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David J. Barton MD and Hawaiian-Pacific Pain and Palliative Care (www.hipppc.com)
Waimanalo Date/ Office Hours and Closures:
Before coming to the office, please, always check here for possible last minute closures and vacations. We were closed the first week in September, from September 1st to the 10th, 2019.
Email or text me with any concerns. If disabled or travel-challenged, consider renewal from home using telehealth.
Our next card sessions will be Wednesday afternoon, Oct 9, 2019, 1 PM to 4 PM, followed by Saturday, Oct 12th, at 0830 to 1000 AM.
Cards are getting backed up at the DOH, taking them ABOUT 2 WEEKS now to process cards for locals.
Two Year Card Statement
I just received word about two-year cards being an option provided by the DOH. I am currently analyzing the medical legal implications of such. It will not save people money as prices are just doubled, including our office fees, so, what are the benefits of such? Let me know how you feel it will help you, if you want a two-year card.
Update: I will support two-year cards under certain specific conditions. What people have told me is that it frees them from the worry of getting the card renewed. For others, who have caregivers and non-residential grow sites, it saves them the bother of completing, scanning, and uploading those forms every year. A few patients have circumstances where the lapse of a valid card has jeopardized their employment or legal well-being, so the continuity of a two-year card may be a benefit.
In my mind, it is for those who have been patients for several years with chronic conditions based on specific conditions and diseases. However, the option for a two-year card was put in place by legislators and activists more concerned about making it all appear recreational rather than maintaining proper medical standards in the current environment where there is still federal prohibition and legal consequences. As far as I know, Hawaii is the ONLY state that offers a multi-year card. All that tells me is that our state government ignored well established medical standards as set by a national or federal association of state medical boards, in spite of being told beforehand of its violation. It is offered by the state only for renewals AND only if by the same physician seen the previous year. You can't go out looking for a new provider who will do two-year cards.
In my practice, I still require the yearly questionnaire update be completed and the interview take place, which can be by telehealth. Telehealth is an easy and convenient method of follow-up at the one-year mark and requires minimal effort and time. That is the minimal standard of care required for medical and legal purposes. There are no cost savings for the 2-year card since you are paying for each year of care, basically doubling the office fee. The state doubled its fee, so there are no cost savings.
As most people know, I make myself very available to my patients who have valid cards, and at times, even for those who currently have lapsed or not yet certified cards, but have medical questions. I would be still liable for every day of those two years for patient care and to maintain the 329 cards validity. I'd still have to maintain costly DEA, NED, and medical licenses that keep your card valid for the entire period of your 329 cards. If any of my licenses become invalid at any point during those two years, your 329 cards immediately become invalid. If I retire or become ill, unable to maintain the practice, your card is made invalid. Plus, if having a two-year card, and you fail to do the yearly questionnaire and yearly interview, your card will be revoked. Lastly, if the state passes recreational legal legislation that allows everyone to grow their own plants, there will essentially be no need for 329 cards. At that point, l will stop the medical cannabis practice. Once I inform the DOH of such, all cards certified by me become invalid. If such becomes the case, I will maintain my licenses for one year to cover everyone, but not two years.
If you understand this entire statement, and still want a two-year card, write me and explain why it would help you. If you email me about getting a two-year card without having read this, I will ask you to read it and ask yourself if you are really benefiting from this option given by the DOH.
https://medmj.ehawaii.gov/medmj/welcome is the link to do the Online DOH registration
Yearly Questionaire (This replaces the yearly patient use questionaire form that is filled out at the office. It is NOT the required DOH yearly registration, which must be done prior to coming to the office)
New Instructions from the Department of Health Concerning Electronic Access to 329 cards (includes information for OUT of State Guests): Click here AND here: OUT OF STATE GUESTS: Click Here
(Starts March 5th: Both in-state and out-of-state patients whose applications have been approved March 5, 2019 and afterwards, will have online access to their 329 cards to save to their mobile devices and/or print a hard copy to keep. The DOH does NOT mail your card to you anymore. Cards are currently being issued within two days of submission after certification.
ALL patients may use this link to submit their personal use yearly questionaire to Dr Barton prior to coming to the office:
Renewals are eligible for home telehealth videoconferencing interviews. Email me for more information.
