Maryland Becomes 19th State to Legalize Medical Marijuana
When the Maryland General Assembly passed HB 1101 in its 2013 legislative session, it made history by paving the way for the state’s first hospital-based medical marijuana program. Physicians have been an important impetus to bring this bill to fruition, as it was introduced by Del. Dan Morhaim, M.D., the only physician in the General Assembly, and was based on a proposal from the secretary of the Department of Health and Mental Hygiene (DHMH) Joshua Sharfstein, M.D.
Governor Martin O’Malley’s administration had previously opposed medical marijuana legislation out of concerns that it could violate federal laws that prosecute state employees involved in distributing medical marijuana. However, the experience of other states with similar programs has eased those concerns, and the administration this year withdrew its opposition.
Medical cannabis, or marijuana, has few clinical studies documenting its effectiveness in symptom control for cancer and other diseases, including chronic pain. However, many clinicians believe it can be useful for preventing nausea and vomiting, stimulating appetite, improving sleep and reducing pain.
The legislation created an independent commission within the Department of Health and Mental Hygiene that is charged with developing a request for proposals from academic medical centers to establish medical marijuana programs for select patient groups, approving applications and monitoring and overseeing the programs that are established.
Gov. Martin O’Malley appointed the 11 members of the new commission this September. Its chair is Paul W. Davies, M.D., a pain management specialist who is the founder and CEO of KURE Pain Management. Board-certified in interventional pain management, and fellowship-trained in pain management, Dr. Davies has over 10 years’ experience treating patients in pain.
The other commission members are:
· Michael A. Horberg, M.D., MAS, FACP, FIDSA, executive director of Research and Community Benefit for the Mid-Atlantic Permanente Medical Group and director of the Mid-Atlantic Permanente Research Institute
· Robert A. Lavin, M.D., attending physician on faculty at the University of Maryland, School of Medicine, and the Kernan Hospital of Baltimore. He is also director of the Chronic Pain Management Program at the Baltimore Veterans
· Shawn McNamara, Ed.D., M.S.N., R.N., assistant dean of the School of Health Professions, and Nursing Program administrator for the Community College of Baltimore County
· Kevin W. Chen, Ph.D., MPH, associate professor in the Center for Integrative Medicine and Department of Psychiatry at the University of Maryland, School of Medicine
· Dario Broccolino, J.D., State’s Attorney for Howard County since 2008
· William C. Charles, Pharm.D., a clinical pharmacist specializing in discharge and readmission reduction at MedStar Franklin Square Medical Center
· Deborah R. Miran, president and founder of Miran Consulting, Inc., who advised both brand and generic drug makers on the FDA approval process
· Colonel Harry Robshaw, III, chief of police, Cheverly Police Department
· Nancy Rosen-Cohen, Ph.D., executive management professional experienced in healthcare reform and corporate development
· Eric E. Sterling, J.D. attorney with over 32 years of experience in medical marijuana issues
Dr. Davies comments, “The commission is charged with developing policies, rules and regulations to implement the legislation. We hope to accept applications starting in 2014 for academic medical programs involved in investigating uses of medical marijuana. Such curriculum have residency programs and be involved in human research.”
Each program applicant must describe what medical conditions will be treated, treatment duration, proper dosage, where marijuana will be obtained, sources of funding, measurement methods for data and outcomes. They will have to provide DHMH with daily data on participating patients and caregivers that will be shared with appropriate law enforcement agencies.
Some of the many issues the new commission must grapple with include where the marijuana seeds will be obtained, who will grow the plants, what the security criteria will be and who is allowed to dispense it. To oversee implementation of the program, the commission seeks to appoint a full-time administrator. Due to the complexities of implementation, medical marijuana is not expected to become available in Maryland until at least 2015.
Chronic Pain Patients Will Benefit
“I’m optimistic that this legislation will benefit many patients with chronic pain,” Dr. Davies notes. “We’ll have to establish which disorders will benefit from medical marijuana, but patients are likely to include those with cancer, HIV/AIDS, chronic pain and neurological disorders. The committee will define specific diagnoses, which is very important, because we should make sure that Maryland patients have access to useful interventions. Our state is unique because we are studying outcomes data to make sure that we see symptom improvement and potential benefits, without significant side effects.”
Dr. Davies adds, “We’ll be closely watching developments in Washington, D.C., the closest area to approve medical marijuana. Surprisingly, after three months of operation, they have only enrolled 30 patients, where they expected a stampede. Physicians should closely follow the progress of implementing this program and support it because it may be a new tool to help fight pain.”
Physicians and Public Invited to Commission Meetings
The commission held its first meeting on September 24, 2013. In 2014, it will generally meet on the third Tuesday of each month. All meetings are open to the public, and physicians are encouraged to attend. Over the course of the meetings, the commission will be taking testimony from the public, physicians and experts. For more information, physicians should visit http://dhmh.maryland.gov/SitePages/Medical%20Marijuana%20Commission.aspx.