Policy
What is MSMA’s policy regarding medical marijuana?
MSMA adopted the following policy regarding medical marijuana in 2017: “MSMA believes there is evidence that suggests marijuana and its related derivatives may have therapeutic benefits for patients with certain medical conditions. As such, MSMA calls on the Food and Drug Administration and the Drug Enforcement Administration to promptly revise marijuana’s current classification as a Schedule I controlled substance in order to facilitate evidence-based, scientifically-valid clinical research to evaluate its efficacy and safety.”
What is AMA’s policy regarding medical marijuana?
The AMA has a number of existing policy positions on marijuana.
Policy on cannabis and cannabinoid research can be found here.1
Policy on medical marijuana can be found here.2
Policy on recreational marijuana use can be found here.3
Where can I find the Missouri medical marijuana amendment and the rules promulgated by the Department of Health and Senior Services?
The medical marijuana amendment (Amendment 2 from 2018) can be found at the Secretary of State’s website here.4 An overview of the Department’s rules regarding medical marijuana can be found on the DHSS website here.5 The rules in their entirety can be found on the Secretary of State’s website here6 and here.7
Physicians
Are physicians required to complete the physician certification form?
No. There is no requirement to complete the physician certification form if a physician does not agree that the patient has a qualifying condition or does not believe medical marijuana to be an appropriate treatment for the patient, or does not believe medical marijuana to be an appropriate treatment for any patient.
Where can I find a physician certification form?
The physician certification form can be found on the Department of Health and Senior Services website here.8
What specifications must a physician meet before they are allowed to complete a physician certification for a patient?
A physician who completes a physician certification form must be an active Missouri-licensed MD or DO in good standing with the Board of Registration for the Healing Arts.
Can any other medical provider complete a physician certification?
No. Only a Missouri-licensed allopathic (MD) or osteopathic (DO) physician in good standing may complete the physician certification.
What must physicians do prior to certifying a patient with a qualifying condition?
A physician who wishes to certify a patient with a qualifying condition must be a licensed Missouri physician in good standing with the Board of Registration for the Healing Arts. Prior to completing the physician certification form, a physician must meet with and examine the qualifying patient, review the patient’s medical records or medical history, review the patient’s current medications and allergies to medications, discuss the patient’s current symptoms, and create a medical record for the patient regarding the meeting. A physician must also discuss risks associated with medical marijuana with the patient, including known contraindications applicable to the patient, risks of medical marijuana use to fetuses, and risks of medical marijuana use to breastfeeding infants.
Once this is completed, and a physician concludes that the patient suffers from a qualifying condition and medical marijuana is an appropriate course of treatment, the physician then may complete the certification form.
Must a physician-patient relationship be established before certifying a patient?
Yes. Establishing a physician-patient relationship under Missouri state law includes an in-person physical examination, medical interview, and a review of a patient’s medical records prior to completing the physician certification form.
What constitutes a complete medical record for a patient seeking a physician certification form?
Missouri requires physicians to complete an adequate and complete medical record for each patient, including patients for whom a medical marijuana certification is completed. Under state law, an adequate and complete patient record shall include documentation of the following information:
(1) Identification of the patient, including name, birthdate, address and telephone number;
(2) The date or dates the patient was seen;
(3) The current status of the patient, including the reason for the visit;
(4) Observation of pertinent physical findings;
(5) Assessment and clinical impression of diagnosis;
(6) Plan for care and treatment, or additional consultations or diagnostic testing, if necessary. If treatment includes medication, the physician shall include in the patient record the medication and dosage of any medication prescribed, dispensed or administered;
(7) Any informed consent for office procedures.
Records must be made available to the Missouri Board of Healing Arts upon request, and must be maintained by the physician for a minimum of seven years from the last time the patient was seen.
Patients & Procedure
How does a patient obtain a license to use medical marijuana?
A patient must visit an active Missouri-licensed MD or DO in good standing with the Board of Registration for the Healing Arts and request that the physician complete a physician certification form. The physician certification form is not a recommendation that the patient should use medical marijuana - it simply verifies that the physician believes the patient has a qualifying condition. The patient must then submit the form to the Department of Health and Senior Services with an application and application fee.
Once the DHSS online submission system becomes available, the physician must submit the physician certification form directly to the department. Until the system is online, patients should submit their physician certification form with their application and application fee.
What conditions qualify for a patient to receive a medical marijuana license?
How long before a certified patient license expires?
A patient identification card expires one year after the card is issued by the department.
How long does the state retain information on certified patients?
Patients must reapply every year for a patient identification card. DHSS has not adopted policy regarding how long patient information is retained.