We NOT ONLY help people get cards...we provide the aftercare that makes you successful.
We expect people to be successful! We expect people to change their lives for the good!
How to get your card, includes a DOH video? Click here.
Clinic hours and information is here
Why get a state "329" cannabis card anyways? See here!
Gun enthusiasts need to read this: Click and read the second paragraph
New electronic measures are in place, since March 5th and afterwards. You download your license from your personal DOH MJ account instead of receiving it in the mail.
Check the latest card issuance times (in pink) from the state DOH: here.
I would start the renewal process about 4 weeks before your license expires.
We do not know the status of any card applications, so please do not call me for the status of your card. First, check your own account for its status as explained here: Click this link. If your application dashboard says it is in my box still, and you have been seen in the office already, then contact me.
Time to renew? You can now renew from home! Renewals are eligible for home telehealth videoconferencing interviews. (Email me for more information.)
Traveling issues? Telehealth follow-ups for renewals are Thursday afternoons (after 3 pm), and set by appt.
Always, contact me at the Hawaii Pain Gmail address for the forms and instructions. Text me for more precise times on that day.
For renewals only: It is essentially the exact same process every year. One must do the DOH online registration, and then have it certified during the office vist. If traveling to the office is difficult due to legitimate reasons, call/text/email me and let me know, as other arrangements can be made.
Please note: Please notify Dr Barton when you wish to attend a particular card session to either renew their license certification, or to get a new one. Please do this by either text or email. If you do not have it, my contact information can be found after submitting the above contact information in the auto-responder letter.
Patients are not allowed to submit the "329 cannabis license application directly to the Dept of Health. A fair number of people mistakenly are under the impression that the DOH will automatically send them a "329" cannabis license when they apply online through the state's website. The DOH does not know about your DOH online registration until it is certified by the physician, and the rules state that people must be seen by the doctor NO LESS THAN once per year. Once the physician certifies you, then your application goes to the DOH offices for card issuance. We try to make the process as easy as possible, but it is NOT our system, and we get frustrated by it just as much as you do. Getting a card is the exact same process every year, except one does not need to re-prescreen after the first year. See here!
I am satisfied that the confidentiality of the DOH database is secure enough, pending further review of the DOH rule making process, which allows police access to the database under necessary and reasonable yet limited conditions. Those who received letters from the HPD gave them permission to access it by trying to register a new gun. I think it must be pretty obvious now that registering a new gun is not allowed by them if you have a medical cannabis card.
CARD SHOP REGRET?: if you were seen by a signature clinic or a Physician/APRN card signer only, where all they do is just sign your certification, and do not provide followup care and directions, I am sorry but please understand that we can't provide further information and care to you, unless you come for a consultation. I can only give medical advice within the Doctor-Patient relationship, which must be established. Generally, you can tell if you went to a signature clinic, if you do not know who the doctor is that signs your card, and it is not easily seen from their website. Signing a certification is the easy part, getting your patients to be successful is the hard part!
(We do not use an appointment system, so please do not contact me asking for an appointment. All one needs to do is prescreen, if required, get the ok, and show up when you wish during one of our Oahu card session hours. See this link as well:
Hawaii Law does not allow insomnia, stress, anxiety, ADHD, depression, or any Non-PTSD psychiatric conditions as qualifiers for a card! All patients with any of these psychiatric conditions should be under the care of a psychiatrist/psychologist first, including PTSD, and would need their authorization first, before we can get involved for pain. In fact, most experts would recommend non-medication therapy for such conditions. ACT care has been shown to be most effective. You can find those trained in ACT here: Oahu/Hawaii ACT.
In addition, for tourists and visitors, unless you are a frequent or prolonged visitor with a local mailing and residence address in Hawaii, you can not get a Hawaii State Cannabis License YET. Hawaii is working on a reciprocity program that would allow it to recognize STATE medical cannabis cards issued in other states. Don't feel bad..you don't want to get ripped off by these Hawaiian Stores selling reportedly inferior products at insane prices anyways! Just read the reviews on the internet.
