If you told Missourians two decades ago that medical cannabis would become legal in the state, 99% of the people would have laughed at the notion. The other 1% were hard at work to make the dream a reality.
The program is off to a bit of a dodgy start, with the state already granting medical marijuana cards but no market to supply them; but it IS starting. There are already 22,000 medical marijuana patients in MO and applications are rapidly picking up pace.
The state isn’t expected to have a legal supply of cannabis for sale at dispensaries until March 2020 at the earliest, but there are still advantages to having a card before the first dispensary opens. One advantage is that you can grow your own cannabis at home if you get the additional cultivation certificate from the state. You’ll also be among the first to be able to buy legal cannabis at dispensaries once they open.
Read below to find out everything you need to know to navigate the new Missouri medical marijuana landscape. Whether you’re just beginning to use cannabis or have been using it for years, we want to make sure you have accurate and reliable information so you can find the relief you need and the happiness you deserve.
In this article, you'll learn about:
[Click any of the section titles below to jump there]
- How Do I Become a Medical Cannabis Patient in Missouri?
- Who Qualifies for Medical Cannabis in Missouri?
- How to Find a Doctor for an Evaluation
- The NuggMD Process
- What to Expect When Talking to the Doctor
- How to Apply for Your Missouri State Medical Marijuana Card
- Missouri's Cannabis Cultivation Rules
- What Types of Marijuana Consumption Methods are Available in Missouri?
- What Does Marijuana Feel Like?
- What if My Dose is Too High?
- What is Cannabinoid Hyperemesis Syndrome?
- Frequently Asked Questions
How Do I Become a Medical Cannabis Patient in Missouri?
Becoming a medical marijuana patient in Missouri is the only way to legally use cannabis in the state. Fortunately, it isn’t hard to qualify and the process of becoming a patient is simple.
1) Find out if you qualify for cannabis treatment
2) See a doctor who can give you a recommendation
3) Apply for your card with the state
It’s that easy!
NuggMD has Missouri-licensed physicians available 7 days a week so you can see a doctor today.
Who Qualifies for Medical Cannabis in Missouri?
To find out if you qualify for medical marijuana card in Missouri, you’ll need to examine state residency, medical condition and age.
You must be a resident of Missouri in order to get a medical marijuana card there. To prove your residency, you’ll need:
1) A statement that the qualifying patient resides in Missouri and does not claim resident privileges in another state or country, and
2) One of the following:
- a copy of a valid Missouri driver’s license,
- a Missouri Identification Card,
- a current Missouri motor vehicle registration, or
- a recent Missouri utility bill;
If none of these proofs are available, the director of the program may accept “some other evidence of residence in Missouri, which shall be approved or denied by the director of the medical marijuana program as sufficient proof of residency.” Be aware that this denial or acceptance is at the sole discretion of the director though.
Missouri has a list of qualifying conditions, but the list is very open:
(D) Intractable migraines unresponsive to other treatment;
(E) A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including, but not limited to, those associated with
- multiple sclerosis,
- Parkinson’s disease, and
- Tourette’s syndrome;
(F) Debilitating psychiatric disorders, including, but not limited to, post-traumatic stress disorder, if diagnosed by a state licensed psychiatrist;
(G) Human immunodeficiency virus or acquired immune deficiency syndrome;
(H) A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication;
(I) Any terminal illness; or
(J) In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to,
- hepatitis C,
- amyotrophic lateral sclerosis,
- inflammatory bowel disease,
- Crohn’s disease,
- Huntington’s disease,
- sickle cell anemia,
- agitation of Alzheimer’s disease,
- cachexia, and
- wasting syndrome.
Under these rules, most residents of the state who are over 18 and seek cannabis treatment will qualify.
A medical marijuana patient must be 18 or older to apply to the program. Parents or guardians who have a minor child who needs cannabis treatment, such as a child with Dravet’s or epilepsy, will need to be their child’s caregiver, and the card for a minor patient will only be issued to the patient’s parent or guardian.
How to Find a Doctor for an Evaluation
It’s not necessarily easy to find a physician who’s willing to talk about marijuana as a medical option. Fortunately, you do have options if your family physician is unwilling to discuss the issue. It’s important to find a legitimate doctor for your medical marijuana recommendation.
