i Board of Medicine and Board of Osteopathic Medicine Physician Certification Pattern Review 2024 Annual Report Section 381.986(4)(j), Florida Statutes (F.S.), directs the Board of Medicine and the Board of Osteopathic Medicine to “jointly create a physician certification pattern review panel that shall review all physician certifications submitted to the Medical Marijuana Use Registry.” The Physician Certification Pattern Review Panel (Panel) shall track and report the number of physician certifications and the qualifying medical conditions, dosage, supply amount and form of marijuana certified. These data shall be reported both by individual qualified physician and in the aggregate, by county and statewide. The 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 July 1, 2022, through June 30, 2023. Physician Certification Pattern Review Panel Chair and Vice Chair Mr. Nicholas Romanello, Esq., Chair William Kirsh, D.O., Vice Chair Members Patrick Hunter, M.D. Michael Wasylik, M.D. Zachariah Zachariah, M.D. Ms. Valerie Jackson Mr. Christopher Creegan This report provides a summary of the data for Fiscal Year 2023 (FY) (the 2024 Annual Report). In November of 2021, the Panel requested that the data cycle dates for the annual report be changed to align with the fiscal year for future reports. Comparisons between the data from FYs 2021, 2022 and 2023 were made. All physician certification data was extracted from the Medical Marijuana Use Registry (MMUR). Physician licensure information was extracted from the Division of Medical Quality Assurance (MQA) Licensure Database. 1. FY 2021 Data: 12 months of data, July 1, 2020, through June 30, 2021. 2. FY 2022 Data: 12 months of data, July 1, 2021, through June 30, 2022. 3. FY 2023 (2024 Annual Report): 12 months of data, July 1, 2022, through June 30, 2023.
ii Overview of the 2024 Annual Report Contents Date Range for 2024 Annual Report Data July 1, 2022, through June 30, 2023 Purpose of the Panel The Panel reviews physician certification patterns and produces an annual report. These findings are reported 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), F.S. Highlights of Trends in Physician Certifications 1. Based upon a review of the data for FYs 2021, 2022 and 2023, the data have reflected a steady increase in the number of physician certifications, physician certifications containing at least one order for smoking as a route of administration, the distinct number of qualified patients with certifications and the number of qualified physicians. Physician certifications: 921,464 to 1,142,172 to 1,315,123. Certifications with smoke order(s): 860,291 to 1,089,072 to 1,266,276. Qualified patients with certifications: 607,220 to 757,600 to 859,026. Qualified physicians with certifications: 1,656 to 1,725 to 1,742. 2. The greatest number of certifications were issued by a small percentage of qualified physicians. This ratio has been increasing as a small percentage of physicians continues to see more patients and more patients continue with subsequent certifications each fiscal year. 2021: 80% of certifications were issued by 15% of qualified physicians; 1,000 + certifications each. 1% of certifications were issued by 45% of qualified physicians; 1‐49 certifications each. 2022: 83% of certifications were issued by 17% of qualified physicians; 1,000 + certifications each. 1% of certifications were issued by 43% of qualified physicians; 1‐49 certifications each. 2023: 84% of certifications were issued by 19% of qualified physicians; 1,000 + certifications each. 1% of certifications were issued by 40% of qualified physicians; 1‐49 certifications each. 3. The ordered average daily dose (mg) has shifted each year. This year, using a geometric mean calculation, daily dose amounts have decreased across all routes of administration for both low‐THC cannabis and medical marijuana due to the implementation of Emergency Rule 64ER22‐8, which set daily dosing limits for each allowable form of marijuana. Smoking as an appropriate route of administration remains consistently at the top of the limit allowed under Florida law, 2.5 oz. per order period. See page 5 for more information on the daily dosing limits and the exemptions available.
iii CONTENTS
Physician Certification Pattern Review, 2024 Annual Report 1 I. General Process for Medical Marijuana Certifications 1. Requirements for Qualified Physicians Physicians qualify to recommend medical marijuana if they hold an active and unrestricted license as an allopathic physician under Chapter 458, F.S., or an osteopathic physician under Chapter 459, F.S., and successfully complete an approved 2‐hour Continuing Medical Education course and examination. The physician must complete the course before each biennial license renewal deadline to retain this distinction. All Florida‐licensed physicians must provide information for a primary practice location. However, physicians may self‐report as “Not Practicing,” maintain an active license, and not provide a primary practice location. See Table 1. Table 1. Total number of Florida‐licensed physicians qualified to certify patients for medical marijuana. Reported Physician Practice Location Address FY 20211 FY 20221 FY 20231 In a Florida County 2,299 2,038 2,198 Not Practicing 32 25 28 Out of State 98 81 86 1 Data cycle is July – June prior to January 1st publication date. See page i. 2. Requirements to Issue a Physician Certification Figure 1 illustrates the general process to issue a physician certification. As of June 30, 2023, 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; reviewed the Prescription Drug Monitoring Program (PDMP) database; and diagnosed the patient with at least one qualifying medical condition. Qualified physicians are responsible for the determination that the medical use of marijuana would likely outweigh the potential health risks for the patient. Physicians must complete the medical consent form and, when appropriate, submit required documentation as part of the certification process. See section 381.986(4)(a–g), F.S. Figure 1. General process for determining if medical marijuana is an appropriate patient treatment.
