CHICAGO — Patients must have a doctor's signature to buy medical marijuana in Illinois, but some health systems are forbidding doctors from putting pen to paper because the drug is still illegal at the federal level.
Others are cautiously allowing doctors to participate in the pilot program, even conducting training sessions to make sure doctors know their legal responsibilities as gatekeepers.
Illinois is among 23 states that permit marijuana for medical use, but the program has been slow to start since the law was enacted two years ago. Seven cultivation centers have been green-lighted to start growing cannabis; sales will begin later this year.
Yet, only 2,800 patients have qualified for the program, a frustratingly low number for the new industry. Hesitance from the medical establishment may be one reason. For some doctors, marijuana provides an exciting new treatment option. Others want to avoid an unfamiliar substance that wasn't covered in medical school.
"We're all cautious about new things. We want to test the waters," said Dr. Scott Cooper, president of the Illinois State Medical Society, which provides training to doctors on the marijuana law. "There's going to be a learning curve."
Some patients also are waiting for Gov. Bruce Rauner's administration to approve 11 additional conditions and diseases — including migraine, osteoarthritis and post-traumatic stress disorder — that were recommended by an advisory board in May. The move would open legal marijuana to thousands, perhaps millions, more Illinois residents.
Under the law, doctors must sign a five-page form attesting that they have a "bona fide physician-patient relationship" that goes beyond a marijuana consultation, and that the patient has an approved diagnosis and is likely to benefit from using marijuana. Doctors, not patients, mail the form to the Illinois Department of Public Health.
From the start, state regulators took a hard line, disciplining one doctor for allegedly misleading potential patients by offering pre-approval for medical marijuana and warning other doctors against setting up medical cannabis clinics.
"I still to this day believe that's responsible for the doctor shortage," said Tammy Jacobi, owner of a Chicago business called Good Intentions that helps patients fill out paperwork.
The disciplined doctor, Brian Murray, once worked at Good Intentions, but now the company is only a matchmaker, providing a list of doctors willing to consider recommending marijuana, Jacobi said. "The state of Illinois definitely keeps their eyes on Good Intentions," Jacobi said.
Many large health systems in the state are allowing doctors to use their own judgment and encouraging them to know the law. In late May, Downers Grove-based Advocate Health Care, which has the state's largest physician network, held a daylong seminar, drawing about 100 doctors.
"Our goal is to assist patients on their path back to health," Advocate Medical Group CEO Dr. Kevin McCune said in an email. "Physicians work with each patient to determine the best treatment plan in order to achieve this."
Patients' access to medical marijuana mostly depends on where they get their medical care.
In southern Illinois, two major health care organizations —Southern Illinois Healthcare and Southern Illinois University — are preventing doctors from formally recommending marijuana. Both cited the federal view of marijuana as a controlled substance with no accepted medical use.
But Dr. David Yablonsky, who has clinics in Maryville and Edwardsville, said he has written marijuana certifications for patients with fibromyalgia, Crohn's disease and multiple sclerosis.
"I really challenge health centers and other physicians to be open-minded, to talk to patients and read about this," Yablonsky said, stressing marijuana's lower toxicity and addictiveness compared to prescription painkillers.
In central Illinois, there is no across-the-board policy on medical cannabis for doctors who are part of the Urbana-based Carle Foundation Hospital and Physician Group.
"There are many points of view about the clinical efficacy of cannabis as a therapeutic or medical treatment option," said Dr. Matthew Gibb, chief medical officer. "Carle has determined that our providers practicing in their areas of specialization have the best understanding of their patients."
In Chicago, Northwestern Memorial HealthCare has adopted a system-wide policy in which its more than 1,500 physicians "must provide informational materials and discuss the facts and uncertainty around medical marijuana" before certifying any patient, according to spokesman Christopher King. Rush University Medical Center doesn't yet have an official position, hospital spokeswoman Deb Song said.
Meanwhile, veterans receiving treatment at Veterans Affairs hospitals have a somewhat easier time getting a medical marijuana card. VA doctors, as federal employees, aren't permitted to recommend controlled substances, so the state's rules spell out that those under VA care don't need a doctor to sign off.
Associated Press medical writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson