Skin Cancer and Cannabis in Florida

Skin Cancer Gets Me a Cannabis Card?

Cancer is one of the conditions that qualifies a person for a medical marijuana recommendation from a doctor in Florida. Skin cancer is the most common form of cancer, with about 4.5 million cases diagnosed in the United States each year.  But does a diagnosis of skin cancer make a person eligible for medical marijuana?  Yes -skin cancer IS a type of cancer.  Skin cancer is not as deadly as many other types of cancer, but it is no joke.

Why Use Cannabis for Skin Cancer??

Most people with skin cancer do not take chemotherapy, they do not have the nausea and other side effects of chemo, so why would they want to take medical marijuana?  Simple: because CBD and THC have anti-cancer properties.  Applying cannabis oil  or a topical cream to the skin might curb the development and spread of cancer, and cannabis oil taken internally could have a beneficial effect on any deeper cancers that are present.

Note that I used words like ‘might’ and ‘could’  in the previous paragraph.  We have studies that show that CBD and THC inhibit or kill cancer cells in the test tube. We also have studies that they work on mice or other lab animals.  We have anecdotal reports of people using cannabis oil to clear up suspicious or cancerous spots.  Sounds promising.

At this point, we DO NOT HAVE studies that show how effective it is for humans. And we don’t yet know how it stacks up against other treatments. Promising but unproven are two appropriate descriptions.

I personally would not reject a proven method that has a high success rate (surgery) to go solely with a semi-proven or unproven method.  But a combination of the two methods does make sense to me.  I go to the dermatologist, but between visits, I apply cannabis oil on moles and spots as a preventative. If the cannabis product works, there won’t be any cancer for my dermie to remove.  And if the cannabis doesn’t work, the cancer will be detected in 6 months or a year, and then will be removed.  This 1,2 approach minimizes the risk of developing life-threatening metastatic cancer.

Science!

Here are some of the scientific reviews that indicate that cannabinoids might help with skin cancer:

In a nutshell, cannabinoids slow the growth or kill skin cancer cells while having little or no effect on normal cells. They trigger apoptosis (programmed cell death). One of the mechanisms involves the fact that cancer cells have an unusually high number of CB2 receptors on their surface, and THC overstimulates these cells.  Cannabidiol works in a somewhat different way, but has similar effects.

Getting that Cannabis Card

So if a person qualifies for a Florida medical marijuana card because they have a diagnosis of skin cancer, how do they move forward towards actually getting a card? There are a few simple steps.

Obtain Your Medical Records

The first thing needed is a copy of your medical records. Most doctors who recommend cannabis will require you to document the fact that you have or had cancer or some other qualifying condition. Recommending doctors are generally not able and willing to make a primary diagnosis – you should not go to them if you think “maybe I have cancer.”   But once you are diagnosed, they can put you into the state MMJ registry.

Medical records can be sent either directly to the patient, or to the doctor. I had them sent to me because I wanted to read over them first, and because I hadn’t yet decided on a doctor.

The records from your regular doctor may not have all the detail that is on the records from your dermatologist. If you plan on qualifying for a medical marijuana card based on skin cancer, your records from the skin doctor are most important. But get both to provide to your cannabis doctor – they need to understand you as a patient.

Some patients who have had suspicious moles removed fall into a category referred to as ‘dysplastic’ – this is generally considered pre-cancerous. Dysplastic moles (or nevii) are not normal, but they are not cancerous.  These indicate higher risk for future skin cancers.  Dsyplastic nevii alone are probably not enough to qualify for medical cannabis – a diagnosis of actual cancer is probably needed.

Find a Doctor

Under Florida’s current system,  MDs and DOs (medical doctors and osteopathic doctors) are allowed to make recommendations for cannabis.  But first, they need to pay the State of Florida a fee, take an online course, pass an exam, and then they get permission.  And many doctors who work in hospitals or medical school clinics are limited or prohibited by their employers from using this form of medicine.  Bottom line is that there are bureaucratic roadblocks and hoops to jump through, and fewer than 2000 of the state’s physicians can give cannabis cards in mid 2018. So you will probably have to find another doctor.

One way to find an MMJ doctor is to use the list published by the Florida Department of Health (DOH!). Check to see if your family doc is already on the list (unusual, but it happens). Then find a doctor near you.  Start calling, and ask lots of questions. Some doctors might not accept new patients, and others only accept certain types of patients (some neurologists might not accept cancer patients, for example). Some doctors are reluctant to accept new patients if they are only interested in a MMJ card.

There are also clinics that specialize in medical marijuana – these may have names that include words like compassionate, 420MMJ or green.  You have probably already seen their ads online if you have searched for any term related to medical marijuana. Many of the doctors in this type of practice write dozens of recommendations each week – they know the regulations and they are more likely to be comfortable giving a card to any patient who qualifies. One company that links up patients and doctors that a friend recommended is Florida Health Tech.com

Visit the Doctor – and Can you be Sure of Approval ??

Many patients who are in the process of getting a card are understandably worried that they might spend time and money to visit a doctor, and then be denied.  It doesn’t happen that often.  The best way to avoid any such possibility is to talk to the office prior to booking an appointment.  Let them know what your diagnosis is, ask if they do a pre-screening where they can ask a few questions that will make it clear if you are a ‘yes’ or a ‘no’ or a ‘maybe.’   No one can guarantee that you will get a card (the doctor makes an objective decision based on your records and the regulations), but some places guarantee that you will get your money back if you don’t get a card.