NuggMD works with state-licensed Missouri medical marijuana doctors who can give you an honest evaluation of your condition and help you decide if cannabis is an option worth trying.
Whichever doctor you choose for your evaluation, it will be helpful, although it’s not required, to have your medical records on-hand for your medical evaluation. This will ensure you receive the most appropriate evaluation and recommendation for your condition. The records you might want to gather include, but aren’t limited to:
- Patient charts
- Current prescriptions
- Physical therapy records
- Medical test results
- Hospital records
If you dread the thought of sitting around at the doctor’s office, or you just don’t have enough time in your day, you can conduct your medical marijuana evaluation entirely online. Simply enter getnugg.com/md/Missouri in your web browser and relax while you get your evaluation from the comfort and privacy of your own home.
The NuggMD Process
Here’s the NuggMD process:
1) Create an account at NuggMD
2) Input your basic information, including your name, age and address
3) Enter your medical history with as much detail as possible
4) Enter your payment information while you wait in your virtual waiting room. Your wait shouldn’t be long
5) When your new physician is available, they will conduct your evaluation via NuggMD’s online telemedicine platform.
Once you’re approved, the doctor will complete your recommendation and email it to you via the NuggMD platform along with specific instructions to complete the registration process. You won’t need to worry that it will be a confusing process because NuggMD’s support staff can help if you get stuck along the way.
What to Expect When Talking to the Doctor
Your video consultation can be as long or short as you need it to be, so don’t be afraid to ask your new doctor any questions you may have about your condition and how medical marijuana might fit into your treatment plan.
NuggMD’s physicians are passionate about cannabis as medicine and want to work with their patients to achieve the best treatment plan.
Here are a few questions you might like to consider asking your doctor:
- Which form or forms of delivery should I consider?
- Should I use higher CBD strains?
- What dose and frequency should I use?
- Will cannabis interact with any other medications or herbs I’m currently taking?
- What side effects, if any should I watch for?
Be sure to tell your new physician about all herbs and supplements you’re taking as well as your medications so they can assess any possible interactions.
As a NuggMD patient in Missouri, you’ll pay only $99 for your medical cannabis evaluation. If you’re not approved, your evaluation is free, so you’ve got nothing to lose!
How to Apply for Your Missouri State Medical Marijuana Card
Once you’ve been evaluated and approved for medical marijuana treatment by your doctor, your physician will email your recommendation to the address you provided, along with instructions for how to apply for your card using the state’s online application system. You must fill out your state application within 30 days of receiving your recommendation from your doctor.
- First, make sure you’ve entered your CORRECT SSN and date of birth during your NuggMD registration process. Your doctor will need this to complete your recommendation. You can’t go back and fix this yourself if you or your doctor make a mistake on your state application paperwork or recommendation. Instead, you’d have to submit a help ticket to request the Department to fix it, causing a delay in your application. So make absolutely sure you’ve entered the correct number.
- Wait for your doctor to send your recommendation to you via email. It should only take between 24 and 48 hours to receive it.
- Next, you’ll create an account at the state’s application portal.
- Fill out the requested information.
- Once you read the terms and conditions and confirm that you’re not a robot, you’ll finish up your registration and wait for your verification message in your email. It shouldn’t take long.
- Once you verify your email, you can click the link to sign in and complete the rest of your application. You can find detailed walk-through instructions here.
If you get stuck on your application or have any questions about the process, feel free to reach out to our customer service team.
VERY IMPORTANT: YOU MUST SUBMIT YOUR STATE APPLICATION WITHIN 30 DAYS AFTER RECEIVING YOUR DOCTOR’S RECOMMENDATION
Missouri’s Cannabis Cultivation Rules
During the application process, you’ll notice under the “Questions” tab that it asks if you wish to cultivate your own cannabis. Qualifying patients can cultivate their own cannabis in Missouri if they want to. The rules are very strict and must be followed to the letter to avoid problems with the law.
- Patient cultivation MUST take place in an enclosed, locked facility.