Physician Certification Pattern Review, 2024 Annual Report 2 Physicians must submit required documentation and maintain up‐to‐date certification information in the MMUR. When closing a certification, physicians must note adverse events or reductions in use of other controlled substances. To continue to use medical marijuana as a treatment for the patient’s medical condition(s), physicians and patients must complete the entire process as 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 on 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 marijuana in a form for smoking). Patients are allowed one current (active) certification and one pending (future) certification. Each order has a start and end date. Physicians can modify current orders. Once a physician certification has been issued, first‐time qualified patients must obtain a Florida Medical Marijuana identification (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 medical marijuana treatment center (MMTC) in Florida. 4. Reporting Physician Certification Data Physician certification data for this report were pulled directly from the MMUR rather than vendor‐ generated reports used previously. This investment toward internal control of data gives the Office of Medical Marijuana Use (OMMU) more support for its Quality Assurance team, a critical feature in live data systems. Increased data access will allow rapid reporting by developing dashboards. Physician primary practice locations (addresses physicians provide in the Practitioner Profile) are taken 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 separate document, “Data Tables for Physician Certification Pattern Review, 2024 Annual Report.” Figure 2. General process for Florida residents who are interested in obtaining certifications for medical marijuana.
Physician Certification Pattern Review, 2024 Annual Report 3 II. Trends in Physician Certifications Table 2 and Figure 3 show the growth in number of physician certifications, individual patients and qualified physicians. Patient counts reflect distinct counts, though patients may have more than one certification in each time period. Table 2: Growth in physician certifications for medical marijuana use. FY 2021 FY 2022 FY 2023 Percent Change FY 2022 to FY 2023 Certifications 921,464 1,142,172 1,315,123 15% ↑ Individual Patients 607,220 757,600 859,026 13% ↑ Qualified Physicians with Certifications 1,656 1,725 1,742 1% ↑ All Qualified Physicians 2,429 2,144 2,312 8% ↑ Figure 3. Number of physician certifications and distinct patient counts in FY 2021, FY 2022 and FY 2023. Table 3 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 and Figure 5.
Physician Certification Pattern Review, 2024 Annual Report 4 Table 3: Number of certifications in each data set. FY 2021 FY 2022 FY 2023 All Certifications 921,464 1,142,172 1,315,123 Average number of certifications per physician 556 662 755 Range in number of certifications per physician 1 to 25,033 1 to 32,686 1 to 34,383 Median 66 76 87 Mode 1 1 1 Individual Patients 607,220 757,600 859,026 FY 2023 (N=1,742) FY 2022 (N=1,725) 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. FY 2021 (N=1,656)
Physician Certification Pattern Review, 2024 Annual Report 5 Two changes occurred during the past three reporting periods. First, edibles as a route of administration became available on August 27, 2020, when the Department of Health issued production standards. Second, Emergency Rule 64ER22‐8, effective August 26, 2022, implemented section 381.986(4)(f), F.S., by quantifying a daily dose amount with equivalent dose amounts for each allowable form of marijuana dispensed by a medical marijuana treatment center. This rule also established submission procedures of a request for an exception to the daily dose amount limit, the 35‐day supply limit of marijuana in a form for smoking, and the 4‐ounce possession limit of marijuana in a form for smoking. See Figure 6. Figure 6. Month and year count for certifications created and newly enrolled patients (no previous certifications) from January 1, 2018, through June 30, 2023. Point values for January and July are shown for each line. The June 2023 values are in black. Figure 5. Percentage of certifications issued by physicians in each of the four groups. For example, in FY 2023, 0.01% of certifications issued were from physicians (N=74) who issued only one certification and 84% of certifications issued were from physicians (N=335) who issued 1,000 or more certifications. Physician counts in each group are in Figure 4.
Physician Certification Pattern Review, 2024 Annual Report 6 III. Trends in Patient Qualifying Condition Physicians are required to determine that a patient’s medical condition meets one of the qualifying conditions listed in section 381.986(2), F.S. The list is included in Table 4. Patients may have more than one qualifying condition recorded in the MMUR by a qualified physician and more than one certification. Table 4: Trends in the total number and percentage of qualifying conditions reported in each data set. Conditions listed in bold font are the top three qualifying conditions reported by physicians. Qualifying Condition FY 2021 FY 2022 FY 2023 Number Percent2 Number Percent2 Number Percent2 (a) Cancer 59,999 3.8% 66,457 3.8% 71,876 3.6% (b) Epilepsy 19,154 1.2% 16,921 1.0% 18,631 0.9% (c) Glaucoma 13,072 0.8% 15,069 0.9% 16,178 0.8% (d) Positive status for human immunodeficiency virus (HIV) 9,203 0.6% 8,833 0.5% 9,125 0.5% (e) Acquired immune deficiency syndrome (AIDS) 2,051 0.1% 1,963 0.1% 1,953 0.1% (f) Post‐traumatic stress disorder (PTSD) 607,004 38.6% 695,592 39.4% 809,425 40.2% (g) Amyotrophic lateral sclerosis (ALS) 12,153 0.8% 3,997 0.2% 4,861 0.2% (h) Crohn’s disease 29,649 1.9% 32,965 1.9% 32,368 1.6% (i) Parkinson’s disease 8,945 0.6% 7,285 0.4% 7,388 0.4% (j) Multiple sclerosis (MS) 184,113 11.7% 160,218 9.1% 177,791 8.8% (k) Medical conditions of the same kind or class as or comparable to those enumerated in paragraphs (a)–(j)1 412,835 26.2% 508,124 28.8% 590,239 29.3% (l) A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification 3,494 0.2% 3,292 0.2% 2,923 0.1% (m) Chronic nonmalignant pain 212,507 13.5% 244,899 13.9% 269,918 13.4% Total qualifying conditions reported: Total number of certifications: Total number of individual patients: 1,574,179 921,464 607,220 1,765,615 1,142,172 757,600 2,012,676 1,315,123 859,026 1 Physicians are required to provide information on certifications under qualifying condition (k) same kind or class. 2 Percent of total qualifying conditions reported.
