Electronic Fall 2025 | Issue 64
State Legislative Update
By: Mark Peysakhovich, IPS Legislative Consultant
WHAT YOU SHOULD KNOW ABOUT ILLINOIS’ MEDICAL CANNABIS PROGRAM
Illinois recently had an anniversary of sorts. The first medical cannabis dispensary was officially cleared to open in Illinois ten years ago, on August 25, 2015. Over that time, the Illinois Department of Public Health (IDPH) has approved a total of 375,560 qualifying patients (including 1,358 persons under 18 years of age). As of April 2025, there were 133,887 current/active patients in the medical program. (https://mcpp.illinois.gov/updates/mcpp-update-display.mcpp-update-04302025.html)
Nationally, 40 states have legalized some sort of medical/medicinal cannabis program. (Let’s note here that I realize that the words “medical” and “medicinal” don’t mean the same thing. I use the word that the state of Illinois uses, “medical.”) And 24 of those states allow some sort of recreational access to cannabis. (https://www.ncsl.org/health/state-medical-cannabis-laws) In other words, much of the U.S. population lives somewhere with some form of state-legal cannabis program. Most of our physicians and other health care providers also live and practice in states with legal cannabis programs.
But even though medical cannabis has been legal here for over a decade, most patients and providers are still unclear on the details and logistics of Illinois’ medical cannabis program. Nothing demonstrates this lack of clarity more than one dreaded word: “prescribe.” Some of you know how it goes. Since medical cannabis is legal under state law, a patient asks the doctor to prescribe it. But since cannabis is illegal under federal law and lacks the rigorous scientific backing of a “real” medicine, the doctor declines. Confusion and frustration ensue.
This is unfortunate, especially since eligibility for Illinois’ Medical Cannabis Patient Registry Program has nothing to do with a prescription, recommendation or referral from a provider. Understanding that federally regulated prescribers cannot prescribe a federally illegal drug, states generally base a patient’s eligibility on lists of debilitating medical conditions, which vary state to state. (Illinois’ current list of debilitating medical conditions that make a patient eligible for the medical cannabis program can be found here: https://dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/debilitating-conditions.html.)
So, the only thing a doctor can do but does not have to do is certify that a patient has the medical condition in question. Having discussed this topic with many health care providers over the years, I’ve learned to stay away from general discussions on cannabis, and to stay focused on what they need to know about Illinois’ program. Here is the short list of information that has been the most helpful to most of the health care providers I know:
If any adult can go to a dispensary in Illinois and buy cannabis, why does anyone even bother with medical certification? Because medical cannabis card holders avoid paying 30 percent or more sales tax.
Illinois’ medical cannabis law does not require a physician to do anything. Under this law, you don’t have to even discuss cannabis, much less take any action on any medical cannabis-related query.
There is no such thing as prescribing medical cannabis. The only thing a physician can do but does not have to do (see #1), is to certify that a patient has a specific medical condition that makes them eligible for medical cannabis.
Certifying that a patient has a medical condition is not as easy as signing a piece of paper. As is the case with most things these days, the process is digital. First, a provider must register with the Illinois Department of Public Health by setting up an online account and submitting their credentials. More information here: https://dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/hcp-resources.html.
If, for whatever reason, you cannot or do not want to provide a medical cannabis certification, here is the most effective response: “The state has a registration process that I would have to go through before I could provide medical cannabis certifications. Unfortunately, I can’t help because I am not registered. We would be happy to provide you with any relevant medical records if you consult a different provider.”
It seems that a lot of the drama around medical cannabis certification comes when the patient feels that the doctor does not want to “prescribe” them medical cannabis. They feel judged and resent being denied. They probably don’t understand the whole certification process vs. a prescription. In many cases, describing the process per #5 makes things much easier.
For good or ill, a patient’s access to medical cannabis does not depend on you alone. A variety of companies charging in the neighborhood of $250 will provide a patient with a medical cannabis certification after one telehealth visit.
I hope you find this helpful. If you have any questions or suggestions on this topic, please reach out to IPS Executive Director Kristen Malloy (kmalloy@ilpsych.org).
Note from the Editor: This article is addressing the regulatory aspects of the medical cannabis process in Illinois and is not intended to address the clinical aspects. Anorexia nervosa and PTSD are the two psychiatric dx on the state list of approved dx. At the federal level, cannabis remains classified as a Schedule I substance under the Controlled Substances Act, where Schedule I substances are considered to have a high potential for dependency and no accepted medical use. Psychiatrists should be familiar with the evidence of efficacy of cannabis use (THC?) for our patients, risks of addiction and impact of chronic use.