- Under no circumstances is a patient allowed to cultivate, or have someone cultivate for them, more than 6 flowering marijuana plants. 6 plants per patient is the absolute limit.
- A patient may only cultivate up to 6 flowering plants, 6 non-flowering plants up to 14 inches tall, and 6 clones under 14 inches tall at any given time.
- Two qualifying patients may share the same enclosed, locked facility for up to 12 flowering plants, 12 non-flowering plants and 12 clones.
- If one of the qualifying patients is also a primary caregiver for another qualified patient, they may cultivate up to 6 more flowering plants, 6 more non-flowering plants, and 6 more clones for a total of 18 each.
- A patient can’t cultivate in a place where they are prohibited by state law or private contract.
- The plants must be clearly labeled with the qualifying patient’s name.
- The cultivation authorization must be displayed in close proximity to the plants and list the name of the qualifying patients or primary caregiver they are being cultivated for, and the address of the facility in which the plants are being cultivated.
You do not need additional certifications or paperwork from your doctor, but you will be required to answer extra questions on your online application and allow the Department to access your growing facility if and when they request to see it.
To apply for the additional cultivation certificate, go to the “Questions” tab and click “Yes” on the cultivation question. Below it, you’ll fill out the information required. You’ll need to describe the cultivation area you will be using, what security measures it will have, and who will have access to the area. You’ll also need to indicate whether others will be sharing the cultivation facility with you and provide details about them if applicable.
The state will require an additional $100 fee if you’re approved for a cultivation certificate.
What Types of Marijuana Consumption Methods are Available in Missouri?
Different states have different rules about the types and concentrations of marijuana that can be made available to patients. For instance, in New York patients are prohibited from smoking marijuana, but are allowed to “vape” marijuana concentrates or flower. Some states only allow low THC products, while others allow very high potency products. Each state’s laws are different.
In Missouri, your consumption methods aren’t limited. You can smoke it, eat it, use concentrates, tinctures, topicals or whatever method you and your doctor think is appropriate.
There are 3 main consumption methods to consider when deciding which method or methods are best:
- Oral ingestion
- Topical application
Let’s explore each in more detail.
This is the most common, and fastest form of ingestion. Inhaled cannabis enters your bloodstream directly through your lungs. This can be accomplished by smoking joints, blunts or bongs, or by using vape pens, dab rigs or table top vaporizers. There are dozens of ways to inhale cannabis. You can discuss with your doctor which method is best if you choose this route.
The effects of inhaled cannabis usually peak around 30 to 90 minutes and wear off within a few hours, depending on metabolism and tolerance. This makes it one of the more preferred methods for pain because of its rapid effect. It’s also preferred by novices because inhaled cannabis usually has a less potent high than eating it and wears off faster if the user accidentally ingests more than they are comfortable with.
Note that no one has ever died from a cannabis overdose, but being too high can be a very uncomfortable experience for a new user. In such a case, the faster it wears off, the better.
So, inhaling cannabis is an ideal method of ingestion for many patients because of its quick onset and shorter half-life. But there are a few notable downsides and risks. It’s hard to look at the news today without hearing about the vaping crisis. Currently, the CDC believes that additives in illegal vape cartridges, namely Vitamin E Acetate, are causing severe lung injuries.
So far, more than 2,506 people have been hospitalized and 54 people have died from these vaping lung injuries. Therefore, you should NEVER buy a vape pen from a black market source. It’s very difficult to know what additives are in the oils and they may be dangerous.
This has many patients turning back to smoking flower, but even if this is legal in your state (and it is in Missouri) smoking is not entirely without risk either. Those with asthma, COPD or other lung disorders might not be able to tolerate smoke and it’s generally agreed that smoking anything isn’t good for anyone.
There is another alternative. Dry herb vaporizers come in desktop and handheld models, and they’ve advanced a lot over the past few years as cannabis users have increased demand for this option. Some even allow users to heat both concentrates and flower.
Dry herb vaporizers heat cannabis flower to temperatures just below combustion. This allows the cannabinoids in the plant to heat up and be inhaled without adding the chemicals and tar that result from combustion. If you think this might be a good alternative form of ingestion for you, ask your doctor during your visit.
