Pubdate: Sun, 31 Jan 2010
Source: Baltimore Sun (MD)
Copyright: 2010 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Authors: Kelly Brewington and Meredith Cohn
Bookmark: http://www.mapinc.org/find?253 (Cannabis - Medicinal - U.S.)

PUTTING FENCES AROUND MEDICAL MARIJUANA USE

The Bill to Be Introduced, Making Maryland 15th State to Allow It, 
Might Be the Most Stringent in the Nation

Even as a proposal to legalize medical marijuana emerges in Maryland, 
a backlash over the burgeoning industry has developed in other states 
- - and is likely to influence legislation here.

Last week, the Los Angeles City Council tried to rein in the growth 
of marijuana dispensaries, limiting the number to 70 and imposing 
tight restrictions on where and how they can operate. And in 
Colorado, towns are trying to shutter some of the hundreds of 
dispensaries that have popped up.

But supporters of the Maryland proposal say they have learned from 
problems in states that approved use of the drug without uniform 
regulations on the dispensaries providing it. The result, they say: 
Maryland's measure could be among the most stringent in the nation.

"I looked at a compendium of legislation from all the other states 
and I knew from being in California that we absolutely didn't want to 
do that," said Del. Dan Morhaim, a Baltimore County Democrat and a 
physician who plans to sponsor a bill that would make Maryland the 
15th state to allow the medical use of marijuana. "From the 
physician-patient point of view, I wanted a bill that I would be 
supportive of as a doctor."

Advocates and some medical experts say a growing body of research 
shows the drug can be an effective tool to help patients struggling 
with some diseases. The Maryland proposal would allow marijuana to be 
given to patients with a "debilitating medical condition," such as 
seizures, severe chronic pain or severe nausea as a result of cancer treatment.

But not all physicians agree it's a good idea.

Dr. Kevin Cullen, an oncologist and director of the University of 
Maryland Marlene and Stewart Greenebaum Cancer Center, isn't sure the 
state needs a new law. He said he'd probably never recommend medical 
marijuana to cancer patients because other drugs are more effective.

"It's important that the lawmakers speak to the medical community 
directly and assess the need for this," he said. "It may be that 
they're having a 'me, too' reaction to other states. I have no idea 
who the lobby may be for this."

Unlike laws in some other states, the proposal Morhaim discussed last 
week would license growers and dispensaries, would allow doctors to 
recommend marijuana only to patients with whom they have a 
long-standing relationship and would control who could provide the 
drug to homebound patients. People would not be able to grow their 
own marijuana and would be limited in the amount they could buy each 
month as well as the ailments they could use it for.

(Sen. David Brinkley, a Republican from Frederick, is the measure's 
sponsor in the Senate.)

Morhaim, a longtime medical-marijuana supporter, said this 
legislative session is the right time to pursue the change.

Last fall, the American Medical Association urged the federal 
government to downgrade its classification of marijuana from a 
dangerous drug with no medical use, clearing the way for more 
clinical research of the drug and development of cannabis-based medicines.

At the same time, access to medical marijuana has been growing 
nationwide since the Obama administration loosened federal 
enforcement of the drug last fall, saying it would not prosecute 
users in states with medical marijuana laws. With other states 
legalizing medical marijuana, Maryland had an opportunity to study 
their successes and missteps.

In crafting the measure in the House of Delegates, Morhaim, who is 
originally from Los Angeles, looked at that city's experience with 
medical marijuana as an example of what not to do.

Because California's 1996 law legalizing medical marijuana did not 
regulate dispensaries or set up a means for distributing the drug, 
localities had to come up with rules on their own. While cities such 
as Oakland mandated regulation of dispensaries, including 
restrictions on where and how they can operate, Los Angeles left the 
question open; storefront dispensaries with on-site doctors 
flourished across the city.

"I don't want doctors who will just write an open-ended marijuana 
prescription to a patient they just met," he said. "I am quite aware 
of the L.A. problem; it's clearly out of control."

Similarly in Colorado, which has had a medical marijuana law since 
2000, towns have begun trying to close dispensaries. Until last year, 
there were only about a dozen dispensaries statewide. Since then, 
hundreds have opened, serving about 40,000 patients.

