Medicinal Reefer Madness

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At the Takoma Wellness Center in
Washington, D.C., medical marijuana strains are labeled with percentages
of natural chemical compounds and symbols that tell which strains help
with staying awake, sleeping or eating.

The waiting room at the Takoma Wellness Center looks not unlike a doctor’s office. Two black leather chairs bestride a coffee table, and informational pamphlets reside in a display on the back wall. A hamsa, a Middle Eastern symbol for health, happiness and good fortune, sits above one of the chairs.

But in the next room, nine different strains of marijuana, four types of leaves for cooking marijuana-infused foods and two concentrated extracts sit ready for purchase by Washington, D.C., medical marijuana patients.

“We want to make sure that we match the strain to what it is they’re looking for,” said Rabbi Jeffrey Kahn, owner of the dispensary.

About 120 people in Washington, D.C., are registered medical marijuana patients, 35 of whom get their medicine from the Takoma Wellness Center on Blair Road, said Kahn. The city allows patients suffering from HIV, AIDS, cancer, glaucoma and muscle spasticity to obtain doctors’ recommendations and register their medical marijuana need with the department of health, which then issues patient identification cards.

Just blocks away, in the state of Maryland, people suffering from the same ailments cannot legally acquire that same medicine. That may change in the near future, however, because of the work of the Natalie M. LaPrade Medical Marijuana Commission.

The commission, which held its first meeting in September 2013, was established when Gov. Martin O’Malley signed House Bill 1101 into law last May. The independent 12-person group, which reports to Dr. Joshua Sharfstein, secretary of Maryland’s Department of Health and Mental Hygiene, is tasked with establishing regulations that would allow an academic medical center to establish a medical marijuana program.

“It’s time to put in a responsible, accountable program for the purpose of helping people,” said Del. Dan Morhaim (D-11), who introduced and sponsored the original bill. “I think people finally see that this makes sense from a point of compassion and care for themselves and their families, and I think the medical community has come together as well.”

A wide margin of Marylanders — 90 percent — support the use of marijuana for medical purposes when prescribed by a doctor, according to a 2013 poll by Goucher College’s Sarah T. Hughes Field Politics Center. Nationally, polls that have asked Americans since 2010 if they favor medical marijuana range between 60 and 81 percent in favor. A diverse array of health organizations, which include the American Nurses Association, the American Public Health Association, of which Morhaim is a member, Kaiser Permanente and various HIV/AIDS and cancer advocacy groups, support the idea of medical marijuana.

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In Washington, D.C., about 120 people are registered for medical marijuana. Most patients use vaporizers rather than smoke, one dispensary owner said.

Washington, D.C., and 19 states — not including Maryland — have medical marijuana laws on their books. While the fine print of the programs varies, most require a doctor’s recommendation, which then allows a patient to be issued an identification card and placed in a state registry. Some states have dispensaries, where patients can buy medical marijuana; others, such as Alaska and Hawaii, allow patients to grow their own cannabis.

Maryland takes a different approach with its Medical Marijuana Commission, which is named after bill co-sponsor Del. Cheryl Glenn’s mother. Glenn (D-45) became a medical marijuana advocate after seeing her mother and brother-in-law suffer from pain that their prescribed medications didn’t alleviate.

The law stipulates the commission consist of the secretary of health and mental hygiene or a designee; someone who is or was a medical marijuana patient; someone appointed by the National Council on Alcoholism and Drug Dependence; three physicians who specialize in addiction, pain, oncology, neurology or clinical research; a pharmacist; a scientist who has studied marijuana; a representative of the Maryland State’s Attorneys’ Association; a representative of the Maryland Chiefs of Police Association and an attorney knowledgeable about medical marijuana.

Under the law, a medical marijuana program would be under the direction of an academic medical center defined as a hospital that operates a medical residency program for physicians and conducts research overseen by the federal Department of Health and Human Services with human subjects. The law stipulates that the program would be investigational in nature and would provide marijuana to patients for medical use.

“We should have a very careful and concise type of program,” said Nancy Rosen-Cohen, a commission member and executive director of the
National Council on Alcoholism and Drug Dependence of Maryland.

Doubts Among Advocates
Sharfstein calls Maryland’s law a “middle-of-the-road approach,” modeled after how the U.S. Food and Drug Administration handles a drug that has potential benefits and harms.

But advocates for medical marijuana patients aren’t so sure patients will actually get medicine in their hands under the law.

“We don’t even consider Maryland one of the medical marijuana states because the program that has been created is so weak that potentially no patients who need medical marijuana will be able to obtain it,” said Rachelle Yeung, a legislative analyst for the Marijuana Policy Project. “The functionality of Maryland’s program depends entirely on the participation of these university hospitals.”

