More than three years after the Maryland legislature first approved of medical marijuana, legal doses of the medicinal herb may finally find their way to Maryland patients.
"We're almost there — we expect cannabis to be in the hands of patients by the end of the summer," said Dr. Paul Davies, chairman of the Maryland Medical Cannabis Commission. "We are expecting within the next couple of weeks that we will start doing final inspections on growers."
Those who have followed Maryland's efforts to provide access to legal medical cannabis may take Davies' optimism with a grain of salt — legislation heralding soon to be accessible cannabis was first passed in 2013 and the commission's present inspection process takes place against a backdrop of ongoing litigation concerning the allocation of the limited number of growers permits issued. But there are fairly concrete signs that medical cannabis is truly imminent this time around.
Here in Carroll County, one of those signs is Dr. John Wah, who is already seeing prospective medical cannabis patients, and in some cases writing them recommendations for cannabis use. A Greater Baltimore Medical Center trained internist with a background in both primary and sub-acute rehabilitation care, Wah's Maryland Cannabis Physicians office is on Poole Road, off Md. 97, just outside of Westminster City proper.
By Carroll County Times and The Baltimore Sun staff
Aug 15, 2016 | 9:22 PM
"Right now, on average, I am seeing between six and 10 patients per day," Wah said. "A lot of those people have been waiting since 2013 when the legislation first passed in Maryland, and they have been waiting patiently."
The Maryland Medical Cannabis Commission first opened the state's prospective patient registry on April 10 and so far, more than 2,000 patients have registered, according to Davies. Meanwhile, more than 200 physicians, including Wah, have registered with the commission to recommend cannabis. Only a registered provider can write a letter for recommendation to use medical cannabis — prescription of cannabis is prohibited by a 2005 Supreme Court Decision — and then only to a patient who is registered.
"The registry for providers is going to open up to other specialties, such as nurse practitioners, etc., in the coming months," Davies said. "That will increase the number of providers that are able to recommend cannabis."
In Maryland, Wah said, registered physicians can recommend cannabis for conditions ranging from severe nausea to chronic pain to PTSD and more, all listed on Wah's website. Crucially, physicians may also write a recommendation for "any condition that is severe, for which other medical treatments have been ineffective, and if the symptoms 'reasonably can be expected to be relieved' by the medical use of Cannabis."
"I think that's where some people are a little bit hesitant because they think, "They're using it for anything,'" Wah said. "Well, the interesting thing is it relieves so many different symptoms."
People are used to taking Tylenol or perhaps a prescription opioid for pain, Wah said, and maybe Zoloft for anxiety and depression and perhaps metformin for diabetes. It's not surprising, he said, that a single treatment that can impact so many diverse systems would seem alien to us.
And yet that is exactly what initially drew Wah to investigate cannabis as medicine, he said. In dealing with a patient in primary care who had high blood pressure and diabetes, he became frustrated with people seeking pharmaceutical answers rather than considering lifestyle changes, such as diet alterations and more exercise.
"The culture is they just want a pill, and it's not the patient's fault. And it's not the physician's fault — it is really a societal problem," Wah said. "I just found myself getting very frustrated with the whole idea of, just add another pill. By the time a lot of these people are in their 60s and 70s they are taking somewhere between 10 and 20 medications."
Medical cannabis, in Wah's estimation, provides an opportunity to reduce the number of medications patients are using. As to the apparent irony, he responds that every medication, every medical treatment decision he makes involves a risk benefit analysis, and "out of all the meds I use, if I had to place medical cannabis along the spectrum of risk, it is going to be down at the bottom."
Compared to opioid medications such as Percocet or OxyContin or the benzodiazepines such as Xanax, all of which carry a risk of overdose and addiction, cannabis is just far less risky in Wah's opinion.
"You can even look at over-the-counter medications. People think that ibuprofen is safe," he said. "Well, if you took ibuprofen for a few days it may be safe, but if you took three doses every day for two months, you could end up dying from an ulcer in your stomach."
At the same time, Wah said he wants to be clear that he is not simply handing out doctor's notes for cannabis — in most cases, prospective patients must be previously diagnosed by a physician and bring their medical records to their appointment. Wah also considers his practice that of an internist who also happens to recommend cannabis, and will refer patients out for other treatments where necessary.
"I think the most important thing for the community to understand is medical cannabis is part of the treatment, but that is not all; it's not just that," he said.
But Wah's patient will need to wait at least a little longer before medical cannabis becomes an actual component of any treatment plan. No growers or dispensaries in Carroll County are yet operational, and a recommendation from Wah absolutely does not make black market marijuana legal to use.
At least two medical cannabis dispensaries plan to operate in Carroll County. State regulations limit the number of dispensaries to two per legislative district, and both DLD Enterprises Inc. and MyBond LLC won first stage approval dispensary licenses for District 5, which encompasses all of Carroll, in December.
"We're still negotiating for our lease," said Diane Davison, a Baltimore attorney who is both legal counsel for and a principal with DLD Enterprises. "I don't know of any grower that will have product before mid-to-late fall, so there is no way any dispensary will have product if they do open."
Andrew Cohen, a partner in Grassroots Cannabis, which obtained a grower's license as Maryland Compassionate Care and Wellness, LLC, is still renovating its facility in Taneytown.
"Our facility is under construction and we expect a summer completion," he said. "We hope to have product produced and ready for distribution in the fall."
Prospective patients should be aware then, that a recommendation from Wah, $200 not covered by any insurance plans, or any other physician must be renewed every 12 months.
"It is probably a little early," Davies said."Those recommendations are no good until there is cannabis dispensaries."
In the meantime, whether prospective patients wish to be examined and receive a recommendation from Wah, or simply learn more, the door to Maryland Cannabis Physicians is open. For information, visit www.mdcannabisphysicians.com, call 667-367-2260 or simply stop on by.