If a patient already has a medical marijuana license from another state, are they automatically eligible for a patient license in Missouri?
No. A patient must have a Missouri medical marijuana license to use and purchase medical marijuana in Missouri. There is no reciprocity with other states.
Can patients use medical marijuana in the hospital?
Can a physician certify hospital-based patients?
Marijuana is listed as a schedule I drug by the DEA and FDA, which are defined as drugs with no currently accepted medical use and a high potential for abuse. As such, many hospitals in Missouri face legal uncertainties when considering the effects of allowing medical marijuana on their premises. A handful of hospital systems have already adopted policies that prohibit medical marijuana on their premises and prohibit the physicians their system employs from certifying patients. Hospitals and other health care facilities in Missouri are subject to federal law if they receive reimbursement from federal programs like Medicare and Medicaid. These hospitals in particular may be hesitant to jeopardize their reimbursement eligibility status by allowing patients to possess Schedule I drugs in their facilities. Certification forms for hospital-based patients will have to be considered on a case-by-case basis, depending on the hospital’s policies and regulations. The Missouri Hospital Association has issued some guidance on hospital-specific medical marijuana topics. It can be found at their website.9
How does a physician know what the proper dosage is for a patient?
The dose authorized by the physician certification form per 30-day period is four ounces of dried, unprocessed marijuana or the equivalent. If a patient wishes to purchase more than that amount per 30-day period, the patient must present certification and an alternate recommended dose from two physicians.
Is there a way to restrict a certified patient from using smokable marijuana?
No. A physician certification form is not a recommendation or a prescription. The physician only certifies that a patient has a qualifying condition. The method in which the patient consumes marijuana is up to the patient’s preference.
Is it okay to certify a child with a qualifying condition?
If a physician wishes to certify an unemancipated minor under 18 with a qualifying condition, the physician must receive the written consent of a parent or legal guardian who asserts that he or she will serve as a primary caregiver for the qualifying patient.
When does a physician certification expire?
A physician certification expires 30 days after the completion of the physician certification form.
Does the Department of Health and Senior Services keep a list of physicians who will complete a physician certification?
No. At this time, DHSS does not maintain such a list.
Dispensary/Cultivation Facilities
When will a patient be able to purchase medical marijuana from a licensed facility in Missouri?
The Department of Senior Services estimates that licensed medical marijuana facilities will be operational by January 2020.
Are there any education and training requirements for employees of a licensed dispensary or licensed cultivation facility?
Yes. Facility employees and facility security managers must complete security training related to theft-prevention and controlled access areas, training related to the methods of cultivation, processing, or testing used by the facility, training related to sanitation procedures, training related to the differences in the purported effects and effectiveness of the strains of medical marijuana available for purchase at that dispensary and the methods of their use, training related to recognizing the signs of medical marijuana abuse, and training related to HIPAA requirements and the DHSS-operated statewide track and trace system. If licensed to operate by DHSS, a dispensary or cultivation facility must adhere to department regulations and standards.
If they possess a medical marijuana license, can a patient cultivate their own medical marijuana?
If a patient who is approved for a medical marijuana card also applies for a patient cultivation identification card, they may cultivate up to six flowering plants per patient. The patient must also abide by security protocols from DHSS if they wish to cultivate their own plants.
Resources & Links
1. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2FHOD.xml-0-5331.xml
2. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2Fdirectives.xml-D-95.969.xml
3. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2FHOD.xml-H-95.924.xml
4. https://www.sos.mo.gov/CMSImages/Elections/Petitions/2018-051.pdf
5. https://health.mo.gov/safety/medical-marijuana/rules.php
6. https://www.sos.mo.gov/CMSImages/AdRules/main//EmergenciesforInternet//19c30-95.028IEpdf.pdf
7. https://www.sos.mo.gov/CMSImages/AdRules/csr/current/19csr/19c30-95.pdf
8. https://health.mo.gov/safety/medical-marijuana/pdf/physician-certification-form-standard.pdf
9. https://web.mhanet.com/medical-marijuana.aspx
More resources at www.msma.org/medical-marijuana
Contact MSMA at 800-869-6762 or email heidi@msma.org.
What is MSMA’s policy regarding medical marijuana?
MSMA adopted the following policy regarding medical marijuana in 2017: “MSMA believes there is evidence that suggests marijuana and its related derivatives may have therapeutic benefits for patients with certain medical conditions. As such, MSMA calls on the Food and Drug Administration and the Drug Enforcement Administration to promptly revise marijuana’s current classification as a Schedule I controlled substance in order to facilitate evidence-based, scientifically-valid clinical research to evaluate its efficacy and safety.”
