Once a month, Jody Shimpach gets in her car and makes the 40-mile drive to Rochester to buy medical marijuana to help treat her husband, Michael's, multiple sclerosis.

Shimpach, of Owatonna, said medical marijuana has vastly improved her husband's quality of life, helping to ease his pain and allowing him to stop using prescription opiates. But one frustration with Minnesota's program remains — the high cost of the drug. Every month, she spends $300 of her Social Security check to buy her husband's medical marijuana.

"By hook or by crook, I am going to find a way that I can afford it, and that's not easy to do, but I just cut back on everything that I possibly can," she said.

The slow rate of patients signing up for Minnesota's medical cannabis program is a big reason for the high costs, said Dr. Kyle Kingsley, CEO of Minnesota Medical Solutions. It's been six months since the company opened its Rochester marijuana dispensary at 3456 E. Circle Drive NE. The clinic has seen hundreds of patients during that time. Still, he said the number of patients registering for the state's medical marijuana program has been on the low end of the business' projections. Kingsley said patients spend an average of $250 per month on cannabis.

"The one issue is we would love to see more patient numbers just so that we can decrease our prices, and that's really important," said Kingsley, a former emergency room physician who grew up in Harmony.

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Patients slow to sign up

Statewide, 920 patients have completed the registration process to be able to buy medical marijuana since it became legal on July 1, according to the Minnesota Department of Health's Office of Medical Cannabis. Nearly 500 health care practitioners have registered in order to certify patients for the program.

Minnesota has one of the strictest medical marijuana laws in the nation, only allowing medical cannabis to be used in pill, liquid or oil form. Patients must have one of nine qualifying conditions, such as cancer, multiple sclerosis or a terminal illness to qualify. However, Minnesota Department of Health Commissioner Dr. Ed Ehlinger announced last month that "intractable pain" would be added to the list of qualifying conditions, beginning Aug. 1. Intractable pain is defined as a "pain state in which the cause of the pain cannot be removed or otherwise treated."

Kingsley said he is pleased by the health commission decision and expects it will lead to more patients enrolling in the state's medical cannabis program.

"We're encouraged by that, and we anticipate that there will be some increase in patients when intractable pain as a qualifying illness starts in August, but the doors aren't going to fly off the place," he said.

In July, Kingsley said the company planned to open additional locations in Moorhead and Eden Prairie by late fall of 2015. Those would be in addition to their Minneapolis and Rochester locations. But those plans have been put on hold until May or June. State law requires Minnesota Medical Solutions and the other approved distributor, LeafLine Labs, to open four locations each in different congressional districts by July 1.

Kingsley said a recent discovery has him optimistic that price may be lowered in the future. The company has developed a new marijuana strain called "Katelyn Faith" that may be the most CBD-rich strain in the world and could help lower costs.

Maren Schroeder said the price of medical cannabis remains a primary concern for patients. Schroeder is co-founder of Sensible Minnesota, a nonprofit group that advocates for patients who use cannabis.

"I have a lot of patients I'm working with that won't even try to get into the program because of the cost. It is very cost prohibitive for these patients," she said.

As such, she said she knows of patients who have returned to buying marijuana illegally to treat their conditions because it is cheaper. Also driving some to buy on the black market is a concern among some patients that they are developing a tolerance to the marijuana strains used by the state's two manufacturers.

Many doctors remain skeptical

Another challenge is getting doctors on board with the idea of medical cannabis. Minnesota Medical Association President Dr. Dave Thorson said in many ways, little has changed in the six-plus months since medical marijuana was legalized.

"Physicians are still relatively uncomfortable. There is not evidence to show it is beneficial in most situations," Thorson said.

Another concern for physicians is a lack of information about how their patients are being treated once they have been certified.

"We are not getting good communication back from the labs at this time," he said.

Nonetheless, Thorson said he chose to register to certify patients for medical cannabis. The White Bear Lake family practice doctor said one of his patients who suffers from multiple sclerosis has seen a major improvement in her symptoms since she started using cannabis. Other eligible patients have opted not to enroll in the program because of the costs.

Help finding a doctor

Minnesota Medical Solutions is taking steps to make it easier for people to find physicians who will certify them for the state's medical cannabis program. On its website, a tab labeled "Find a doctor" directs patients to two Twin Cities-area clinics. The company also is working on developing a form that patients can submit, and the clinic will help connect them with health care providers that are willing to certify patients.

In addition, Kingsley said efforts continue to reach out to physicians in the state to make the case for medical cannabis as a treatment.

"Generally speaking, the more informed physicians are about our specific processes and the Minnesota system, the more comfortable they are with it," he said.

Mayo Clinic allows its health care providers to decide whether they want to certify patients for the medical cannabis program.

"The Minnesota Medical Cannabis Program is a voluntary program for eligible health care providers. It is each doctor's decision whether to participate in the program. Mayo does have a policy to assist those providers who choose to participate in the program," Mayo Clinic spokeswoman Ginger Plumbo said in a statement.

Rewarding outcomes

Kingsley said the most rewarding part of the job so far has been seeing how medical cannabis has helped change some people's lives. He said, in some cases, children with intractable seizures who began taking cannabis and gone from having dozens of seizures a day to a handful or none. He's particularly excited to see terminally ill patients who have been able to get off of strong prescription opiates.

"They are able to get off their opiate pain medicines and transition to cannabis. That's a remarkable thing," Kingsley said. "Instead of being in an opiate-induced stupor for the last weeks or months of their life, they are able interact with their family, and that's a pretty amazing thing."