After his 88-year-old mother fell and broke her neck six years ago, Bill Crouse knew he needed to do something. For four months his mother was “off the planet” on opiates in a Plantation nursing home. She was depressed, anxious, constipated and “meaner than snot.”
Crouse was desperate.
He took his mother to see Dr. Michelle Weiner, a Miami pain management physician and medical marijuana expert. By May 2018, Crouse’s mother’s opiates were entirely replaced by marijuana tinctures, which he drops under her tongue or mixes in with applesauce.
Until he moved his mother into a private assisted living facility last year, Crouse had to sneak his mother her three-times-daily doses when no one was around.
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“The facilities have the same core problem,” Crouse said. “They have no protocol. They have no set method.”
Fears over losing Medicaid and Medicare funding — because federal law still considers all marijuana use illegal — keep most nursing homes and assisted living facilities pot-free, despite recommendations from doctors to card-holding patients who reside there.
Medical marijuana is a burgeoning industry in Florida, and seniors are a burgeoning population. According to population statistics, residents 65 and older will outnumber minors nearly 2 to 1 by 2030.
When Crouse’s mother got her medical marijuana card, she was patient 1,176. The patient population is now nearing 200,000 and legislation to lift a ban on smoking the drug is set to hit the governor’s desk this week.
Despite an environment where the Legislature is dialed in on the expansion of access to medical marijuana in all of its forms, one of the largest groups who would benefit is being left behind.
While using the drug has had success in treating chronic pain, Parkinson’s, glaucoma and other diseases that come with age, many seniors in Florida don’t have access to medical marijuana.
One medical cannabis physician, Dr. Kelly King of Hillsborough County, called nursing homes “a real microcosm of all the problems that the elderly deal with.”
Bob Asztalos, a lobbyist for the Florida Health Care Association — the state’s largest advocacy group for long-term care providers — said members see a benefit to the treatment but are restricted by the federal government..
Facilities are inspected based on federal standards, he said, and while federal authorities have never raided a nursing home in Florida, “no one wants to be the first.”
“I don’t think that nursing homes are afraid of it. We’re just caught in the middle between the federal government and the state government,” he said. “It’s always tough for us because we’re regulated by the federal government and state government equally, and [they] don’t always agree on things.”
Shad Haston, CEO of the Florida Assisted Living Association, said while some private providers are administering the drug, they warn others to be cautious.
“We have told our members if they participate in Medicaid, or if they intend to participate, they should be leery of allowing it to happen,” he said.
That advice followed “some comments made by then-AG Jeff Sessions that alluded to the federal government’s concerns about it,” he said.
William Barr, the new U.S. Attorney General, spoke in his Senate confirmation hearing about the fact that several states have made laws allowing the use of medical marijuana.
Barr said the “right way to resolve” the matter is legalizing medical marijuana through the federal legislative process. As for state law, he promised not to go after states where it’s legal.
“To the extent that people are complying with the state laws, distribution and production and so forth, we’re not going to go after that,” he said.
In an effort to protect facilities that allow marijuana under their rules, a bill that recently passed through the Senate by Sen. Jeff Brandes made it known that the state cannot ban marijuana use from those places.
“I think for me, it’s making sure we recognize that Floridians have said that marijuana is a medicine and that we treat it as such,” the St. Petersburg Republican said. “That means we keep it as available as an option.”
Weiner, the doctor who prescribed medical cannabis to Crouse’s mother, travels to nursing homes and assisted living facilities to speak about how the elderly can benefit from marijuana treatments.
Since she started recommending cannabis two years ago, she says she’s weaned over 150 patients off opioids and onto medical marijuana instead. The older patients, however, are “totally screwed” by the fact that cannabis is still a federally restricted drug.
“They’re too old to remember to take the medication and nurses can’t give it to them by law. They’re at a loss, and the cost is an issue,” she said. “How does a 90-year-old know to call a company every month and get it shipped to them?”
Weiner said she also recommends cannabinoid oil or CBD, which is now legal under the 2018 Farm Bill that Congress passed in December. Florida, however, has not yet incorporated the federal statute into state law, and CBD products remain illegal. Therefore, most facilities won’t administer CBD treatment or even allow patients to take it on their own.
“[The elderly] are over-medicated, they have so many side effects from medications that cause dizziness, constipation, cognitive confusion,” Weiner said. “[Marijuana or CBD] would be a great way to substitute it for other pharmaceuticals. Until Florida incorporates what just passed in the Farm Bill into this law … it’s still in a waiting zone.”
Tya Eachus met Weiner when she was giving a talk on CBD at The Palace, a Kendall assisted living facility where Eachus’ mother was living.
Eachus became interested in the treatment and researched the many ways it would help her 92-year-old mother.
The Palace refused to administer CBD oil, a rule Eachus has been fighting for months. She recently filed a complaint with the state’s Agency For Health Care Administration against the rules that keep facilities from administering CBD.
Eachus, who lives in Kendall, is in the process of moving her mother from The Palace to a facility in Aventura where she will pay a private contractor $300 a month to administer CBD oil and check her mother’s blood pressure.
“If they would allow it, the residents would be relaxed and more comfortable in their surroundings, and it would be a more pleasant experience for everybody,” Eachus said. “They’re impeding my mother’s well being by not allowing her to have it.”
Josephine Cannella-Krehl, a clinical social worker and marijuana advocate, works with facilities like The Palace to educate them on CBD and marijuana treatments.
She mainly focuses on independent, private-pay facilities that have more flexibility in what they can allow. She hopes to be a voice for elderly residents who “are not going to be vocal about what’s missing for them.”
Cannella-Krehl, a regular presence at legislative committee meetings, is pushing for a provision that would make facilities able to have caregiver status. As of now, each medical marijuana patient is allowed one registered caregiver who has the ability to purchase and administer the drug on behalf of the patient.
“How realistic is it to expect a son, a daughter or non-family member to come to a facility to administer the medication, two, three, four times a day? It’s unrealistic,” she said. “The unintended consequence is that the elders who can benefit greatly have no access.”
Crouse knew this expectation all too well. When his mother was in a nursing home, he had to go three times a day to administer the drug. His mother has been in an assisted living facility for a little over a year, where they will administer the drug for him. But he has to be the one to purchase it, and he gives the assisted living facility two-month supplies ($600 worth) when they start to run low.
He pays in cash and he does a lot of driving, but says it’s all been worth it.
“My mother is off all the opiates. She has less anxiety, her pain is dramatically reduced,” he said. “Her depression is gone and she’s the socialite of the facility. She talks more and is able to communicate better. I’m a steadfast one … when you’re the son you’re kind of there for the long haul.”