More than a dozen people gathered in a room at the Carroll County Agriculture Center on a Saturday in late February, finding their seats in plastic folding chairs after grabbing information packets and fliers from two folding tables. The meeting topic? Marijuana.
But not like that. This was an information session on medical cannabis, as the plant has been called under Maryland medical cannabis regime since the Natalie M. LaPrade Medical Marijuana Commission was re-dubbed the Natalie M. LaPrade Medical Cannabis Commission in 2015. Those in attendance were not there to learn of the dangers of marijuana, but, in many cases, to learn of the plant’s potential to minimize the dangers of legally prescribed opioid pain medications.
“I’ve been on opioids since January 2001. So for 18 years,” said Ken Noto, of Westminster, who has dealt with crippling chronic pain from fibromyalgia. “I take a combination of oxycodone and Oxycontin.”
“His pain levels would be so bad, he was basically bedridden,” Noto’s husband, Dan Goff added. Opioids helped with the pain, but with their own side effects, they didn’t always help Noto get out of bed.
But for the past year, Noto has been a card-carrying medical cannabis patient, experimenting with different products, from flower to tinctures to tablets, that he said have improved his quality of life. And while he hasn’t stopped going to pain management, he’s needed far less.
“What I was taking in 2017 versus what I am taking now, it’s 35 percent less opioids,” Noto said. “I have more energy now.”
What Noto has not had, is a reliable, local source for this alternative to opioid drugs.
Dispensaries in Carroll
Although the Maryland General Assembly first approved medical cannabis in 2013, various delays in implementation and legislative corrections meant the first pre-licenses for growers and dispensaries were not issued until 2016. And while dispensaries have opened in other Maryland counties, and a growing facility, Grassroots Cannabis, has been operating in Taneytown since 2017, no dispensaries have yet opened in Carroll.
“Because there are no dispensaries out here, I have to run to Reisterstown, Columbia, or Baltimore City,” Noto said.
But that will be changing soon, which is why Noto was at the meeting — an information session on cannabis products put on by Herbology, the retail arm of Grassroots Cannabis, which will be managing the CarrollCanna dispensary for owner Diane Davison. Like much of the rollout of medical cannabis in Maryland, her dispensary has also faced numerous unexpected delays, but Davison said she currently expects to open her Westminster location at 700-K Corporate Center Court, by sometime in June.
“Obviously the area has been eagerly anticipating a dispensary,” Davison said. “We are sorry it took this long, but we are full steam ahead at this point.”
And in the interim, medical cannabis card-carrying patients now have another local alternative — home delivery.
“We began home delivery in Carroll County on March 19, and we are beginning to see some activity,” she said. The 1-800-KUSH-CAB service now delivers cannabis products between 11 a.m. and 6:30 p.m. on Tuesdays and Fridays.
Under Maryland law, two dispensary licenses are permitted per state senatorial district, and there was a second pre-license awarded in Carroll to another group, MyBond LLC, owned by Kim Myrick and Ron Bond. But while the pair initially spoke with the Times following their being awarded their pre-license, they have not responded to any further inquiries since late 2017, when Bond confirmed via LinkedIn message that the partnership was looking at a location in the 140 Village Shopping center.
According to Westminster Planning and Zoning Commission documents, however, MyBond received the necessary zoning permissions to open a dispensary in June 2018, at 330 140 Village Road, Westminster.
Pain relief success
Either or both dispensaries finally opening will be a great relief to Noto and others who attended Februaries meeting, such as Becky Strong, of Manchester.
“I have had multiple orthopedic replacements. These hips are not mine, neither are my knees, so I have chronic pain,” Strong said in an interview after the meeting. “I have been on a number of different medicines, ibuprofen; a number of different things.”
Then she thought, why not give medical cannabis a try?
“It has helped a lot. I am off any prescription pain meds. I am still on a small anti-inflammatory and I rarely take any ibuprofen anymore,” Strong said. “It’s helped everything.”
Priscilla Shope, of Taneytown, attended the meeting not because of her own pain issues, but for a family member.
“I came here for my sister. My sister is on opioids and drugs and she is in so much pain, but it puts her into bed and she can’t function,” Shope said. Until recently she was very much against the use of cannabis, she said, and has never used it herself, “but I’ve learned that education is everything. I’ve learned so much about the benefits.”
Of particular concern to Shope is the ongoing opioid addiction epidemic, and she is interested to see how cannabis as a pain management tool might help.
At least one study published in 2018 in the Journal of the American Medical Association found a small decrease — on the order of 6 percent — in the rate opioid medications were prescribed in states that had legalized cannabis for medicinal or recreational use.
And while not as comprehensive as that study, the experience of Dr. John Wah, founder of Maryland Cannabis Physicians, in Westminster, where he recommends cannabis for patients, is similar in Carroll County.
