Maryland lawmakers have a new idea to fight the deadly heroin epidemic that has swept across the state: Treat addicts with medical marijuana.
A House of Delegates committee agreed to tuck the proposal into a bill that would extensively rewrite the laws governing the state's medical marijuana program. The bill, to be considered by the full House Friday, would add "opioid use disorder" to the list of medical conditions physicians can cite when recommending medical marijuana to patients.
"With the problems we're having with heroin, this is something that should be available in the state of Maryland," said Del. Cheryl Glenn, a Baltimore Democrat and chair of the influential Legislative Black Caucus.
The black caucus forced lawmakers to reconsider the state's fledgling medical cannabis program this year after few minority-owned companies won preliminary licenses to grow or process the drug, despite a state law requiring racial diversity be considered.
As lawmakers wrestled with how to expand the industry, the House Health and Government Operations Committee adopted an amendment to include opioid addiction among the already broad list of ailments that can be treated with marijuana.
Early estimates suggest that some 2,000 people died of heroin and other opioid overdoses in Maryland last year. Legislators and Hogan administration officials are looking for solutions to the problem. The idea of opening the door to using marijuana as a treatment shows how even seemingly unorthodox ideas are being considered.
Marijuana researchers say there is no scientific evidence that smoking marijuana would be an effective treatment for opioid addiction.
"There is evidence that cannabis may be effective in alleviating certain forms of pain, and may be useful therefore in reducing opioid use. But there is no evidence that cannabis may help reduce opioid addiction,"said Dr. Daniele Piomelli, professor of anatomy and neurobiology, pharmacology and biological chemistry at the University of California, Irvine, and a cannabis researcher.
"This is not something any legislature should decide lightly on, without the backing of scientific data."
Del. Sandy Rosenberg, a Baltimore Democrat who led the team of House lawmakers rewriting the bill, said he felt there were grounds to add heroin addiction to the list of ailments allowed to be treated by marijuana.
"We have looked at the medical evidence, and we thought it made sense," Rosenberg said. He emphasized that doctors would have discretion to decide whether marijuana was an effective treatment for heroin addiction. He said that given the magnitude of the heroin problem, it was wise to have this option.
"We thought we should leave it up the doctors," Rosenberg said. "We don't legislate medical judgment."
Republican leaders in the House and state Senate questioned the wisdom of the move.
"Replacing one habit with another may not be a good idea," said House Minority Whip Kathy Szeliga, a Baltimore County Republican. Treating opioid addiction with pot is a not a clean-and-sober approach."
Activists in Maine sought unsuccessfully to allow the use of marijuana in treating opioid addiction, and the legislature in Nevada is also considering the issue.
Maryland's medical cannabis law is already one of the broadest in the country — a wide range of ailments are allowed to be treated with marijuana and a range of medical providers are allowed to recommend it.
The breadth of the program attracted more than a thousand applications to launch the industry last year.
The Senate is drafting its own plan to rework the medical marijuana program, but its version does not include using the drug to treat heroin addiction.
Treatment for heroin addiction typically involves using another drug that acts on the parts of the brain that are stimulated by opioids to dull cravings. Methadone and buprenorphine, the most commonly used drugs, have slightly different effects but both work on that principle.
It's not clear what impact using marijuana to treat opioid addiction might have. One problem is that researchers tend to study any of the hundreds of chemicals found in the marijuana plant, rather than the entire plant, so those chemicals can be processed into consistent medications.
Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University and a cannabis researcher, said one small study of a chemical in marijuana showed some promise in preventing addiction relapse, but the study wasn't conducted with human subjects.
A study of the psychotic chemical, called THC, showed no effect on opioid use by primates.
There is stronger evidence that marijuana works as a treatment for chronic pain — a problem often treated with opioid pills that can be addictive — and some recent studies have concluded that states with access to medical marijuana have lower rates of heroin and opioid pill overdose deaths.
That's not necessarily because the addiction itself is being used treated with marijuana. A team of researchers from the Rand Corporation and the University of California, Irvine, suggested that in states where medical marijuana is widely available, chronic pain sufferers turned to that instead of opioid pills. And recreational drug users might be encouraged to illegally get hold of medical marijuana rather than pills.
Yet, many opioid addicts already smoke marijuana, and that has not curbed the opioid epidemic, said Dr. Robert DuPont, a former White House drug czar under two Republican administrations who is now president of the Institute for Behavior and Health, which works to stop illegal drug use.
DuPont, who is also a fellow at the American Society of Addiction Medicine, said he supports cannabis research and believes individual chemicals will eventually be made into medications that benefit a host of maladies. He also understands why some would want to know if it could curb the nationwide opioid epidemic.
For now, he said: "There is no science, and it's not even close."
"There is no doubt people who have an addiction problem will find marijuana attractive, but I have trouble imagining it would make a difference for an opioid dependent person," he said. "There is a lot of study of the chemicals in the marijuana plant and that needs to continue."
Baltimore Sun reporter Erin Cox contributed to this article.