Physician Certification Pattern Review, 2024 Annual Report 7 In September 2020, the Panel requested information on the top five medical conditions qualified physicians recorded most often in the MMUR under qualifying condition (k). In November 2020, the Panel asked for more detail on the medical conditions of patients certified under qualifying condition (f) PTSD. Data for Tables 5, 6 and 7 are physician entries to the MMUR under qualifying condition (k). These data were collected separately from the data in previous tables and will vary slightly. For live data systems like the MMUR, each download is a snapshot in time; small differences in the data are expected. Data submitted using a paper copy of Form DH‐MQA‐5027 (rev. 02/2018) are not included. Table 5. Patient medical conditions1 reported by physicians for 1% or more of patients certified as qualifying condition (k) “medical conditions of the same kind or class as…” in FY 2023. Patient medical conditions by category using the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems FY 2023 Number Percent2 1. One form of “anxiety” (e.g., generalized anxiety disorder, depression, insomnia, panic attacks, sleep disorders). 207,991 44% 2. One or more symptoms, diseases, or disorders for “chronic pain from neuro or muscular degeneration or injury” (e.g., cervical or lumbar pain, degenerative disc/joint disease, muscle spasms, myopathic encephalopathy, restless leg syndrome, rheumatoid/osteoarthritis). 108,223 23% 3. Only “chronic pain” or “pain” reported. 44,072 9% 4. One or more forms of “anxiety” AND one or more forms of “chronic pain from neuro or muscular degeneration or injury.” 29,768 6% 5. Two or more forms of “anxiety” as listed. 34,252 7% Others with 1,421 or less: digestive, respiratory, infectious disease, circulatory, genitourinary, genetic, skin and connective tissue, ophthalmological. 26,986 6% Unable to determine 25,064 5% Number of medical conditions reported: 476,356 Number of qualifying condition (k) certifications: 590,239 Number of distinct patients in this table: 326,658 Number of physicians in this table: 739 1 Patients may have multiple certifications and one to five medical conditions. 2 Percent of total number of medical conditions reported.
Physician Certification Pattern Review, 2024 Annual Report 8 In the MMUR, all certifications using qualifying condition, (k) “Medical conditions of the same kind or class [SKC] as or comparable to those enumerated in paragraphs (a)–(j),” require identification of one or more qualifying conditions (a)–(j) the physician identifies as a match to the patient’s medical condition(s). Because a patient’s certification may include multiple medical conditions, and/or multiple matches to qualifying conditions (a)–(j), the records were sorted to review only those certifications with one other qualifying condition (a)–(j). In this reporting period, 69% (407,125 of 590,239) certifications met these conditions. See Table 6. Table 6: Number and percentage of times each qualifying condition (a)–(j) was identified as being the “same kind, or class” as the patient’s medical condition. Conditions listed in bold font are the top three reported by physicians. Qualifying Condition1 FY 2023 Number Percent2 (a) Cancer 3,566 0.88% (b) Epilepsy 6,157 1.5% (c) Glaucoma 426 0.1% (d) Positive status for human immunodeficiency virus (HIV) 1,444 0.4% (e) Acquired immune deficiency syndrome (AIDS) 165 0.04% (f) Post‐traumatic stress disorder (PTSD) 258,707 63.5% (g) Amyotrophic lateral sclerosis (ALS) 1,657 0.4% (h) Crohn’s disease 11,952 2.9% (i) Parkinson’s disease 2,270 0.6% (j) Multiple sclerosis (MS) 120,781 29.7% Total single qualifying condition reported: Number of distinct patients in this table: Number of physicians in this table: 407,125 299,767 728 1 Qualifying condition (k) patient medical condition(s) may align with more than one qualifying condition, only certifications with one (a)–(j) qualifying condition noted are shown here. 2 Percent of total number of single qualifying conditions reported. Table 7 provides an expansion of SKC data requested by the Panel in the 2021 recommendations to staff. The Panel was specifically interested in patient medical conditions physicians identified in certifications that identified qualifying condition (f) PTSD as being the same kind or class or as comparable to the patient medical condition.
Physician Certification Pattern Review, 2024 Annual Report 9 There were 300,950 medical conditions reported in 285,518 certifications for 216,908 patients by 658 physicians that met the Panel’s request. Medical conditions reported by physicians for 1% or more of patients with qualifying condition (k) certifications were grouped into six categories. Table 7: Number and percentage of patient medical conditions physicians reported as being the “same kind, or class” as qualifying condition (f) PTSD under qualifying condition (k) requirements between July 1, 2022, through June 30, 2023. Medical conditions listed under qualifying condition (k) certifications that do not use (f) PTSD are provided for comparison. Patient medical conditions1 by category using the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems FY 2023 Listed PTSD No PTSD listed Number Percent2 Number Percent2 1. One form of “anxiety” (e.g., generalized anxiety disorder, depression, insomnia, panic attacks, sleep disorders). 205,734 68.4% 2,257 1.3% 2. Two or more forms of “anxiety” as listed. 34,100 11.3% 152 0.1% 3. One or more forms of “anxiety” AND one or more forms of “chronic pain from neuro or muscular degeneration or injury.” 25,344 8.4% 4,424 2.5% 4. Only “chronic pain” or “pain” reported. 10,729 3.6% 33,343 19.0% 5. One or more symptoms, diseases, or disorders for “chronic pain from neuro or muscular degeneration or injury” (e.g., cervical or lumbar pain, degenerative disc/joint disease, muscle spasms, myopathic encephalopathy, restless leg syndrome, rheumatoid/osteoarthritis). 2,855 0.9% 105,368 60.1% 6. Digestive (e.g., abdominal pain, anorexia, loss of appetite, celiac disease, colitis, diabetes, diverticulitis, irritable bowel syndrome, nausea, pancreatitis, vomiting, wasting syndrome) 3,664 1.2% 9,912 5.7% Combined total for medical conditions identified 647 times1 or less: autoimmune, circulatory, genetic, genitourinary, infectious disease, ophthalmological, respiratory, and/or skin and connective tissue. 3,254 1.1% 10,156 5.8% Unable to determine 15,269 5.1% 9,974 5.6% Number of medical conditions: 300,950 175,406 Number of distinct patients: 216,908 118,258 1 Patients may have multiple certifications and one to five medical conditions. 2 Percent of total medical conditions reported.
