Published January 22nd, 2020 at 6:00 AM
The morning’s dicey weather had passed, but Friday afternoon’s cold drizzle still seemed best suited for a blanket and a cup of hot tea — or something stronger for an early start to the weekend.
Nevertheless, folks filtered into a brightly lit storefront on the far end of a strip center in Raytown. The no-frills office could have been an insurance agency, except for the large marijuana leaf painted on a side wall.
Handling intake duties were Darby Cook, owner and founder of Missouri Cannabis Clinic, and pharmacist Jana Lappin, clinical outreach coordinator. Standing by was Dr. Mike Poppa.
Missouri voters approved medical marijuana in November 2018, and in recent months the Missouri Department of Health and Senior Services (DHSS) has been issuing licenses for growers, transporters and other parts of the medical marijuana supply chain.
DHSS anticipates issuing licenses for retail sales as early as Friday, and product is expected to be ready for sale by the spring. But with retail customers first needing official certification of their medical condition, standalone clinics like Cook’s have emerged as key players in the state program.
The constitutional amendment allowing medical marijuana sets out 10 categories of qualifying conditions, including cancer, epilepsy, glaucoma, or HIV/AIDS.
But none of those conditions brought Troy Hall to the Missouri Cannabis Clinic. The 48-year-old drywall finisher was there for relief from aches in arthritic knees and in a right foot that has a plate and six screws from an old softball injury.
Hall is representative of a sizable chunk of medical marijuana patients expected to qualify for the program under the more general ailments approved in the constitutional amendment.
Those include any ongoing medical issues treated with potentially addictive prescription medicines or other conditions the doctor considers to be chronic, debilitating or otherwise helped through medical marijuana — including Crohn’s and Alzheimer’s diseases.
Poppa said about half of the people he sees are there for chronic pain, while the other half either come with a psychological diagnosis or persistent abdominal pain. Poppa’s role is to review medical records and certify to the state that the patient has a qualifying condition.
At Missouri Cannabis Clinic, the patient pays $199 for the certification. The state card costs an additional $25.
Hall said it will be a relief to finally use pot legally to dull his pain. “I have been arrested so many times for weed it’s not even funny,” he said.
As Flatland learned from talking with about a dozen patients at Missouri Cannabis Clinic, and at the Green Health Docs clinic on the Country Club Plaza, Hall is far from alone in having self-medicated with pot even before it was legal for medical purposes.
Missouri Cannabis customer Anthony Hoover, 59, of Raytown, sprinkles pot into hot tea to alleviate residual spine and shoulder pain from a car accident. And Justine Kenner, 24, of Kansas City, knows that smoking it helps with her anxiety and depression.
Hoover and Kenner, like other patients, prefer pot over manmade narcotics that can be addictive and cause undesirable side effects.
Hoover plans to pay an additional $100 fee so he can grow pot himself. He used to live on a farm, and has seen marijuana grow in the wild. He doesn’t have any fears of losing his crop.
“They call it weed for a reason,” Hoover said. “You’d have to have a ‘death thumb’ to not be successful.”
As Hall found out with Poppa, obtaining physician certification can be as simple as a consultation of a few minutes. Answer a few questions from the doctor, and you are done.
Poppa likes to see his patients in person. But Dr. Kathy Trumbull sees Green Health Docs patients via video chat from her Kansas City-area apartment.
As she was on duty one recent evening, patients waiting to see her included a 20-year-old Raymore woman seeking relief from chronic migraines, and a husband and wife — both in their 50s — from Hamilton who were wanting help with the wife’s seizures and spinal pain.
One of the staffers on duty that evening was 35-year-old Abbey Triplett, the branch manager of the clinics in St. Joseph and Kansas City. A native of Liberty, she is also an enthusiastic user of marijuana to treat her anxiety and depression.
She hated the medication prescribed for her illnesses. “It just put me in a really dark place,” she said.
Poppa and Trumbull segued naturally into the medical marijuana arena.
Board certified in occupational and preventive medicine, Poppa has for years seen patients with chronic pain as he has specialized in treating and diagnosing worker’s compensation cases.
Trumbull is an obstetrician-gynecologist, but she said her subspeciality of reproductive endocrinology prepared her for the outer edges of medical care through procedures like in vitro fertilization. She views medical marijuana similarly in that it is pushing the medical envelope.
“It doesn’t phase me as much,” Trumbull said. “Yes, we are going to have to figure this out as we go.”
The medical establishment has not been quite as fast to warm up to medical marijuana.
Observers said many providers are reluctant to have anything to do with a substance that remains illegal at the federal level.
The fear is not so much that doctors will be prosecuted under drug laws. Rather, executives worry about getting kicked out of programs like Medicare and Medicaid, which pay the medical tab for millions of Americans. As a federal agency, the Department of Veterans Affairs also says its physicians cannot recommend medical marijuana or help their patients obtain it.
That is also the stance of the Missouri Primary Care Association (MPCA), which represents safety-net clinics, including big operations like Swope Health Services and Samuel U. Rodgers Health Center in Kansas City. An MPCA representative said federal funding precludes its members from sanctioning medical marijuana in any way.
Resistance to medical marijuana among other professional organizations is often couched in an argument about a lack of conclusive data on the medical benefits of pot. For instance, the American Academy of Family Physicians, which is based in Leawood, Kansas, said usage must be based on “high-quality, evidence-based public health, policy, and patient-centered research, including the impact on vulnerable populations.”
The Missouri Hospital Association (MHA) has provided a lot of guidance as its members weigh their policies on medical marijuana. The association is reminding members to think not only about potential impacts on providers, but also about existing policies on drug-testing employees and smoking within the facility.
The association said there is at least one federal court case that appears to give doctors the green light in discussing the potential health benefits of medical marijuana.
Even with all the angles to consider, MHA spokesman Dave Dillon said in an email that, “What we’ve learned from other states is that the challenges are short-lived and not particularly disruptive.”
Three of the largest operators of hospitals and clinics in Kansas City, Missouri, are Saint Luke’s Health System, HCA Midwest Health and Truman Medical Centers (TMC). Truman was the only one of the three to respond to inquiries about their policies on medical marijuana.
In a statement provided to Flatland, TMC said that while its providers are “devoted to compassionately caring for patients,” they would not be certifying patients for medical marijuana because of “too many unanswered questions and concerns that range from legal to medical.”
The statement also said that, moving forward, the system would “continue to discuss and review” its policies on medical marijuana.
Medical schools are also trying to navigate the shifting landscape of medical marijuana, with differing state laws and the conflict with federal law. Kansas City University of Medicine and Biosciences (KCU) is one of those institutions.
Schoen Kruse, associate dean of curriculum at KCU, said, medical marijuana has not altered what medical students learn. Medical schools have long had units on the signs and symptoms of addictive substances, including pot, alcohol and LSD.
The difference now, Kruse said, is that medical schools must prepare students for a world in which pot is now recognized as a potential medicine.
Students have told him that friends at home are asking their opinions about medical marijuana, and Kruse said the school’s main job is to arm them with as much evidence-based research as possible and to stress the need for them to keep up with the literature.
Ultimately, he said, it will be up to each student whether they want to incorporate medical marijuana into their treatment protocols — just like some doctors today steer clear of opioids.
“I can only imagine some of the challenges our future graduates will face when it comes to (medical marijuana),” Kruse said. “There are not going to be clean lines like there are for so many drugs out there.”
Mike Sherry is senior reporter for Kansas City PBS. He can be reached at firstname.lastname@example.org or 816.398.4205.