Gov. Ige signed HB1488 which means patients may now grow TEN plants per license starting June 29, 2017
Office Policy Changes:
- As of November 1, 2017, we will no longer see patients who have not completed their error-free DOH online registration beforehand, including the uploading of your required documentation! If corrections are needed, (review the common errors here) you can deal directly with the DOH. It should be quite clear by now that the DOH does not tolerate any errors in the information. Once your application is sent to the DOH, we do not have any access to it.
- Effective February 2018, all patients must notify Dr Barton that they wish to attend a particular card session to either renew their license certification, or to get a new one. There are too many inappropriate people showing up for clinic which makes things difficult for the office and all clients. Please do this by either text or email. My contact information can be found after submitting the above contact information in the auto-responder letter.
- Cards are NOW taking just a few days. If you do not receive your card from the Dept of Health, in a timely manner, before you do anything, check its status in your personal state medical cannabis DOH account. What that says is the first question I will ask you if you contact me. Odds are that you had errors which caused the DOH to reject your application, and so they sent it back to you for correction. The DOH contacts you through the email address you gave them. DO NOT put down any bogus information for your email address, phone numbers, and such. You will not get your card and you are not fooling anyone by hiding. You will just be causing us headaches!
If traveling, sitting, or climbing stairs are an issue due to disability, pain, or any other legitimate cause, please let us know ahead of time, so we can accomodate you.
For all patients, don't get caught up in the magical subculture of medical malarkey called strain specific treatment for any medical condition. There are no medical studies showing any strain specific treatment of any condition? Demand the chemistry profiles of your products. Warning: theoretically, if I had to sell my product, and at these outrageous prices, then I would claim all sorts of stuff I had read off the internet in the pseudo-science of recreational users and lay websites. Strain names are all tainted and unreliable, their genetics are adulterated, and the grow methods vary way too much to produce reliable known characteristics in a plant. Plus, the supposed medicinal value in any one human being is pure malarkey. There is no medical evidence to support any strain-specific claims. It needs to remain within the faddish non-medical unscientific lay subculture that developed it. In any cannabis based medication, one only needs to know the form or delivery method, what is in it and in what amounts. One needs to know the cannabinoid and terpene profiles in the original material and compounded products.
- If you have not received your card, please check its status online in your own state account. CHECK YOUR INBOX FOR AN EMAIL FROM THE STATE. Way too many errors are still being made by applicants in the DOH registration. Please be careful and do it right the first time. We can't help you with errors because the state's system does not allow anyone but you to fix the errors. Let me say that again: Only you can fix your errors! The biggest problem to getting a card are errors in the information submitted to the state, and the lack of required documentation being uploaded. Be sure to read this: https://www.medicalmarijuanaofhawaii.org/fyi-avoid-doh-application-rejections-errors.
- If you are new and can wait, please try to come in during the second or third weeks of the month. The state mails out renewal reminders during the last week of any given month, so renewals usually come in that first week, or the procrastinators come in the last week of any given month. This is a suggestion only, as we will see all qualified patients who come in!
For RENEWALS ONLY, you can email me at the Hawaii Pain email account to request our own 2017 office forms prior to being seen in the office. I will send you two pdf files, that you can print up, fill in, and bring into the office, in order to expedite your office visit. The state DOH online application still needs to be completed. If you want these forms, you must email me a request, and please, in that request, use the term "2017 office forms". I will not respond to text or phone requests.
Patients must have completed their DOH application prior to being seen in the office, or are able to do so on their own device at the time of the interview. See the fee schedule if office assistance is absolutely needed, which is done by appointment only. In addition, we do not know usernames and passwords to your state account, so unless you remember them, you can't fix anything.
We will allow your DOH application to remain in our DOH account queue for up to 4 to 6 months, after which it will be automatically returned to your own account for safe keeping and to allow you the freedom to use it as you wish. All unfinished applications not certified by me, completed prior to January of 2017, have been returned to the personal accounts of patients. Be sure to track the progress of your application in your own DOH Med MJ account. Once certified and submitted by the physician, we no longer have access to or any any knowledge about your application, or its status. That means we do not know anything about your card once the registration is submitted to the DOH. We are not agents for the State of Hawaii Dept of Health, nor do we work for them. This license is like a Driver's license, and it is a legal document between you and the State of Hawaii. We do not issue licenses. They are mailed to you from the DOH. Currently, cards are taking between 2 and 4 weeks to be received by patients.
