Pubdate: Thu, 06 Sep 2018 Source: Baltimore Sun (MD) Copyright: 2018 The Baltimore Sun Company Contact: http://www.baltimoresun.com/ Details: http://www.mapinc.org/media/37 Author: Sarah Meehan MARYLAND'S MEDICAL CANNABIS PROGRAM TECHNICALLY BANS FOOD PRODUCTS -- YET SELLS PLENTY OF EDIBLE ITEMS Maryland has banned food from its medical cannabis program but it still provides ways for patients to ingest the drug. Dave hadn't slept for more than three hours straight after a series of botched surgeries 18 years ago left him with chronic pain so intense it kept him awake at night. Relief was hard to come by -- until he made a tray of marijuana-infused brownies. Half of a small fudgy square was enough to put him to sleep for 14 hours. "It was the first thing I found that worked for the nerve pain," he said. Medical marijuana has since become part of the 62-year-old's pain-management regimen, and he's one of thousands of patients in Maryland who are ingesting cannabis extracts to treat their conditions. For a state that has banned food from its medical cannabis program, Maryland provides plenty of ways for patients to ingest the drug. Patients won't find pot brownies on local dispensary shelves, but a gray area in the law allows the shops to sell tinctures, tablets, powders and drinks alongside machines customers can use to make cannabis-infused oils. While state regulators worry the sale of cannabis-infused sweets would cross into recreational practice, they say they are working to better define which edibles are appropriate for the state's medical market as demand for such products flourishes. It's easy to see why some patients prefer ingesting marijuana extracts to smoking it. It's a discreet alternative that provides patients a more precise method of dosing. The drug's effects take more time to activate when it's ingested, but they also last longer. Maryland is one of 30 states, plus Washington, D.C., that have a regulated medical marijuana market. Nine of those states also allow the recreational use of marijuana. Some states, such as Ohio, permit cannabis-infused foods as part of their medical marijuana programs. Others, like Arizona, do not allow the sale of any edible forms of the drug. When medical marijuana first hit Maryland's market in December, the only infused products available were vape pens. Product lines have since expanded, coinciding with an increase in the number of patients, growth in the number of operating dispensaries and a boost in medical cannabis sales. Maryland dispensaries sold 15,317 infused products -- items other than dried marijuana including edibles, vape cartridges and patches -- in December. By July, that figure increased five-fold to 77,216 products sold in the month. Monthly dispensary sales topped $9.6 million in July, up from $1.8 million in December, according to data from the Maryland Medical Cannabis Commission. Dried marijuana still dominates sales, but dispensary owners and managers say patients can't get enough of ingestible products. For a first-time visitor walking into Pure Life Wellness, the range of products at the Federal Hill dispensary is surprising. Edible items, vape cartridges and weed journals line the shop's shelves. The faint scent of marijuana hangs in the shop, and dried leaves sit in jars under glass. Jackie Doloway, owner of Pure Life Wellness, showcases a variety of tablets made by Dixie, a national brand of infused cannabis products, that she says are a favorite among customers. Some of the tablets calm anxiety; others have energizing effects. Medical marijuana is now available in Maryland, more than four years after the General Assembly passed a law legalizing it. Standing up the industry -- with growers, processors, dispensaries and doctors -- took longer than expected. The law needed to be tweaked, rules needed to be written and legal... "They're great just for anyone who's battling aE& insomnia or anxiety throughout the day," Doloway said. Lori Dodson, deputy director for the Maryland Medical Cannabis Commission, said the commission wants to make more of those products available to give patients options for medicating. Food is excluded from the local market because the commission does not want to conflate the medical intent of the state's marijuana program with the drug's recreational allure. Butt the state is looking to revise language in the law to better define what cannabis products are considered food, Dodson said. Neither Dodson nor dispensary owners could point to the line between prohibited foods and legal edible products. Does a chewable tablet qualify as food? Is an elixir a drink? "A lot of it has to do with marketing and education, really treating these products