Physician Certification Pattern Review, 2024 Annual Report 10 IV. Trends in Orders by Type, Route, and Average Daily Dose Data in this section refer to the total number of orders across all certifications, or to the geometric mean of the daily dose ordered per physician by route and type. Within each certification, the number of orders and the maximum daily dose in milligrams per day (mg) for any order, route or type, can vary. Tables 8 and 9 provide the total number of orders by type and route for all certifications between July 1, 2020, and June 30, 2023. The growing number of certifications increases the number of orders. Edible and Inhalation order counts have increased more rapidly than other routes of administration. Table 8: Total number of orders for low‐THC cannabis, by route, in all certifications in each data set. Edibles as a route of administration became available August 27, 2020. Route FY 2021 FY 2022 FY 2023 Percent Change FY 2022 to FY 2023 Edibles 2,257,090 3,226,136 3,618,148 12% ↑ Inhalation 2,512,034 3,224,199 3,620,983 12% ↑ Oral 2,546,474 3,234,702 3,539,508 9% ↑ Sublingual 2,119,418 3,143,905 3,274,318 4% ↑ Suppository 300,903 472,315 230,075 51% ↓ Topical 2,455,131 3,167,278 3,326,417 5% ↑ Table 9: Total number of orders for medical marijuana, by route, in all certifications in each data set. Edibles as a route of administration became available August 27, 2020. Route FY 2021 FY 2022 FY 2023 Percent Change FY 2022 to FY 2023 Edibles 2,356,750 3,308,693 3,732,916 13% ↑ Inhalation 2,620,144 3,297,212 3,761,694 14% ↑ Oral 2,615,992 3,298,967 3,537,798 7% ↑ Sublingual 2,200,278 3,207,690 3,093,701 4% ↓ Suppository 309,768 475,743 142,476 70% ↓ Topical 2,530,751 3,232,525 3,193,720 1% ↓ Tables 10 and 11 show the statewide average of the physician’s average daily dose ordered in milligrams per day (mg) for six routes of low‐THC cannabis and medical marijuana. With three full years of data, changes in trends were noted in the average daily dose amounts ordered.
Physician Certification Pattern Review, 2024 Annual Report 11 On August 26, 2022, Emergency Rule 64ER22‐8 went into effect, implementing section 381.986(4)(f), F.S., by quantifying a daily dose amount with equivalent dose amounts for each allowable form of marijuana dispensed by a medical marijuana treatment center. This rule also establishes submission procedures of a request for an exception to the daily dose amount limit, the 35‐day supply limit of marijuana in a form for smoking, and the 4‐ounce possession limit of marijuana in a form for smoking. Comparing the FY 2022 data with the FY 2023 data, and including outlier amounts, low‐THC cannabis average daily dose amounts ordered have decreased for all routes of administration. Edibles decreased by 54%, Inhalation by 15%, Oral by 46%, Sublingual by 51%, Suppository by 22%, and Topical by 53%. The FY 2022 data and FY 2023 data comparison of medical marijuana average daily dose amounts ordered, including outlier amounts, similarly showed a decrease across all routes. The Edibles route decreased by 70%, Inhalation by 19%, Oral by 64%, Sublingual by 71%, Suppository by 48%, and Topical by 75%. In order to retain all data observations and make comparisons without skewing caused by outlier amounts, the data presented here uses a geometric mean (GeoMean) calculation. A geometric mean uses all data observations to create a mean closer to the median. See the “Terms and Definitions” section for more detail on geometric mean calculations and outliers. Table 10: Statewide geometric mean daily dose (mg) for low‐THC cannabis, in Edibles, Inhalation and Oral forms, in each data set. Edibles as a route of administration became available August 27, 2020. Number of physicians with orders in each year is included in brackets. Low‐THC Edibles Inhalation Oral FY 2021 [1,423] FY 2022 [1,553] FY 2023 [1,594] FY 2021 [1,451] FY 2022 [1,501] FY 2023 [1,532] FY 2021 [1,500] FY 2022 [1,560] FY 2023 [1,584] GeoMean 179 192 88 212 226 193 189 203 109 Max1 1,000,000 1,000,000 300,300 1,000,000 1,000,000 700,250 1,000,000 1,000,000 400,400 Min1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Median1 200 200 60 200 200 200 200 200 100 Mode1 200 200 50 200 200 200 200 200 200 1Numbers changed from previous reports where the Max, Min, Median and Mode to reflect all ordered amounts. (Descriptive counts were previously taken from the average of all ordered amounts.) Table 11: Statewide geometric mean daily dose (mg) for Low‐THC cannabis, in Sublingual, Suppository and Topical forms, in each data set. The number of physicians with orders in each year is included in brackets. Low‐THC Sublingual Suppository Topical FY 2021 [1,435] FY 2022 [1,514] FY 2023 [1,524] FY 2021 [682] FY 2022 [791] FY 2023 [690] FY 2021 [1,415] FY 2022 [1,508] FY 2023 [1,512] GeoMean 177 191 93 205 228 179 159 177 83 Max1 1,000,000 1,000,000 450,450 1,000,000 1,000,000 420,420 1,000,000 1,000,000 500,500 Min1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Median1 200 200 100 200 222 200 200 200 100 Mode1 200 200 200 200 200 300 200 200 200 1Numbers changed from previous reports where the Max, Min, Median and Mode to reflect all ordered amounts. (Descriptive counts were previously taken from the average of all ordered amounts.)