You Gotta Pay

Unfortunately, insurance companies in Florida will not pay for a visit specifically for a medical marijuana recommendation, or for the marijuana itself.  The FDA has not registered cannabis as an approved medicine, and insurance only pays for things that are FDA approved. If you are visiting a doctor for some other reason, and if they are certified to make a recommendation, they might do it then for little or no additional cost.  But almost all patients are getting an appointment just to get a card, and they have to pay for it out-of-pocket.  The first visit is usually around $200, and the follow up visit required every 7 months to stay in the state database is usually a bit less than the initial visit.

Some places only take cash – this is the norm in dispensaries that retail cannabis, and even some doctors require greenbacks instead of cheque or credit card. The reason is that federal law threatens banks and credit card companies that accept ‘drug money’ – and the law has been interpreted so that medical dispensaries treated the same as a cocaine cartel or a meth lab owner.  This has created a logistical nightmare for canna-businesses; they find it difficult or impossible to get basic financial services, even when they are operating in a state-legal medical program. Congress keeps talking about fixing this problem, but they have been talking for years and you should ask if you need to pay in cash.

After the Doctor, the State

Once the doctor has examined you and told you will be entered into the state registry, you will need to apply for the actual card.  The doc will give you instructions on how to log into the state website to fill out the application.  If you have a Florida driver’s license or state ID, your picture should pop right up. You can upload another picture if you like, but that increases the risk that your application gets derailed … they scrutinize other pictures, and if the photo doesn’t meet some technical specification, they could reject the photo and demand a new one … adding weeks to the process.

The State of Florida does accept credit cards, and the fee is $75.  A state ID is only $25 – maybe the boys in Tallahassee love some citizens more than others?

Snowbirds and other part-time residents are also eligible for a Medical Marijuana Use Registry Identification Card. The rules are a bit more complicated, but it requires some sort of proof of seasonal residency, like a mortgage or rental agreement, utility bills, etc.

As of the middle of 2018, it seems that the system for issuing the cards is working fairly well (it was really slow at first).  It takes about 2 weeks from filling out the application to getting an email code that allows a person into a dispensary to purchase. And about 2-3 weeks after that, look for the physical card in the mail.

Visiting the Dispensary

Once you receive the email that has your approval and patient number, you can print that out and take it to any dispensary in Florida with your driver’s license or state photo-ID.

I wrote about my first visit to a Florida dispensary here.  At the time, there were two companies with dispensaries near me.  By the end of next month there will be four, and that number will probably climb over 10 in the next year. Consumer choice is a good thing.

For my skin, I purchased a concentrate that is a thick, oily, substance in a syringe. It is high in THC, but low in CBD.  When the new guys open a dispensary near me next month, I will be buying an oil concentrate that contains both CBD and THC in a 1:1 ratio.  There is research that a combination of  both CBD and THC can be more effective against cancer than either of these cannabinoids alone.

Random Thoughts About Skin Cancer, Cannabis, and Life

Bob Marley and Cancer

Bob Marley died when melanoma skin cancer on his foot metastasized and spread through his body. Bob was aware of the cancer early on, but he rejected western medicine and put all faith in God and His Herb.  Bob consumed lots of cannabis, but unfortunately, it did not save his life.

While smoking ganja didn’t work for Bob Marley, I think it is likely that applying concentrates directly to a suspicious mole will lead to much higher concentrations of the active cannabinoids reaching the out of control tissue. Also, oral dosing of cannabis (edibles, capsules) leads to higher blood levels of cannabinoids, and works over a longer time period. People who have studied cannabis therapy often say that smoking cannot deliver the dose needed to bring a cancer under control.

Will Applying THC to Your Skin Get You High?

Probably not, but maybe. Some research has shown that topical cannabis creams and lotions do not change blood levels of THC – the molecule stays in the skin and shallow fat tissues, and is time-released to the point of zero euphoria.

On the other hand, there are transdermal patches that do deliver THC across the skin, into the blood. The ingredients in the cream or patch can influence the movement of cannabinoids into the blood.  And areas where the skin is thin (wrist, ankle, inside of elbow, etc) might allow greater absorption.

I have never felt a high or euphoria or intoxication after applying concentrated THC to pigmented spots on my skin.  But your mileage might vary – you might want to start low and go slow to prevent any overwhelming experience.

And a Very Important Closing Thought

Even if all the cancer was cut away and removed, even if you now consider yourself to be cancer-free, you should be aware that nearly half of the patients with the most common type of skin cancer (Basal Cell Carcinoma) have a re-occurrence of the disease in the first five years (source). Other types of skin cancer also re-occur at a fairly high rate. If you ever get diagnosed with skin cancer, you should start thinking about yourself as a cancer patient (many people don’t really).  You should limit exposure to the sun, and take other reasonable precautions. It’s time to regularly visit a dermatologist.  And what about cannabis as a second line of defense?  No one can guarantee that cannabis will definitely prevent skin cancer or reduce the risk. But combined with standard care, it makes for a sensible strategy.