"Since the taxonomists cannot agree, I would strongly encourage the scientific community, the press, and the public to abandon the sativa/indica nomenclature and rather insist that accurate biochemical assays on cannabinoid and terpenoid profiles be available for Cannabis in both the medical and recreational markets. Scientific accuracy and the public health demand no less than this." (Ethan Russo, MD)
At this point in time, I can't support the state's dispensary system!
I am personally shocked at the prices being charged by these dispensaries. They are much higher than I had estimated. More power to those who can afford them. The majority of patients can't afford those prices so basically, "Thank you for nothing". We will continue our efforts to empower patients to be self sufficient.
Plus, state entities do not provide HIPAA level privacy rights, which is a Federal right. HIPAA laws are Federal Laws, not state laws. Your purchases are going to be recorded and put into a database, and we do not know who has or will have access to that database yet. Neither the state or the Dept of Health has even talked about privacy rights of patients involved with the dispensaries. (How do I know? I asked them).
Here is my question and answer from the DOH:
ME: Since Federal HIPAA laws do not apply to these entities, what kind of privacy can patients expect from any information collected by them, either through solicitation or sales?
DOH: I expect this may vary from dispensary to dispensary. Patient confidentiality at the dispensary level is not addressed in 329D or our administrative rules that I am aware of. I’ve copied the dispensary program in case they have additional information to add that I may have overlooked.
My thoughts: I have not heard anything further. You may write the DOH and your representatives if you have similar concerns. I would encourage it. Before you give anyone your personal information, get the privacy policies in writing. Do not give away private personal and medical information. The dispensaries are NOT licensed to practice medicine, so when they open do not seek medical opinions from them. Do not tell them your diagnoses. They have absolutely no need for your personal medical information. Only the Dept of Health and your doctor are under legal mandate to protect your information...remember that!
This does not affect the majority of my patients. While most medical offices on Oahu and around, who certify, are clueless about the "real world", and their patients will be forced to be dependent on these dispensaries, we take the opposite approach. I encourage "local" patient support, and patients taking care of other patients, through teaching and encouragement. Malama First is what we are about. The majority of my patients have no need for any dispensaries, as they grow their own so they have safe sources of access. You will not find that at the "signature clinics", where the goal is to make money signing certifications, as quickly as possible. We are not business oriented! We are people and mission oriented.
Remember, these dispensaries do not have any magical knowledge of strains and their medical use. Medically, there is no such thing as strain specific treatment for any conditions in any given individual. All this strain talk is manufactured pseudo-science developed by a subculture of recreational users and lay websites. There are no medical studies involving specific strains and their treatment in any given condition. If anyone says that there is, then you have just talked with a "snake oil" salesman, trying to sell you their outrageously priced product. Roughly speaking there are only three types of cannabis:1. High THC recreational 2. Balanced medicinal with lower THC and higher CBDs 3. very low THC high CBD medicinal. All can have differing terpene profiles and the profile report can tell you which ones dominate, as certain terpenes have various effects. I would urge all to learn more about this. I agree with the medical science thinking of Dr Ethan Russo, MD. (https://news.lift.co/indica-sativa-complex-chemistry-of-cannabis/)
"When asked about the different purported effects between Cannabis indica and sativa, Russo unequivocally stated that, “There are biochemically distinct strains of Cannabis, but the indica/sativa distinction as commonly applied in the lay literature is total nonsense and an exercise in futility… It is essential that future commerce allows complete and accurate cannabinoid and terpenoid profiles to be available.” (Ethan Russo MD)
DEA policy dictates that all DEA licensed physicians can't have anything to do with dispensaries, or their agents, and distribution. You will never find my name associated with any of the dispensaries. I have nothing to do with distribution of this Schedule One drug. The state's dispensaries are still considered "illegal criminal enterprises" by the Federal Govt, and that is not going to change anytime soon.
Even our state lawmakers have failed to protect them by their failure to reschedule cannabis off of the state's Schedule One status! After they open and the DEA has fully vetted them, or shut them down, I will reconsider this stance. From my own practice audits, a minority of Oahu patients will use the dispensary system, but that may just reflect my practice demographics of locals. The dispensary program's success will depend on many factors, but mainly price, and the prices I have heard being thrown around are pretty much non-starters, but for only the most desparate. They do have a purpose, and can be helpful, but I am still not happy with the vertical system put into effect, as it disenfranchised all the local farmers who are phenomenal growers. In fact, the whole system put in place seems designed to fail. The state could have implemented a cannabis commodities market buying all the cannabis produced, that would have supported local cultivators and farmers. Instead, they went with an elitist system, back by investors with deep pockets, hoping to make it big with recreational tourist sales. Little concern was shown for the local medical patient and families, many with generations and decades of experience, growing locally under difficult Hawaiian conditions. Mauka and windward, from my side of the island, these stores are more a curiosity and do not really have "Local" support. That is my personal opinion.
I do not buy the argument that dispensary products are superior. Audits in other states do not bear that out as truthful, because as corners were cut to improve profits, lots of top shelf product burdened with mold and pesticides was allowed to be sold. In the meantime, we encourage all patients to learn to grow. I can discuss the benefits and disadvantages of this in the privacy of the office consult only.
The Nation of Hawaii, a United Nations recognized IPO, Indiginous People Organization, has outreach teaching programs to help patients be successful growers and to test their yields for potency and safety. Some of the most therapeutic and effective cannabis is fresh and raw, made from your own organic pesticide free garden. It is known that raw, fresh, unprocessed and unheated natural CBDs are 4 times more effective than otherwise. In this form, there is minimal disability and psychoactivity as we strive to improve function. I encourage the use of low THC high CBD cannabis in the raw form for many chronic pain conditions. In addition, the hobby of gardening is very therapeutic and is part of my 6 step pain management program. (See: https://www.ecpain.com/ which is an old website of mine. It is unfinished but the information is still most valid.) We want you to learn how and why this medicine is working for you. We want you to learn about the three types of cannabis, forget about strain classifications, and understand about the other therapeutic components of cannabis such as the Terpene profiles.
Telehealth follow-ups as arranged. As my patients know, I am very available most of the time. Cancer patients should text or email me at any time.
Please text or email me with needs, using contact info found in the autoresponder letter. If you telephone me on my personal cell number, and I am not able to answer, please leave me a brief message to let me know your primary need or purpose in callling. The message is converted to text and sent to me. I may be in a position to text you back if I know the number is textable.
We Know PAIN. Chronic severe pain nearly always involves sleep, depression, anxiety and other possible mood issues, along with conditioning and muscular dysfunction. One must explore life and one's sense of inner peace, avoid toxic people and situations, and minimize counter-productive and self-sabotaging attitudes and behaviors. Having solid hobbies and diversions help people to cope. Growing cannabis is a wonderful and satisfying hobby. Getting off as many pharmaceuticals as possible helps to improve your health. Cannabis therapies are ideal in that they help nearly all the above in multiple ways. We are not a 5-minute signature clinic. We take chronic pain seriously and promote action to deal with all the above-mentioned situations and conditions. Our goal is to help people take back their lives from the pain and get them back to their families and loved ones as well as possible.
Currently, card issuance by the DOH is around 2 to 4 weeks (latest audit:14 to 17 days), with some taking longer. We DO NOT know the status of cards with the DOH. You can check your application status and follow its progress online in your own Dept of Health MEDMJ account. https://medmj.ehawaii.gov/medmj/welcome
How to get a State of Hawaii Medical Cannabis "329" license? The quick overview!
All new patients should Pre-Office screen. Please read this link: (https://www.medicalmarijuanaofhawaii.org/when-contacting-us-clinic-contact-info). Pre-screening requires sending me information by text, email, or phone. Read the link just cited. To get contact information, sign up above. Filling out the above Contact Information fields and submitting them to me is NOT prescreening. I would not do the DOH registration until you have been accepted by a physician, with a good chance you will be approved.
