Maryland's medical marijuana paradox  [Editorial]

Advocates are generally praising Maryland's proposed new medical marijuana regulations as a step in the right direction after an initial effort failed to make the drug available to patients with chronic pain, nausea and other conditions thought to be alleviated by it. But they have raised concerns about some details, particularly in how doctors would be required to handle the drug, that essentially boil down to this paradox: They object that the regulations would treat marijuana like any other medicine and that they would not.

When a doctor prescribes a statin to control cholesterol, for example, we would expect him or her to specify exactly what type, the dosage, the frequency of use and so on. This is not something we would leave up to the pharmacist or, certainly, the drug company. In the same vein, the proposed marijuana regulations call for doctors to specify the quantity and strain of marijuana they recommend for their patients. Common sense, right?

No, the advocates say. Recommending a strain and dosage amounts to the same thing as a "prescription," even though the law and regulations call it a "recommendation," and there's well established case law making clear that doctors can't prescribe marijuana, for fear of losing their medical licenses or worse. In this regard, advocates want marijuana treated differently from other drugs.

Another part of the regulations calls for physicians who recommend marijuana for their patients to undergo a commission-approved training course and whatever continuing education requirements the state's medical marijuana commission deems appropriate. Advocates object to that, too, saying in this instance that marijuana should be treated like all other drugs. Physicians do not need to take courses or continuing education credits to prescribe whatever new drugs come on the market in any other context. They are expected to do their own research on a drug's uses and dangers and to prescribe it appropriately. But the trouble with marijuana is that it has not been approved by the Food and Drug Administration or subjected to controlled clinical trials, as any other drug would be.

We sympathize with both sides in this controversy. Advocates are right to be concerned that we do not again create a medical marijuana program — something that an overwhelming majority of Maryland voters support — that fails to provide access to marijuana for people who could potentially be helped by it. And the commission is right to frame the program in a medical and scientific context rather than as legalization-light, as medical marijuana has turned out to be in some other states.

Maryland can surely find a way to work around the contradictions produced by these two points of view. Dr. Paul Davies, the chairman of the commission, said last week that the commission intended the specifications for the strain, dosage and so on to be an option for doctors, not a requirement. And MedChi, the state medical society, is already working on marijuana courses for physicians, which will most likely be available online or in person and which will focus on the specifics of Maryland's law. So long as the commission is making a good faith effort to ensure that the program is not overly restrictive — and all indications so far suggest this is the case — they can make it work.

But the real issue here is a federal policy on marijuana that is increasingly out of touch with reality. Marijuana is classified as a Schedule I controlled substance, the criteria for which are drugs that have a high potential for abuse, lack a currently accepted medical use in the United States, and lack an accepted level of safe use under medical supervision. Marijuana is debatable on the first point, certainly in comparison to other Schedule I drugs like heroin and cocaine (not to speak of, say, tobacco). But at a time when 23 states and the District of Columbia have medical marijuana programs, some of them in place since the 1990s, it's laughable to claim that marijuana fits the latter two criteria.

The U.S. Department of Justice has announced a policy that it will not prioritize the prosecution of those involved in legitimate medical use of marijuana. But that's not good enough. Not only does it leave the matter to the whim of whatever administration is in the White House but it also leaves in place restrictions that have effectively quashed research into marijuana's medical properties and risks and prevented doctors from managing its use as they would other drugs. Separate from the broader questions about national marijuana policy — whether it should be treated like alcohol, as is the case in Colorado and Washington, or whether it should be effectively decriminalized, as is the case in Maryland and several other states — it is clear that it should be removed from Schedule I so that its pharmacological use can be properly studied and regulated.


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