Eating cannabis results in a very different high than inhaling it. When we inhale cannabis, we absorb delta-9 THC into our lungs and then our bloodstream, but when we eat it, the THC is converted to 11-hydroxy-THC in our livers before it is absorbed into our bloodstream through our guts. 11-hydroxy-THC induces a much more potent and longer lasting high. Even people who’ve smoked cannabis for years can be surprised by the potency of an edible.
And if you take too much, it will take a very long time to wear off. Generally, the onset of the effects of edibles will be felt between 30 and 90 minutes and will last up to 8 hours or even longer for a particularly potent dose.
In other words, edibles are extremely unpredictable.
Tolerance for edible doses is extremely varied as well. 10 mg is a commonly recommended first time dose, but many first timers find that as little as 2.5 mg is more than enough. If you don’t know what your tolerance for edibles is, then the motto is “go low and slow.”
This means that you may need to take a few days to find your dose. Many a novice cannabis user has taken a 10 mg dose, and when it didn’t kick in after waiting an hour, they took more. If they are one of those people that metabolizes cannabis more slowly, it usually ends up in a very unpleasant high or even vomiting and delirium.
So, if you’re inexperienced with edibles, be patient. You might want to consider trying just 2.5 mg and then waiting five or six hours before taking a larger dose.
Remember this always when trying a new ingestion method: you can always take more, but you can never take less.
Topicals are a great option for patients who want to use medical marijuana without experiencing the psychoactive effects. Topicals deliver cannabinoids through the skin, but very little THC absorbs into the bloodstream.
Be aware that transdermal patches are the exception to this rule because the cannabinoids are combined with agents to make them more easily absorbable through the skin. So you can actually get high from some transdermal patches. Be sure to ask before you use a new kind of patch or topical if this is a concern.
What Does Marijuana Feel Like?
If you’ve never had marijuana, it’s a bit hard to describe. You’ve probably heard stories about food cravings, euphoria and giggle fits. Most of these stories are true. As a matter of fact, it’s a good idea to keep some healthy munchies on hand so you don’t end up devouring an entire bag of potato chips or a box of Twinkies. Most people find it to be a pleasant experience, although there are some who dislike the feeling and can’t tolerate it well enough to derive a medical benefit from cannabis.
Until you know how you’re going to react to cannabis, plan pleasant and distracting activities during use. You might even want to have someone sit with you for the first time. This is because if you take more than you can tolerate, you can feel disconnected from reality or paranoid. You can even hallucinate, although this is very rare. Everyone is different.
Do NOT drink alcohol with marijuana.
Common side effects of marijuana are:
- Changed perception of time
- Loss of concentration
- Increased energy
- Decreased energy (A.K.A. couch lock)
What if My Dose is Too High?
The side effect of cannabis that no users enjoy is anxiety. Anxiety is almost inevitable if you take a dose that’s too high for your tolerance. Some people get anxious on doses as low as 5mg, while others can chow down 100mg candy bars and barely feel it. This means you can’t use your friends or local budtender as a compass for your own tolerance. And having a tolerance that high is very rare unless you’re a long-time cannabis patient.
A new cannabis patient who ate a 100mg, or even a 50mg edible would likely feel like they need a padded room and be turned off from the prospect of ever taking cannabis again. In fact, many people who mistakenly say they’re allergic to cannabis just took too much their first time.
If you find that you’ve taken more cannabis than you can comfortably tolerate, stay calm. Remember that no one has ever died of a cannabis overdose. Also, don’t be embarrassed. You’re not the first person, and you won’t be the last, to suffer a panic attack or anxiety from consuming too much cannabis.
If you do experience this problem, be sure to call your doctor as soon as possible to have your dose adjusted. Remember, 5mg or even 2.5mg is a perfectly reasonable dose for a first time consumer. It’s ok to break those commonly-found 10mg doses in half or even quarters. And if you can find microdose products available in 2.5mg, 3.7mg or 5mg doses for your first time use, try them out! You may be surprised to find that this is more than enough.
START LOW AND GO SLOW! PATIENCE IS THE KEY!