as medicine," said Matt Kirby, a partner in Remedy, a Columbia dispensary. Kirby said patients often ask about the edibles available at Remedy, and he knows a number of patients who make their own edibles using dried flowers to infuse oils. The Livo machine is a popular appliance sold at Remedy and other dispensaries that infuses fats with cannabis extracts. After the Maryland medical cannabis industry launched in late 2017, business grew quickly. Baltimore County has nine dispensaries, two of which are Curio Wellness and AmediCanna Dispensary. "It's like a Mr. Coffee for cannabis oil," Kirby said. Customers can use the oils to make anything from salad dressing to granola -- foods dispensaries don't currently supply. "Long gone are the days of, like, your stinky brownies," Doloway said. For Dave, cannabis is one of the few pain relievers he's found that has lasting effects -- particularly when eaten. At his request, The Baltimore Sun is using his first name only to protect his privacy. "I started researching this because I couldn't find any pain relief anywhere else," the Baltimore resident said. Nearly two decades ago -- before medical marijuana was available in Maryland -- a friend sent him cannabis oil from California, and he began eating it in pea-sized drops. Patients who wind up in emergency rooms because of drug use have far more types of drugs in their systems than the standard screening test used by hospitals is catching, a new study has found. While the drug epidemic has focused on opioid use, two-thirds of patients who ended up at two University... Some users can go wrong by ingesting too much medical marijuana before they feel its effects. But the edible products at local dispensaries come with specific dosing instructions. Dispensary employees also advise patients to "start low and go slow." "Cannabis is not a one-size-fits-all medicine. It's not, 'Take two Tylenol and like call me tomorrow,'" Doloway said. "Everybody's body is different. Everybody's tolerance is different. It could take a couple different tries and a couple different things to find what works for you." James Hendricks, manager of Maggie's, a Hampden dispensary, said edibles allow patients to dose more precisely than smoking or vaping -- down to tenths of milligrams. "We also have a lot of elderly folks who are used to taking pills and tablets, so this is almost exactly what they want," Hendricks said. "They want to come in and say, 'Give me something to take in the morning, and then in the afternoon and be done.' They're not interested in developing necessarily a lifestyle of ... buying a lot of pipes and bongs." More medical marijuana patients continue to register in Maryland. By Aug. 9, Maryland had 36,836 patients certified to receive medical marijuana, with 15,956 patients pending approval by the commission. An email from a medical marijuana dispensary owner alerting patients to a state investigation into whether a Maryland cannabis grower used pesticides and warning them of possible harmful side effects has spurred concern throughout the young industry. Patients like Dave crave more edibles. But they are not cheap. For instance, at Pure Life Wellness, Dixie's packs of 20 tablets go for $20-$40; elixir bottles range from $28-$50 each; and tinctures cost $40-$90. Medical marijuana is not covered by insurance. "I don't think it's going to be for everybody. I don't know if it's going to be for me in total -- certainly not at current prices," Dave said. "Right now if I was to stop taking any of my $10 a month prescriptions, I would have to spend $500 to $600 a month at the dispensary." Hendricks, who previously worked in Colorado's weed industry, said products in Maryland are more expensive and less potent than in other states. "Part of it probably has to do with: This is a brand new industry here, and you want to be more on the conservative end," Hendricks said. He said many patients at Maggie's have been surprised to learn that Maryland doesn't allow more edibles. But it's unlikely other infused edibles will be sold at dispensaries without a legislative change. Food sold at dispensaries would also have to be cross-regulated by the Maryland Office of Food Safety. Cookies and candy infused with cannabis extracts begin to clearly cross a line into the recreational market, Dodson said. "While those are sometimes more appealing to patients, we also have to be very careful because now you're appealing to a younger population," Dodson said. "We have to be careful that we're not getting product into the wrong hands." Some believe it's just a matter of time before we see pot for sale for personal use. With that as a backdrop, how do parents start the conversation?