Missouri has already approved more than 17,000 patients for its yet-to-be-launched medical marijuana program — a stark contrast to neighboring Illinois, which had less than 3,000 patients in the first 10 months. 

Licenses for Missouri’s dispensaries are expected to be awarded by January, and cannabis should be available for medical card holders by spring. 

At their core, Missouri and Illinois programs do the same thing: They allow doctors to certify patients to use cannabis if they have a qualifying condition. But there are significant differences in the details of each law, including who has access, how they’re getting access and how the programs can be changed in the future.

A quick comparison of the number of medical card holders in Missouri proves it's easier to gain access to the program. People like Dan Viets, who helped write the law, believe that’s a good thing.

“Article 14 of the Missouri Constitution is one of the best medical marijuana laws in the country,” he said. 

He believes programs like Missouri’s that have easier access are the best. He said this ensures patients are getting the medication they need.

One of the main differences between the two laws is how they were passed. Missouri’s was done through a voter referendum that made it a constitutional amendment. This means that lawmakers don’t have much of a say on how the program is run. 

“If it were merely a statutory initiative, the Legislature would already have begun to undo important parts of it,” Viets said. “That’s not going to happen because it is in our constitution.” 

Illinois passed their law legislatively, and there was some negotiating to get it passed.

“The only way we were able to pass it was to make it not only one of the strongest but one of the most restrictive medical marijuana programs in the country,” said state Rep. Bob Morgan, D-Deerfield. “At the time, we required patients to get fingerprinted, so we treated our patients like criminals.” 

Missouri and Illinois both have legal medical marijuana programs, but there are significant differences between the two laws and how patients are getting access to medical cards.

Illinois was one of the earliest states to approve a medical program in 2013, and the stigma surrounding cannabis has since lessened nationwide.

Illinois and Missouri both have several qualifying conditions like cancer, epilepsy and chronic pain. But in Missouri, the law allows patients to also be certified “in the professional judgment of a physician.” This means if a doctor believes cannabis could help an ailment that isn’t included on the state’s list of qualifying conditions, patients could still get a medical card. 

“That’s not unusual,” said Viets. “Doctors have that discretion with most medications … and there are several other states that do the same. That’s the way it ought to be.” 

Doctors often can prescribe medications for illnesses or conditions they were not necessarily intended to treat. But this also presents another glaring difference between the two laws.

In Illinois, the law requires a “bona-fide relationship” between the patient and physician. This means the physician has to prove they have had an ongoing relationship with that patient. They also have to prove they’re responsible for the assessment and treatment of the condition that’s going to be treated with the drug. 

Chris Stone, who owns medical dispensaries in Illinois, believes that “bona-fide relationship” is crucial to patient health. 

“They need to understand what you’re currently taking, if you’re taking other medications and how that would interact with your body and how cannabis would interact with those other medications,” said Stone. 

Viets argued that this could be limiting patients in Illinois from entering the program, because certain hospitals forbid physicians from certifying patients. Hospitals primarily do this because they fear they may lose federal funding since cannabis is still illegal nationally. 

“Those patients who have a so-called bona-fide relationship with a doctor may very well have that relationship with a doctor who is forbidden by his or her employer from qualifying that patient for cannabis,” Viets said. “It is very important, therefore, that there be an alternative for patients. That’s a very unfortunate provision in the Illinois law.” 

There are still some hospitals in Illinois that do not allow doctors to certify patients to use medical cannabis, but it is not as big of an issue now compared to when the program first began.

Lyndall Fraker, who is in charge of Missouri’s program for the Department of Health and Senior Services, said the law takes a lot of pressure off the department in deciding who can get a card for cannabis. 

“It really gave the autonomy to the doctor for that doctor-patient relationship,” said Fraker. “It puts more of it back on the doctor and their license through the board of healing arts than it does us, actually, telling them what they can and can’t do.”

But, Morgan believes maintaining that patient-physician relationship is crucial in preventing, what he called, “doctor mills.” This is where doctors can set up their own clinic and charge extra to individuals who just want access to cannabis, not necessarily for medical purposes. Morgan said this “jeopardizes the real integrity you have of making sure these are the patients that are intended to participate in the program.”

Fraker pointed out that Missouri’s law does not address this. 

“There’s nothing that says a doctor can’t be anything but a certification doctor and they can charge as much as they want or do as many patients as they want. 

Illinois also monitors who is getting access to a medical marijuana card and which doctor certified them. The state collects a lot of data that is intended to help recognize any trends that could point to “bad actors.” 

Missouri is still deciding who gets to operate the 94 dispensaries and 60 cultivation sites the law allows for. Even that is a stark difference compared to Illinois, which allowed for a maximum of 60 dispensaries and 21 cultivation sites. 

Also, Illinois will not approve any additional cultivation sites for its new allowance for recreational use, at least to start. Lawmakers completed multiple demand studies that suggested more dispensaries might present a glut in the market. 

Looking through a fiscal lens, Illinois’ more restrictive approach led to much less money for the state. The first year of operation brought in roughly $4.5 million dollars, while Missouri has already cashed in $17 million, primarily on facility application fees.

The states both use that money to maintain their medical cannabis programs, but where the additional funds goes is different as well. Illinois law mandates that excess funds go to crime-prevention programs, while Missouri sets aside money for veteran programs.

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