Medical Marijuana May Be Legal But Too Early to Exhale

Feb 01, 2019

December 6 marked a milestone in Missouri, the 32nd state to legalize medical marijuana; it was the day the law took effect. But the process will be long, arduous, perhaps even contentious as many physicians want nothing to do with it. As for patients, getting a prescription for the drug won’t happen any time soon. Then there are the medical marijuana dispensaries, cultivators and manufacturers…only recently have they gained access to Missouri Department of Health and Human Services (DHHS) online form to apply for a license and pay the respective fee.

Patients should start the process
To be clear, patients who are eager to get a script for medical marijuana will have to be – no pun intended – patient. First, they will need to find a doctor willing to recommend them for medical marijuana. Medical professionals who are proponents of medical marijuana suggest that patients start identifying doctors who will offer medical marijuana as a treatment option. Patients must prove positive for at least one of the following qualifying conditions including cancer, epilepsy, PTSD, chronic pain, HIV, prescription medication addiction, terminal illness, or any other medical condition determined to be debilitating or chronic.

Second, the physician will have to “certify” the patient.
Certification means that a doctor determines whether a patient suffers from one or more of the qualifying conditions as outlined in Amendment 2. Paperwork would be completed on the patient’s behalf that certifies the patient is eligible to access medical marijuana. This is different from prescribing medical marijuana – certifying and prescribing are two different things. Once a patient is certified, he or she is required to obtain a medical marijuana card from DHHS. Only then can patients visit a dispensary to acquire medical marijuana. According to the constitutional amendment approved by voters last November, this process (applying for medical marijuana card) must begin by early June. Based on the timeline (see below), realistically, it may be 2020 before patients will actually receive their first dose of medical marijuana.

Many physicians not on board, yet
Because marijuana is deemed a Schedule 1 controlled substance by the federal government, many physicians are opposed to the idea. Some say that although cannabis plants have legitimate medical uses, Missouri’s medical marijuana program could provide access to products that aren’t sold in standard dosages or purities. Simply put, patients may not know what they are getting. This proves difficult for doctors to determine risks versus benefits. Doctors employed by large health systems may also be more reluctant to participate, as the stigma associated with incorporating the drug into medical use is still widely negative in Missouri.

Provider shortages in rural areas, like West Central Missouri and Eastern Jackson County, will also make it difficult for patients to find doctors willing to offer certifications for use. Couple that with federally qualified health centers (FQHCs), that are funded by the government, inherently will not be able to certify patients due medical marijuana’s Schedule 1 status.

Private practice physicians may be more open
However, independent physicians like Lisa Roark, whose practice is in Cassville, Missouri, is on board. She told the Kansas City Star in  recent interview that the opioid epidemic is what pushed her to promote the merits of medical marijuana.

Sara Bubenik, another Kansas City primary physician, agrees with Roark. She intends to primarily use medical marijuana as an alternative to opioid painkillers. “There’s an opioid epidemic because there’s so much pain people don’t know how to manage,” she said in a published report.

Bubenik also cautions against medical marijuana use for individuals under 25, unless in extreme cases, and looks to state regulators to enforce standards for labeling medical marijuana products and testing them to ensure labels are accurate and products are safe to use.

Medical marijuana will not be covered by insurance. Patients will have to pay out of pocket or find direct primary care providers (patients pay a monthly fee to the provider).

A few key dates for Amendment 2
Jan. 5, 2019: DHHS started accepting pre-filled application fees.

  • Patient fee is $25 per year.
  • Cultivation fees: $10,000 initially, then $25,000 per year.
  • Infused-product fees: $6,000 initially, then $10,000 per year.
  • Dispensary fees: $6,000 initially, then $10,000 per year.

June 4, 2019: All application forms and instructions are to be posted on this date, based on rules finalized by DHHS. That includes application for four types of medical-marijuana licenses: patient, cultivation, infused-products manufacturer and dispensary.

July 4, 2019: DHHS begins accepting applications for patient and patient caregiver licenses.

Aug. 3, 2019: DHHS begins accepting cultivation, infused-products manufacturer, and dispensary licenses. Amendment 2 says DHHS must award a minimum of 192 dispensaries licenses, 61 cultivation licenses, and 82 infused-product manufacturer licenses.

Dec. 31, 2019: Deadline for approval of the Aug. 3 applications. Entities granted a cultivation, manufacturing or dispensary license will receive it “within 150 days after the application is received, if your application is approved,” according to a FAQ published by DHHS.

accessHealth News will publish Part Two on this topic in our March issue. Look for a local spin as Live Well Community Health Center providers will weigh in on what the new law means for Lafayette County and surrounding rural areas.

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Tonia Wright

Publisher, Editor-in-Chief

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