What is AMA’s policy regarding medical marijuana?
The AMA has a number of existing policy positions on marijuana.
Policy on cannabis and cannabinoid research can be found here.1
Policy on medical marijuana can be found here.2
Policy on recreational marijuana use can be found here.3
Where can I find the Missouri medical marijuana amendment and the rules promulgated by the Department of Health and Senior Services?
The medical marijuana amendment (Amendment 2 from 2018) can be found at the Secretary of State’s website here.4 An overview of the Department’s rules regarding medical marijuana can be found on the DHSS website here.5 The rules in their entirety can be found on the Secretary of State’s website here6 and here.7
Physicians
Are physicians required to complete the physician certification form?
No. There is no requirement to complete the physician certification form if a physician does not agree that the patient has a qualifying condition or does not believe medical marijuana to be an appropriate treatment for the patient, or does not believe medical marijuana to be an appropriate treatment for any patient.
Where can I find a physician certification form?
The physician certification form can be found on the Department of Health and Senior Services website here.8
What specifications must a physician meet before they are allowed to complete a physician certification for a patient?
A physician who completes a physician certification form must be an active Missouri-licensed MD or DO in good standing with the Board of Registration for the Healing Arts.
Can any other medical provider complete a physician certification?
No. Only a Missouri-licensed allopathic (MD) or osteopathic (DO) physician in good standing may complete the physician certification.
What must physicians do prior to certifying a patient with a qualifying condition?
A physician who wishes to certify a patient with a qualifying condition must be a licensed Missouri physician in good standing with the Board of Registration for the Healing Arts. Prior to completing the physician certification form, a physician must meet with and examine the qualifying patient, review the patient’s medical records or medical history, review the patient’s current medications and allergies to medications, discuss the patient’s current symptoms, and create a medical record for the patient regarding the meeting. A physician must also discuss risks associated with medical marijuana with the patient, including known contraindications applicable to the patient, risks of medical marijuana use to fetuses, and risks of medical marijuana use to breastfeeding infants.
Once this is completed, and a physician concludes that the patient suffers from a qualifying condition and medical marijuana is an appropriate course of treatment, the physician then may complete the certification form.
Must a physician-patient relationship be established before certifying a patient?
Yes. Establishing a physician-patient relationship under Missouri state law includes an in-person physical examination, medical interview, and a review of a patient’s medical records prior to completing the physician certification form.
What constitutes a complete medical record for a patient seeking a physician certification form?
Missouri requires physicians to complete an adequate and complete medical record for each patient, including patients for whom a medical marijuana certification is completed. Under state law, an adequate and complete patient record shall include documentation of the following information:
(1) Identification of the patient, including name, birthdate, address and telephone number;
(2) The date or dates the patient was seen;
(3) The current status of the patient, including the reason for the visit;
(4) Observation of pertinent physical findings;
(5) Assessment and clinical impression of diagnosis;
(6) Plan for care and treatment, or additional consultations or diagnostic testing, if necessary. If treatment includes medication, the physician shall include in the patient record the medication and dosage of any medication prescribed, dispensed or administered;
(7) Any informed consent for office procedures.
Records must be made available to the Missouri Board of Healing Arts upon request, and must be maintained by the physician for a minimum of seven years from the last time the patient was seen.
Patients & Procedure
How does a patient obtain a license to use medical marijuana?
A patient must visit an active Missouri-licensed MD or DO in good standing with the Board of Registration for the Healing Arts and request that the physician complete a physician certification form. The physician certification form is not a recommendation that the patient should use medical marijuana - it simply verifies that the physician believes the patient has a qualifying condition. The patient must then submit the form to the Department of Health and Senior Services with an application and application fee.
Once the DHSS online submission system becomes available, the physician must submit the physician certification form directly to the department. Until the system is online, patients should submit their physician certification form with their application and application fee.
What conditions qualify for a patient to receive a medical marijuana license?
- Cancer
- Epilepsy
- Glaucoma
- Intractable migraines unresponsive to other treatment
- A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including but not limited to those associated with multiple sclerosis, seizures, Parkinson’s disease, and Tourette’s syndrome
- Debilitating psychiatric disorders, including, but not limited to, post-traumatic stress disorder, if diagnosed by a state licensed psychiatrist
- Human immunodeficiency virus or acquired immune deficiency syndrome
- A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication
- A terminal illness
- In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to, hepatitis C, amyotrophic lateral sclerosis, inflammatory bowel disease, Crohn’s disease, Huntington’s disease, autism, neuropathies, sickle cell anemia, agitation of Alzheimer’s disease, cachexia, and wasting syndrome
How long before a certified patient license expires?
