With any new medical treatment, the primary consideration for doctors is the evidence — how effective is it, what are the side effects, what are the indications, what is the appropriate dose, and so on. That should go for lawmakers and regulators, too, even when it comes to the emotionally charged issue of medical marijuana. There is a mountain of anecdotal evidence suggesting cannabis is useful in treating pain, nausea and other symptoms of chronic disease, but there is precious little in the way of rigorous scientific study. That's why Maryland lawmakers should opt for a path toward legalizing medical marijuana that puts academic research ahead of wide availability.
A task force designated to study the issue split more or less evenly between a research-oriented approach limited to academic medical centers and one that would immediately have given doctors wide latitude to prescribe the drug. The legislature doesn't have to adopt either of them, but given the passage of a medical marijuana bill in the state Senate last year, it's a good bet that the General Assembly will give serious consideration to one or the other. State Health Secretary Dr. Joshua Sharfstein is backing the go-slow proposal, and the science — or the lack thereof — is on his side.
Medical marijuana has long been caught in a Catch-22 of federal regulations. A drug can't be approved for use without evidence of its effectiveness and risks, but marijuana's status as a Schedule I controlled substance meant it could not be studied. That's absurd; much more dangerous drugs, including cocaine and opiates, are recognized for medical use, and doctors can consult a wealth of evidence about when they are appropriate.
But the best the medical establishment can say about marijuana — despite widespread therapeutic use in more than a dozen states — is that it appears to hold promise for some conditions. How much promise, and under what circumstances, is not conclusively known, not in the way we would expect of any other drug put on the market. We do not know what patients would be good candidates for therapeutic use of marijuana, what strains of the plant make for the most effective treatments, what doses are necessary, or whether, in some cases, the risks — paranoia, for example — outweigh the benefits.
Dr. Sharfstein's proposal more or less mirrors the advice of the Institutes of Medicine. He is advocating for academic medical centers (institutions like Johns Hopkins Hospital or the University of Maryland) to apply to the state for permission to try out treatment protocols on particular classes of patients — say, those in hospice or suffering from muscle spasms. The institutions would report their findings, and the state would gradually amass a body of knowledge about what works and what doesn't. At that point, it would be appropriate for the state to consider expanding the availability of medical marijuana and giving more doctors latitude in prescribing it, but not before.
Advocates, including a pair of state senators who have been treated for cancer and are strong backers of medical marijuana, are unlikely to be happy with this approach. Sen. David Brinkley, a Frederick County Republican who previously sponsored legislation much like the more liberal of the task force's two proposals, said his concern is to ensure that patients who are using the drug or could benefit from it can access it safely and legally. State law now allows those arrested on marijuana possession charges to be found not guilty by reason of medical necessity under certain circumstances. But they are still forced to procure the drug on the black market.
It's true that the status quo is flawed, but jumping to the conclusion that Maryland should allow wide availability puts the cart before the horse.
Moreover, a research approach doesn't necessarily mean that the number of patients who have access to medical marijuana would be unduly limited. More than one study could and likely would be conducted at a time, and patients wouldn't necessarily have to travel to the urban centers where the state's research hospitals are located to take part. But even if they did, that would make marijuana no different from any other experimental treatment.
Legalizing medical marijuana would be complicated no matter what approach Maryland takes. The state would have to figure out a way to regulate the growing of marijuana and to ensure its security from farm to user, as well as to make sure patients are legitimately using the drug to treat themselves and not selling it or giving it to others — a problem with all controlled substances. And the fact that marijuana remains illegal under federal law presents additional complications for all those who would be involved under either scenario. But those difficulties would unquestionably be greater under a more expansive program. Better to start small, gather evidence and leave open the possibility for more widespread use if and when medical marijuana is proven effective.