When the average person pictures the process to get a medical marijuana card, they may picture a sketchy office, staffed by pot-heads handing out cards to anyone who comes through the door.

At least, this is a point of view that Lynette Brownlow, office manager at UMed, a medical marijuana clinic in Dowagiac, deals with on a regular basis. Often, she will have to explain to both potential patients and those opposed to marijuana that the clinic treats marijuana the same they would any other prescribed drug.

“Some people just want a card even if they don’t have a qualifying condition,” Brownlow said. “That doesn’t happen at our clinic. You need the proper documentation.”

The number of medical marijuana card holders has increased in recent years. In 2016, there were 218,556 medical marijuana patients in the state of Michigan, according to the Medical Marijuana Policy Project. In 2015, there were 3,718 patients in Berrien and Cass counties alone, according to the Michigan Department of Licensing and Regulatory Affairs.

Contrary to what people may believe, those 218,556 Michigan patients went through a complex, multi-step process to acquire a medical marijuana card.

Step 1

First, a patient must have a qualifying condition. These conditions fall into three categories, A, B and C. “A” conditions are specifically listed in Michigan’s medical marijuana statute and are considered “debilitating medical conditions.” These conditions include cancer, glaucoma, positive HIV status, acquired immune deficiency syndrome, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s disease and nail patella.

“B” conditions are conditions not listed in but protected by the statute that produce any of the following symptoms: wasting syndrome, severe and persistent muscle spasms, severe and chronic pain, nausea and seizures. “C” conditions include Post Traumatic Stress Disorder.

Step 2

People wishing to be card holders must then obtain medical records provining they have one of these qualifying conditions. Different clinics will have different requirements, but UMed requires one medical record for A and C conditions. For B conditions, they require three records over a course of six months that are less than two years old.

Step 3

Get a doctor’s recommendation.

While any qualified physician can give a medical marijuana recommendation, most primary care physicians and family doctors will not hand them out. This is the reason specialty marijuana clinics like UMed exist.

“Certain hospitals and medical institutions do not approve of medical marijuana and suggest their doctors don’t get involved with the certification process,” said Dr. Christopher Prince MD.

Prince is a certified ER physician who has been working with UMed on a contract basis for the past seven years. He regularly sees patients, looks over their medical records and grants medical marijuana recommendations.

“If you make it into my room and you’re talking with me, you’ve already gone through one of the basic screenings by having the documentation to support your condition,” Prince said. “I want to feel confident that I have enough documentation that if you get into trouble, I can defend my recommendation and prove we have a ‘bona fide’ doctor-patient relationship.”

Creating a “bona fide” doctor patient relationship is an important factor in the medical marijuana card process, because if a doctor-patient relationship cannot be proven in court, it leaves a medical marijuana user open to prosecution in specific cases.

“If a doctor has to testify and doesn’t convince a judge of a few key things, then the doctor-patient relationship can be voided,” Berrien County Prosecutor Michael Sepic said. “Marijuana in Michigan is still illegal, but when you have a card you are immune from prosecution, so if the doctor situation is such that a judge doesn’t think it’s a valid medical relationship, then that voids the immunity the card provides in respect to the case we have charged.”

If a doctor-patient relationship is voided by a judge, it opens up the doctor and clinic up to investigation as well.

Step 4

People seeking medical marijuana cards must then send in an application including their doctor’s recommendation. The application will then pend approval from the state of Michigan. The application process usually takes two to three weeks, though Brownlow has seen the process take months.

After the application is approved, applicants will need to get their card renewed once per year. Prince does not require more frequent follow-ups, but he will make himself available to answer any questions a patient might have.

People who research online about how to recieve a medical marijuana card will find a plethora of sites offering web recommendations, one of the most popular being NuggMD. Popular in California, these types of medical marijuana evaluations claim to provide patients with a recommendation in minutes and involve speaking with a doctor via web chat.

While this option seems like a convenient and easier way to obtain a medical marijuana card, Michigan patients should steer clear. Michigan’s requirements for bona fide doctor-patient relationship includes an in-person evaluation. Online recommendations do not meet this criteria.

Despite the complexity of the medical marijuana certification process and the potential risks that accompany it, both Brownlow and Prince believe that their work helping people obtain medical marijuana cards is meaningful and important.

“It’s not about getting people high,” Brownlow said. “It’s about about treating people. It’s about making their lives better.”