Connect with us

California, Cannabis and Telehealth: Part I

The ancillary companies that provide goods and services to the cannabis industry are legion. From equipment, real estate, legal services, and technology to packaging, labeling, intellectual property, hardware, and apparel, the list is basically endless for the opportunities that abound in the cannabis ancillary sector. One of the cooler ancillary areas that hasn’t gotten a

The post California, Cannabis and Telehealth: Part I appeared first on Harris Bricken.

Published

on

The ancillary companies that provide goods and services to the cannabis industry are legion. From equipment, real estate, legal services, and technology to packaging, labeling, intellectual property, hardware, and apparel, the list is basically endless for the opportunities that abound in the cannabis ancillary sector. One of the cooler ancillary areas that hasn’t gotten a ton of play is the cross section of telehealth and medical cannabis, especially where medical cannabis has overwhelmingly been deemed an essential service during COVID.

Just like state cannabis regulations, telehealth regulations vary by state. Telehealth (also known as telemedicine) is “. . . the distribution of  health-related services and information via electronic information and telecommunication technologies.” The use of telehealth has seen a considerable uptick during the pandemic. And securing cannabis recommendations from physicians via telehealth apps or platforms is no exception. Of course, giving and securing a recommendation in this manner comes with some caveats. In this post, I focus specifically on California’s current relationship with telehealth and cannabis, which has thankfully evolved.

Telehealth compliance in California is governed by, among other things, Business & Professions Code, Section 2290.5. The Medical Board of California (“MBC”) also provides comprehensive guidance regarding telehealth as well as guidance on physicians recommending cannabis for their patients. Specifically, MBC guidance on cannabis and telehealth provides that “[t]he use of telehealth in compliance with B&P Code section 2290.5, and used in a manner consistent with the standard of care is permissible.” Does this mean then that California physicians can start using telehealth to virtually dole out cannabis recommendation after recommendation? Definitely not. Let’s start with the cannabis side of things.

Proposition 215 (aka Health and Safety Code Section 11362.5), passed in 1996, permits qualified patients to acquire and use cannabis for specific medical needs via recommendations from their treating physician (cannabis cannot be prescribed because it is a federally illegal, Schedule I controlled substance). According to the MBC:

physicians should document that an appropriate physician-patient relationship has been established, prior to providing a recommendation, attestation, or authorization for cannabis to the patient. Consistent with the prevailing standard of care, physicians should not recommend, attest, or otherwise authorize cannabis for themselves or family members.

Further, pursuant to Business and Professions Code section 2525.2, a physician can’t recommend cannabis for medical purposes to a patient unless the physician is the patient’s attending physician, and “attending physician” means a “physician who has taken responsibility for an aspect of the medical care, treatment, diagnosis, counseling, or referral of a patient.”

The physician must also conduct and document a medical examination of the patient before deciding whether or not medical cannabis is appropriate for recommendation. At minimum, per the MBC, that physical exam (which maybe could be done now remotely because of COVID) should include:

the patient’s history of present illness; social history; past medical and surgical history; alcohol and substance use history; family history with emphasis on addiction, psychotic disorders, or mental illness; documentation of therapies with inadequate response; and diagnosis requiring the cannabis recommendation.

Business and Professions Code section 2525.3 states that physicians recommending cannabis to a patient for a medical purpose without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. And all of this is in the context of a physician exercising the appropriate standard of care, which also includes, among other things, maintaining a treatment plan, ongoing monitoring of the patient, and compliant recordkeeping.

So, how can a cannabis telehealth business take advantage of Prop. 215?

There are two types of telehealth business models in play. Synchronous (use of video conferencing or a telemedicine app or platform to recreate an in-person experience) and asynchronous (where there’s no virtual interaction between physician and patient, but the patient provides all of their medical information via an app or tech platform to be reviewed later by their treating physician). Typically, a third party company (made up of non-physicians) provides the app or tech platform while the physicians that utilize the platform treat patients accordingly. When we get inquiries from telehealth companies around cannabis recommendations in California, they want to know whether it can be done in the first place (“yes”), and whether they can have a financial relationship with a dispensary or other cannabis licensee that will provide cannabis to those patients accessing their app or tech platform.