Physician Certification Pattern Review, 2024 Annual Report 12 Table 12: Statewide average daily dose (mg) from all physician’s average daily dose for medical marijuana, in Edibles, Inhalation and Oral forms, in each data set. Edibles as a route of administration became available August 27, 2020. The number of physicians with orders in each year is included in brackets. Medical Marijuana Edibles Inhalation Oral FY 2021 [1,553] FY 2022 [1,689] FY 2023 [1,710] FY 2021 [1,599] FY 2022 [1,674] FY 2023 [1,680] FY 2021 [1,601] FY 2022 [1,667] FY 2023 [1,681] GeoMean 176 193 58 227 248 202 196 214 78 Max1 1,000,000 1,000,000 600,600 1,000,000 1,000,000 500,300 1,000,000 1,000,000 420,420 Min1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Median1 200 200 50 200 250 200 200 200 70 Mode1 200 200 60 200 200 200 200 200 50 1Numbers changed from previous reports where the Max, Min, Median and Mode to reflect all ordered amounts. (Descriptive counts were previously taken from the average of all ordered amounts.) Table 13: Statewide average daily dose (mg) from all physician’s average daily dose for medical marijuana, in Sublingual, Suppository and Topical forms, in each data set. The number of physicians with orders in each year is included in brackets. Medical Marijuana Sublingual Suppository Topical FY 2021 [1,528] FY 2022 [1,608] FY 2023 [1,627] FY 2021 [762] FY 2022 [884] FY 2023 [746] FY 2021 [1,500] FY 2022 [1,597] FY 2023 [1,610] GeoMean 178 198 57 207 233 120 157 182 45 Max1 1,000,000 1,000,000 444,444 1,000,000 1,000,000 25,000 1,000,000 1,000,000 400,400 Min1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Median1 200 200 50 200 250 200 200 200 40 Mode1 200 200 50 200 200 200 200 200 50 1Numbers changed from previous reports where the Max, Min, Median and Mode to reflect all ordered amounts. (Descriptive counts were previously taken from the average of all ordered amounts.)
Physician Certification Pattern Review, 2024 Annual Report 13 V. Top Five Physicians by Reporting Measures The following tables provide information on the top five physicians in each data set and include: 1. Number of certifications. 2. The number and physician’s percentage of the top three qualifying conditions: (f) PTSD, (k) Medical Conditions of the Same Kind or Class as or Comparable to those enumerated in paragraphs (a)–(j), and (m) Chronic Nonmalignant Pain. Physician Specialty Area as provided in the Practitioner Profile in the MQA Licensure Database is included, if available. 3. The highest average maximum daily dose in milligrams per day (mg) by type and route. Note: 1. Per Florida law, allopathic and osteopathic physicians are not required to include or update specialties in the Practitioner Profile. Specialty information in Tables 15, 16, 17, 34, 35 and 36 is as of July 5, 2023, and may not reflect current information. 2. Physician license numbers in this section have been de‐identified with a unique identifier (UID). 3. Patients may have more than one qualifying condition in a single certification, and more than one certification in a reporting period. 1. Physicians with the Highest Number of Certifications Table 14: Top five physicians with the highest number of certifications in each data set. FY 2021 FY 2022 FY 2023 UID Number of Certifications Number of Patients UID Number of Certifications Number of Patients UID Number of Certifications Number of Patients AY 25,033 9,905 AY 32,686 12,496 AY 34,383 12,499 AZ 15,806 9,711 BA 17,677 11,820 BA 19,679 12,956 BA 15,516 10,742 EH 15,735 12,746 DY 16,892 10,913 DL 9,841 6,978 DL 14,918 13,374 DL 15,369 10,956 CY 9,521 6,456 DW 13,677 10,839 EX 14,892 11,425
Physician Certification Pattern Review, 2024 Annual Report 14 Table 15: Top five physicians with the highest number of certifications including “Qualifying Condition (f) PTSD.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 7,815 to 25,033 10,060 to 32,686 14,892 to 34,383 Range in Percentage of Physician’s Certifications including (f) PTSD 75% to 98% 73% to 99% 73% to 98% Physician Specialty Area1 Family Medicine Pediatrics Radiology‐Diagnostic Hospice and Palliative Medicine Not Listed Radiation Oncology Pediatrics Family Medicine Not Listed Family Medicine Diagnostic Radiology Pediatrics Not Listed 1 Reference notes on page 13. Table 16: Top five physicians with the highest number of certifications including “Qualifying Condition (k) Medical Conditions of the Same Kind or Class.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 7,024 to 25,033 9,348 to 32,686 6,852 to 19,679 Range in Percentage of Physician’s Certifications including (k) Same Kind or Class 34% to 78% 17% to 80% 44% to 82% Physician Specialty Area1 Family Medicine Pediatrics Radiology‐Diagnostic Hospice and Palliative Medicine Not Listed Radiation Oncology Pediatrics Family Medicine Not Listed Radiation Oncology Pediatrics Family Medicine Not Listed 1 Reference notes on page 13.
