Legalizing Medical Cannabis in Maryland
The process of legalizing medical cannabis in Maryland was an extended and torturous one compared to that in other states. The law approving it was initially passed by the Maryland Legislature in 2014. Because of disagreements, however, about the licensing of growers, processors, and dispensaries, cannabis did not actually become available until December of 2017. Now that it has actually been in use for 10 months, how are things going? That question was the subject of recent conferences sponsored by the Maryland/DC Chapter of the American Society of Addiction Medicine and the Baltimore County Medical Society.
The medical cannabis program has been popular. The initial demand was so high that it exceeded cannabis supplies. With the resolution of that issue, participation in the program has been growing steadily as can be seen from the statistics available on the Maryland Medical Cannabis Commission website. As of October, over 64,000 patients have registered, and the number has been increasing by about 300 per day. Recommenders – who can be physicians, dentists, nurse practitioners, or podiatrists – now number 1,075.
Not surprisingly for such a new and popular program, suggestions for improvements were voiced at both conferences. Some of the concerns were:
- Dispensary staff. Because cannabis is illegal on a Federal level, physicians can only recommend its use rather than prescribe it. Although physicians usually tell patients the specifics of the type of cannabis that they recommend, such as the ratio between THC and CBD concentrations, the staff at the dispensaries sometimes ignore these recommendations. Physicians are accustomed to a different type of relationship with a pharmacist, who will simply implement the prescription as written or call if questions arise. Having professional medical consultation available at a dispensary is not required and therefore its presence is variable
- Amount of cannabis dispensed. Patients routinely obtain a 30-day supply of cannabis and the default amount is 120 grams of dried plant or 36 grams of cannabis extract. For many people, this is more than is necessary, which is leading to concern about diversion to recreational users. A smaller amount can be specified by the physician, but this requires an additional step. Some physicians are apparently not aware of this problem and therefore do not change the amount from the default.
- Qualifying medical conditions. As expected, pain is the most common condition for which cannabis is being used. The next largest group, however, is “Other.” This unspecified category is allowed by the regulations for any “chronic medical condition which is severe and for which other treatments have been ineffective”. To have so many patients in this category raises unanswered questions about how the cannabis is being used. Furthermore, one of the most identified conditions is PTSD, for which there is no consistent evidence that cannabis is effective.
Medical cannabis is a complex and rapidly evolving issue nationally as well as in Maryland. Check in at this site periodically for further updates.
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