Medical marijuana: A good concept, a convoluted bill

Our view: Proposed regulations of legalized cannabis need more consideration

February 28, 2011

Maryland's current law on medical marijuana doesn't make a lot of sense. Rather than outlawing it completely or, as several states have now done, creating a controlled system allowing those with certain medical conditions access to the drug, Maryland has taken the approach of keeping marijuana illegal but allowing those caught with small amounts of it to claim medical necessity as a defense. If the judge buys it, the penalty drops to a $100 fine. While this system has the virtue of simplicity — no thorny questions for legislators and regulators about what diseases qualify as medical necessity, no licensing of growers or dispensers — it forces patients to buy drugs illegally and leaves the state with no real idea of how many of them are using the drug and to what effect.

Del. Dan Morhaim, the legislature's only physician, deserves a great deal of credit for trying to untangle this mess. As he has pointed out, even if the medical community remains divided on the benefits of marijuana in mitigating the symptoms of cancer, AIDS, glaucoma, arthritis and other maladies, it doesn't make sense to treat it as if it were more dangerous than any number of powerful drugs — such as narcotics — that patients can already get by prescription. Although medical studies of marijuana's effects aren't sufficient at this point to make a definitive judgment, and marijuana has not been studied by the Food and Drug Administration, anecdotal evidence of its benefits is strong enough to justify more than the laissez-faire stance Maryland has taken so far.

Critics of the legislation point to California, whose 1996 medical marijuana law (based by ballot initiative, not a process of thorough legislative vetting) has led to an explosion of pot shops and physicians who would write prescriptions on the flimsiest of pretenses.

No one wants that, and Dr. Morhaim has gone to great lengths to devise a system that controls every aspect of the process, from grower to dispenser to physician to patient. In fact, he may have gone a bit too far; the bill, while laudable in intent, is extremely complicated and requires the establishment of whole new regulatory regimes that are not well defined.

Here's how the legislation would work: The Department of Health and Mental Hygiene would issue requests for proposals from farmers who want to grow marijuana under the program. The health department would need to estimate how many people might take advantage of the program, how much marijuana they would need, and how much a given farm could produce so that the state would have the least number of growers possible to meet demand. The bill would require the health department to work with the Department of Agriculture to develop regulations for the quality of the marijuana and for the security of the facilities.

The health department would also license dispensaries, establish registries of patients and produce special photo IDs for them. It would have to review information submitted by physicians to determine that the doctors have a bona fide medical relationship with the patients and aren't, as in California, operating pot prescription mills. Patients would have to choose one dispensary as their source for marijuana, and could only get it somewhere else if they changed their registration with the state. The department would also have to set up procedures to revoke marijuana privileges for those whose medical conditions change. It would regulate the price of the marijuana, conduct criminal background checks for people throughout the supply chain and develop a computer system to track the amount of marijuana dispensed to each patient, among other things.

The Department of Legislative Services and the health department are at odds about how much this will cost, with DLS estimating it will cost about $3.7 million when fully phased in, and the health department predicting it will need as much as $15 million right away. But cost shouldn't be an issue; it's hard to imagine anyone has ever found a way to lose money on selling marijuana. The broader point is that the legislation is asking the health department to regulate things it's not only inexperienced with but which it has never really contemplated.

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