Physician Certification Pattern Review, 2024 Annual Report 15 Table 17: Top five physicians with the highest number of certifications including “Qualifying Condition (m) Chronic Nonmalignant Pain.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 5,899 to 25,033 7,500 to 32,686 8,243 to 34,383 Range in Percentage of Physician’s Certifications including (m) Chronic Pain 45% to 96% 41% to 96% 38% to 87% Physician Specialty Area1 Family Medicine Pediatrics Plastic Surgery Not Listed Family Medicine Internal Medicine Pediatrics Obstetrics and Gynecology Not Listed Family Medicine Pediatrics Not Listed 1 Reference notes on page 13. 2. Physicians with the Highest Average Daily Dose – Low-THC Cannabis by Route Table 18: Low‐THC cannabis: Edibles, top five physicians with the highest average daily dose (mg). Edibles as a route of administration became available August 27, 2020. FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders AT 44,800 3 AT 44,800 3 AT 22,415 6 DZ 14,000 6 EI 19,388 39 EI 21,000 3 EA 10,650 6 EJ 19,000 15 AJ 20,000 1 DT 10,000 3 AA 17,649 21 DZ 14,000 9 I 8,948 166 DZ 14,000 51 EJ 8,420 9 Geometric mean1: 179 mg/day Geometric mean1: 192 mg/day Geometric mean1: 88 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 16 Table 19: Low‐THC cannabis: Inhalation, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EJ 19,000 15 ER 20,792 39 EA 9,988 8 EI 17,621 43 DZ 14,000 9 AT 9,600 4 DZ 14,000 51 EI 10,675 6 Y 9,000 2 AM 12,244 129 AJ 10,000 1 I 9,000 177 EN 10,000 3 EJ 8,517 9 Geometric mean1: 212 mg/day Geometric mean1: 226 mg/day Geometric mean1: 193 mg/day 1 No outliers removed. Table 20: Low‐THC cannabis: Oral, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DI 18,080 9 EI 20,435 37 DZ 14,000 9 DZ 14,000 6 EJ 19,000 15 ER 11,908 39 EA 9,988 8 AA 17,649 21 EI 10,600 6 I 9,000 177 DZ 14,000 51 AJ 10,000 1 AA 7,875 55 AM 12,284 132 EJ 8,467 9 Geometric mean1: 189 mg/day Geometric mean1: 203 mg/day Geometric mean1: 109 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 17 Table 21: Low‐THC cannabis: Sublingual, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EI 20,435 37 EI 21,000 3 AJ 11,000 4 EJ 19,000 15 DZ 14,000 9 EA 9,988 8 DZ 14,000 51 ER 11,150 36 I 9,000 149 AM 12,244 129 AJ 10,000 1 DM 8,453 1,119 EO 9,518 743 EJ 8,463 9 Geometric mean1: 177 mg/day Geometric mean1: 191 mg/day Geometric mean1: 93 mg/day 1 No outliers removed. Table 22: Low‐THC cannabis: Suppository, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EJ 19,000 15 ES 17,500 6 DO 10,000 42 AM 14,000 18 ET 14,200 37 AM 9,400 9 DZ 14,000 51 DZ 14,000 9 I 9,000 138 EO 9,319 731 EJ 12,598 6 DM 8,676 1,090 I 9,000 270 EU 8,905 19 Geometric mean1: 205 mg/day Geometric mean1: 228 mg/day Geometric mean1: 179 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 18 Table 23: Low‐THC cannabis: Topical, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders AJ 21,000 8 EI 20,435 37 EI 21,000 3 DI 20,033 3 EJ 19,000 15 DZ 14,000 9 DH 20,000 2 DZ 14,000 51 AJ 10,000 1 DZ 14,000 6 AM 12,556 129 ER 8,664 33 EF 10,725 4 EN 10,000 3 EJ 8,450 9 Geometric mean1: 159 mg/day Geometric mean1: 177 mg/day Geometric mean1: 83 mg/day 1 No outliers removed. 3. Physicians with the Highest Average Daily Dose – Medical Marijuana by Route Table 24: Medical marijuana: Edibles, top five physicians with the highest average daily dose (mg). Edibles as a route of administration became available August 27, 2020. FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EP 36,500 12 EI 21,000 3 DI 13,102 23 AT 16,833 9 AT 10,052 9 EA 10,650 6 EI 16,824 45 EO 5,084 486 AT 8,983 15 EJ 16,000 18 DZ 4,707 9 DM 7,821 1,211 EQ 14,000 3 EB 3,158 9 Geometric mean1: 176 mg/day Geometric mean1: 193 mg/day Geometric mean1: 58 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 19 Table 25: Medical marijuana: Inhalation, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EP 36,500 12 EI 10,675 6 DI 10,386 29 EI 16,891 45 EO 5,322 483 DQ 10,000 3 EJ 16,000 18 DZ 4,900 9 EA 9,988 8 EQ 14,000 3 AT 3,333 6 DH 9,082 56 EB 14,000 10 ES 3,035 36 Geometric mean1: 227 mg/day Geometric mean1: 248 mg/day Geometric mean1: 202 mg/day 1 No outliers removed. Table 26: Medical marijuana: Oral, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EI 18,025 42 EV 13,214 8 DI 11,169 27 EJ 16,000 18 EI 10,600 6 EA 9,988 8 EQ 14,000 3 EO 5,184 486 DH 9,773 46 DZ 14,000 54 DZ 4,800 9 AA 7,170 55 AM 12,284 132 EW 3,148 36 Geometric mean1: 196 mg/day Geometric mean1: 214 mg/day Geometric mean1: 78 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 20 Table 27: Medical marijuana: Sublingual, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EP 35,750 12 EI 21,000 3 AJ 11,000 4 EI 18,933 40 EO 5,175 486 EA 9,988 8 EJ 16,000 18 DZ 4,793 9 DM 8,439 1,121 AM 15,148 132 EJ 3,805 20 EG 8,400 1 DZ 14,000 54 ES 2,735 39 Geometric mean1: 178 mg/day Geometric mean1: 198 mg/day Geometric mean1: 57 mg/day 1 No outliers removed. Table 28: Medical marijuana: Suppository, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DZ 14,000 6 EJ 16,000 18 ES 17,500 6 DO 10,000 42 AM 14,000 18 ET 14,592 36 AM 9,400 9 DZ 14,000 54 EJ 12,598 6 DM 8,676 1,090 EO 9,330 731 EO 6,719 366 DC 3,298 87 AY 7,281 57 DZ 4,797 9 Geometric mean1: 207 mg/day Geometric mean1: 233 mg/day Geometric mean1: 120 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 21 Table 29: Medical marijuana: Topical, top five physicians with the highest average daily dose (mg). FY 2021 FY 2022 FY 2023 UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders UID Average Daily Dose (mg) Number of Orders DH 14,333 35 EI 18,458 41 EI 21,000 3 DZ 14,000 6 EJ 16,000 18 EO 5,189 480 AJ 12,500 8 AM 15,148 132 DZ 4,767 9 EF 10,725 4 EB 14,000 3 EJ 4,454 17 EA 9,988 8 DZ 14,000 54 AT 3,263 6 Geometric mean1: 157 mg/day Geometric mean1: 182 mg/day Geometric mean1: 45 mg/day 1 No outliers removed.