And that is where things get interesting. In my next post, I’ll analyze whether a telehealth company can lawfully have such a set up in California. So, stay tuned.

The post California, Cannabis and Telehealth: Part I appeared first on Harris Bricken.

Continue Reading

Growing

How to Identify Pests in Your Cannabis Grow

Experienced and novice cannabis growers alike understand that pests can ruin a crop, no matter how well watered, fed, or tended. One of the keys to making sure that your plants grow into healthy, robust, and consumable cannabis is to keep a close eye o…

Published

on

Experienced and novice cannabis growers alike understand that pests can ruin a crop, no matter how well watered, fed, or tended. One of the keys to making sure that your plants grow into healthy, robust, and consumable cannabis is to keep a close eye on any pests that might infiltrate your grow, then take the appropriate steps to eradicate them without ruining your garden. Not only will it help keep the plants alive, thriving plants have more energy to produce trichomes and terpenes, making for better bud

Let’s take a look at some common pests found on cannabis plants, how to identify them, and lastly, get rid of them for good. With just a little maintenance and vigilance, your cannabis garden can be pest-free.

Ad

Common Pests Found on Cannabis Plants

According to the Smithsonian Institution, there are likely more unclassified insects in the world than classified, and the running guess is somewhere between 2 million and 30 million. Thus, this is by no means a definitive list of bugs that feed on cannabis but should serve as a good starting point for most pest problems. 

Caterpillars

Before a caterpillar turns into a beautiful butterfly and flits away, it can be very hazardous to your cannabis plants. You know that book The Very Hungry Caterpillar? Turns out it’s a true story about how caterpillars eat everything in sight, including that tasty cannabis. Caterpillars can be very dangerous because they tend to go unnoticed, especially if they are a borer caterpillar, meaning they burrow into the plant and eat it from the inside out. But even caterpillars on the exterior will nosh away, potentially causing great damage to your plants. 

To figure out if caterpillars are ruining your plants, inspect the leaves weekly for holes from feeding, droppings on the leaves that look like tiny black specks, holes, and damage to the stems, and yellowing on upper leaves.

Natural enemies of caterpillars are wasps and praying mantises, and introducing those to the environment could make a difference. These options are typically easier for outdoor grows, but can also work indoors with some preparation. Other interventions include using a product like Bug Blaster spray or neem oil (which you can make at home).

Neem oil use has been controversial in some cannabis circles, as there is a belief among some that it may play a role in CHS (Cannabis Hyperemesis Syndrome), however, no definitive statements can be made without more research. The connection between neem oil and cannabis hyperemesis syndrome has yet to be fully explored or verified, but it’s still good to be aware and to be sure to closely follow usage directions.

Aphids

Even house plants have the occasional plague of aphids. Tiny and red, yellow, black, pale, green, or brown, these bugs can be easy to miss because they cling to the underside of leaves, reproduce quickly, and drain your plant of nutrients. Outdoor grows tend to fare a little better in the battle against aphids since natural predators are present, but indoor plants can be decimated quickly by these teensy pests. Not only do they siphon nutrients away from the plant, they leave a sweet substance called “honeydew” that attracts other insects and turns the leaves black and moldy

Aphids and their honeydew on a plant

The honeydew left behind from aphids leads to further damages to the plant by attracting even more pests. photo credit

Because that honeydew attracts other pests, if you begin to notice a lot of ants or ladybugs coming around your plants, it’s a pretty good sign that you’re well into an aphid problem. Aphids can be hard to shake, but wasps and ladybugs are natural predators. Nonetheless, you should visually inspect the underside of plant leaves at least once a week. If introducing predators doesn’t ameliorate the problem, there are a couple of natural solutions to get rid of cannabis pests to try, like garlic or tomato leaf water. 

