At the Green Health Docs medical marijuana certification clinic in Florissant, the walls are painted bright green, and a television show called “Munchies” plays on a loop in the waiting room.

Marijuana is new for 68-year-old Brenda Lane, who is trying to balance on a dorm room-style saucer chair while she fills out medical forms. Lane, of St. Peters, has a packet of papers in her hand outlining many ailments, including rheumatoid arthritis, glaucoma and kidney failure. She’s in constant pain.

“That’s how I tell I’m alive,” she said. “I wake up, I’m in pain. Yep! I’m alive.”

Although medical cannabis is legal in Missouri and any doctor licensed in Missouri can certify patients for use, the region’s physicians don’t agree on whether certifying patients is safe, legal or ethical.

Even though one of Lane’s doctors at Missouri Baptist Hospital was weaning her off opioid prescriptions, she wouldn’t certify Lane for a medical marijuana card.

“They won’t touch it with a 10-foot pole,” Lane said. “But it’s just gotten worse and worse, and they’ve run out of medicine to give to me.”

Some doctors have jumped on the opportunity to help patients use a treatment they’ve been wanting for years. But others, such as Lane’s rheumatologist, have refused, citing a lack of clinical evidence on medical marijuana’s safety and effectiveness and that the federal government still classifies it as illegal.

A welcome alternative

Dr. Patricia Hurford, one of the physicians certifying patients for medical cannabis in Missouri, was long skeptical of medical marijuana’s benefits.

“I felt like maybe it was a gateway drug, or there wasn’t enough science to support its use,” said Hurford, an orthopedic specialist in Kirkwood.

Hurford also practices in Illinois. After that state approved medical cannabis in 2013, she began to change her mind. Her patients, many dealing with chronic pain, started asking her about using it.

After conventional drug therapies didn’t help one patient, Hurford finally decided to give cannabis a try.

“I could not control their pain with medications, both opioids and non-opioids,” she said. “After that patient was certified, I saw a dramatic change in their quality of life.”

For Hurford, it’s important to explore how to decrease the use of potentially addictive painkillers among her patients.

“Given the complications I have with opioids, and the number of patients who slide into addiction with opioids, I find cannabis to be a much safer and helpful alternative,” she said.

Even though the state doesn’t require it, she provides patients with lists of potential risks and side effects of cannabis use, which include memory problems, lung disease, allergic reactions.

For some doctors, it’s too early

Unlike other medical treatments, there isn’t an accepted standard of treatment for using medical marijuana for most of the state’s qualifying conditions, said Fred Rottnek, director of community medicine at St. Louis University.

“I think that the cart’s in front of the horse a bit,” he said. “Even though states have legalized medical and recreational cannabis use, at the federal level, it still has not been receiving a green light,” he said.

Because the federal government still classifies cannabis as an illegal drug with no therapeutic use, the usual methods used to test if drugs are safe or effective, such as randomized clinical trials and safety approval from the Food and Drug Administration – just don’t exist for most uses of medical marijuana.

“If we’re going to talk about cannabis as a medication, it’s important for us to have this medication reviewed, studied, establish a safety profile and understand what it does with the body,” Rottnek said. Until those tests can be done, he’s just not comfortable certifying.

Sarah Fentem | St. Louis Public Radio

The American Medical Association has advised health systems to not recommend non-FDA approved cannabis use until doctors know more. The Missouri State Medical Association is calling for the FDA to allow researchers to study medical cannabis, and the St. Louis Metropolitan Medical Society came out against several potential ballot initiatives in 2018 that legalized medical use, including the one that became Missouri law. A spokeman said the society is not for or against its use but wants more research.

At least one St. Louis-area hospital system, Mercy Health, has barred its physicians from certifying or recommending medical marijuana for patients.

Lyndall Fraker, director of the state’s medical marijuana program, said he’d like to see the federal government legalize marijuana.

“But until we do, I think we’re going to rely on each individual doctor doing their own research and determining it being right for their patients,” he said.

The Missouri Department of Health and Senior Services is preparing a primer that will explain the certification process to doctors and help them interpret the state’s rules, Fraker said.

Furthermore, doctors have long prescribed medicines and procedures for non FDA-approved use, Hurford said.

“Physicians do that all the time; those are off-label or non-clinically supported treatments that in their minds are effective or safe,” she said.

One can still find medical research on medical marijuana’s effectiveness, she said. It’s been legal for years or even decades in other states and countries, and clinical research has proven it can help people sleep and ease nausea.

Giving patients a sense of control

But that medical cannabis exists outside the traditional medical pipeline is exactly what makes it attractive to so many patients, Rottnek said.

“A lot of people who are proponents of medical cannabis are proponents because they feel like they can control their health in ways that have not been managed well by traditional medicine,” Rottnek said.

Pain and anxiety are the most frequent symptoms cited by potential marijuana patients, said Blake Bell, the owner of Bell Chiropractic in Florissant, which has been certifying patients since late last year.

“I see people in pain every single day, and I see how it can change who you are as a person when you're in pain and the things that you'll do to get away from it,” he said. “And if marijuana works, then it should be available.”

Green Health Docs patient Brenda Lane said she couldn’t care less about FDA approval and clinical trials.

“No. No! If you live in as much pain as I live in every day, no,” she said. “I have no wavering thought about it at all. I’ve always been one who would try anything.”

Correction: An earlier version of this story misstated the Missouri State Medical Association's position on medical marijuana. The association is calling for the Food and Drug Administration to allow researchers to study medical cannabis.

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