Missouri will most likely have a minimum of 192 medical marijuana dispensaries by 2020 — including several in Jefferson City and Cole County, according to a spokesman for the organization that successfully promoted the statewide initiative on the Nov. 6 ballot.
In unofficial results, the amendment received 1,572,592 votes statewide (65.54 percent), while 826,777 votes (34.46 percent) opposed it. All votes in Missouri will be certified Nov. 30; the amendment becomes law Dec. 6.
At least 24 dispensary licenses must be issued for each of Missouri's eight congressional districts (for a total of 192), said Jack Cardetti, spokesman for New Approach Missouri, the organization that promoted the ballot measure. Eighty infused-products licenses must also be issued.
"That way, you ensure that there is someone close by. We don't think it's fair that patients would have to drive halfway across the state (for marijuana)," he said.
Local interest in dispensaries
In Jefferson City, about 10 people have reached out to the city since the midterm election, exploring the possibility of opening medical marijuana dispensaries, City Administrator Steve Crowell said.
The callers may not understand that preparations for medical marijuana are in the state's hands, Crowell said. As the possibility of having medical marijuana dispensaries nears, the city will probably go through processes to get residents' input.
"I think staff is doing some preparatory work right now. We've got to do it soon," he said.
The city wants to begin formulating plans — determining what it can or cannot do — as soon as possible, said Joy Sweeney, director of Jefferson City Council for Drug-Free Youth. Sweeney said she's spoken not only with city leaders, but with lawmakers to find out how they tilt on the medical marijuana issue.
The initiative lays out a series of timelines for when the Missouri Department of Health and Senior Services (DHSS) has to get the program up and running.
The amendment makes marijuana use legal for: treatment of cancer; epilepsy; glaucoma; intractable migraines (those persistent migraines that don't respond to other treatments); chronic medical conditions that cause 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 (when diagnosed by a state licensed psychiatrist), including but not limited to post-traumatic stress disorder; human immunodeficiency virus or acquired immune deficiency syndrome; chronic medical conditions whose treatment could lead to physical or psychological dependence (if a physician determines cannabis would be effective and safer); any terminal illness; or (in the professional judgment of a physician) any other chronic debilitating medical condition.
The amendment and the medical marijuana system are based on those that have passed in Colorado and Oregon before full recreational use of marijuana passed in those states, Cardetti said.
"We wanted to avoid situations like Arkansas is going through right now," Cardetti said. "They passed a medical marijuana law in 2016, and they still don't have medical marijuana up and running."
Implementation by state
DHSS has 180 days from Dec. 6 to write the rules and regulations concerning medical marijuana.
Gov. Mike Parson sent out a statement shortly after the amendment passed.
"As governor, it is my job to ensure successful implementation of the people's will," Parson said. "We will begin the very detailed process of implementing a process that makes medical marijuana available to qualified patients."
"We are reaching out to stakeholders for input and reviewing other states' regulations to determine best practices," according to the DHSS website.
During the first week of June, DHSS will make applications available to patients.
On Aug. 3, the organization will provide applications for three different types of licenses — a cultivation license, allowing someone to grow the medical marijuana; an infused-products license, allowing someone to make oils, vapors and other products; and a dispensary license, allowing someone to create a retail space where medical marijuana users may go to buy the products.
The patients are to take their applications to their physicians and ask them to certify that they have one of the conditions covered by the bill.
The DHSS is to have 30 days to process each application. Identification cards will cost $25.
The agency will have up to 150 days to grant licenses for cultivation, infused products or dispensaries.
"The amendment spells out how many licenses it must give out," Cardetti said. "It creates a floor for how many licenses there will be."
Cultivation facilities require a $10,000 non-refundable application fee and a $25,000 annual fee.
Dispensary facilities require $6,000 non-refundable application fee and a $10,000 annual fee.
Medical marijuana-infused manufacturing facilities require a $6,000 non-refundable application fee and a $10,000 annual fee, according to health.mo.gov/medical marijuana.
It will be late 2019 or early 2020 before people can actually take a card and walk into a dispensary to buy marijuana.
Amendment may still face challenges
Although the initiative passed relatively easily statewide, it does have opposition, Sweeney said.
She said a Kansas City attorney advised during a statewide conference call last week that once the amendment becomes law, there are three things local communities may do to oppose the dispensaries.
They can certainly prevent the dispensaries from being placed within 1,000 feet of schools, churches and day care facilities, he said.
"(Communities) might be able to file some type of claim, saying it is injurious to the health of the community," Sweeney said. "Cultivation security was another thing that he suggested local city and county attorneys look into. Insuring the security required for cultivation sites is also required for home grows."
That may be difficult and costly to enforce, Sweeney added.
Karen O'Keefe, director of state policies with the Marijuana Policy Project in Washington, D.C., said in Arkansas, a holdup was how the state licensed dispensaries. It had a limited number and a grading system that had a possibility of bias.
In Arizona, the state created a lottery to choose who got dispensaries, she said. "If applicants were qualified, they literally had a lottery. They had to make sure there were high enough standards for who would get into the lottery."
Oklahoma has moved quickly, O'Keefe said. It has 12,281 licensed patients, 661 dispensaries and 1,060 growers. Whoever met the requirements by law got a license.
Medical marijuana faced a lot of litigation in Florida, she said.
"Other states had legislators tempted to undermine the will of the voters. In Missouri, it (may be) unlawful to undermine that will," O'Keefe said.
That is among the hurdles, Sweeney said. She and others have reached out to cities, counties and prosecuting attorneys about filing a preliminary injunction against the new law. Opposition to the law has even created some draft language for the injunction.
"We are trying to see if anybody is willing to take on that. A challenge is that anybody who comes out against this is being vilified," she said, "for public officials, or any organizations and associations."
Implications for medical community
The opposition to medical marijuana hopes the medical community will step forward and oppose it.
No medical communities have come out in favor of the law, which puts physicians in a precarious position because marijuana is not U.S. Food and Drug Administration-approved.
The Missouri Hospital Association has deliberately stayed neutral on medical marijuana during the election season, according to Dave Dillon, association vice president of public and media relations.
"Now, it's a real thing. We are intending to hold webinars for members for folks to try to understand the implications," Dillon said. "The reality is — the public is viewing it as something that is coming down the pike."
Jeff Howell, director of government relations for Missouri State Medical Association, said hands are somewhat tied because people have to wait and see what the DHSS rules look like.
"We'll be heavily involved in that process. We don't want to force physicians to support this," Howell said. "The amendment is pretty vague when it comes to the nuts and bolts of how this is going to work."
It's more common than not to have physicians who are not interested in prescribing marijuana when there aren't peer-reviewed scientific articles about how effective the product is. Every strain is different.
"There are a lot of open questions right now for physicians in Missouri," Howell said.