Just before 10 a.m. this past Thursday, a few people mingled outside the storefront waiting for the sign on the door to flip to “open.”

When the door opened, they filled in and perused the items on the shelf and in the glass case by the register that contained colorful bottles that promised relief from afflictions.

Located in the Czech Village, the Corner Store Apothecary and More sells cannabidiol, or CBD, oil-based products derived from hemp for medicinal or holistic health.

Hemp contains minimal amounts of tetrahydrocannabinol, or THC — the psychoactive ingredient in marijuana — and can be sold legally in the United States as nutritional supplements.

Kymm Loeffler, owner of the Corner Store Apothecary, said her customers use CBD for relief from conditions that can vary from seizures, chronic pain, cancer-related symptoms, eczema, anxiety and chronic pain.

Madeline Kreitzer, 26, of Cedar Rapids, is a customer of the apothecary and an instructor at Heat Yoga. She uses the oil to alleviate aches from her classes and to manage her PTSD symptoms.

She also was a medical marijuana patient when she was a resident of Colorado.

“Everything has its place and personally for me, I have found better results taking cannabis and CBD,” she said. “Personally, I found much more health benefits from cannabis than from most pharmaceuticals.”

The line of customers outside the apothecary Thursday morning represents the strong interest of some Iowans to have greater access to medical marijuana — an interest that has resulted in Iowa following in the steps of many other states.

Loeffler and Jeanette Ramirez, co-owner of Nette and Hanna’s Apothecary Store and More in Marion, believe area physicians are beginning to warm to the idea of medical marijuana. Both owners said customers have come to their stores on the recommendation of their primary care doctors.

“It’s what’s working for them,” Ramirez said. “You don’t have to like that I’m selling this stuff, you don’t have to like my opinion on the recreational or medicinal purposes, and that’s OK. But you cannot deny people the right to feel OK.

“It’s all about the people and being able to have access that works for them without having the access to the narcotics through the pharmaceutical companies,” she said.

But even as state officials and approved companies prepare for the first products containing ultralow THC to be sold statewide come Dec. 1, Iowa physicians do not seem to be jumping in on with the program in great numbers, some say.

DOCTORS WORRY

Lawmakers expanded Iowa’s medical cannabis law in 2017 to allow cannabidiol with no more than 3 percent of THC for certain illnesses and medical conditions, including cancer, multiple sclerosis, AIDS or HIV, Crohn’s disease, Parkinson’s disease and more.

To obtain the product, patients must have a physician certify their condition to approve them for a medical cannabidiol registration card, which in turn allows patients and their caregivers to legally possess marijuana.

“What we’ll probably see as time moves forward and the program is launched, more providers will feel comfortable. But most likely, it’s just in the early stages and people are unaware.” - Dr. Jolene Smith, Pain Specialists of Iowa in Des Moines

The state health department has approved 598 registration cards as of Wednesday.

Although some doctors are on board with the idea, many at the Iowa Medical Cannabidiol Advisory Board in Ankeny on Aug. 3 don’t see the program gaining a lot of traction.

Dr. Jolene Smith, with Pain Specialists of Iowa in Des Moines, was among the presenters at the meeting of the advisory board — the group tasked with offering recommendations on the implementation of the program.

Smith said she senses physicians’ caution comes down to two things — the lack of knowledge about the program as well as a lack of information regarding legal liability, as marijuana still is defined as an illegal substance by federal officials.

“So it could be a combination of both, but I think there’s just hesitancy in anything that’s new that hasn’t been developed,” Smith said.

“What we’ll probably see as time moves forward and the program is launched, more providers will feel comfortable. But most likely, it’s just in the early stages and people are unaware.”

Iowa has licensed two medical marijuana manufacturing facilities and five dispensaries that eventually will sell oils, creams, suppositories and other products to those who have state-issued registration cards.

A Cedar Rapids-based manufacturer Iowa Relief LLC, a subsidiary of New Jersey-based Acreage Holdings, was licensed June 29 and joins Des Moines’ MedPharm, which was licensed on Dec. 1.

“We’re noticing that our physician side of the equation still is lacking, agreed Lucas Nelson, General Manager of Outsourcing Services for Kemin Industries. “Too many people are having the exact same response from physicians who say, ‘This is junk science.’”

NEGATIVE OUTCOMES OR A BETTER ALTERNATIVE?

That it’s an effort that’s patient driven and not pushed forward by the medical community presents a real possibility that it could affect the health and well-being of Iowans in a way state officials don’t yet know, said Peter Komendowski, president of the Partnership for a Drug-Free Iowa, a policy group aimed at reducing crime and drug use statewide.

“If Iowa did not have enough milk in their schools, would the legislature open a dairy farm to raise milk? Why is the solution in this case for Iowa to get into the business and rush to the market?” Komendowski said.

“They don’t go into other businesses. The only reason we can see they would because there was a strong enough push in terms of lobbyists to convince them they should do this.”

Komendowski and others with the Partnership for Drug Free Iowa said during the advisory board meeting that their biggest concern is that this program would open the door wider to the potential for legalized recreational use in Iowa.

Ramirez argued that this would not be the case, as people in Iowa “are already doing it.”

“What it’s going to do is open the door so these people don’t have to hide it anymore,” she said. “Medicinal or not, it’s something that’s already out there, so it’s not going to be anything new.”

But Komendowski’s concern is one shared by some doctors as well. Iowa Medical Cannabidiol Advisory Board member and oncologist Dr. Robert Shreck said he’s heard doctors in pain management and psychiatry fields say that “the last thing they need is one more mind-bending drug in the population.”

“We’ve already got alcohol and opioids — why throw another one in there?” he said.

On the other hand, Smith with Pain Specialists of Iowa said there is some evidence that some patients could benefit from medical marijuana in their pain management, assisting them in lowering their pain medication – including prescription opioids, which some public health experts say has contributed to the high rates of addition and overdose deaths across the state in recent years.

“I can’t say cannabis is the problem eraser for the opioid crisis — but we’ve found it could reduce or eliminate opioid requirements,” she told the board.

And some Iowans who hope to use medical marijuana for this purpose believe it’s still out of reach for them. Kelle Collins is the primary caretaker for her 76-year-old mother, a Des Moines-area woman suffering from degenerative discs in her neck that leaves her reclusive and reliant on opioid pain killers.

“I had a mom that was busy, energetic, had a great job and she’s reduced to really being home at the age of 76,” she said.

Collins’ mother wished to remain anonymous for fear of her doctor’s reaction.

Collins — an aesthetics manager at Kemin Industries, MedPharm Iowa's lead consultant — and her mother proposed medical marijuana as an alternative to her pain management doctor. The doctor turned down the idea immediately, she said.

“We’ve done our research and I think (my mother) should have the option,” Collins said. “Why would a pain doctor not want to do everything they could to find an alternative for these drugs?”

Nelson said the company is undergoing educational outreach as well as hosting focus groups in Cedar Rapids and Des Moines to answer questions and bring the program to greater awareness.

“There’s still too much uncertainty about how this works,” Nelson said.

Gazette reporter Erin Jordan contributed to this report

l Comments: (319) 368-8536; michaela.ramm@thegazette.com