Pubdate: Sat, 26 Jul 2014
Source: Baltimore Sun (MD)
Copyright: 2014 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Michael Dresser
Page: 1

MEDICAL POT RULES RAISE CONCERN

Advocates Worry Proposed Regulations Will Discourage Doctors From 
Participating

Proposed rules for Maryland's nascent medical marijuana system are
drawing objections from a leading advocate, who says the regulations
could discourage doctors from participating.

Del. Dan K. Morhaim, one of the chief sponsors of the legislation,
criticized the draft regulations for requiring training and continued
education in the medical use of marijuana for physicians who want to
help their patients access the drug.

"Please don't create any barriers for physicians," Morhaim, a
Baltimore County Democrat and the General Assembly's only physician,
told the state's Medical Marijuana Commission at a hearing this week.

Morhaim warned that requiring continuing medical education could deter
doctors because, he said, courses on marijuana are not readily
available. He also questioned the need for doctors to take periodic
courses on marijuana when they don't have to do so for more dangerous
drugs they prescribe.

"Physicians are professionals and can and do make determinations of
what they need to know before giving medicines to patients," Morhaim
said.

Morhaim and others are also raising concerns that the proposed rules
would expose physicians to prosecution by the federal government,
which continues to treat marijuana as a dangerous drug with no medical
exceptions.

The commission is working to finish draft regulations that could
determine the success or failure of Maryland's second effort to allow
the distribution of marijuana for medical purposes.

The commission this week released its initial version of proposed
rules for physicians in the program. Last month, the panel circulated
a similar set of rules for prospective growers of legal medical marijuana.

So far, the commission's efforts are receiving mixed but largely
positive reviews.

"I think they're doing an exceptional job on this first attempt," said
Michael Liszewski, government affairs director of Americans for Safe
Access, a national organization that backs the use of marijuana for
medical purposes.

For both the doctors and growers, the commission published its draft
rules so it could get feedback from people and organizations with a
stake in how the Maryland's new medical marijuana system is structured.

Advocates say they want to avoid a repetition of Maryland's first
attempt to set up a medical marijuana system last year, when the
General Assembly passed legislation so restrictive that not a single
patient in Maryland was able to legally obtain the drug. That law
restricted medical marijuana distribution to the state's academic
medical centers, none of which were interested in participating.

This year's version of the law removes that barrier and expands the
authority to recommend medical marijuana to virtually any licensed
physician. It also creates licenses for up to 15 state-approved
growers and establishes the framework of a distribution network.

While the legislature created the broad parameters of the program, it
left many of the details to a commission with much broader powers than
it had under the previous statute. With its draft proposals for
physicians and growers already circulating, the panel plans to float
its ideas over the next several weeks for regulating marijuana
distributors, providing ID cards for qualifying patients and
conducting inspections of licensed facilities, said acting executive
director Sharon H. Bloom.

The unpaid, governor-appointed commission must deliver its final draft
regulations to the state health department by Sept. 15. After the
department's secretary signs off on final proposed regulations, they
will go to a joint House-Senate committee for comment before taking
effect.

Proponents hope to begin providing qualifying patients with
Maryland-based cannabis products by early 2016.

Before passing this year's legislation, lawmakers heard extensive
testimony on the potential for marijuana to alleviate symptoms of
epilepsy, cancer chemotherapy, auto-immune diseases, post-traumatic
stress disorder and other serious medical conditions. Maryland is one
of 23 states and the District of Columbia to have passed laws to allow
use of the drug for medical purposes.

One of the big differences between this year's law and2013's is that
any doctor whois licensed to prescribe controlled substances can apply
to the commission for a permit to recommend marijuana for patients
with a valid medical need. The patients would be issued state ID cards
that will let them buy marijuana from licensed outlets.

Under the proposed rules, doctors would recommend the precise strain
and dosage of the cannabis products. They would also be required to
take an approved orientation course in the marijuana program as well
as whatever continuing medical education courses the commission might
adopt. Advocates see problems. "A number of the proposed regulations
are either onerous or require illegal action on behalf of physicians,"
said Rachelle Yeung, legislative analyst for the Marijuana Policy Project.

Yeung explained that under a Supreme Court decision, physicians have a
First Amendment right to "recommend" marijuana to patients but are
forbidden under federal law to "prescribe" a substance that is still
classified as a Schedule 1 drug, along with heroin and cocaine. To
avoid getting participating physicians in trouble, she noted, the law
avoids the word "prescribe."

But by leaving it to the physician to specify the strain and dosage,
Yeung said, the regulations could put doctors in danger of federal
prosecution. She said it would make sense to leave the job of matching
patients with specific strains of marijuana up to dispensaries.

Commission chairman Dr. Paul Davies said he was not sure it would be a
problem because other states with medical marijuana programs have
dealt with the same issue.

Gene M. Ransom III, chief executive officer of MedChi, the state
medical society, agreed that the regulations should place as few
barriers to physician participation as possible. However, he said he
does not see the proposed continuing education rules as onerous and
added that MedChi is working to develop marijuana courses it can certify.

Baltimore County State's Attorney Scott Shellenberger, a medical
marijuana skeptic who opposed the legislation when it was first
proposed, said he's encouraged by what he called "stringent" draft
rules on growers and doctors. He praised the requirements that
physicians spell out their criteria for recommending the drug.

"It does seem on physicians as if efforts are being made to make sure
we're dealing with a legitimate medical condition," he said.

The proposed regulations on growers have received a more broadly
positive response.

Mike McCarthy, a longtime horticulture industry executive who has
formed a company called Medijuana MD LLC to compete for a growers'
license, said he'd like to see some tweaks to the proposed rules. For
instance, he sees no reason for a provision limiting each grower to
cultivating one strain of cannabis. But overall he's satisfied and
optimistic.

"We were pleased with what they've put forward so far," he
said.

Davies, an Annapolis pain management specialist, said the commission
is committed to making medical marijuana available as quickly as
possible in a way that neither limits its use unnecessarily nor a
"Wild West" marketplace. He said the panel will study the comments it
receives and make changes where necessary.

"I'm very, very optimistic that we're going to have a great program in
the state of Maryland," he said.
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MAP posted-by: Matt