But the state didn't address dispensaries in the law, creating a lack 
of uniformity in how they operate, said Brian Vicente, co-chair of 
Colorado's Sensible Patient and Provider Coalition. The coalition 
includes medical marijuana advocacy groups, business owners, 
caregivers and patients who are seeking some new regulation of 
medical marijuana.

The Colorado law said only that sick patients with a doctor's 
permission could possess and cultivate marijuana - or appoint a 
caregiver to do it for them if they were too sick or didn't have the 
expertise. One caregiver could handle many patients - the patients 
would merely have to designate the person as their caregiver. Some 
caregivers began opening stores, a boon to those who can't or don't 
want to grow their own marijuana and don't want to buy it "on the 
street or in an alley," he said.

The Maryland proposal hopes to avoid that situation by allowing 
caregivers to serve only one patient, Morhaim said.

Vicente said most dispensary owners are paying taxes and working to 
help sick people, but the coalition fears "a select handful are 
probably breaking some laws."

In the meantime, he said, towns have reacted differently. Denver 
"embraced them," and has written regulations for the dispensaries. 
But Centennial, Colo., tried to close its dispensary and the owners sued.

Maryland, he said, has an opportunity to set a statewide, even 
national, standard for how to deal with the medical-marijuana issue 
by establishing a system of uniform taxation and regulation of 
dispensaries - no squabbling over rules.

But Vicente also warns the lawmakers not to make the rules too 
restrictive. The state should let patients grow marijuana, because 
it's cheaper than prescription medication, he said, and many patients 
can't afford traditional health care. Also, requiring a 
recommendation from a long-time doctor would be a problem for 
patients whose physicians fear federal prosecution or just won't 
write a referral.

Maryland lawmakers suggest having growers be licensed by the 
Department of Health and Mental Hygiene and the Department of 
Agriculture, which would charge a licensing fee. Growers would have 
to submit to regular testing and monitoring.

"If you're going to have people use this, you have to make sure it's 
a safe and secure unadulterated supply. Grow-your-own approach opens 
the door to all kinds of misuses," Morhaim said.

Meanwhile, doctors disagree over whether marijuana is even helpful 
for their patients, and whether they would prescribe it.

Cullen, the UM cancer specialist, said marijuana is a carcinogen, and 
when you're treating people with cancer you don't want to expose them 
to more carcinogens. He also said marijuana is used as an anti-nausea 
medicine, but newer medicines developed in the past 10 years are 
better. And, finally, the active ingredient in marijuana has been 
made available as a pill, called Marinol, for those with chemotherapy 
induced nausea.

"It's rarely used because it doesn't work as well as newer 
medications," he said. "And most patients don't like the feeling they 
get from Marinol on top of chemotherapy."

Cullen said he's "fairly agnostic" on medical marijuana for other 
purposes, but for cancer it's not a useful drug.

Dr. Steven P. Cohen, a pain specialist and an associate professor of 
anesthesiology at the Johns Hopkins School of Medicine, said he would 
recommend marijuana to patients, but only after other therapies had 
failed. He'd make sure patients were responsible, compliant and 
informed about the risks of the drug and would agree to routine monitoring.

Marijuana, and the class of marijuana-like drugs called cannabinoids, 
can be effective treatment for people with central nervous system 
pain, such as those with multiple sclerosis and stroke, said Cohen. 
"For these patients, it would be great; these things are notoriously 
hard to treat."

But there's no research on the long-term effects of the drug and few 
can justify using it as a first-line treatment, he said.

"Some studies have shown efficacy in the short-term, like six weeks 
or two months, but what happens after a year?" he said. "Especially 
if you smoke, you have questions about motivation, memory problems, 
there may be risks for cancer, bronchitis, lung disease and emphysema."

Still, because treating pain is so complicated and few drugs offer 
long-term relief, Cohen doesn't see a problem with adding marijuana 
as another tool to help patients.

"People die from opioids, I see it all the time," he said. "They are 
probably inherently more dangerous than cannabinoids and they are 
used all the time for chronic pain. So why wouldn't you use cannabinoids?"
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MAP posted-by: Richard Lake