A medical cannabis bill is once again being considered by the Missouri House of Representatives. It received a hearing before a packed room on Wednesday in Jefferson City in the Health and Mental Health Policy committee. The legislation calls for a program to be established that would allow patients with painful, incurable illnesses to be treated for pain with marijuana.

State Rep. Jim Neely (R-Cameron) 2016 file photo courtesy of Tim Bommel, Missouri House Communications

Healthcare professionals and patients testified Wednesday on behalf of the the bill, arguing that medical cannabis is a safe and effective form of treatment for pain, but some state representatives and law enforcement officials say it would be under-regulated and would present a conflict between state and federal law.

Expansion of medical cannabis in Missouri has been a perennial issue in the Legislature, but has never made much headway. Currently Missouri law permits the use of non-psychoactive, low-THC cannabis oil, called CBD for medical treatments. Last year, a bill that would expand legal treatments beyond CBD oil died on the floor of the house, after becoming bogged down with various amendments and limitations.

State Rep. Jim Neely (R-Cameron) sponsors this year’s version of the bill. While it covers a limited scope of instances where a patient can get access to medical marijuana, it would still mark a major step forward for expanding treatment options. If passed, a medical marijuana registration system would be created in Missouri by the Department of Health and Senior Services. Having a “debilitating and incurable condition” would qualify a patient for treatment.

Neely stresses the safety of medical cannabis. “I have probably over 20,000 hours working in the emergency room,” he said, citing his experience as a healthcare professional. “I have never had a marijuana overdose.”

Dr. Adrianne Poe, a neuroscientist at the Washington University medical school pain center, says the National Academy of Sciences published research in January that showed cannabis to be a safe and effective pain treatment. She says the review, which looked at more than 10,000 studies on human patients since 1999, addresses a big problem for pain management professionals.

“The very first thing that physicians need to do is find an alternative therapy to opioids as treatment for chronic pain,” she said, explaining CDC guidelines on pain care. “The national academies has given us an answer on that, and the answer is cannabis.”

Poe says the use of cannabis for pain treatment is an effective way to reduce the prescription of opioids — citing a 25 percent drop in opioid overdose deaths in states where medicinal cannabis is legalized. She says CBD oil can treat inflammation, but it does not have the same pain-relieving effects as other forms of cannabis that contain higher levels of THC that are currently illegal in Missouri.

Cannabis-based treatments are also used to treat severe epilepsy in children. Several family members of children with epilepsy testified in favor of the bill at the Wednesday hearing, as well as Jim Taber, a parent who says his son benefitted from cannabis based pain relief while receiving cancer treatment.

Taber says his son used Marinol, an FDA-approved, synthetic version of THC to relieve pain and keep his appetite up, but having more drug options would help.

“The whole plant doesn’t have the same side-effects as the synthetic product.” he said, “and that’s why they wouldn’t continue him on it”.

State Rep. Keith Frederick (R-Rolla) and Jason Grellner, head of the Missouri Narcotics Officers association, raised concerns about the safety of a drug which is not fully regulated by the FDA.

“There really is no assurance in any state that has medical marijuana, that if I go back on another day or in another medical marijuana shop, that I am getting the same drug,” Grellner says. “There is no standardization of dose.”

Grellner also testifies that even if Missouri does allow medical marijuana, it won’t change the fact that the federal government still considers it a schedule I substance. He warns that doctors who prescribe marijuana may lose their ability to write prescriptions of any controlled substance, even if it is legal in the state.

Platte County Prosecuting Attorney Eric Zahnd echoes Grellner’s worries about a contradiction between state and federal law.

“Decriminalizing marijuana would have no impact on the fact that it would remain a federal crime.” He said. “It would put officer Grellner and every other officer in the state of Missouri in an intractable dilemma… what law would they enforce?”

Zahnd says loosening state laws on cannabis would not stop the federal government from prosecuting people. US Attorney General Jeff Sessions, who has historically opposed drug legalization, may be more harsh on drug violators than Obama administration appointees.

The committee on legislative research estimates that establishing a medical cannabis program would cost just under $1 million the first year, but would bring in a similar amount in following years once the program begins accepting applications.

Frederick, who voted against similar legislation last year, would not say exactly what the Health and Mental Health Policy Committee plans to do with medical cannabis legislation, but says he was generally against the idea of a treatment getting approved without the usual vetting process other drugs go through.

A similar version of the bill was introduced by State Sen. Rob Schaaf (R-St. Joseph), but has not seen action in the Senate for almost two months.