*While no one has ever died of a cannabis overdose, you can develop a condition called Cannabinoid Hyperemesis Syndrome. If you start to experience any abnormal symptoms like severe vomiting that will not go away, call 911 or head to the nearest emergency room.
What is Cannabinoid Hyperemesis Syndrome?
People are using larger and more potent doses of THC. Lately, a poorly understood syndrome has occurred with cannabis users called cannabinoid hyperemesis syndrome. No one knows what causes cannabinoid hyperemesis syndrome, but current theories are that it results from over-stimulating CB1 and CB2 receptors with very high doses of THC.
According to current medical understanding, this condition only appears to affect people who have been using cannabis at least once a day for years, and is very rare even in this small subset of people. But because this condition can lead to death due to dehydration in very rare cases, it’s appropriate to warn all cannabis users of this condition.
The condition seems to occur in three distinct stages:
Prodromal: This stage can last for a few months or even years. During this stage, the patient will suffer mild nausea and stomach pain. Unfortunately, this tends to lead to a person taking more cannabis to relieve the symptoms. If you begin to notice this type of persistent nausea, notify your doctor immediately because you may need to quit using cannabis for a while.
Hyperemetic: During this stage, the patient will vomit profusely and can become dehydrated and malnourished as a result of the constant nausea. Some patients may find relief from a hot shower. It’s absolutely vital to see a doctor if this happens if the patient hasn’t seen a doctor already because this is a very serious and potentially fatal condition.
Recovery: The only known treatment that works for cannabinoid hyperemesis syndrome is to quit smoking marijuana. The symptoms generally go away in a day or two after the patient stops using marijuana. If cannabis use starts again, the symptoms will almost certainly return.
No one knows yet why some people get CHS. Most people don’t. It’s still a very rare condition. There’s no way to tell ahead of time who can develop the condition and who won’t. So, be patient. Use the minimum amount of cannabis necessary to treat your condition according to your doctor’s instructions. And always, always call your doctor and report any unexplained symptoms of nausea, belly pain or vomiting.
Need Help? NuggMD’s Here for You
NuggMD’s knowledgeable customer service team is here to answer your questions every day via email and live chat. It’s their mission to think outside the box and creatively solve problems so you can have the best experience possible.
Of course, the laws aren’t perfect, so there are some things that can’t be fixed (yet). In those cases, we can reach out to advocacy organizations, state and local legislators and our communities. Below, we’ve included a list of local advocacy organizations that you can reach out to. If you know of any other organizations we can add to this list, we’d love to hear from you.
15 N. 10th St.
Columbia, MO 65201
Marijuana Policy Project
P.O. Box 21824
Washington, D.C. 20009
New Approach Missouri
2025 Zumbehl Rd, #291
St. Charles, MO 63303
Missouri Cannabis Industry Association
15 N. 10th St.
Columbia, MO 65201
Missouri Medical Cannabis Trade Association
1015 Grupp Rd, #31674, St. Louis MO, 63131
Phone: (800) 766-0599
Andrew Mullins, Executive Director
PR – Media Inquiries: Jack Cardetti (573) 680-4009
Frequently Asked Questions
Is it legal to possess cannabis even though there are no dispensaries yet?
Yes, but only if you have a medical marijuana card.
How much cannabis am I allowed to possess?
You can purchase and possess up to four ounces, or the equivalent in concentrates. If you are cultivating cannabis (with permission from the Department) you may possess up to a 90 day supply at one time so long as the cultivated cannabis stays on the cultivator’s property and in their possession.
How much is the state card application?
The application is $25 for patients and caregivers. There is an additional charge of $100 for those who wish to cultivate their own.
How long does it take for the state to process a medical marijuana card application?
As provided by Amendment 2, Sec. 3(19), the state has up to 30 days to process your application. If they don’t finish processing it within that time, then your physician recommendation would serve as your card. This is highly unlikely to happen though because the Department’s been processing cards very quickly. In some cases, patients are receiving their state certifications via email within 48 hours. And since you will print out your patient identification card instead of waiting for it to arrive in the mail, the process is even faster. As applications begin to pick up at the beginning of 2020 in anticipation of the first dispensaries opening, it may take a bit longer.
How long does my certification last?