The bill’s fiscal and policy note, a summary and assessment of a bill’s impact prepared by the Office of Policy Analysis in the General Assembly’s Department of Legislative Services, notes that both the University of Maryland Medical System and Johns Hopkins University signaled they did not intend to participate as academic medical centers for a similar bill in 2012 and confirmed that the positions have not changed.

“DLS notes the possibility that — although the bill requires a specified infrastructure to be established and expenditures to be made — ultimately, there may be no programs for that infrastructure to support,” the note said. The fiscal and policy note also pointed out that costs are likely to be significant for a participating institution.

A spokesman for the University of Maryland School of Medicine said the institution is still in the process of evaluating its position. Johns Hopkins Medicine is open to discussing it with the state, but it would be premature and speculative to commit to a program or discuss its pros and cons until regulations are passed, a spokeswoman there said.

Ryan Vandrey, an associate professor in the department of psychiatry and behavioral sciences at Johns Hopkins University, has studied addiction and withdrawal in chronic marijuana use. He was on the advisory group that assisted the Maryland legislature on two medical marijuana bills. The bill that did not pass would have allowed dispensaries, similar to those in D.C., to open in Maryland. Vandrey supported both bills, but he thinks a lot of questions have yet to be answered about the bill that passed and how regulations will deal with those issues.

“Even though this is a passed law in the state of Maryland, there’s no guarantee it’s going to get up and running and work, no guarantee a teaching hospital will sign on and get a program going. It’s not entirely clear how that interaction of supply of the drug and medical oversight and billing is going to work or make it work,” he said. “I think money is a key thing that hasn’t been solved yet.”

Yeung and others with doubts about an academic medical center pursuing a medical marijuana program say institutions may fear losing federal funding or facing federal prosecution. Although in August 2013, U.S. Attorney General Eric Holder said the Justice Department would not challenge state medical marijuana programs, marijuana is still illegal under federal law.

Eric Sterling, president of the Criminal Justice Policy Foundation and a Maryland commission member, is playing a major role in crafting the state’s regulations. He said whatever program is implemented in Maryland will comply with the Justice Department’s guidelines.

“We’re not operating in an area of fear,” he said. “The commission is going to have to develop regulations which have to go through a rigorous process of review before they take effect.”

Sterling and other commission members think the allure of doing groundbreaking medical marijuana research will reel in researchers and their respective institutions.

If prosecution were to become an issue, the law offers reimbursement of attorney fees for state employees who face a federal criminal investigation in connection with their work in carrying out the program. The law also allows the governor to suspend medical marijuana programs if there is a chance state employees will face federal prosecution.

To help potential patients in Maryland, Morhaim will introduce a bill this session that will allow doctors at Maryland hospitals and hospices, once approved by the commission, to recommend marijuana.

“It will make the program workable [and] available to patients,” he said.

The Patients
From appetite stimulation to muscle relaxation, according to the current research, patients suffering from a wide range of ailments benefit from marijuana’s therapeutic effects. While there are differences between each policy, in the District of Columbia and the 19 states that have medical marijuana programs, illnesses such as HIV, AIDS, cancer, glaucoma, multiple sclerosis, muscle spasticity, chronic pain, epilepsy, Crohn’s disease, post-traumatic stress disorder, chronic pain and severe nausea can all qualify a patient for medical marijuana.

“What makes it a medicine is that it works to relieve very troubling symptoms,” said Sterling. “It’s effective to reduce pain so that somebody who is in pain can use much less of a much more dangerous narcotic drug.”

Although patients’ marijuana use technically is illegal in Maryland, an affirmative defense law allows a defendant to prove medical necessity.

For some patients, marijuana is simply the most effective medicine.

Adam Epstein, a 17-year-old Reisterstown resident, was diagnosed with Tourette syndrome in fifth grade. It manifested itself in uncontrollable head shaking that caused severe neck pain. In the beginning, his head would be shaking all day, every day.

“The known medications that all the neurologists used for Tourette’s, none of them worked,” said his mother, Kathy. “They didn’t give him one minute of relief.”

Some flattened his personality and made him tired all the time, while another medication’s possible side effects included a patient’s eyes rolling up and getting stuck, requiring a shot of epinephrine.

After doing research to make sure marijuana wouldn’t interfere with his medication, Epstein decided to experiment. When he did, a friend noticed Epstein’s shaking had stopped. He used it on an as-needed basis and realized that using it once could alleviate his symptoms for more than a week at times. His family thinks the severity of his symptoms might have lessened in intensity long-term from his marijuana use.

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