CLEVELAND, Ohio – Physicians employed by the Cleveland Clinic, University Hospitals and the MetroHealth System cannot recommend that their patients use medical marijuana, each institution said.

There are over 300 doctors throughout Ohio the state has cleared to recommend the drug, and more are being approved each month. Many of them are in private practice since many large health care systems don’t want doctors they directly employ to seek certificates from Ohio to recommend medical marijuana, said Columbus oncology, palliative care and hospice physician Jerry Mitchell at an Ohio medical marijuana meeting last week.

Mitchell, who said he will at some point apply for certification to recommend, was unaware of the breakdown of how many certified doctors are direct employees of health care systems, versus independent practitioners.

At Cleveland Clinic, the decision was driven by a lack of FDA action on cannabis, said spokeswoman Carolyn Deming Glaviano.

“Similar to other major physician associations, the Cleveland Clinic continues to stand by the Food and Drug Administration’s approval process as the most effective way to ensure the safety, efficacy, and purity of medications provided to patients across Ohio," she said. "Until the marijuana products receive regulatory approval, we will not be involved with the distribution of unapproved cannabis products through dispensaries.”

The Cleveland Clinic directly employs nearly 4,000 doctors.

University Hospitals had 3,907 total providers last year, spokeswoman Katelyn McCarthy said.

“Due to the discrepancy between state and federal law with regard to the legality of marijuana use, UH employed physicians are not able to recommend the use of medical marijuana at this time," she said in a statement.

The policy does not apply to private practice physicians with University Hospitals privileges, McCarthy said, but they could not recommend marijuana on any UH campuses.

MetroHealth spokeswoman Tina Shaerban-Arundel said the system’s practice was to prohibit doctors on staff from recommending medical marijuana because, she said, it has always been its protocol. MetroHealth has about 630 doctors on staff, she said.

“MetroHealth is currently reviewing the available information (the current regulatory framework, the science supporting medical cannabis, and the needs of our patient population) to develop a policy,” she said on Thursday.

Under Ohio law, doctors with medical licenses in good standing can be eligible for the certificate to recommend medical marijuana. The doctor has to have a bonafide relationship with the patient before recommending and has to have diagnosed or confirmed the diagnoses of any of 21 medical conditions that may qualify someone for cannabis.

Physicians submit an application for the medical marijuana patient and caregiver registry, which isn’t yet activated since product hasn’t yet hit shelves. The registry sends patients medical marijuana e-cards, which are good for a year, then requires the doctor to renew them.

Some marijuana may be available next month. Most of it is expected to be available next year.

Doctors are expected to discuss with patients the risks and benefits of medical marijuana. Doctors can terminate the recommendation if patients die, no longer have the diagnosis or conditions to qualify for medical marijuana or abuse or divert medical marijuana.