illness and disabilities, serves as director of operations. She also is a card-carrying marijuana patient and uses different strains of the drug to help with a long list of debilitating conditions.
The two see patients on Tuesdays and Thursdays. On the other three weekdays, they make home visits to cancer and hospice patients.
Typically, patients could see Gebhardt just by walking in, but business has been so busy, he started booking appointments two weeks in advance.
Medical cannabis is a "tool toward better health" for patients with a variety of qualifying medical conditions, Risola said. "The people coming in to see us are on opioids, and they may have an addiction to it, but they're taking it for a medical purpose — for chronic pain. We're seeing them able to reduce these medications."
It has been "different than anything I've ever seen working in health and wellness for the last 15 years," she said.
Several states have legalized marijuana, but the federal government still classifies it as an illegal drug. In January, the U.S. Department of Justice directed all U.S. attorneys to enforce the Controlled Substances Act.
Gebhardt and Patel continue to grow their practices while they wait for that to play out. Education and promotion are important for a new breed of doctors diving into a controversial practice based on a drug that carries a stigma dating as far back as the 1930's with the propaganda film, Reefer Madness.
When not treating patients, Patel spreads the word about how "euphoric" and "non-euphoric" strains are administered, how they benefit different conditions and how patients can maneuver the state's often cumbersome eligibility process. He has been on the radio, spoken at medical support group meetings and to members of a local veteran's group, some who deal with PTSD.
Patel also gave a presentation to physicians at Regional Medical Center-Bayonet Point.
Dr. Rao Musunuru, who invited Patel to speak, said the presentation was not an endorsement of medical marijuana or Patel's practice, but a way to educate local doctors.
"I wanted the doctors to know what the state laws are surrounding it," Musunuru said.
There are many misperceptions, said Sonal Patel, who was enlightened after attending a medical conference with her husband and asking a guest speaker about side affects.
"He asked me, 'What makes you think there are side affects?'" she said. "People think there has to be a high with marijuana. Not all strains do that."
Most people think medical cannabis is smoked in bud form, Patel said.
Florida state law bans the smoking of medical cannabis. Patel's patients typically administer the drug through tincture or oil, patches or vaping
So much controversy still surrounds the word "marijuana," Risola said they used "cannabis" in the clinic's name, instead.
"It's semantics, but definitely plays into the overall picture," she said. "From a medical perspective, we really try to stay true to the plant, true to the medicine, and that's cannabis."
Most new patients are "cannabis naive," Risola said, so the clinic offers guidance during what can be a frustrating trial-and-error period to find a proper dose. Risola runs an online support group, blogs and holds one-on-one coaching sessions. She replies to Facebook messages, even at 3 a.m., and spends hours on the phone fielding questions.
Costs can be steep for patients who pay for treatment out of pocket. A medical marijuana identification card costs $75, and must be renewed annually. And medical marijuana is not covered by insurance.
Costs vary depending on the physician and the dispensary. Some offer coupons and discounts for new patients. Some physicians accept cash only.
For Patel's patients, it starts with a free telephone consultation to determine their eligibility for the state registry. Patients must be diagnosed with a qualifying condition, and must have seen their physician within the year. An initial office visit — to evaluate patient records, conduct an exam and discuss strains and doses — is $165. Follow-up appointments are $150.
"Usually I see (patients) every 10 weeks, adjusting the dose until they know how much they need," said Patel. Then he sees them every seven months, as required by Florida law.
Gebhardt charges $250 for the initial hour-long evaluation. The cost includes medication orders that last about four months.
Patients spend their first 30 minutes with Risola, going over dispensary and medication options and creating a plan. The next 30 minutes are with Gebhardt for a physical exam. If patients qualify, Gebhardt puts them on the registry with orders for medication that last about four months. Follow up visits cost $150.
The cost of medical marijuana varies depending on the amount and strains used. Patients interviewed by the Tampa Bay Times said they spent from $200 to $350 per visit to the dispensary, enough for one to two months.. There is a delivery charge for those who don't make the trek to dispensaries in neighboring counties.
Pasco County has no dispensaries. However, it could soon.
Representatives for Surterra Wellness recently met with county officials for a proposed dispensary at 4218 U.S. 19. in New Port Richey. They haven't submitted an application, but they applied for a county building permit.
In a 2017 ordinance, Pasco County Commissioners said only two dispensaries could exist in Pasco, until it had more than 1,200 patients. County zoning requirements say medical marijuana dispensaries must be at least 500 feet from an elementary, middle or high school.
The lack of access can be frustrating for patients who just want to feel better, Patel said.
Medical marijuana is not a miracle drug, he said, but it can improve a person's quality of life and should be readily available for those who qualify.
"Some people ask me if it will cure their cancer. It won't. But it will help with the side effects," Patel said. "This is about doing the right thing for the right reason. It's about offering patients a compassionate and alternative form of medicine."
Contact Michele Miller at firstname.lastname@example.org. Follow @MicheleMiller52. TyLisa C. Johnson at email@example.com.