Physician Certification Pattern Review, 2024 Annual Report 22 VI. Marijuana in a Form for Smoking Certifications with orders for smoking began on March 18, 2019, when Senate Bill 182 (2019) was signed into law by Governor Ron DeSantis. See section 381.986 (4)(c), F.S. Table 30: Number of certifications that contain at least one order for smoking in each data set. FY 2021 FY 2022 FY 2023 All Certifications with at Least One Order for Smoking 860,291 1,089,072 1,266,276 Average number of certifications with smoking per physician 591 695 790 Range in total number of certifications with smoking per physician 1 to 24,624 1 to 32,584 1 to 32,358 Median 66 75 86 Mode 1 1 1 All Patients (with smoking certifications) 575,095 728,655 832,636 Table 31: All smoking orders, percentage of total qualified physicians with orders for smoking, and descriptive statistics (in ounces ordered) in each data set. FY 2021 FY 2022 FY 2023 All Orders for Smoking 4,931,098 6,302,534 7,367,715 Percentage of Physicians with Orders for Smoking 88% 91% 92% GeoMean ounces ordered 2.46 2.47 2.55 Max1 2.50 7.00 10.00 Min1 0.1 0.01 0.025 Median1 2.50 2.50 2.50 Mode1 2.50 2.50 2.50 1Numbers changed from previous reports where the Max, Min, Median and Mode to reflect all ordered amounts. (Descriptive counts were previously taken from the average of all ordered amounts.)
Physician Certification Pattern Review, 2024 Annual Report 23 Table 32: Trends in the total number and percentage of qualifying conditions reported in certifications containing at least one order for smoking. Patients may have more than one qualifying condition per certification. Conditions listed in bold font are the top three qualifying conditions reported by physicians. Qualifying Condition FY 2021 FY 2022 FY 2023 Number Percent1 Number Percent1 Number Percent1 (a) Cancer 51,713 3.5% 59,224 3.5% 65,131 3.4% (b) Epilepsy 17,165 1.2% 15,513 0.9% 17,461 0.9% (c) Glaucoma 11,870 0.8% 14,126 0.8% 15,293 0.8% (d) Positive status for human immunodeficiency virus (HIV) 8,509 0.6% 8,426 0.5% 8,785 0.5% (e) Acquired immune deficiency syndrome (AIDS) 1,825 0.1% 1,651 0.1% 1,653 0.1% (f) Post‐traumatic stress disorder (PTSD) 576,442 39.3% 670,199 40.0% 787,288 40.7% (g) Amyotrophic lateral sclerosis (ALS) 11,423 0.8% 3,559 0.2% 4,508 0.2% (h) Crohn’s disease 27,065 1.8% 31,483 1.9% 31,161 1.6% (i) Parkinson’s disease 6,810 0.5% 5,896 0.4% 6,212 0.3% (j) Multiple sclerosis (MS) 169,059 11.5% 148,922 8.9% 168,759 8.7% (k) Medical conditions of the same kind or class as or comparable to those enumerated in paragraphs (a)‐(j) 389,109 26.5% 485,470 28.9% 569,008 29.4% (l) A terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification 3,100 0.2% 3,043 0.2% 2,641 0.1% (m) Chronic nonmalignant pain 193,155 13.2% 229,990 13.7% 258,082 13.3% Total qualifying conditions reported: Total number of certifications: Total number of patients: (with smoking certifications) 1,467,245 860,291 575,095 1,677,502 1,089,072 728,655 1,935,982 1,266,276 832,636 1 Percent of total qualifying conditions reported.
Physician Certification Pattern Review, 2024 Annual Report 24 Table 33: Top five physicians with the highest number of certifications containing at least one order for smoking. FY 2021 FY 2022 FY 2023 UID Number of Certifications Number of Patients UID Number of Certifications Number of Patients UID Number of Certifications Number of Patients AY 24,624 9,844 AY 32,584 12,482 AY 34,358 12,492 AZ 15,802 9,711 BA 17,316 11,646 BA 19,406 12,762 BA 15,429 10,700 EH 15,716 12,735 DY 16,652 10,816 DL 9,840 6,978 DL 14,918 13,374 DL 15,368 10,956 CY 9,392 6,407 DW 13,668 10,834 EX 14,884 11,422 Table 34: Top five physicians with the highest number of certifications containing at least one order for smoking and including “Qualifying Condition (f) PTSD.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 7,740 to 24,624 10,059 to 32,584 14,884 to 34,358 Range in Percentage of Physician’s Certifications including (f) PTSD 75% to 99% 74% to 99% 73% to 98% Physician Specialty Area1 Family Medicine Pediatrics Diagnostic Radiology Not Listed Family Medicine Pediatrics Diagnostic Radiology Not Listed Family Medicine Pediatrics Diagnostic Radiology Not Listed 1 Specialty information is as of July 5, 2023, and may not reflect current information.