A patient must recertify at least annually. A physician is also within their rights to require their patient to return for certification more often if they feel the patient’s condition requires closer monitoring.
Will my health insurance cover my certification?
Amendment 2 states: “Nothing in this section shall be construed as mandating health insurance coverage of medical marijuana for qualified patient use.” Because cannabis is still federally prohibited, it’s unlikely that insurance companies will be covering it soon. Some insurance carriers make an exception for Epidolex, which is approved at a federal level.
Is there a tax on cannabis sales?
Yes, your retailer will be required to charge an additional 4% tax for your purchase. There may be other applicable local taxes as well.
Can I purchase cannabis in Missouri with an out-of-state card?
No. Missouri doesn’t have reciprocity with any other state cannabis program. The only way to legally purchase cannabis in Missouri is to present a Missouri Department-issued patient identification card. However, if you have “equivalent identification card or authorization issued by another state or political subdivision of another state,” you are not subject to arrest for possession of less than 4 ounces or the equivalent. You should talk to a lawyer before attempting to possess cannabis in the state with out out-of-state card because your out-of-state authorization may not be considered equivalent.
Can I get a card if I have a criminal record?
Yes. Criminal records don’t disqualify applicants from getting patient identification cards. However, your card can be denied if you:
- Lie or provide false or misleading information on your application,
- Provide incomplete information on your application, or
- Don’t apply for a state card within 30 days of your certification date.
Your card can be revoked if you:
- Violate any provisions of the program’s rules,
- You possess more marijuana than your card allows (likely 1 year suspension),
- You sell or traffic any drugs (guaranteed permanent removal from the program).
Can a nurse practitioner or dentist recommend cannabis?
No. Only a state licensed physician or osteopath can write a cannabis recommendation.
I have a caregiver who cultivates for me. Can I cultivate also?
No. Only your caregiver or you can cultivate for you. You can’t both cultivate at the same time.
Can I be fired for using marijuana if I have a Missouri Patient Identification Card?
Amendment 2, Sec. 7(1)(d) states that a cannabis patient can’t “bring an action against any employer, former empoyer, or prospective employer for wrongful discharge, discrimination, or any similar cause of action or remedy based on the employer, former employer, or prospective employer prohibiting the employee, former empployee, or prospective employee from being under the influence of marijuana while at work or disciplining the employee or former employee, up to and including termination from employment for working or attempting to work while under the influence of marijuana.”
Can my landlord prohibit marijuana use in my residence?
Missouri’s laws didn’t just concentrate on protections for patients. The built in protections for landowners and employers as well. Just as Missouri’s rules allow employers to fire or not hire cannabis patients, the rules allow the barring of cannabis use by contract. If your lease prohibits use or cultivation, this is a contract. If you agree to the contract, then you can be evicted for breaking this contract. Therefore, you need to ensure that your potential or current landlord will approve this use first.
Can I be denied an organ transplant if I become a medical marijuana patient?
Not in Missouri. Amendment 2 provides specific protections for organ transplant patients. Specifically, the law says “No patient shall be denied access to or priority for an organ transplant because they
hold a Qualifying Patient identification card or use marijuana for medical use.”
How many patients can a primary caregiver have?
“No individual shall serve as the Primary caregiver for more than three Qualifying Patients.” (Amendment 2 Sec. 7)
How many plants can be cultivated in a single locked patient cultivation area?
A single patient may have 6 seedlings, 6 immature plants, and 6 flowering plants to provide a continuous supply. Two patients may cultivate together for a maximum of 12 seedlings, 12 immature and 12 flowering plants. If a patient is also a caregiver, they may grow an additional six plants of each type for their patient. Under no circumstances can a single, enclosed, locked facility cultivate for more than three people. That’s a maximum of 18 seedlings, 18 immature and 18 flowering plants.
Can I use cannabis in public?
No. Amendment 2 Sec. 7 (7) says “No Qualifying Patient shall consume marijuana for medical use in a public place, unless provided by law. Violation of this prohibition shall subject the violator to sanctions as provided by general law.”
Can I make extracts with butane or other volatile materials?
No. Only those with a state-issued manufacturing license can use flammable gasses or dangerous materials for extraction.