Georgia’s cannabis registry off to fast start; doctors want more info

Key points in Georgia’s medical marijuana law:

Who may apply to the state’s new registry?

  1. An adult who has one or more of the eight diseases or disorders specified in the new law, and who has been a resident of Georgia for at least one year;
  2. Legal guardians of an adult who has one of the eight diseases or disorders specified in the new law, and who has been a resident of Georgia for at least one year;
  3. Parents or legal guardians of a minor child who has one or more of the eight diseases or disorders specified in the new law, and has been a resident for at least one year or was born in Georgia and is under one year of age.

How may someone apply for the registry?

  • Any application must be sent in by the physician who is treating the patient, using the state's online registry forms. The physician must also register with the state as being approved to recommend the treatment as allowed by law.

What diseases or disorders are covered by the law?

  1. Cancer, when the disease has reached end stage or the treatment produces related wasting illness, recalcitrant nausea and vomiting;
  2. Seizure disorders related to diagnosis of epilepsy or trauma-related head injuries;
  3. Severe or end-stage amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig's disease);
  4. Severe or end-stage multiple sclerosis,
  5. Severe or end-stage Parkinson's disease;
  6. Severe or end-stage sickle cell disease;
  7. Crohn's disease;
  8. Mitochondrial disease.

How long can a patient stay legal on the registry?

  • Two years. To renew registration, patients must again consult with their doctor and receive state approval to continue.

Where can patients buy cannabis oil made legal by the law?

  • Georgia law does not address the oil's manufacture or how to buy or obtain it. In fact, the sale of any form of marijuana is and remains a violation of state and federal law. Essentially, state lawmakers this year only created a way for some people to be protected from prosecution for having a limited form of the oil in their possession. The Georgia Commission on Medical Cannabis — also new this year — is now studying whether to recommend the law go further but has not yet reached a conclusion.

Source: Georgia Department of Public Health

Medical marijuana — A brief history in Georgia:

1980 — A state panel is created to review requests to use marijuana by patients with cancer and other serious illnesses, but it's never used.

January 2014 — House Bill 885 is introduced by state Rep. Allen Peake, R-Macon, to legalize the use of cannabis oil, a limited form of medical marijuana, by patients who suffer from certain types of seizures.

March 2014 — Conservative skepticism and infighting among GOP leaders doom HB 885 as the state House and Senate fail to reach a compromise in the waning hours of the legislative session. But lawmakers agree to further study the legalization of medical marijuana.

Summer 2014 — Gov. Nathan Deal backs the use of clinical trials in Georgia to study cannabis oil's effect on children suffering from seizure disorders, although he expresses skepticism over outright legalization. The legislative study committee begins meeting on the issue as people from across the state testify about concerns and possible benefits of making medical marijuana legal in Georgia.

November 2014 — Peake "pre-files" House Bill 1 ahead of the 2015 legislative session, dubbing it "The Haleigh's Hope Act" after a Georgia child whose parents have been among those advocating for legalization of the oil.

January-February 2015 — The House passes HB 1 after Peake agrees to drop efforts to allow manufacturers to grow and cultivate marijuana in Georgia. Instead, HB 1 would grant immunity from prosecution for those who are authorized to possess the drug. The bill, however, expands on 2014 efforts by widening who could use cannabis oil, including those with cancer, epilepsy and sickle cell disease.

February-March 2015 — The Senate initially counters with a much more restrictive medical marijuana proposal to only allow a very limited trial program involving children with epilepsy. Negotiations between Senate and House leaders, however, eventually produce agreement over a much more expansive bill.

March 25, 2015 — The House gives final passage to HB 1, sending it to Deal after weeks of emotional testimony from children and parents seeking access to the oil. The state would be required to set up a registration process for the oil's use, and families would be required to get a doctor's recommendation.

April 16, 2015 — Deal signs HB 1 and tears up at the signing ceremony as he gestures to dozens of families with children suffering from debilitating conditions. "This certainly has touched my heart, " the governor says, "and I'm pleased today we're going to make a difference."

June 16, 2015 — The Georgia Department of Public Health launches the state's first-ever medical marijuana registry.

July 31, 2015 — More than 100 patients have qualified for registry cards in its first 45 days of business.

By the numbers — Georgia’s medical marijuana registry according to the state Department of Public Health:

Number of doctors registered: 162

Number of patients registered: 138

Ages of patients: less than 17 years old (50 percent); 18-24 (11 percent); 25-49 (23 percent); 50+ (16 percent)

Conditions most cited for treatment: Seizures (59 percent); multiple sclerosis (19 percent); cancer (8 percent); mitochondrial disease (8 percent); Crohn’s disease (6 percent).

Source: Georgia Department of Public Health (through 11 a.m., Aug. 11)

Story highlights

  • More than 130 patients qualified for Georgia's new medical marijuana registry in its first 50 days of existence, allowing them to use a low-THC cannabis oil for some diseases and disorders.
  •   Some doctors have begun calling for training and information about the cannabis oil and how it works.
  •   Georgia public health officials have so far approved 162 doctors for the state's new registry, which went live in June.
  •   The U.S. Drug Enforcement Administration still classifies marijuana as a Schedule I drug, the most dangerous class of drugs with a high potential for abuse and addiction, and no accepted medical uses.
  •   Georgia this year created a way to protect some people from criminal prosecution for having the cannabis oil in their possession.

Twilight fell on the Wages family’s compound, easing the August heat as Jim “J-Bo” Wages gently wrapped his arm around his 12-year-old daughter, Sydney, and kissed her cheek. His message received, J-Bo turned the key to the family four-wheeler and it roared to life. A smile fluttered across his daughter’s face, and they raced across the yard.

