Though medical marijuana was legalized in Michigan in 2008, debate is still raging over which patients are eligible to use the treatment.

According to the Michigan Medical Marijuana Act, medical patients in the state of Michigan who want to use marijuana to treat their conditions must first obtain registry identification cards from the Michigan Department of Community Health — a process that has ignited controversy over who should be allowed to use the drug.

And with limited research on the drug that is backed by the federal government, many physicians are hesitant to suggest it as a treatment option, though patients and advocates swear by the drug’s medical efficacy.

Between April 6, 2009 and Oct. 8, 2010, the department received 65,816 new or renewal applications. So far it has approved 35,802 and denied 7,938 of those applications. Most of the denied applications were incomplete, according to the department’s website.

To apply for a card, a patient needs written certification from a licensed physician verifying that he or she has one of the “debilitation medical conditions” specified in the state law. The list includes cancer, glaucoma, HIV/AIDS, Crohn’s disease, Alzheimer’s disease. In addition, the various symptoms of chronic or debilitating conditions are also included, like severe or chronic pain, severe nausea or wasting syndrome — significant weight loss caused by the AIDS virus or chronic fever and diarrhea.

Dr. Daniel Berland, an assistant professor of internal medicine and anesthesiology at the University’s Medical School, treats patients with acute and chronic pain at the University Hospital. He said most of his patients who go to the hospital for chronic pain are either using marijuana or asking for it, which is a “drastic change” from just a year ago.

Dr. James Riddell IV, an associate professor of internal medicine in the Medical School and an infectious disease specialist at the University Hospital who works with HIV/AIDS patients, said some doctors refuse to recognize marijuana as a treatment option, while others not affiliated with the University hand out written certifications for their patients “willy nilly.” He estimated that about 25 percent of doctors, like him, generally support the possibility that marijuana has medical benefits but want to see more scientific evidence.

“You get varying attitudes, and I think in general, physicians are sort of a conservative bunch and in general what we like to see before we endorse any treatment is data,” he said, adding that he has provided written certifications to a “select number” of his patients.

The law only gives a general list of qualifying conditions. To help physicians in the state, Riddell was one of nine doctors at the University who put together a comprehensive guide last March that details how marijuana reportedly affects patients with each qualifying condition.

The guide — based on findings from previous studies on the drug — explains that there are more effective medications for treating each condition. Doctors also agree that until more research is done, marijuana should be used as a last resort and only after other treatments have failed.

Berland, who has never provided a written certification for a patient, said the scientific evidence behind the medical benefits of marijuana is simply not substantial enough to merit the drug as a treatment option. The research that is available, he said, consistently shows that other proven treatments work better and are often cheaper than marijuana. For pain relief, marijuana is about as effective as Tylenol with codeine, he said.

“We all want to have a bias that this drug could be useful, and many of us have a bias that it should be decriminalized,” Berland said.