Doctors, dentists, surgeons and a variety of other health care providers came out in large numbers to learn about Maryland’s medical cannabis program on Sunday, Feb. 21.
More than 100 health professionals attended the Maimonides Society brunch at the Suburban Country Club to hear Del. Dan Morhaim, who is also an emergency medicine physician, and Dr. Lynn McPherson, a professor and vice chair for education in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore, speak about medical cannabis and the program that is soon to come in Maryland.
McPherson spoke about the pharmacological effects of cannabis as well as what kind of ailments it can be helpful with — she mentioned seizures, Alzheimer’s, arthritis, attention deficit hyperactive disorder, arthritis, post-traumatic stress disorder, nausea and vomiting from cancer and chemotherapy, gastrointestinal disorders, multiple sclerosis, HIV and AIDS and neuropathic pain.
Morhaim also spoke from a medical perspective and gave an overview of Maryland’s medical cannabis program.
“It’s like any other medicine. We prescribe medicine and hope the benefits outweigh the risk,” Morhaim said. “It’s coming, and it’s time for all of us to figure out how to get on board.”
For doctors, it’s as simple as going to the website of the Maryland Medical Cannabis Commission and signing up to be a “certifier”; they can’t technically prescribe cannabis since it’s classified as a federal Schedule I drug. Morhaim introduced a bill in this General Assembly session that would allow dentists, podiatrists and advanced practice nurses to also become certifiers. The bill is still pending.
Licenses for growers, processors and dispensaries have yet to be awarded since the state received a large number of applications, but Morhaim expects growers’ licenses to be awarded in a few months.
Following the presentations, an extensive question-and-answer session followed. The diversity of disciplines — neurosurgeons, gastroenteroloists, pediatricians, addiction specialists, psychiatrists, oncologists and ear, nose and throat specialists — showed that there is interest as well as questions from doctors across the health care spectrum.
While the crowd was clearly curious, many had a number of concerns about how medical cannabis will be used, how patients will be advised and what the future holds for the program. Morhaim admitted there are gaps in the program that need improvement and said this will be a fluid process.
Concerns were expressed about the lack of required physician education, questions were asked about data collection — Maryland will have robust data collection — and doctors asked about impairment in cannabis use, interactions with other drugs and how cannabis use will be monitored for patients, another area that is a bit murky.
While a doctor can recommend cannabis to a patient, it is up to the dispensaries to tell the patient how to use the cannabis whether it’s through using a vaporizer or ingesting a tincture. Morhaim recommended doctors keep in touch with patients and their dispensaries for monitoring.
Orthopedic surgeon Gary Pushkin and internist Tyler Cymet, both board members of the Maryland State Medical Society MedChi, expressed concerns that cannabis prescriptions wouldn’t be entered into the state’s prescription drug monitoring program, which lists narcotic prescriptions. Morhaim said any
patient that attempts to get cannabis recommended by more than one doctor will be flagged and could have their medical card revoked.
“It’s brand new. There’s so much we don’t know about it scientifically and medically, and it’s opening up a whole new area and it’s hard,” Pushkin said. “It’s just hard, you want to help people. So on the one hand there’s this sense of urgency to get the stuff out there … on the other hand, you’re trying to foresee as many unforeseen consequences as we can and deal with them ahead of time.”
Cymet felt similarly.
“We want it used, we want it used effectively, and now it’s just the messy part of implementation,” he said. “It’s not a matter of not respecting it, not wanting it, it’s how do we do it best?”
Pushkin doesn’t expect to recommend cannabis to his patients in the short term, as he wants to see how the program plays out. But he’d also like cannabis to be delivered like other drugs he prescribes.
“Get away from the idea of people getting high and impaired, but [instead] ‘I’m taking a pill of this part of marijuana that’s going to control my nausea or this part of marijuana that’s going to increase my appetite during chemo,’” he said.
Dr. David Gorelick, an addiction psychiatrist, physician, pharmacologist and professor of psychiatry at the University of Maryland School of Medicine, said he sees enormous promise.
“The Maryland program, I believe, offers a controlled, safe way to make medical cannabis available to patients where there’s clear evidence they’ll benefit from it and hopefully [will] open the way to more research so we can expand our knowledge, get a better picture of where it might be beneficial and what some of the side effects and limitations are that we need to take into account,” he said. “We are operating unfortunately with a fair amount of ignorance, certainly in the United States, because of
Morhaim was encouraged by the interest and said it was entirely appropriate for doctors to be cautious.
“Obviously, a lot of physicians are interested,” he said, “and they certainly should do their homework and research.”