SIOUX FALLS (AP) – Medical marijuana advocates have convinced South Dakota voters that legalizing the drug for medical use is a good idea, but they are struggling to do the same with many of the state’s physicians.

A split between the state’s largest doctors’ association and medical pot proponents was evident Tuesday at a meeting for a legislative committee tasked with studying the issue. The South Dakota State Medical Association was one of the most vocal opponents of the ballot measure last year. Though the law passed with 70% of the vote in November, the organization’s president, Dr. Benjamin Aaker, told lawmakers that many of its concerns with medical pot have remained.

That’s a potential problem for medical pot advocates because the new law, set to take full effect in November, will depend on involvement from physicians. It will require people who want a medical marijuana ID to get a physician’s written certification stating that patients have a “debilitating medical condition” and could benefit from using cannabis.

Aaker raised a host of issues with medical cannabis. He was concerned with how it will be administered, as well as medical problems associated with pot use like cancer, heart disease and schizophrenia. He also pointed to indications in other states that traffic fatalities, emergency room visits for drug overdose and children’s consumption of pot all increased after medical marijuana was legalized.

But Melissa Mentele, who launched the medical cannabis legalization campaign, said that reluctance from physicians and health care providers could result in a bumbling rollout of the program that will ultimately hurt patients. She said she envisioned an environment where patients could receive a recommendation from their family physician, but worried that if health care providers opted out, it would leave room for “doc-in-a-box” facilities that have little oversight or mission beyond recommending medical pot.

“This will create a state filled with patients who have no option,” she warned.

While Mentele charged that potential pot patients have been turned away from the state’s largest health care systems, an organization that represents health care providers said they are currently working on policies to comply with the law. But as lawmakers consider possible changes to the law, health care providers are in no hurry to start issuing medical pot certifications.

“It’s impossible to complete until this has played itself out,” said Tim Rave, the president of the South Dakota Association of Healthcare Organizations.

The law will technically go into effect July 1, but state agencies have well into the fall to set up the program. The Department of Health has a Nov. 18 deadline to start issuing the medical marijuana ID cards that permit people to buy and grow pot in their homes, as well as protect them from arrest and prosecution. The state’s Supreme Court is currently weighing a case that will decide whether a separate constitutional amendment legalizing both recreational and medical pot will take effect.

Aaker encouraged lawmakers to keep a tight list of medical conditions eligible for marijuana treatment, but he acknowledged that the research around medical cannabis has been limited and there are situations where patients benefit from it. 

“If the intent is to help people who are hurting, we need to find the people that this can help,” he said.