Beginning in 1998, Baltimore County resident Jim Dunnigan sang for years with a choral group of about 30 men. But four years ago, he would tremble so badly that he stopped performing publicly.
“Without anything, I shake so bad that I can’t even feed myself,” Dunnigan, 84, said. “You just could not live with this.”
He went to a neurologist who put him on three medications, which made him feel like a zombie. He discovered drinking beer would free him of the tremors at least for a couple hours. And then, his family physician, Dr. Vincent Wroblewski, recommended medical cannabis.
“After trying this thing, I realized that there was no buzz associated with this,” Dunnigan said. “It’s not like I drank two Bloody Marys and I know I got a buzz on it; there was no buzz.”
He first tried swallowing cannabis pills, and then using dried cannabis flowers. The shaking calmed.
“What it’s enabled me to do is to go back to singing,” said Dunnigan, who started performing publicly again six months ago.
After the sale of medical cannabis products got underway in Maryland in late 2017, the business experienced quick growth, aiming to help people like Dunnigan reclaim their lives from a slew of ailments, including chronic pain and seizures to post-traumatic stress disorder.
“[Sales] probably exceed what we expected at first,” said Brian Sanderoff, the general manager and clinical director of the Curio Wellness dispensary in Timonium. “One of the factors that can affect that is the number of dispensaries that are opening and the number of patients that are getting certified.”
In Maryland, there are 65 dispensaries that have received their final licenses to operate, with 13 in Baltimore County and eight in Baltimore City, said Jennifer White, communications director for the Natalie M. LaPrade Maryland Medical Cannabis Commission, the group that oversees the state’s medical cannabis program. Some 37 dispensaries in the state have yet to complete the approval process to receive their final licenses and become operational, she added. Between May 22 and July 30, the number of certified patients eligible for medical marijuana in Maryland grew from 27,585 to 35,836, according to commission data.
“We’re very busy every day,” said Bryan Hill, the owner of Charm City Medicus, a Baltimore dispensary.
Dispensaries provide a wide range of products to certified patients who have received a medical recommendation, which is permission from a registered provider to purchase medical cannabis. At Curio Wellness, the dispensary sells a variety of cannabis products in the form of elixirs, tablets, balms, tinctures and flowers, which can be smoked, among other products to administer the cannabis, such as crystal pipes.
Or, patients can use their choice of cannabis to make their own product to meets their needs. Justin Ashendorf, 37, a Curio Wellness dispensary patient care adviser, likes to make his own edibles in coconut oil form, dosing out his cannabis into candy molds that he hardens in his refrigerator.
“I can either eat it or, if I don’t like the taste, I can put it in coffee and stir it and drink it,” he said. “It bonds very well with cannabis.”
Each cannabis form has varying time frames for the onset of its effect; patients desiring a quick onset may choose a flower or vape form, both of which see effects in one to five minutes and last one to four hours. Other forms, such as tablets, can have later onsets, occurring up to three hours after use.
One of the main issues Ashendorf, of Towson, takes medical cannabis for is chronic pain, which is the top ailment plaguing Howard County and Maryland medical cannabis users. He was born with several birth defects due to amniotic band syndrome, which is when amniotic fluid hardens around the fingers and toes in utero, preventing their growth.
“When I hit puberty, I started experiencing intense pain,” Ashendorf said. “It basically feels like the bones are trying to come out of the tips of my fingers.
“I started experimenting with cannabis when I was around 15, and I did notice that it really helped with the pain. I had tried previous pharmaceutical medications, but I am not a fan of any of the side effects.”
Like every other patient who receives medical cannabis in the state of Maryland, he got a recommendation for cannabis from a registered provider, who must have an active, unrestricted medical license, authorization to prescribe controlled substances, be in good standing with the Maryland State Board of Physicians and be registered with the Maryland Medical Cannabis Commission.
A registered provider can give a recommendation for what to purchase in a dispensary, but it is up to the patients what they choose to buy, White said. However, there is a cap on the amount of cannabis that a patient can purchase in a 30-day period, a limit that can go as high as 120 grams of flower or 36 grams of THC, or tetrahydrocannabinol, a mind-altering compound.