A patient identification card expires one year after the card is issued by the department.
How long does the state retain information on certified patients?
Patients must reapply every year for a patient identification card. DHSS has not adopted policy regarding how long patient information is retained.
If a patient already has a medical marijuana license from another state, are they automatically eligible for a patient license in Missouri?
No. A patient must have a Missouri medical marijuana license to use and purchase medical marijuana in Missouri. There is no reciprocity with other states.
Can patients use medical marijuana in the hospital?
Can a physician certify hospital-based patients?
Marijuana is listed as a schedule I drug by the DEA and FDA, which are defined as drugs with no currently accepted medical use and a high potential for abuse. As such, many hospitals in Missouri face legal uncertainties when considering the effects of allowing medical marijuana on their premises. A handful of hospital systems have already adopted policies that prohibit medical marijuana on their premises and prohibit the physicians their system employs from certifying patients. Hospitals and other health care facilities in Missouri are subject to federal law if they receive reimbursement from federal programs like Medicare and Medicaid. These hospitals in particular may be hesitant to jeopardize their reimbursement eligibility status by allowing patients to possess Schedule I drugs in their facilities. Certification forms for hospital-based patients will have to be considered on a case-by-case basis, depending on the hospital’s policies and regulations. The Missouri Hospital Association has issued some guidance on hospital-specific medical marijuana topics. It can be found at their website.9
How does a physician know what the proper dosage is for a patient?
The dose authorized by the physician certification form per 30-day period is four ounces of dried, unprocessed marijuana or the equivalent. If a patient wishes to purchase more than that amount per 30-day period, the patient must present certification and an alternate recommended dose from two physicians.
Is there a way to restrict a certified patient from using smokable marijuana?
No. A physician certification form is not a recommendation or a prescription. The physician only certifies that a patient has a qualifying condition. The method in which the patient consumes marijuana is up to the patient’s preference.
Is it okay to certify a child with a qualifying condition?
If a physician wishes to certify an unemancipated minor under 18 with a qualifying condition, the physician must receive the written consent of a parent or legal guardian who asserts that he or she will serve as a primary caregiver for the qualifying patient.
When does a physician certification expire?
A physician certification expires 30 days after the completion of the physician certification form.
Does the Department of Health and Senior Services keep a list of physicians who will complete a physician certification?
No. At this time, DHSS does not maintain such a list.
Dispensary/Cultivation Facilities
When will a patient be able to purchase medical marijuana from a licensed facility in Missouri?
The Department of Senior Services estimates that licensed medical marijuana facilities will be operational by January 2020.
Are there any education and training requirements for employees of a licensed dispensary or licensed cultivation facility?
Yes. Facility employees and facility security managers must complete security training related to theft-prevention and controlled access areas, training related to the methods of cultivation, processing, or testing used by the facility, training related to sanitation procedures, training related to the differences in the purported effects and effectiveness of the strains of medical marijuana available for purchase at that dispensary and the methods of their use, training related to recognizing the signs of medical marijuana abuse, and training related to HIPAA requirements and the DHSS-operated statewide track and trace system. If licensed to operate by DHSS, a dispensary or cultivation facility must adhere to department regulations and standards.
If they possess a medical marijuana license, can a patient cultivate their own medical marijuana?
If a patient who is approved for a medical marijuana card also applies for a patient cultivation identification card, they may cultivate up to six flowering plants per patient. The patient must also abide by security protocols from DHSS if they wish to cultivate their own plants.
Resources & Links
1. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2FHOD.xml-0-5331.xml
2. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2Fdirectives.xml-D-95.969.xml
3. https://policysearch.ama-assn.org/policyfinder/detail/Cannabis?uri=%2FAMADoc%2FHOD.xml-H-95.924.xml
4. https://www.sos.mo.gov/CMSImages/Elections/Petitions/2018-051.pdf
5. https://health.mo.gov/safety/medical-marijuana/rules.php
6. https://www.sos.mo.gov/CMSImages/AdRules/main//EmergenciesforInternet//19c30-95.028IEpdf.pdf
7. https://www.sos.mo.gov/CMSImages/AdRules/csr/current/19csr/19c30-95.pdf
8. https://health.mo.gov/safety/medical-marijuana/pdf/physician-certification-form-standard.pdf
9. https://web.mhanet.com/medical-marijuana.aspx
More resources at www.msma.org/medical-marijuana
Contact MSMA at 800-869-6762 or email heidi@msma.org.