Spider Mites

Spider mites are like the supervillains of cannabis pests: uber reproductive, zombie-like in their ability to come back from what you thought was death, capable of spinning webs while eating everything in sight then completely disappearing before turning up again – they’re nearly impossible to spot and even harder to eradicate. Spotting spider mites is difficult because they are minuscule, but doing a daily inspection of both sides of your plant leaves could help to prevent a massive infestation.

Signs of spider mites begins with speckles, then a browning or yellowing of leaves, and premature leaf death.

If any parts of your plant are covered in fine webbing, that’s a sure sign you’re in a bad spot. The best way to avoid mites is to stay vigilant with your leaf inspections. If you do notice signs of mites, try introducing a fan into the environment. Strong air currents make it difficult for mites to breed. Spider mites also prefer temperatures of 60-80 degrees, so experimenting with temperature might also slow an infestation down. Since mites are likely to come back, consider a spray like Azamax or Spinosad to get rid of them for good (again, be sure to follow use directions carefully).

Fungus Gnats

Fungus gnats are just as hungry as caterpillars, but their gourmet meal is from the stem and roots of your plants and not the leaves. Beginning at the topsoil level, both larvae and adults will munch their way down into the root system, badly impact plant drainage, and compromise the structural stability of your plants. However, they’re nearly impossible to spot because they are dark in color, as is soil.

Fungus Gnats

Although fungus gnats are small, the damage they leave behind is mighty. photo credit

Seeing swarms of gnats near the base of your plant is one sign you’ve got a fungus gnat problem. Other symptoms are stems that weaken and simply fall over, adult plants that start to droop, wilt, spot, or yellow, or plants that stop growing altogether. 

Fungus gnats love moist conditions, so keeping the top layer of soil dry is a smart preventative measure. Some other hacks to try include placing a cloth on top of the soil to prevent female gnats from laying eggs or laying a sticky pad near the plant’s base to stick larvae. You could also mix some peroxide and water and spray it around the area of gnat infestation. A common-sense tactic for an indoor grow is to put screens on the windows and the doors closed to keep gnats out. 

Why Pests and Bugs Are Attracted to Cannabis

Something to keep in mind about pests, in general, is that they love a monoculture or a space dedicated to growing only one crop. Researchers from the University of California Davis theorize that if an insect makes itself at home in that one crop, it has a large food supply, creating an all-you-can-eat kind of scenario for the pest, making it that much harder to eradicate. As you likely don’t want to introduce other plants into a cannabis garden (for a number of reasons), this issue will always exist to some degree when dealing with weed. 

This is why, as mentioned, another option is to introduce other beneficial insects. Not only do they prey on harmful pests, but they are also an excellent chemical-free pest control option. The bugs already want to be there, you’re just bringing them to the dinner table. 

Ad

The Wrap Up

Identifying pests should be a regular ritual, just like watering and delivering nutrients to your plants. When you keep them pest-free, all that hard growing work will hopefully pay off in healthy and efficacious plants. Once you’ve harvested, you can move on to other fun challenges like doing a proper cure for your cannabis harvest, and how to store your cannabis stash


How do you deal with pests in your cannabis grow? Share your techniques in the comments!

Photo Credit: ilovegrowingmarijuana (license)

Continue Reading

Connecticut

Governor of Connecticut Pushes For Legalizing Adult-Use Cannabis In Budget Address

Connecticut’s Governor Ned Lamont proposed legalizing recreational cannabis in his budget address this week.

Published

on

Connecticut’s Governor Ned Lamont proposed legalizing recreational cannabis in his budget address this week.

Continue Reading

News

South Dakota Governor Delays Implementation of Medical Marijuana Initiative

It seems that Governor Kristi Noem isn’t quite done derailing voter-approved cannabis initiatives.

Published

on

It seems that Governor Kristi Noem isn’t quite done derailing voter-approved cannabis initiatives.

Continue Reading

Trending