Hospitals and state research centers rely heavily on federal funds, making them wary of participating in a program to distribute a drug that remains illegal under federal law. Proponents say research into marijuana's efficacy can face multiple challenges — especially because the federal government controls the supply of marijuana that can be used in such studies.
"The hospitals don't want to take it because they're afraid that the federal funding that they receive will be taken away," said Del. Joseph Vallario, a Prince George's Democrat. He chairs a committee that has killed other bills to loosen pot laws, but he considers himself an unwavering supporter of medical marijuana.
The Obama administration has indicated that it will not prosecute federal marijuana crimes if state laws have legalized the drug's use, but that has not entirely allayed such fears.
"The federal government still has regulations about this stuff, and the hospitals have to weigh all those things to see whether they'd fall into the criteria of what they could do," said commission member Col. Harry Robshaw, chief of the Cheverly Police Department.
Eric E. Sterling, president of the Criminal Justice Policy Foundation, a private nonprofit educational organization that focuses on criminal justice issues and "failed global drug policy," said that wariness might not be warranted. The federal government has never sued a state to block a medical marijuana program since California adopted its program in 1996, he said.
Still, Carroll County State's Attorney Dario J. Broccolino, also on the commission, understands that it's uncharted territory for the state, and hospitals have a right to take a wait-and-see stance. "I can understand their timidity because it's the great unknown. They're not going to commit to anything until all the regulations are published."
As a result, those the Maryland law was intended to help remain stymied.
"For the day-to-day life of a patient in Maryland, nothing has changed with this law," said Michael Liszewski, policy director for Americans for Safe Access, a group that advocates for medical marijuana.
Advocates knew the passage of Maryland's law was not going to make the drug immediately available — legislative aides estimated setting up the program would take until fiscal 2016. And while the advocates would have preferred a more expansive measure, Liszewski said it was clear they would have to settle for something less than ideal.
Twenty states and the District of Columbia have a medical marijuana program, but Maryland is among a minority that do not allow dispensaries and the only one that ties it to research activities, according to the National Conference of State Legislatures. A medical marijuana user in Maryland can still be arrested for possession, but showing medical necessity can be used as a defense in court to avoid conviction.
Medical marijuana proponents take heart in polls that show increasing support for their cause — a Goucher College poll in November found 90 percent of Marylanders back medical marijuana. There is a greater comfort level with the drug, with some who now use it medicinally having once used it recreationally.
Considine, 60, takes "several tokes" in the morning and later in the day for the muscular weakness and fatigue that comes with post-polio syndrome.
"My condition is all about conserving energy," said the Halethorpe resident.
Stricken with polio before he was 2, Considine was able to live a largely normal life, working first in restaurants and later in land title companies until 1998, when he developed post-polio syndrome.
He had used pot recreationally as a younger man, less so after he married and had two children who are now in their 20s. Having retired, he starts his day with coffee and "three tokes," which help the pain and spasms of his afflicted muscles.
The former chef still cooks his family's meals, a once simple task that saps his strength. "My back and legs are shot when I'm done," Considine said, and smoking more pot later in the day helps him get the sleep that his doctor says is the best medicine for his condition.
He would smoke more, but the cost is prohibitive so he limits himself to about $75 to $150 worth of marijuana a month.
In Annapolis, the debate has broadened this session and includes two other pot proposals. One would legalize marijuana, regulate it and tax it like alcohol; it is considered unlikely to pass this year. A second would decriminalize the possession of small amounts.
Advocates for medical usage say that while they have no problem with legalization of the drug for any purpose, such a measure alone wouldn't address all their needs. For example, if marijuana were subject to an excise tax, like alcohol, those who use it for medical purposes would have to pay the same as those using it recreationally.
Sen. Bobby Zirkin, a Baltimore County Democrat who is pushing to make marijuana possession a civil offense without jail time, said the other proposals still don't resolve the problems with Maryland's medical marijuana system.