Physician Certification Pattern Review, 2024 Annual Report 25 Table 35: Top five physicians with the highest number of certifications containing at least one order for smoking and including “Qualifying Condition (k) Medical conditions of the same kind or class.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 6,744 to 24,624 7,408 to 17,316 6,192 to 19,406 Range in Percentage of Physician’s Certifications including (k) Same Kind or Class 34% to 78% 55% to 80% 44% to 86% Physician Specialty Area1 Family Medicine Family Practice, Hospice and Palliative Medicine Pediatrics Radiology‐Diagnostic Not Listed Family Medicine Pediatrics Radiation Oncology Hospice and Palliative Medicine Not Listed Pediatrics Radiation Oncology Family Medicine Not Listed 1 Specialty information is as of July 5, 2023, and may not reflect current information. Table 36: Top five physicians with the highest number of certifications containing at least one order for smoking and including “Qualifying Condition (m) Chronic nonmalignant pain.” FY 2021 FY 2022 FY 2023 Range in Total Number of Certifications 5,799 to 24,624 7,473 to 32,584 8,189 to 34,358 Range in Percentage of Physician’s Certifications including (m) Chronic Pain 45% to 96% 41% to 96% 37% to 87% Physician Specialty Area1 Family Medicine Pediatrics Plastic Surgery Not Listed Family Medicine Pediatrics Internal Medicine Obstetrics and Gynecology Not Listed Family Medicine Pediatrics Not Listed 1 Specialty information is as of July 5, 2023, and may not reflect current information.
Physician Certification Pattern Review, 2024 Annual Report 26 VII. Summary of the 2024 Annual Report Physician certifications created for qualified patients each month continue to show a cumulative increase for each year of reporting. For example, certifications increased by 48% (51,478 to 76,262) from January 2020 to January 2021, then increased by 24% (to 94,551) for January 2022. From January 2022 to January 2023, certifications per month increased at a slower rate, 21% (113,992). The most recent monthly count was 117,313 for June 2023. New patient enrollment each month increased by 27% (18,979 to 24,135) from January 2020, compared to January 2021, then decreased by 6% (to 22,716) for January 2022. Enrollments each month then decreased by 3% (to 22,128) for January 2022. The most recent monthly count was 20,977 for June 2023. The average daily dose ordered for low‐THC cannabis and medical marijuana has decreased significantly for all routes of administration since the previous fiscal year due to the implementation of daily dosing limits for all forms of marijuana in rule. The average amounts ordered for marijuana in a form for smoking remain consistent with previous reports, though some amounts ordered were higher this fiscal year. Data Tables for Physician Certifications contain detailed certification data for individual qualified physicians, and in the aggregate, by county and statewide, and are provided in a separate document. Panel Recommendations from 2023 Report Requests to Panel Support Staff: 1. Add information on the impact of COVID‐19 on physician certification counts, if possible. 2. Add data on order counts by age groups, if possible.
Physician Certification Pattern Review, 2024 Annual Report 27 VIII. Panel Recommendations for FY 2023 1. Include national level medical condition prevalence data in future reports, if possible.
Physician Certification Pattern Review, 2024 Annual Report 28 IX. Terms and Definitions Average (AVG) daily dose is the average of all maximum daily doses ordered within a physician certification by route of administration and type (low‐THC cannabis or medical marijuana). Average ounces are the average of all “total ounces per 35‐day order period of marijuana in a form for smoking” by certification, physician, county, or state. Cannabidiol (CBD) for low‐THC cannabis ordered by route(s) in the MMUR is measured in milligrams per day. Chronic nonmalignant pain means pain that is caused by a qualifying medical condition or that originates from a qualifying medical condition and persists beyond the usual course of that qualifying medical condition. County is based on the primary practice location (address) physicians provided in the MQA Licensure Database. Dose is the milligrams (mg) per day for each route of administration a physician recommends in the MMUR as part of a certification for marijuana. The “total mg/day” is the sum of all doses for a given form and type of marijuana ordered. All dose data entered were used. Form is a term referenced in section 381.986, F.S., to describe the routes of administration. Geometric mean is a method for describing the central tendency of a set of numbers by finding the product of their values. An arithmetic mean adds numbers instead of multiplies them. The geometric mean is used when there are large fluctuations in a data set to prevent outliers from skewing result, yet still included those data points in the analysis. Low‐THC cannabis means a plant of the genus Cannabis, the dried flowers of which contain 0.8 percent or less of THC and more than 10 percent of CBD weight for weight; the seeds thereof; the resin extracted from any part of such plant; or any compound, manufacture, salt, derivative, mixture, or preparation of such plant or its seeds or resin that is dispensed from an MMTC. Marijuana means all parts of any plant of the genus Cannabis, whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant or its seeds or resin, including low‐THC cannabis, which are dispensed from an MMTC for medical use by a qualified patient. Medical marijuana treatment centers (MMTCs) are licensed by the state to grow, process, and dispense marijuana to qualified patients who have certifications and identification cards issued by the OMMU. Medical Marijuana Use Registry (MMUR) is a secure, electronic, online medical marijuana use registry for physicians, patients, and caregivers that is accessible to law enforcement agencies, qualified physicians, and MMTCs. Medical use means the acquisition, possession, use, delivery, transfer, or administration of marijuana authorized by a physician certification. The term does not include: 1. Possession, use, or administration of marijuana that was not purchased or acquired from an MMTC. 2. Possession, use, or administration of marijuana in the form of commercially produced food items other than edibles or of marijuana seeds.
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