QUINCY -- The way Dr. Andrew Dunn sees it, someone has to be the vanguard.
Dunn, who practices family medicine at Blessing Physician Services, has some of the same questions a lot of his colleagues across the state do regarding Illinois' fledgling medical marijuana program.
However, Dunn knows that the medical community won't know what benefits the drug might have until someone tries it.
"I'm atypical in prescribing it because a lot of the other physicians in the community are older," the 30-year-old Dunn said. "I'm of the mindset that someone has to be the first to try this. If no one uses or tries this, how are we going to know if it's effective or not? With any drug that comes through FDA, someone has to be first to try it."
To say the state's medical marijuana program has stumbled out of the gates might be giving it too much credit. Then-Gov. Pat Quinn signed a bill on Aug. 1, 2013, that created the state's pilot program, dubbed "the Compassionate Use of Medical Cannabis Pilot Program Act." Quinn's signature made Illinois the 20th state in the U.S. to legalize cannabis for medical use. The law went into effect Jan. 1, 2014, and it took more than 22 months before dispensaries began providing medical-grade cannabis grown at cultivation centers in the state.
By June 1, there were just 7,000 approved medical marijuana patients statewide, a number well short of program estimates.
"We are so low in the patient base," said Christine Wildrick, chief operating officer for Herbal Remedies Dispensary in Quincy. "When the state first introduced this program, the state projected 103,000 patients would be enrolled. We based our entire business plan off the state's projection. We definitely have room for growth."
Herbal Remedies is the only dispensary in Illinois State Police District 20, which includes Adams, Pike, Brown, Schuyler and Scott counties. There isn't another dispensary within 100 miles of Quincy, the closest being a facility in Canton, about 110 miles away. Despite having a corner on the market in West-Central Illinois, Wildrick said, Herbal Remedies has just 120 patients.
There could be some good news on the horizon for Herbal Remedies and prospective patients. Gov. Bruce Rauner is likely to sign an extension to the pilot program, which is due to expire at the end of 2017. Rauner is expected to extend the program to July 2020 and will add post-traumatic stress disorder and any terminal illnesses with life expectancy of less than six months to the list of qualifying diseases and conditions. Having PTSD on the qualifying list would open the program to many veterans who suffer from PTSD.
Of course, for those potential patients to have access to the drug, they'll need doctors who agree that their patients have a qualifying condition to help certify them for the program. Some doctors are leery of certifying patients for the program out of fear of prosecution for recommending a drug that is illegal. As a result, Herbal Remedies is trying to educate physicians about how the drug is used medically, and the dispensary tries to reassure physicians they will not be prosecuted.
"We've had a few physicians reach out in a roundabout way to ask questions about the program or the medicine specifically," said Andy Schnack, who manages Herbal Remedies. "The interest is starting to increase, and there is a desire for more education."
Schnack said the dispensary can't refer patients to a doctor.
"The best we can do is to educate the patient, who can then educate their doctor," he said. "We want to work with the doctor. We don't want the patient to abandon their doctor after they start shopping here. We want them to communicate with their doctor."
Dunn would like the state to better define what constitutes a doctor-patient relationship. For a person to qualify for the medical marijuana program, he needs to have an established relationship with the referring doctor.
"It's unclear as to what that means," Dunn said. "Do I have to see them once, or do I have to see them for six months, a year, two years? It's not really clearly defined."
The biggest thing that physicians, especially family physicians, worry about is whether they are the appropriate prescriber of medical marijuana.
'I don't treat glaucoma. I don't treat AIDS, and I don't treat cancer or 95 percent of the diagnoses that are on there," Dunn said. "If that's the case, am I the one who should be recommending medical cannabis, or is it a specialist?'"
But medical marijuana patients do not need to see a specialist to qualify for the program.
One patient whom Dunn recommended for the program appears to have benefited from the use of medical marijuana.
"I've been able to de-escalate the amount of narcotics that he is on and improve his symptoms," Dunn said. "His daily life seems to have improved."
The goal, Dunn said, is to eliminate patients' use of narcotics.
"Let's be open-minded to everything and not shut things out because it is not a tried-and-true that we've done it for 50 years-type of method," Dunn said. "We always have to be inventive and thinking of new ways to do things."
Dunn is unsure what the future holds for medical marijuana.
"If they want it to take off, there has to be more people on board with it," he said. "There has to be more buy-in from (the) physician's perspective. With it being now recognized as a medical treatment, we hope is there going to be more research into what it can do."
For any research to be done on medical marijuana, it needs to be reclassified by the federal Drug Enforcement Administration. Since cannabis is listed as a Schedule I controlled substance, it is not accepted for medical use by the federal government. As a result, no testing can be done with the drug.
"All of us have been misinformed about what marijuana is," Wildrick said. "Back in the mid-1930s, when cannabis went through prohibition and became illegal, there was nothing in regard to scientific facts that marijuana was bringing harm to individuals as medicine."
Wildrick hopes the program is around for a long time to come.
"Up to this point in time, there have been no adverse events from the cultivation center side, from the dispensaries' side or from the patients' side," she said. "How can the program not be expanded when it's doing all of these good things? Nothing adverse has come as a result of the program in place. It is helping so many individuals."