Advocates for medical marijuana hope Illinois’ plan to expand its program will give the industry the boost it needs to sustain itself — but some doctors warn that, despite changes made to protect them, they still have legal and medical concerns about the product.

After previously rejecting efforts to make medical marijuana available to more people, Gov. Bruce Rauner’s office has indicated he will sign into law a bill to lengthen the pilot program by more than two years, to July 1, 2020. The legislation also adds two new qualifying conditions: post-traumatic stress disorder and terminal illness.

More broadly, the plan would remove the requirement that physicians recommend the drug for their patients, and instead only require that doctors certify that a patient has a qualifying condition. This provision is meant to address physicians’ unease about recommending a drug that is illegal to prescribe or possess under federal law.

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One person who plans to take immediate advantage of the change in the law is Lon Hodge, a veteran diagnosed with PTSD.

“The minute that goes through, I’ll be applying,” said Hodge, 62, a Grayslake resident who uses a service dog to help him cope with his PTSD.

Because he had bad experiences with other medications, Hodge said he did extensive research on the subject before trying legal marijuana in Colorado two years ago. He’s found that with strains that contain less THC, the component that gets users high, and more of another component known as CBD, he can finally sleep through the night without nightmares and have productive days.

Medical marijuana business owners welcomed the planned expansion as a potential lifesaver for the industry. Joseph Friedman, owner of PDI Medical dispensary in Buffalo Grove, expected the changes to help broaden the patient population.

“It’s a breath of fresh air and a sense of relief for the industry,” he said. “It’s going to help a lot of people who really need the help.”

After a sluggish start, the medical marijuana program in Illinois has been growing slowly but steadily. The state has about 7,000 authorized patients and that number, while still significantly lower than initial projections, has almost doubled since medical marijuana went on sale in November. Sales have risen to more than $2 million a month at 37 dispensaries statewide.

Jim Champion, a military veteran and member of the state’s Medical Cannabis Advisory Board, said the changes in the law would help not only veterans with PTSD but others who suffer from the condition, including victims of abuse, assaults and accidents. He welcomed the change even though the future of the board is uncertain because the new law would have the governor reconstitute the 16-member panel.

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PTSD affects about 3.5 percent of the population, according to the National Institutes of Health, which would amount to about 450,000 people in Illinois alone. One-third of the cases are diagnosed as severe, and only half of those diagnosed are receiving treatment. It’s more likely to affect women than men, and members of the military are at higher risk.

To qualify for medical marijuana in Illinois, a patient must have a doctor certify that he or she is likely to benefit from using marijuana to treat one of about 40 specific qualifying conditions, including cancer, severe fibromyalgia and spinal cord injuries.

At least five other states list PTSD as a qualifying condition for medical marijuana, according to a Washington, D.C.-based lobbying group, the Marijuana Policy Project. In New Mexico, half of all medical marijuana patients use it to treat PTSD. At least three states also permit the drug for treating terminal illness, while several other states don’t limit the use of medical marijuana to certain conditions but leave it up to doctors’ discretion.

Yet numerous medical groups remain opposed to the use of marijuana as medicine. The American Medical Association has called the drug “dangerous” and stated that its sale should not be legalized, while calling for more research on its effects.

The use of marijuana to treat PTSD, in particular, is opposed by the American Psychiatric Association, the Illinois Psychiatric Society and the U.S. Department of Veterans Affairs. Each of those groups said there is no credible scientific evidence that marijuana is an effective treatment for PTSD, and that research suggests it can actually be harmful to people with PTSD by increasing their anxiety.

Among veterans using the VA health system, cannabis use disorder has been the most common form of substance abuse since 2009, affecting almost one out of four veterans, the VA has reported.

The results of research into the effects of marijuana on PTSD have been mixed. Yale University researchers analyzed 46 studies on the subject and found that, while many studies cited a reduction in PTSD symptoms, the lack of large, controlled trials rendered the findings inconclusive.

Dr. Joshua Straus, co-director of outpatient behavioral medicine at NorthShore University HealthSystem in Evanston, said other studies hadn’t shown the benefit. Among his own patients, he has often seen regular use of marijuana increase anxiety.

While conventional PTSD treatments involving medications such as Zoloft and cognitive behavioral therapy help many patients, Straus said, others receive fewer benefits or suffer intolerable side effects. So while marijuana has been shown to be effective treating pain, he believes more research is needed on its use for PTSD.

The chief barrier to research remains the U.S. Drug Enforcement Administration’s classification of cannabis as a Schedule I substance — the same as heroin — meaning it has no accepted medical use and a high risk of abuse.

Earlier this year, however, the DEA authorized what sponsors say is the first randomized, controlled trial of whole plant medical marijuana as a treatment for PTSD. The $2 million study, funded by the state of Colorado, will test the effects of varying ratios of THC and CBD on veterans.

Partly because of limited research, many doctors in Illinois remain cautious or skeptical about using marijuana for any condition.

Dr. Asokumar Buvanendran, a professor who practices anesthesiology and pain medicine at Rush University Medical Center, said one concern is interaction of marijuana with other medications, particularly opioids, which he said have not been sufficiently studied.

His other concern is about how doctors can track medical marijuana use. The proposed change in the law would add medical marijuana to the state’s prescription drug monitoring program, so doctors would know which patients are using it, and to make sure patients don’t seek multiple referrals by different doctors.

To get more doctors to participate, Buvanendran said, marijuana would need to be reclassified at the federal level, or at minimum the DEA, which licenses doctors to prescribe drugs, would need to provide assurances that it will not penalize doctors who prescribe marijuana.

In addition, the proposed change from doctors recommending marijuana to merely certifying a qualifying illness may help assure doctors that they won’t be held liable if something goes wrong with a patient using marijuana, said Dr. Charles Bush-Joseph, an orthopedist and professor at Rush, and a team physician for the Chicago White Sox and Bulls.

Bush-Joseph is also a consultant for state-certified medical marijuana grower Cresco Labs, and helped design the company’s program to educate doctors about medical marijuana.

“I believe there is benefit to it,” he said. “Physicians are trying to educate themselves. Now that the standard [for certifying patients] is a little lower, I think more doctors will be willing to participate.”

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