“I would say at least half of the people I see for medical cannabis evaluations are for pain,” Wah said. “By the time people come to see me they’ve already tried the standard pain management routes.”
And many people, like Noto, don’t like being on large doses of opioids for long periods of time, Wah said, while some others do develop addiction or dependency problems beginning with opioid medications. Cannabis, he believes, can be a key factor in addressing these issues by giving chronic pain patients an option other than taking opioids or taking nothing.
“It’s well known that cannabis can help people cut down on their pain medication dosing. It definitely works synergistically,” Wah said. “Whether somebody can come off the pain management and function well, that’s really [based on] the individual, but everyone can get down to a lower dose. That’s a huge benefit.”
Pain management problems
There are some hurdles and problems however, Wah noted. Some patients, for instance, run into professionals that will not treat patients who also use medical cannabis, including some pain management specialists, he said.
Jim Sipes, of Union Bridge, said he began using opioids after a back injury but eventually developed an opioid dependency problem that led to multiple overdoses.
“In November I nearly died from an overdose because I was trying to come off the opioids, went out and got something from the street and it was pure fentanyl,” Sipes said.
He now uses only medical cannabis to treat his pain, but said that when he sought treatment for bipolar disorder and PTSD at Carroll Hospital, he was told he could not participate in the program if he was using cannabis.
“It’s really hard to get mental health care through Medicare and Carroll County called and said, ‘we have an opening, what medicines are you taking?’” Sipes said. “I said, ‘I don’t take anything but this for pain.’ That shut the conversation down on the spot.”
Selena Brewer, Carroll Hospital director of marketing and communications said state and federal laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), prevented the hospital from commenting for this story.
Carroll Hospital is a part of LifeBridge Health, and the organization’s spokeswoman Sharon Boston elaborated on this in an email.
“LifeBridge Health recognizes that while Maryland law permits medical marijuana for registered patients with a qualifying condition, it is still listed as a Federal Schedule I illicit substance. LifeBridge Health has a policy that medical cannabis will not be permitted in any of its participating hospitals,” Boston wrote. “Patients should be open and honest about all medications, supplements and substances that they are using. Medical marijuana may not be compatible with some treatments, and this should be a discussion between an individual patient and their doctor.”
Wah said that in his experience, psychiatry as a profession has been more reluctant to accept patients using medical cannabis than other specialties, but that overall, integration into Maryland’s health system has been fairly smooth.
“If anyone is receiving any anxiety medications, the benzodiazepines, opiates for pain relief and even just psychiatric medications from psychiatrists, sometimes these patients are having to pick one or the other, and it’s very clearly stated to them,” Wah said.
There are other concerns his patients cite however, such as concern about pre-employment drug testing.
Work worries, travel issues
“The biggest concern that people have is employment, and so if I get drug tested, what will happen? If I apply for this new job, what’s going to happen?” Wah said. “The straight answer to that is it’s really dependent on the particular company that the person works for.”
Many companies employ a third party lab to do drug screens for prospective employees, Wah said, and these third parties employ a medical director who helps interpret results. In the case where a candidate tests positive for a controlled substance, such as medical cannabis, he said, the medical director will typically list this as a negative result if the candidate can show they are medically authorized to be using the substance.
“I’ve had a few medical directors reach out to me from pre-employment drug screening places and that’s how I found out about that,” Wah said. “We have around 1,500 patients and no one has been fired or not gotten a job because of their medical cannabis card, that we know of.”
A dicier situation is anyone hoping to take that medical cannabis outside of Maryland, or even onto a federal interstate highway. That’s because under federal law, cannabis is still a schedule I controlled substance, defined as having a high potential for abuse, a lack of accepted safety for its use in medicine and a lack of accepted medical use.
Noto’s husband can use his Maryland caregiver’s card to buy cannabis for Noto in Maryland, “But that’s only for our state. We can ‘t go across state lines. We have family in Pennsylvania and we go up there all the time.”
This is a structural problem that can make things very difficult for people who have weaned off of opioids for chronic pain, Wah said, and then find they need to fly somewhere.
“That’s a big problem, especially for people who travel a lot. It’s just not convenient and that’s a common issue they are going to have to deal with that adds a lot of stress to their life,” he said. “It’s a whole lot easier to go get a bottle of Percocet than to get your medical cannabis card.”
But locally at least, cannabis patients with pain will find things a little more convenient with the coming CarrollCanna dispensary. And Herbology will continue to hold informational meetings through the spring for those who want to learn more, or who are just skeptical.
There are some people after all, Noto acknowledged, who still think medical cannabis is just a smokescreen for recreational use.
“No it isn’t,” he said. “It really helps.”