December 3rd, 2018

So-Called Medical Cannabis in Maryland

The demand for a return to the medical use of cannabis came from consumers, not from physicians. Now I am hearing increasing impatience among Maryland physicians about the position in which they are caught in regard to “semi-professional” medical cannabis in their state. On the one hand, they serve as the system gatekeepers – no one can purchase cannabis at dispensaries with their recommendation. On the other hand, the product that they recommend does not have the dosing precision that accompanies the prescribed medications on which their expertise is based. Even more problematic is that the non-professionals who staff the dispensaries – in contrast to pharmacists – are not required to provide the product that the physician recommends.

Physicians in this country have been helpless bystanders when it comes to the medical use of cannabis ever since the passage of the Marihuana (sic) Tax Act of 1937. Engineered by Harry Anslinger, the resourceful and determined first director of what eventually became the DEA, the law purported to protect the medical use of what had long been a mainstream medication. Passed over the futile objections of the American Medical Association, the law, in fact, spelled the beginning of the end of medical cannabis by imposing heavy administrative burdens on physicians who chose to use it.

More recently, I myself got a clear message about the irrelevance of medical opinion in administrative decisions about medical cannabis. When the Maryland Legislature was preparing to legalize medical cannabis in the state, they asked for MedChi, the state medical society of Maryland, to comment on the initial regulations. I was the person responsible for responding to this request and was troubled when our recommendation – to limit the conditions for which it could be used to those for which there was some evidence – was completely ignored. The final regulations allowed for an “Other” category for any “chronic medical condition which is severe and for which other treatments have been ineffective.” Disturbingly, in the most recent Commission report on the conditions for which cannabis is being recommended, the second largest category is “Other”. This degree of non-specificity would not be regarded as scientific medicine and is inconsistent with the goal of examining initial data regarding use to enable future improvement.

I, therefore, expect that the current murmurs among physicians will grow louder for getting physicians out of the middle of this social and legal muddle. This would involve eliminating barriers on legitimate cannabis research and the development of more conventional pharmaceutical preparations as well as the legalization of the recreational use of cannabis. If this, in fact, comes to pass, I believe that cannabis will be found to have clear medical benefits although not at the level that matches the current level of consumer enthusiasm and expectation.

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