To ensure dispensaries’ security, several measures are taken at each location, including constantly monitoring alarm systems, keeping cannabis products under lock and key at night, and closely checking noncertified visitors. Some dispensaries have taken it a step further, adding armed security guards on-site before and after closing, like at the AmediCanna Dispensary in Halethorpe.
Wroblewski, Dunnigan’s physician, is one of 985 registered providers in Maryland who recommend medical cannabis for patients who typically reach out for assistance. He’s been a family physician in Lutherville for the past two decades and began recommending medical cannabis in January for ailments such as PTSD, migraines and Parkinson’s disease. He gets about six new patients per week who hear about his recommendations from word of mouth or online.
“It’s an ancient medicine that’s been around as long as time has been recorded,” said Wroblewski, who graduated from Johns Hopkins University’s School of Medicine and has been a physician for the past 30 years. “I’ve seen the limitations of our current medical model, which frankly is a pharmaceutical, disease-based model, and I’ve seen its limitations.”
He emphasized the educational component of his care, both for his patients and his own development; he took a Florida state certification course, read information from the American Society of Cannabis Physicians and took a 20-hour course in Baltimore to inform his understanding of medical cannabis. He teaches his patients how not to become dependent on cannabis and to take herbal holidays when they don’t use cannabis, typically one day a week.
“I haven’t seen a whole lot of training in the state,” he said, noting it could be because cannabis is federally illegal.
There is no required additional education to recommend medical cannabis in the state of Maryland, confirmed Gene Ransom, the state medical society’s chief executive officer, adding that MedChi has a medical cannabis task force working on guidelines and policies for medical providers who wish to recommend the drug’s use.
“MedChi has traditionally taken no position really on medical cannabis, one way or the other,” Ransom said. “Once the law passed, we were very involved to make sure that it was done in a way that would protect patients and physicians, and make sure it was done in an appropriate way.”
Ransom said he has physicians that range “the whole gambit” — from those that hate the use of medical cannabis, to others that feel it’s a valuable tool.
As the drug’s status continues to be illegal at the federal level, many patients have reported community acceptance of their cannabis use, while others note a stigma surrounding the plant that still follows them.
A 65-year-old Towson man who declined to be named due to that stigma said that within 24 hours of administering the plant, his spasms ceased. His body adapted to his intake by now, so some spasms have returned, but six months into his usage, they’ve been reduced by at least 50 percent. He also had taken fentanyl for about three years for fibromyalgia and rheumatoid arthritis, and by March, he was completely off opioids.
“I see a great impact there [from cannabis]. Plenty more energy, don’t feel that sedated drug feeling that the opioids have,” he said. “You really don’t realize how clean you are until about 60 days later. You wake up one day and go, ‘Boy, I feel good.’ It’s had that kind of effect, so there’s no desire at all to go back on fentanyl or any other opioid.”
For some patients, continuing use of medical cannabis can rack up a hefty price tag. The drug isn’t covered under insurance in the state, because it is not FDA-approved and deemed medically necessary by Maryland, said Tracy Imm, the public affairs director of the Maryland Insurance Administration.
Ashendorf said costs can range from $150 to $1,500 per month. He declined to share what he personally spends, but noted it is “definitely financially challenging.”
Another challenge has been posed by Metrc, a statewide inventory control system that is used to ensure patients are certified, to process sales and to track patient allotment, or as Sanderoff, the general manager Curio Wellness dispensary in Timonium, said, it’s a “real-time adjudication of people getting their medicine.” Under it, purchases are recorded immediately and deducted from a patient’s allotment of up to 120 grams of cannabis for a 30-day period. When the system isn’t working properly, sales can stall.
“It happens enough for us to certainly notice when it’s a problem, and especially when someone is counting on getting their medicine and they’re unable to do so because the system is down,” Sanderoff said.
He added the dispensary has handed coupons to inconvenienced customers who have to come back, but that the issues “will get worked out easy enough.”
“It’s just frustrating sometimes; it’s part of a new industry,” Sanderoff said.