As proposals take shape for a medical marijuana program in Maryland, the state is considering an approach that would put academic centers such as the Johns Hopkins University and the University of Maryland at the helm as a way of closely monitoring the drug — and studying whether it is effective or safe for wide use.
A state panel met Wednesday for the first time since being formed by the General Assembly with a relatively narrow focus: to study ways to regulate medical marijuana through a licensing agreement with a university. That conservative approach addresses objections from the state health secretary, who has cited concerns about the drug's effectiveness and the uncertainty of federal law.
Marijuana use has gained some acceptance in the medical community as a treatment tool for various chronic illnesses, though it remains controversial. The use of an academic center is a unique model among more than a dozen states that have legalized the use of marijuana for treating pain or illness, according to Dr. Joshua M. Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene.
"It is the most appropriate approach for the level of evidence of marijuana's usefulness," he said, citing a list of the drug's side effects, including paranoia. "If you believe there's no evidence at all, you go with nothing. If you believe marijuana is like penicillin, then you go all the way.
"But there's a yellow-light approach, which I think is the most appropriate here, when it's not clear if the benefits outweigh the risks."
The proposed research model would likely mean far more limited access to medical marijuana than under a measure debated this year in the General Assembly. That measure would have enabled doctors to prescribe marijuana for patients with chronic pain or diseases, and would have established a tightly controlled network of state-registered growers and dispensaries.
The state's Medical Marijuana Work Group, made up of lawmakers, health professionals and law enforcement officials, plans to develop guidelines for a legislative proposal for the 2012 General Assembly. The panel plans to make its recommendations by Dec. 1.
Doctors affiliated with the University of Maryland and Hopkins, both potential hosts of a program, serve on the working group. Sharfstein said when parameters of a program are decided, they will be presented to both universities. Officials at both institutions declined to comment on the legislative study because there was no specific proposal in place.
Fifteen states, most recently Arizona, and the District of Columbia have legalized the use of marijuana for treating pain or illnesses. Maryland appeared poised this year to pass its own legislation, with the Senate overwhelmingly approving a bill to allow physicians to prescribe medical marijuana to some patients. But the bill stalled in the House over concerns about misuse.
Former talk show host Montel Williams, who has multiple sclerosis and said he takes marijuana to deal with pain, came to Annapolis in January and tearfully advocated for the bill. Sens. Jamie Raskin, a Democrat, and David Brinkley, a Republican — both cancer survivors — also pushed for the bill's passage, saying that though they don't use marijuana, they understand why some patients rely on the drug.
But Sharfstein, a former top official with the Food and Drug Administration who took over the state health department in January, opposed the medical marijuana bill, effectively killing the legislation. He cited a lack of scientific consensus about the benefits of marijuana and concerns about regulating a system that the federal government doesn't recognize.
The proposal also drew opposition from law enforcement organizations, which said it would be too difficult to keep marijuana confined to medical patients.
Lawmakers made a tweak this year to a medical marijuana law already on the books since 2003. Under the new law, someone arrested for possession of one ounce or less of marijuana could present a doctor's note, medical paperwork or the testimony of a doctor in court as evidence of a medical necessity. The person could be found not guilty if a judge or jury was convinced of the necessity by a preponderance of evidence.
In the background of the medical marijuana debate looms a vague federal policy on the issue. Joshua N. Auerbach, assistant general counsel in the state attorney general's office said seemingly dueling memos — from the Department of Justice guiding federal prosecutors on drug law and from the Department of Drug Enforcement declining to reclassify marijuana as a less serious drug — have created "legal uncertainty" on the issue.
At its meeting on Wednesday, the work group focused on three areas of study: science issues, regulation and an examination of funding possibilities.
Members plan to make recommendations on several issues, including which medical conditions can be treated, the duration of treatment, and sources of the marijuana. They will also examine diversion issues, such as instituting strict controls against illegal proliferation of medical marijuana.
"This system will do the most good and not create problems in terms of diversion and misuse," said Del. Dan Morhaim, a Democrat and co-sponsor of the failed medical marijuana legislation, and the General Assembly's only medical doctor.
The university-based program being developed by the working group is loosely based on a 1999 report by the Institute of Medicine, an advisory panel of the National Academy of Sciences.
That report does not spell out how government should run a medical marijuana program but rather suggests that any program have compassionate use and investigative elements. That means at least to start, those with no alternative treatment might be the only candidates for marijuana prescriptions, and risks to the patients and efficacy of the drug would be studied.