With the state publishing draft regulations for medical marijuana and an infrastructure for growing and distributing it coming into view, Marylanders who suffer from chronic pain or debilitating disease could gain access to the drug by the middle of next year.
The rules developed by the Maryland Medical Cannabis Commission, which cover doctor registration, licensing, fees and other concerns, were published last week. The state is accepting public comment on the rules through July 27.
"This is a big step in the right direction," said Del. Dan K. Morhaim, a physician who championed the legalization of medical marijuana in the General Assembly. "This should make the program operational, though there should be adjustments every year or so for the next few years as we learn from our experience."
States have approved the use of marijuana for conditions as disparate as nausea from chemotherapy, post-traumatic stress disorder, multiple sclerosis and anorexia.
The draft regulations apply to smokable and liquid forms of cannabis, but not edible forms, which won't be allowed in Maryland.
The rules set fees for two-year licenses at $125,000 for growers and $40,000 for dispensaries. Those fees, second only to those of Illinois, are intended to make the program self-sufficient as required by law.
Hannah Byron, executive director of the Maryland Medical Cannabis Commission, said she does not expect much change to the rules during the 30-day comment period. That means by the end of September, the commission could begin accepting applications for 15 licenses to grow marijuana, an unlimited number of licenses for processors and licenses for two dispensaries per senatorial district.
They would be given preliminary approval and up to a year to develop an acceptable operation. They would need to acquire real estate, gain local zoning approvals, build a facility, install equipment, and hire and train staff.
Some operations might combine growing, processing and distributing.
Any doctor in good standing would be able to refer patients, but Morhaim expected the most interest from those who treat pain, cancer and other devastating diseases.
As with any other drug, doctors would follow the latest research to ensure that marijuana is appropriate for each patient. Doctors would be able to certify patients to get the drug from a dispensary.
Byron said she has heard interest from companies, doctors and patients across the state.
A group that specializes in cultivating marijuana for medical use wants to set up a growing facility that would employ up to 100 people in Easton.
CBD Wellness Group made a presentation to the Easton Town Council this month. The group plans to apply for one of the 15 growing licenses.
Maryland, unlike most states, will require doctors to register to write referrals. The state plans to offer an online course for doctors but dropped a proposal to make training mandatory at the behest of the General Assembly.
That is one reason that Kevin Sabet opposes medical marijuana programs.
Sabet, a former adviser to the Clinton and Bush administrations, runs the Drug Policy Institute at the University of Florida and co-founded the advocacy group Smart Approaches to Marijuana.
He says doctors need training because marijuana is complex and the research insufficient.
In a review of studies published in the Journal of the American Medical Association in June, researchers found mixed benefits from medical marijuana.
Analyzing 79 clinical trials with more than 6,000 participants, they found "moderate quality" evidence of benefits in treating chronic pain and the effects of multiple sclerosis but said there was not good evidence that the drug was effective against nausea and vomiting from chemotherapy, weight gain from HIV infection, sleep disorders or Tourette syndrome.
"This drug is different from other drugs," said Dr. Deepak Cyril D'Souza, a professor of psychiatry at Yale who studies cannabis. "It consists of almost 400 compounds, not one or two like other drugs we prescribe."
He said marijuana strains vary in potency, and could pose troublesome interactions and side effects.
Marijuana has not been approved by the U.S. Food and Drug Administration. There are no dosing guidelines, D'Souza said, and research on the therapeutic effects is "really mixed."
D'Souza sits on a panel in Connecticut that considers which conditions may be treated with medical cannabis there. He said the experience has made him "a naysayer despite my belief in the drug's promise."
Morhaim, a Baltimore County Democrat, said, "This is about patient care. Thousands of Marylanders are suffering needlessly. These are our friends, family and neighbors. This is about getting relief for them."
Sabet said members of the medical community should not give up on marijuana as a therapy for a broad range of conditions. But he said more study is needed.
"We know that there are likely elements of marijuana that have medical promise," he said. "That is what we're trying to do research on."
The Associated Press contributed to this article.