Medical marijuana is legal in Missouri, but some of the region’s largest hospital systems aren’t allowing their physicians to certify patients to use it.

SSM Health will allow certifications for some patients. Mercy hospitals have announced a blanket ban on medical marijuana certification. BJC Healthcare, which includes Barnes-Jewish Hospital in St. Louis, is still formulating its policy.

“A lot of hospitals have decided, 'We’re not going to certify, because then nobody can tell us we’re doing anything wrong,'” Missouri Hospital Association General Counsel Jane Drummond said.

The law passed in 2018 allows all doctors in good standing to certify patients with a qualifying condition to use medical marijuana. But although medical cannabis is legal statewide, the federal government still classifies it as an illegal drug with no medicinal benefits.

That puts hospitals in a bind, Drummond said. Hospitals rely on federal funding to operate and are often inspected by state regulators hired by the federal government.

Administrators are concerned that if they allow medical marijuana certification, they’ll lose funding or even their license, she said.

“I think there are still a lot of questions about liability and possibly regulatory enforcement actions for allowing their physicians to certify when it is still illegal at the federal level,” Drummond said. “That’s why hospitals are super skittish about this.”

That means physicians in private practice are more likely to certify patients, because they have fewer regulatory requirements, she said.

Many physicians, including those representing the American Medical Association, oppose medical cannabis use until more research is done to prove its effectiveness. Because of its federal classification, traditional clinical trials and FDA approval haven’t been completed for most qualifying conditions.

“We believe medical and scientific research on the therapeutic benefits and risks of cannabis products is insufficient at this time,” hospital officials wrote in Mercy’s medical marijuana policy. “There are no peer-reviewed studies or evidence-based recommendations demonstrating its effectiveness in treating disease.”

St. Louis-based system SSM Health is allowing doctors to certify existing patients under limited circumstances. Physicians employed by SSM will be able to certify patients in ambulatory clinics, not hospitals, and only if patients have tried other unsuccessful therapies first.

SSM Chief Medical Officer Alexander Garza knows there isn’t a wealth of research to support certification.

“There’s not a great evidence base to support using this for the majority of complaints that come through,” he said. “But again, I think the important thing for our providers was to trust them to do the right things.”

If patients are going to use cannabis, they should be using it under the supervision of a doctor they know and trust, he said.

“We don’t want our patients to run off to the local doc-in-a-box to get certified for medical marijuana without us participating in that care,” he said.

Garza said leaders of local SSM clinics must decide whether their physicians will certify use. SSM Health will not compel doctors to certify, he said.

A BJC spokeswoman said the hospital system was working on a policy but hadn’t made any concrete decisions.

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