In late February, Missouri's Department of Health and Senior Services posted its first draft of rules for the medical marijuana system that state voters overwhelmingly approved as a constitutional amendment in Nov. 2018.

The first batch of draft rules lists requirements and responsibilities related to ID cards for the program. State officials are writing other medical marijuana rules, too.

The rules are just drafts at this point, not finalized regulations. The state is asking for public input at forum meetings and online. The rules must be completed by early June, when applications and forms for the program go out, according to a timeline published by state officials.

The News-Leader reviewed the draft rules for patient cards, as well as the text of the constitutional amendment, and wrote this set of frequently asked questions.

Marijuana in Missouri:

I'm a patient. When can I apply for a Missouri medical marijuana card?

The state has until June 4 to make application forms and instructions available to the public. It will start taking applications for ID cards on July 4.

What health problems can qualify a patient?

The amendment lists health conditions that must be certified by a doctor in order to get a qualifying patient card:

Cancer

Epilepsy

Glaucoma

Intractable migraines unresponsive to other treatment

A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including but not limited to those associated with multiple sclerosis, seizures, Parkinson’s disease and Tourette’s syndrome

Debilitating psychiatric disorders, including, but not limited to, post-traumatic stress disorder, if diagnosed by a state licensed psychiatrist

HIV/AIDS

A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication.

Any terminal illness

In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to, hepatitis C, amyotrophic lateral sclerosis, inflammatory bowel disease, Crohn’s disease, Huntington’s disease, autism, neuropathies, sickle cell anemia, agitation of Alzheimer’s disease, cachexia and wasting syndrome

For prescriptions of amounts of marijuana greater than the standard monthly limit (more on that later), two physicians would need to sign off on the card application.

Patients would have to get a new physician certification every year to renew their cards.

Any renewal application would need to be submitted at least 30 days before the expiration of the old card.

Can I get a certification from my doctor about this now?

No. It's too early for official health certifications.

State officials posted this notice on the Missouri medical marijuana website in recent days:

"DHSS would like to remind the public that any physician certifications they receive for medical marijuana must be no more than 30 days old at the time an individual applies for a patient identification card, and DHSS will not begin accepting patient identification cards applications until July 4, 2019."

When do we get dispensaries?

The state is working on regulations for licensing the business side of medical marijuana: dispensaries, along with growing, testing and manufacturing operations. At this point, the timeline for those licenses is separate from the state's work on the ID cards. DHSS started taking business application fees for in early January, but it won't begin taking business application forms until Aug. 3. The business licenses have to be awarded no later than Dec. 31.

The amendment calls for almost 200 dispensaries, distributed evenly among the eight congressional districts in Missouri.

What kind of medical marijuana cards is Missouri offering?

There will be three types of ID cards: Qualifying patient cards, primary caregiver cards and patient cultivation cards.

You'll need a patient cultivation card to grow marijuana plants, not just a qualifying patient card.

To get a qualifying patient card, patients would need a physician certification of a qualifying health condition. The certification has to be less than 30 days old at the time of application.

People seeking any of the three types of card will apply through a DHSS website, under the draft rules. The application process would include personal data, a photo, proof of residency such as a drivers licence or a recent utility bill, and an email address.

The state will approve (or deny) and send out cards within 30 days of application. If approved, the cards are valid for 12 months. Qualifying patient cards will cost $25, at least initially. The state is still determining which payment methods will be approved.

What is a primary caregiver?

Caregivers are charged with managing the well-being of qualifying patients. To be a primary caregiver, a person needs to be at least 21 years old under the draft rules.

If a caregiver quits or becomes ineligible to be a caregiver, they need to officially notify the state within 10 days. The state will send a written confirmation that the caregiver has surrendered their card voluntarily.

If I'm a medical cannabis patient, can I also be a primary caregiver?

Yes. A qualifying patient may also serve as a primary caregiver for up to three other other qualifying patients, but patients under a caregiver's watch would not also be allowed to be a caregiver for somebody else. No individual would be allowed to serve as a caregiver for more than three patients.

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How many marijuana plants can patients and caregivers grow?

Patients and caregivers will both be allowed to grow marijuana plants on private property, if they have the proper patient cultivation cards from the state and the proper documentation for the plants.

The number 6 is important here. One patient can grow up to six flowering marijuana plants and six nonflowering plants at any given time.

Two patients may share one facility, with up to 12 flowering and 12 nonflowering plants. If one of those two patients were also a caregiver for a third patient, the total limit increases to 18 flowering and 18 nonflowering plants. The rules specifically exclude any patient homegrowing of more than six plants per patient.

