Epstein was one of several advocates who testified in Annapolis in 2012, when Morhaim was pushing for a different medical marijuana bill.
For other patients, marijuana is a helpful supplement that allows them to use less of other medications that often have debilitating side effects.
Jeff Kabik, 61, suffers chronic spinal and back pain from injuries he incurred earlier in life. To treat his pain, he is prescribed oxycodone, which upsets his stomach and often gives him a headache. He’s also aware that over time, the human body builds up a tolerance to it. Already weary of taking pharmaceutical drugs, Kabik doesn’t like taking the oxycodone too often.
In the midst of his internal debate, he found marijuana.
“I found that medical [marijuana] was really helpful in the way where I wouldn’t need as many prescription pills,” he said.
Kabik serves as somewhat of a marijuana educator as the Maryland Minister of the World Cannabis Ministries, and lobbies in Washington, D.C., and Annapolis as chairman of the U.S. Marijuana Party for Maryland. He and other activists who lobby in the state capital have what Kabik terms a cooperative, in which they work together to acquire marijuana with high quality and low prices.
Still others don’t even require traditional marijuana — as in the kind that’s typically smoked or vaporized — but a derivative that contains certain compounds beneficial in the treatment of their illnesses.
Annapolis residents Gail and Colin Rand, members of the medical marijuana advocacy organization Americans for Safe Access and Temple Beth Shalom in Arnold, think an oil rich in cannabidiol, one of the compounds in marijuana, could be the key to stopping their 4-year-old son, Logan, from having seizures. He suffers from a severe form of pediatric epilepsy, Doose Syndrome, and has endured brain damage and bodily harm from his seizures. Logan only communicates at an 18-month-old level.
“Our little boy has been on some nasty, heavy-hitting, mind-altering drugs, which haven’t worked, and some made the seizures worse,” Gail Rand told the Medical Marijuana Commission at its November meeting. “Some drugs have caused development delays, attention and hyperactivity issues, balance limitations and interrupted sleep.”
The Rands found various reports saying that marijuana rich in CBD and low in THC, the compound that causes most of marijuana’s psychoactive effects, can help control or stop seizures. Colorado, which recently legalized recreational marijuana use, has seen some success with CBD treatment for pediatric seizures.
“Scientists think that CBD quiets the excessive electrical and chemical activity in the brain that causes seizures,” Logan’s mother told the commission. Ideally for her son, the CBD-rich marijuana would be ground, heated and extracted into an oil for oral administration while undergoing quality-control testing every step of the way.
“We have already obtained a recommendation from Logan’s neurologist at Children’s National Medical Center,” in Washington, D.C., Colin Rand told the commission at its December meeting. “Unfortunately, Logan is currently unable to use this recommendation to get the medicine he needs in the state of Maryland.”
Medical marijuana patients in Maryland have protection via a medical necessity defense. If the patient can prove the necessity after his or her arrest, the court will find the individual not guilty.
“That’s all supposing you have the dollars to properly defend yourself and to present that medical defense,” said Gar Roberts of Medical Cannabis Advocates of Maryland. Patients, some of whom could be very ill and frail, would still have to go through the ordeal of being arrested and prosecuted, he pointed out.
Roberts is also not too keen on Maryland’s academic medical center approach, calling it an obstacle that will not allow patients to get their medicine.
“It’s almost like you’re dealing with kryptonite,” he said. “Is this that dangerous? And again, when you look back at history, on record nowhere does it hint that anybody has ever died from cannabis.”
The Need for Research
Maryland’s law is set up so that it can correct some longstanding issues with medical marijuana such as the lack of research and data on medical marijuana patients and outcomes. There are at least 66 cannabinoids, compounds that affect the brain, in marijuana, and each could have its own potential therapeutic effects.
Sterling thinks it’s important to study these compounds in order to understand the mechanism by which marijuana works as a medicine.
“My perspective has been that the federal government has been a major obstacle in permitting research to go forward for how marijuana can be used in medicine,” he said.
Vandrey thinks a lot of state medical marijuana programs are missing opportunities to research patient results.
“Tracking outcomes and requiring reporting on health and trying to ensure continual medical involvement with the patients can be lost in a medically independent program,” he said. “I think as medical marijuana expands across the U.S. and other countries, someone’s got to do some clinical research to fully show the efficacy of this stuff.”
Under Maryland’s law, an academic medical center running a program must be able to define and monitor treatment success or failure and monitor data and outcomes.
“We want to prove the ability of [marijuana] being an effective medication,” said Rosen-Cohen.
As laid out in the law, an academic medical center must specify in its application what medical conditions will be treated, the criteria by which it will include and exclude patients, the source of the marijuana, how health-care providers can participate, how caregivers can interact with patients in the program, a description of the program’s funding, any training for health-care providers and patients and several other protocols. An approved center would also be required to update data on patients and caregivers daily and provide that information to law enforcement in real time.
Dr. Paul Davies, chairman of the medical marijuana commission and president of neck and back pain center KURE Pain Management, said he expects the commission to have regulations available for public comment in the first quarter of 2014 and passed toward the end of the second quarter.
“We’re trying to keep the regulations simple enough to abide by the law [and] simple enough that academic medical centers can design their own research programs,” he said.
Morhaim, the only physician in Maryland’s general assembly, said medical marijuana programs are in the unfortunate situation of having to play catch-up. While there are ways to ingest marijuana without smoking it, such as using a vaporizer, the scientific community hasn’t released pharmaceutical drugs that could mimic the plant’s therapeutic effects or more alternative modes of administering marijuana.
“The law should have been changed 40 years ago, so unfortunately, we’re in the awkward position of having to do some catch-up,” he explained.
Vandrey feels the ideal medical marijuana scenario would be not relying on smoking or vaporizing plant material as medicine, but allowing medicinal chemists to develop drugs that produce the positive effects of marijuana without the intoxication, memory impairment and anxiety that sometimes comes with marijuana use.
“What you have to balance is having that development go in, but in the meantime, still being compassionate enough to allow people to use smoked marijuana or oral marijuana administration because it seems to be working and helping,” he said.
A question Vandrey wrestles with now, and something legislators in medical marijuana states might want to give some thought, is how much smoked marijuana can be integrated into medical practice.
“Do you come up with a scenario that everyone smokes weed and it’s OK? Will that destroy a future market for a more tightly controlled and better-suited medicine?” he wondered. “I don’t know the answer to that.”