The use of medical marijuana in Maryland and how a statewide system could legally provide patient access are once again before the General Assembly, with three bills filed in recent weeks — each proposing a very different system for dispensing and distribution of the drug.
Though federal law criminalizes the use of the drug, some legislators — led by Del. Dan Morhaim, a District 11 Democrat from Baltimore County and the legislature's only medical doctor, and Sen. David Brinkley, a Republican who represents Carroll and Frederick counties in the 4th District — have pushed in recent years for the state to adopt its own laws permitting and providing for the drug's use by medical patients with specific, debilitating conditions, a step already taken by more than a dozen other states and the District of Columbia.
Last year, the legislature passed a bipartisan bill that essentially decriminalized use of the drug by people who can show it is for "therapeutic or palliative relief," cleared the way for physicians to discuss use of the drug with patients without fear of reprisal from the state's medical licensing board, and created a panel charged with making recommendations for medical access to the drug in the state moving forward, said Morhaim, a panel member.
Still, the fact that patients lack a safe way to purchase or receive the drug remains a major gap in the state's overall policy toward medical marijuana use, Morhaim said. It's one he hopes will be filled this session with new legislation based on the findings of the 22-member panel, which split to produce two separate plans for a state-backed medical marijuana system late last year.
"We've already acknowledged that (medical patients who use marijuana) shouldn't be criminalized. That's a step forward," Morhaim said. "But the patient still has to go out and have a dealer-patient relationship, instead of a doctor-patient relationship. They're still putting money into the illegal drug trade, which isn't a good thing."
One panel plan, backed by Dr. Joshua Sharfstein, Secretary of Maryland's Department of Health and Mental Hygiene and a panel member, recommends treating medical marijuana as an investigational drug that specific research institutions in the state would be able to dispense to limited patient pools while studying the treatment's effects.
The other panel plan, endorsed by Brinkley and Morhaim, calls for creating a network of state-sanctioned dispensaries — and growers — that would work with physicians across the state, trained in recommending use of the drug, while also providing for data collection.
On Feb. 10, bills reflecting both plans were introduced in the House by Morhaim, who had said earlier that the legislation would mirror the recommendations of the two plans, and "overlap about 90 percent." Senate versions of the bills were expected to be introduced this week.
"What I hope is that it makes marijuana available to those patients who need it, who have tried everything else and found it didn't help them, in a safe and secure way, under controlled circumstances," Morhaim said.
Even before last week's filing, two committees in the House of Delegates were already hearing a separate bill sponsored by Del. Cheryl Glenn, a District 45 Democrat from Baltimore City, that would legalize the medical use of the drug and allow for home cultivation of marijuana plants by qualified patients, an option not recommended by either plan that came out of the panel but one that exists in other states.
Because of the home cultivation language, that legislation is considered by some to be less likely to succeed than the legislation directly supporting the panel-recommended plans, according to Dan Riffle, a legislative analyst with the Marijuana Policy Project, a medical marijuana advocacy group that has been actively lobbying legislators in the state.
"We've determined that that's something that will not be able to pass, at least at this time," said Riffle, whose organization supports home cultivation but pushes legislation they consider viable.
"We want to move the ball as far forward as we can," Riffle said. "But to the extent that Glenn's bill adds to the conversation, I think that's a good thing."
Glenn said she hopes her bill will spark conversation.
"I don't have any delusions of grandeur," she said. "But whether my bill passes or not, I want the conversation to be there. I want this to be on the table."
Glenn's mother died last year of kidney cancer. Her brother-in-law died five years ago from bile duct cancer. As she watched them "waste away" because they were unable to eat, "several doctors indicated that it was just shameful they could not prescribe medical marijuana as an appetite stimulant," Glenn said.
In part because of that, she has long been working with Morhaim and state Sen. David Brinkley, a District 4 Republican from Carroll and Frederick counties and another leading medical marijuana proponent, on crafting legislation.
She sees controlled, licensed home cultivation by patients with monitored doctor-patient relationships as critical to ensuring the law does not "create a situation of the haves and the have nots," so decided to introduce her own legislation, she said.
"Too many people would not be able to afford the medical marijuana, if they are not allowed to do personal cultivation," Glenn said. "We still have a lot of working poor in Maryland, and we have a lot of people who still can't afford health care."
Morhaim said while he is happy both panel plans "recognize that the status quo is flawed and that it's time to move forward," he hopes the plan he backs gains momentum in the legislature rather than the plan backed by Sharfstein.
He said restricting distribution of the drug to research institutions would limit the benefits of the drug, especially in areas of the state without such institutions, and would unnecessarily proscribe the participation of well-qualified doctors across the state who know their patients best but who don't work at one of the institutions.
"Why should physicians who are perfectly competent and who work in those areas not be able to help their patients?" he asked.
More importantly, Morhaim said Sharfstein's plan simply isn't viable on a practical level, because research institutions like Johns Hopkins University or the University of Maryland that receive federal funding aren't likely to risk that funding — or their own legal standing — by participating in a program that, while created under state law, would still break with federal law.
Sharfstein disagreed, and said he has already heard interest in his plan's potential from state institutions, though he declined to name them.
He also said the amount of evidence on medical marijuana as a therapeutic drug is still insufficient for a system of use based on doctor recommendations. That makes it more appropriate to treat medical marijuana as an investigational drug, and academic institutions often offer the first line of study and testing of such drugs, he said.
"When you don't have convincing evidence that the benefits outweigh the risks, then it's appropriate to be gathering data and to be thoughtful about which patients should be trying the therapy and why," Sharfstein said. "Academic centers do exactly this."
Riffle said he shares Morhaim's concerns about Sharfstein's plan.
How to create state medical marijuana law that contradicts federal law is a concern in general, Riffle said, but it's not an insurmountable obstacle to new state legislation, as was shown with the state legislation passed during last year's session.
"We've already sort of passed that bridge," Riffle said. "We've already said the state of Maryland is going to diverge from federal law when it comes to patients who need medical marijuana."
Now, Riffle said, the discussion is all about "how best to facilitate access."
Del. Shirley Nathan-Pulliam, a Democrat who represents District 10 that includes Catonsville, and a registered nurse, said her stance on medical marijuana is in line with Morhaim's plan, largely because of her concerns with access.
There needs to be a law in Maryland that allows people with serious medical conditions to receive medical marijuana "without endangering their lives and going out on the street, and possibly facing arrest," she said.
She said she would like to see substantive progress on the matter this session, beyond what would be provided by categorizing medical marijuana an "investigational drug" that can only be handled by research institutions.
The medical community has already largely agreed on the medical benefits of the drug for certain patients, she said, including "people with cancer and other diseases that are nauseating" and patients who have trouble eating.
In fact, the drug has been shown to be beneficial for patients suffering from a broad array of illnesses, she said, including multiple sclerosis, as former talk-show host Montel Williams testified when he advocated for a medical marijuana law in the state last year.
"We know that it works," she said. "I don't need to spend a whole lot more time and money investigating it."
Whichever bill emerges as the most likely to succeed — one of the two reflecting the work group findings or Glenn's bill — Morhaim said he hopes the issue receives the same open-minded, bipartisan consideration as the legislation that passed last year.
Medicalizing the use of the drug will help everyone, he said, in part by diminishing its appeal as a street drug.
"It loses its glamour when it's grandma's medicine," he said.