JEFFERSON CITY — Lawmakers have begun digging through the constitutional amendment legalizing medical marijuana that nearly two-thirds of voters approved in 2018.
In some cases, they don’t like what they see — and they’re intent on making changes.
The House last week narrowly approved a plan to require an in-person doctor appointment for people seeking a state medical marijuana ID card. There is nothing currently stopping consultations done over the phone or on the internet.
The proposal also would allow the Department of Health and Senior Services to interview physicians who certify patients, and would clarify that doctors certifying patients must be licensed with the Missouri Board of Healing Arts.
“You could call one of these medical marijuana services, you could talk with a quote-unquote physician on the phone and then they will send you a certification without ever seeing you,” said Rep. Jonathan Patterson, R-Lee’s Summit. “That is not what the people of Missouri envisioned for a medical marijuana program.”
Other proposals would restrict marijuana-infused edibles and would require patients to keep dispensary receipts in order to prove they don’t possess black market product.
Patterson’s amendment to an unrelated proposal on medical marijuana industry background checks survived bipartisan criticism on the floor, by an 86-59 vote. The plan needs another vote in the House before advancing to the Senate.
A bipartisan coalition of opponents argued the measure would impede patient access, potentially violating the voter-approved Amendment 2.
Rep. Peter Merideth, a St. Louis Democrat who sits on a panel probing the medical marijuana program, said low-income people, or people without health insurance, may not have a regular doctor and might be nervous to bring up marijuana use — still illegal under federal law — with a general physician.
He said other patients live in “health care deserts,” without access to robust medical services.
“There are a lot of Missourians who don’t have easy access to a doctor,” Merideth said.
Medical marijuana program backers have argued unconventional physician services fill a gap. While the state has so far certified more than 36,000 patients — exceeding projections — many providers have chosen not to allow their physicians to approve patients.
At least one company operating in Missouri is advertising a “100% online” application process — 420ID, which says it offers an “easy online process” to patients. And the company charges a $175 fee only if the state approves the patients’ application. Its physicians are licensed in Missouri, the company says.
The company won’t approve just anyone.
A patient must meet one of the state’s “qualifying conditions” for a medical marijuana ID card, and must prove it by uploading a Missouri photo ID, medical records or a picture of a prescription bottle “for the condition you are claiming qualifies you for the program.”
One company, Green Health Docs, offers in-person visits as well as a “telemedicine” option.
Merideth said closing off “tele-health” options for patients would drive up the price of consultations. He said it would benefit some doctors, but not others.
“The more you drive down the number of physicians that are doing this, the higher they can charge for appointments,” he said.
Patterson, a general surgeon, said he drafted his legislation in consultation with legislative staff and the Missouri State Medical Association.
Patterson has chosen not to participate in the medical marijuana program. He said many of his colleagues don’t participate, either.
But they might — if the Legislature tightened up the program, Patterson said.
“The goal of this is to make sure that people know that we have a legitimate medical marijuana program that is safe for patients,” he said, adding that some physicians “see it as this shady thing where patients are just calling a number” to get approved.
Lawmakers weren’t on board with every proposed change to the medical marijuana program last week.
His measure would require patients to possess a receipt from a licensed dispensary that is less than 6 months old.
Meanwhile, the Senate approved a measure last week that would place limits on marijuana-infused edibles to ensure they aren’t marketed to minors. Sen. Bob Onder, R-Lake Saint Louis, proposed similar legislation last year.
Onder said he wanted to make sure dispensaries weren’t selling products shaped like gummy bears, for example, which kids might be tempted to eat.
The measure stirred some conflict in the Senate, with some members wondering whether the measure would outlaw edibles all together.
“It doesn’t preclude manufacturers from creating a chewable?” asked Sen. Jill Schupp, D-Creve Coeur.
“It does not,” Onder said.
Editor's note: a previous version of this article misstated the threshold for amending legislation.
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