Responding to growing public support for medical use of marijuana, the House of Delegates approved legislation Monday that would allow specially licensed physicians in Maryland to recommend the drug to patients with debilitating medical conditions.

The bill now goes to the Senate, where supporters are optimistic about its prospects.

The legislation would replace a system put in place last year that is widely regarded as a failure. That system restricted medical marijuana use to patients seeking care at academic medical centers, but none of the centers agreed to participate.

"This is a matter of life and death for our people," said Del. Cheryl Glenn, a Baltimore Democrat whose medical marijuana bill was merged with one sponsored by Del. Dan K. Morhaim, a physician and Baltimore County Democrat.

Under the legislation, approved 127-9, a state commission would license some physicians to write a marijuana recommendation for their patients. Morhaim said the directive would be similar to a prescription, but federal law prohibits calling it that.

Patients would be able to purchase the drug through state-certified growers. The bill would limit the number of growers to 10, who would be chosen and licensed by an existing medical marijuana commission.

"The purpose of the legislation is to put the doctor-patient relationship at the center of the law," said Sen. Jamie Raskin, the Montgomery County Democrat who sponsored the Senate version of the bill.

Raskin pointed out that the Senate has been much more accepting of medical marijuana than the House.

"The Senate has been very moved by the voices of our constituents," Raskin said. "For many people ... it's the difference between constant pain and being able to make it through the day."

The use of marijuana to treat illness enjoys broad public support, even among those who don't favor allowing it for recreational use. A recent Goucher College poll found that about 90 percent of Maryland voters support medical marijuana.

The O'Malley administration has taken a cautious approach to medical marijuana use, however. The highly restrictive model approved last year was based on the recommendation of state health secretary Dr. Joshua Sharfstein Earlier this year, Sharfstein told lawmakers it was "premature" to pass a new law — even though no patients have received the drug through the existing system.

Lt. Gov. Anthony G. Brown, who is running for governor, broke with that position and supported the legislation.

Nina Smith, a spokeswoman for Gov. Martin O'Malley, said the governor supports efforts to fix the system but would not decide whether to sign new legislation until he sees its final form.

Lawmakers heard testimony this year that marijuana can be an effective treatment for a wide variety of conditions, ranging from epilepsy to combating the effects of chemotherapy for cancer.

Among the Marylanders who urged lawmakers to revamp the system was Sarah Robinson of Bowie, who told her story to the Senate committee that will consider the House bill.

She said medical marijuana offers hope for her 9-year-old son, Mason, who has a terminal brain condition called lissencephaly complicated by a severe form of epilepsy that causes five to 30 seizures a day, each potentially life-threatening.

Some studies suggest that products derived from cannabis could help control seizures in some patients. The Epilepsy Foundation strongly supported the bill, and several mothers of children with severe forms of the disease joined witnesses with cancer and multiple sclerosis in testifying in favor of the bill.

Robinson said passage of the bill could be "the miracle we've been waiting for."

"Stopping the seizures can give him so much more quality of life and more time with us," she said.

Philip Gattone, president of the Epilepsy Foundation, which is based in Landover, called the House vote "a big step forward." He said there are a million Americans who have seizures that can't be controlled by drugs now on the market. He said there's compelling anecdotal evidence that cannabis can help some of those patients.

Gattone said an important provision in the bill is that physicians who work with epilepsy patients would be able to obtain a state license that would let them recommend marijuana for their patients. He said it's important that families be able to maintain their relationships with their current care givers rather than turn to someone aligned with an academic center, as last year's bill envisioned.

"There's a trust issue there. There's a partnership there," Gattone said.

Morhaim, the General Assembly's only physician, said Maryland legislators have grown "tired of waiting for the federal government to show some common sense" on marijuana policy. He said the federal prohibition on marijuana is standing in the way of research on the potentially beneficial use of drugs derived from the cannabis plant. Scientists in Israel are doing ground-breaking research on matching specific strains of marijuana to individual conditions, he said.

Morhaim said the legislation calls for regulations to be drafted by Sept. 15. Eligible patients would be issued an identification card entitling them to purchase up to a 30-day supply from a licensed grower and dispenser. The bill would expand on the marijuana-growing system in last year's bill, which never got as far as awarding a license. Among other things, the commission would be required to encourage growers to cultivate strains with demonstrated success in alleviating specific ailments.

"There are thousands of Marylanders who can be helped on a long- and short-term basis," Morhaim said. "There is no excuse to let people suffer."

michael.dresser@baltsun.com