When Ailment Wellness Medical Center in Fredericksburg began advertising itself last year as a place patients could see a “medical marijuana doctor,” staff members say the phone started ringing and didn’t stop.

“We actually had to have Verizon come in and install two more lines,” says office manager Missy Miles. “Our system started dropping calls and wasn’t able to handle the volume.”

But while patient interest has been high, so far most doctors are steering clear of the program and major medical groups are treading with caution.

Some, like Bon Secours Medical Group, are flat out prohibiting their physicians from recommending or certifying patients for medical marijuana, a spokeswoman said.

Others are placing strict limits on when and how their staff can recommend marijuana as a treatment. Sentara Health System will only let neurologists sign up to treat patients with intractable seizures and the University of Virginia Health System only support its use in clinical trials.

And others, including Carilion Clinic, Riverside Health System and VCU Health, say they’re still trying to figure out what to do and are waiting for more guidance from the state Board of Pharmacy or through their own physician workgroups.

The medical groups cited two major concerns. First, the fact that marijuana remains illegal at the federal level, leaving them uncertain of what liability they might be exposed to by recommending it to patients.

Second, there has been relatively little research about the drug in the U.S., particularly by the U.S. Food and Drug Administration, which clinicians often rely on when they prescribe medication.

“There are drug interactions, there are some risks, so it’s not like you can say this is an innocuous drug we can add to your regimen,” said Cindy Williams, vice president and chief pharmacy officer for Riverside.

Sen. Siobhan Dunnavant, R-Henrico, a practicing OB/GYN, acknowledged that medical marijuana lacks some of the evidence that clinicians usually rely on, “but that’s not to say there’s not good literature,” through international studies.

“As those studies become more and more apparent, different specialties will embrace different aspects of recommending this, and it will follow the same kind of process that all best practices in medicine do,” said Dunnavant, who originally sponsored the legislation that created Virginia’s new program.

Few doctors registered

In total, only 251 of the 35,404 doctors licensed to practice in Virginia have registered with the state to write recommendations. The situation has left patients seeking medical marijuana unsure where to turn.

“I don’t think it’s necessarily going to impact the success of Virginia’s program, but it is going to pose a great barrier of access to Virginia patients,” says Jenn Michelle Pedini, executive director of Virginia NORML, the state chapter of the National Organization for the Reform Marijuana Laws.

She says the majority of the calls her office have fielded in recent weeks have come from patients trying to figure out how they can find a doctor participating in the program.

“A lot of the people I heard from are frustrated with how difficult the process is to navigate,” she said, noting that while the state has made it possible to search for physicians who are registered, the system is difficult. Calls to several of the registered doctors on the state’s list revealed many aren’t accepting patients.

Beyond difficulty finding participating doctors, there’s still significant confusion surrounding how Virginia’s medical marijuana program actually works and what products will be produced and dispensed.

Lawmakers significantly broadened the program last year to allow doctors to issue medical marijuana recommendations for any condition, ailment or illness. Legislation passed this year further relaxed regulations and clarified that the program, which was initially viewed as focused on non-intoxicating CBD oil, also allows preparations that include THC at levels that would be considered intoxicating in a recreational setting and therapeutic in a medical context.

Five medical marijuana dispensaries, which will be operated as compounding pharmacies and are required to grow all the marijuana they process on site, are scheduled to open in December at the latest.

The industry group that represents them, the Virginia Medical Cannabis Coalition, says it’s actively working on reaching out to doctors and medical groups to make sure they understand the program and their roll in it.

“I think our interest is just to be sure that everyone has the resources and the knowledge they need,” said executive director Katie Hellebush.

Specialized clinics

Reticence among the medical community is not unique to Virginia’s program. News reports suggest a similar dynamic has played out in the dozens of other states that have already permitted medical marijuana.

To fill the vacuum, clinics focused on medical marijuana have popped up.

In Virginia, so far Ailment in Fredericksburg is the only to actively advertise itself as a participant in the program. The clinic specializes in anti-aging and weight loss treatments.

Miles says the clinic’s two doctors have issued about 200 medical marijuana certificates, which represents half of the 400 the Board of Pharmacy says it’s received and processed to date.

Ailment promotes its medical marijuana practice with low-budget YouTube ads and yard signs in medians. Miles said most patients who have sought them out are suffering from chronic pain, PTSD, anxiety and depression. They charge a flat $250 fee for an appointment.

Like doctors around the state, Miles said patients are sometimes nervous when they approach the office about the program.

“They’re scared to give me their names, phone numbers, address,” she said. “They’re like, ‘Why do I need to give out this information.’ I tell them, ‘This is a doctor’s office. I need to make you an appointment. That’s how it works.’”

Ailment’s approach has raised eyebrows in the General Assembly. Del. Robert Orrock, a Republican whose district is near the Fredericksburg clinic, told his colleagues he was disturbed by the yard signs he had seen advertising a “medical marijuana doctor,” which he does not believe is an appropriate description of the state’s program.

He filed legislation banning physicians from referencing marijuana in advertisements. The law, which still allows physicians to advertise that they are registered with the state to write certifications, goes into effect in July.

Regardless of how it’s advertised, advocates like Pedini at Virginia NORML say they expect more clinics and doctors to eventually get on board. Dunnavant agrees.

“I don’t really know how this is all going to play out, but I can say that none of it is out of the realm of other things in medicine that we have to adapt to,” Dunnavant said. “That’s one thing I’d say about medicine: The only given is change. It’s always going to be changing and we have to try to keep up.”