Patients complete the Dept. of Health online registration process before being seen in the office(https://www.medicalmarijuanaofhawaii.org/so-you-want-329-hawaii-state-medical-cannabis-license). Once accepted, fill out the DOH online registration carefully as there are way too many errors being made, and the system does not allow us to edit any patient application. See the above link for the common errors. The State DOH expects perfection! These registrations bounce from your queue to my queue once submitted. We will allow your DOH application to remain in our DOH queue for up to 4 to 6 months, after which it will be automatically returned to your own account. I try to email you at the same time they are returned to you, so I maybe behind on the time periods)
Patients must be seen in the clinic and visit with Dr Barton to complete the DOH registration certification. (https://www.medicalmarijuanaofhawaii.org/how-get-your-329-medical-cannabis-card) The DOH application registration is afterward sent to the DOH queue for state processing once certified. Clinic hours and fees: https://www.medicalmarijuanaofhawaii.org/clinic-hours-and-costs-preparing-your-office-visit. We do NOT use a traditional appointment system. Basically, on Oahu, we only see patients for cannabis cards on Wednesday afternoon, 12:30 to 4 pm, and Saturday morning, 0830 to 1030 AM, on a first come first serve basis only. I stay until everyone is seen. Thursday afternoons/evenings are for telehealth follow-ups as arranged. We can no longer see patients who have not completed or are not able to finish their applications at the time of visit. In addition, if your DOH online registration remains dormant for greater than 4 to 6 months, we may return it to your personal state account to avoid the clutter.
Once submitted to the Dept of Health, it is impossible for us to make any changes to your application. The state will mail your card directly to you in about 2 to 4 weeks, and perhaps faster depending on the season. Any further changes to your cards are done directly through the Department of Health.
My name on state forms is David Barton
- Registry Applicants – Please check your account at medmj.ehawaii.gov WEEKLY for registration status updates. The average turnaround time for processing complete applications is ten (10) business days, subject to volume and staffing. If you see:
- “Submitted to Physician/APRN“, your application has NOT been submitted to DOH by your physician/APRN. Please follow up with your physician/APRN.
- “Submitted to DOH“, you application has been received by DOH, it has NOT been reviewed so it may NOT be complete. All applications are processed in the order received.
- “Waiting for patient or waiting for physician/APRN“, your application was NOT complete and was returned electronically. Check the email you used to register to see what corrections are needed, make the corrections and resubmit. If you do NOT see a 329 Registration Number your card has not been issued, yet.
- “Registration Number“, your 329 Card has been processed and issued – please allow ample time for postal delivery. Be sure to check the mailing address on your application to be sure there are NO ERRORS that may cause a postal deliver delay. Some VALID address have taken up to 30 days for delivery. If your mailing address is WRONG – please review Changes to Application Information and email email@example.com.
- “Waiting for Activation“, your 329 Card has been processed and issued – but you have a current valid card – your new card will be mailed to you but will not become “Active” until your current valid card expires.
The card hours for Oahu will be Wednesday afternoon and Saturdy morning only.
Please remember, you are not legal until your DOH online registration has been certified by the doctor, after your clinic evaluation.
In view of the numerous incomplete and error-filled online registrations needing fixing, make sure to check the status of your DOH registration to make sure it has been submitted to the DOH after your clinic visit. Once submitted to the DOH, all unfixed errors will be addressed by the DOH through your email contact information.
I would also like to post a warning to patients about so called "vet support" groups, who have formed just to sell vets cannabis. Although they may have a sincere interest in helping vets, you should not have to pay any of them a fee to facilitate the issuance of a medical cannbais card! I have absolutely no business relationships with such groups.
Aunty Pilahi wrote and passed The Aloha Spirit Law, Hawaii State Statute 5-7.5 as traits of character for its people and a way of life.
A – Akahai meaning kindness expressed with a feeling of tenderness
L – Lokahi meaning unity (unbrokenness) expressed with a feeling for harmony
O – ‘Olu’olu meaning agreeable (gentle) expressed with a feeling of pleasantness
H – Ha’aha’a meaning humility expressed with a feeling for modesty
A – Ahonui meaning patience applied with a feeling of perseverance