This was another good day for Sydney, who has autism and suffers from intractable seizures. Just like when the family recently celebrated a new milestone: 10 days seizure-free.

As of Tuesday, more than 130 patients including Sydney had qualified for Georgia's new medical marijuana registry after its first 50 days of business. Yet the pace — celebrated by families and advocates — comes as some doctors have begun calling for training and information about the oil and how it works.

Those concerns in the medical community are not the only hurdles facing families here — the new law legalizing a limited form of cannabis oil to treat illnesses including cancer, Parkinson’s disease and epilepsy does not address the oil’s manufacture or how to buy or obtain it.

In fact, the sale of any form of marijuana remains a violation of state and federal law. Yet, 23 states, plus the District of Columbia and Guam, offer some form of legalized use of marijuana for medical purposes. And Georgia this year created a way to protect some people from criminal prosecution for having a limited form of the oil in their possession.

‘Treatment is in its infancy’

Now advocates, families and doctors here are trying to figure out how best to practically do that.

“This field of treatment is in its infancy,” said Dr. James L. Smith Jr., an emergency room doctor who called himself “arrogant about what I thought was my fund of knowledge” when he first encountered cannabis oil as a possible treatment — one that has since been successful — for his now 8-year-old daughter, who suffers from a severe form of epilepsy called Doose syndrome.

The concerns, however, do not necessarily mean resistance, he said.

“I think physicians have been hesitant to start because of their lack of knowledge of how to dose it,” said Smith, a board member of the influential Medical Association of Georgia. “As a physician, I understand that. I think the physician community has been genuinely interested and wants to know more.”

FDA-approved pharmaceuticals came with own problems

The Wages family was among the very first to receive permission from the state to use low-dose cannabis oil without fear of prosecution, although it first encountered the oil two years ago after watching a national television news program about the oil’s use. By then, Sydney had spent eight years off any of the seven different federally approved pharmaceutical drugs she had initially been prescribed by doctors — a decision J-Bo and his wife, Lisa, prayed over after seeing a visibly more alert and verbal child off the medicine than on it.

Working initially through a naturopathic doctor, the family found a now-California-based company called Dixie Botanicals: “I contacted the lady that Monday and I said, ‘Ma’am, I’m trying to get the CBD (cannabidiol) oil. I have a daughter with epilepsy.’ She said, OK, they have a 2-ounce bottle and that 2-ounce bottle was $160. And, she said, ‘I suggest using the cinnamon flavor,’ ” J-Bo said of that initial phone call.

When he asked whether it was legal, J-Bo said he was told, “hon, you’re fine.”

"She said by the Farm Act, it's less than 0.3 percent THC (the high-inducing chemical associated with recreational marijuana use), so it's legal to ship anywhere," he said.

Feds still don’t approve of marijuana for treatment

It is not clear federal officials would agree with that statement, since the federal farm bill involved limited provisions related to industrial hemp. Marijuana continues to be classified by the U.S. Drug Enforcement Administration as a Schedule I drug, the most dangerous class of drugs with a high potential for abuse and addiction, and no accepted medical uses.

For the Wages family, however, it was a start. That first experience led to several others as they worked — sometimes through trial and error — to figure out what would best help Sydney. They learned to request laboratory reports and researched different and more effective strains of the oil. Knowledge came through word of mouth and, eventually, by connecting with other Georgia families seeking the same.

Sydney now uses “Palmetto Harmony” cannabis oil manufactured through a South Carolina company called Palmetto Synergistic Research — one of three companies currently shipping low-dose oil into Georgia.

They think the oil has helped Sydney. Her seizures are shorter since she started on the oil, they said. On average, she now has a seizure only once or maybe twice a week.

“We have rescue medicines, and it’s sort of the norm,” J-Bo said. “We get — not to say used to it — we sort of get like when you cut your finger. You cut it enough in one place, you get a callus. We sort of get callused to it. I don’t want this to sound any disrespectful way, but I don’t think I would want Sydney any different. She’s taught us so much about unconditional love, faith, patience.”

When Sydney began using the oil, the Wages family returned to a medical doctor who used to treat Sydney. He is monitoring her. She is still not on medicines approved by the Food and Drug Administration, although the family regularly schedules visits for checkups including blood tests.

Doctors seeking more information about cannabis oil

The Medical Association of Georgia has been vocal about getting doctors access to seminars or online webinars as they seek more information about how the oil works. Some physicians worry the oil is, in effect, experimental and not approved by the FDA.

Groups including the Georgia-based Oil for Epilepsy have started to explore how to connect doctors to new and existing research — as well as information about how the oil works and how it’s extracted. There is also talk of forming a new state coalition of people in the medical cannabis industry to help inform doctors and patients about their treatment options and access.

The state Department of Public Health has already partnered with the Georgia Composite Medical Board to develop the process for physicians who may be approached by patients seeking the oil for treatment. Public health officials have so far approved 162 doctors for its new registry, which went live in June.

Georgia has also begun to explore how to develop guidelines related to cultivation and production.

The newly formed state Commission on Medical Cannabis next meets Aug. 26 to talk with manufacturers and growers. Among the topics they are likely to address is the process they use to cultivate plants for the oil. That includes safety, security measures and testing that, among the top manufacturers, is often done by independent UL-listed laboratories.

“I think there’s just a need for additional information in the medical community of what exactly these products are,” said state Rep. Allen Peake, R-Macon, the primary author of the new law, who has been among those willing to bridge the gap as needed. “We’ve made sure families that have wanted the product and properly registered with the state have gotten the product.”