Qualifying patient cultivation licenses will require that the patient or the caregiver grow cannabis "in a facility that is enclosed, locked and equipped with security devices" so that only the patient or the caregiver can get to the cannabis.

The plants must all be labeled with each patient's name, and the cultivation facility needs to display a "cultivation authorization" — one for each patient — much in the way businesses have to display their business license.

How much cannabis are patients allowed each month?

Missouri's proposed rules would allow qualifying patients and caregivers to buy 4 ounces of marijuana per patient, per 30-day period. The amendment mandates not less than that amount.

It's a lot of marijuana, in the context of illegal street sales that often consist of a baggie with an eighth- or quarter-ounce of marijuana inside.

Patients would be allowed to possess up to a 60-day supply, if they don't cultivate their own marijuana. If they do grow their own cannabis, patients or caregivers can possess a 90-day supply. But that supply must remain at the approved cultivating property.

Patients who get a certification from two independent physicians could get a higher limit.

If the two physicians disagree on what that higher limit should be, the state will accept the lower of the two limits.

If patients get certified for a higher limit after their card is issued, patients or caregivers would have to notify DHSS within 10 days.

If any medical marijuana is lost or stolen, it must be reported to DHSS by the patient (or the patient caregiver, if that person was in possession of the cannabis) within two days.

What happens if the patient dies? Can I inherit their marijuana?

No. If the patient dies or becomes ineligible for a qualifying patient card, any excess medical marijuana or plants must be turned over to a licensed dispensary within 30 days. Before giving up the marijuana, the individual in possession of it must make delivery arrangements with DHSS, including a "written, temporary authorization" to transport the cannabis to the drop-off point.

Disposing of marijuana in this way would not subject the possessor to arrest, criminal or civil liability, so long as the person transporting the cannabis can show authorities a copy of the temporary authorization when asked.

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Is this for kids?

The rules as proposed so far say that any marijuana bought from a dispensary would have to be stored in or with its original packaging.

Packaging has been an issue in other states with some form of legal marijuana because states want to keep kids from accidentally ingesting marijuana — or being subject to inappropriate marketing.

In Colorado, for example, packaging has to be child-resistant and carry a universal THC symbol on its front surface. In California, packaging has to be tamper-evident, too.

Missouri's amendment states that all edibles (such as candy or baked goods containing marijuana extract) for sale must be "in individual, child-resistant containers that are labeled with dosage amounts, instructions for use, and estimated length of effectiveness."

But what about Missouri kids being prescribed marijuana?

Yes, children could be qualifying patient cardholders and access medical cannabis. But that access would be regulated more closely than for adults.

Physicians would be able to write a certification for a patient under 18, if they have the written consent of a parent or legal guardian.

The child patient's card would be issued to the parent or guardian, and only a parent or guardian could serve as the child patient's caregiver.

Only a parent or guardian with a caregiver card could purchase marijuana for the child patient, and it would also be that adult's responsibility to "supervise the administration" of the medical marijuana.

What happens if you break the rules?

The draft rules provide for denial and revocation of these cards under certain circumstances. They include:

False or misleading information in an application or failing to complete an application in a timely manner;

Possessing more medical marijuana than allowed;

Violating Missouri drug-trafficking laws, or similar laws from another state;

Spamming the state with faulty applications. Applications would be denied if someone applies for any of the three types of cards and is turn downed twice in a 12-month period, or had an approved card revoked twice within a 24-month period, or a combination of having a denied application and a revoked card within a 24-month period.

Patient cultivation cards would also be revoked if a cardholder fails to immediately give the state access to the place where the cardholder is growing marijuana, upon request.

Primary caregivers must notify the state within 10 days should their qualifying patient die or choose to stop getting care from that cardholder. In those cases, the primary caregiver card is revoked.

Should medical marijuana traceable to a particular qualifying patient or primary caregiver be discovered in the possession of someone else not authorized to possess that medical marijuana, and that marijuana was not reported as lost or stolen, then the cardholder may lose the card.

Nobody, regardless of what type of ID card they hold, may consume marijuana out in public, unless otherwise provided by law.

What else is the state doing with medical marijuana right now?

The Missouri Department of Health and Senior Services is hosting public forums (including one in early March in Springfield) and seeking input from the public online as it writes draft rules for the new medical marijuana system.

It anticipates writing rules on these general topics:

Definitions

General Provisions

Qualified Patient/Primary Caregiver Rules

Medical Marijuana Establishments Generally

Cultivation Facility

Infused Products Manufacturing Facility

Testing Facility

Dispensary Facility

Seed to Sale Tracking

Transportation

Physician/Health Care Provider

Taxation

Penalties

Miscellaneous Provisions

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