A patient let the News-Leader observe while he applied for a medical marijuana card.

Backers of medical marijuana think Missouri's patient application rate is "healthy."

Other than applying for a medical marijuana card, July 23 was a pretty ordinary day for a Springfield man in his mid-30s. He got up early, went in to work and got home by 5 p.m.

He completed the process from his living room in his second-floor, south Springfield apartment. The man invited a News-Leader reporter to observe, on the condition that his name and health condition not be disclosed to the public.

He was among the first 4,500 Missourians to give it a try since the state health department began taking applications June 28. In the month since then, almost all Missouri patient and caregiver applications have been approved, according to data provided to the News-Leader late Monday.

The Springfield man said he lives with one of the health conditions outlined by name under Missouri's medical marijuana law, Amendment 2. The amendment allows physicians to certify patients for marijuana if they live with one of nine diseases listed: Examples include glaucoma, cancer or epilepsy. Patients with other chronic or terminal conditions can also be certified if a physician thinks they should be treated with cannabis. Amendment 2 does not allow for recreational cannabis use, or for anyone to consume cannabis products in public.

A few days before applying, the man saw a doctor for the paperwork required under Missouri law. The doctor has treated the man for his condition for a few years, and the appointment went smoothly, the man said.

When it was time to upload application materials to the Missouri health department's medical marijuana website, the task took about 30 minutes. The application wasn't difficult, the man said. He paid the $25 annual fee.

The most time-consuming aspects of the online process appeared to be selecting a good personal photo — Missouri's rules are similar to those used by the U.S. State Department for passport pictures — then hooking up a home scanner to convert the man's doctor paperwork into a digital file.

The man wondered how long it would take for his application to be processed. The 33 states with some form of legal medical marijuana have worked through patient card applications at varying rates of speed.

Arkansas, for example, began taking applications in 2017, then started mailing out cards in February, according to reporting by the USA TODAY Network in Arkansas. At that point, about 7,000 Arkansas residents had applied.

For Missourians, the process has been quick. Less than 24 hours after applying, the man messaged the News-Leader.

"I'm approved," he said. The health department website sent him a notification, along with a downloadable version of his qualifying patient card. Missouri legal marijuana cards are "nothing fancy," in the words of a state health department spokeswoman. They list patient name, ID number, whether or not the patient has permission to home-grow, and the date of expiration. They don't carry a photo or high-tech features like a drivers license.

When Missouri dispensaries open in 2020, the south Springfield man will be able to step inside and buy legal marijuana for treatment.

Comparing Missouri to other states

Backers of Amendment 2 think the Show-Me State's patient counts are signs of a "healthy" beginning for the medical marijuana program.

"We're heartened to see the number of patients who've signed up for Missouri's program so far," said Jack Cardetti, a political consultant tied to the Amendment 2 movement and a spokesman for the St. Louis-based Missouri Medical Cannabis Trade Association, or MoCannTrade.

Cardetti said that he believes there will be a spike of interest in signing up for patient cards once licensed dispensaries are functioning next year. (People who want to open legal dispensaries are currently preparing applications for state business licenses, due between Aug. 3 and Aug. 17.)

As a late adopter of medical marijuana, Missouri's program has significant differences from those of nearby states, Cardetti noted.

It has moved more quickly and covered more patients than the Arkansas system, Cardetti said. The Natural State became the first state in the Bible Belt to add medical cannabis in Nov. 2016. It started taking patient applications in June 2017. But dispensaries did not open until May 2019.

And there were just two of them, the News-Leader reported. Arkansas state officials approved 12,000 patients for cannabis before opening day.

"What that shows is that there are differences in the laws across the country," Cardetti said.

He said drafters of Missouri Amendment 2 wanted to create a system that would result in medical marijuana access for about 2 to 2.5 percent of state residents, after the program had been operating for three years. Missouri's population is about 6.1 million, so 2.5 percent of residents works out to about 152,000 people.

Some other states have larger proportions of patients. Oklahoma, for example, has enrolled more than 3.5 percent of residents, some 150,000 patients out of a population of 3.9 million. State officials there attribute the high participation rate to a cheap application process and "a lack of restrictions on qualifying conditions," reported Oklahoma City TV station KFOR.

"On patient counts, on all aspects of medical marijuana, Oklahoma essentially has a wide-open system," Cardetti told the News-Leader Monday.

Oklahoma is not the only neighboring state to adopt a more permissive approach.

Illinois legalized medical marijuana in 2013 and recently passed a law allowing recreational marijuana use beginning Jan. 1, 2020. Last year, an average of 1,875 new patients registered for the Illinois program each month, reported Marijuana Business Daily, up from 1,260 per month in 2017. The numbers were expected to grow because Illinois added a state law allowing patients with opioid prescriptions to more easily get marijuana for pain treatment.

Next year, when Illinois goes recreational and begins allowing non-residents to buy up to 15 grams of marijuana, Cardetti said he expects that will affect Missouri's medical program. But he thinks there will be two mitigating factors. One is that it's against federal law to transport marijuana across state lines.

The other, Cardetti said, is that people living in eastern Missouri may be mindful that Illinois charges higher sales taxes on marijuana. They range from 10 to 25 percent, according to the Illinois Policy Institute, compared to Missouri's 4 percent tax that will go toward veteran services.

A University of Missouri-Columbia study published in April used data from other medical marijuana states to predict that 26,000 Missouri patients would be approved for marijuana by 2022, the News-leader reported.

Many observers, particularly pro-cannabis interests, questioned the study. Cardetti characterized it as "well-meaning," but said it relied on older data from states with medical marijuana laws that differed from Missouri's.

In an April interview with the News-Leader, the study's chief author, Mizzou economics professor Joseph Haslag, said that the main challenge in developing the predictive study was "just what other states put out there in terms of the quality of data that researchers can use."

He acknowledged that "there's a little bit of arbitrariness to it" due to the data and the fact that 32 states and the District of Columbia passed medical marijuana laws in three "waves" going back to 1996.

More Missouri medical marijuana news:

Here are Springfield doctors willing to do marijuana certifications

City turns down Kearney Street marijuana dispensary zoning applicant

At Missouri Safe Schools conference, a retired patrolman warns educators about marijuana