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Friday, February 03, 2017

Medical Marijuana & Maryland

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

I understood that medical marijuana was legalized in Maryland years ago, I am still unable to find a doctor that will prescribe it. Why is this?

In Pain

Dear Painful,

You’re right, medical marijuana was legalized in Maryland in 2014 but still is not available in Maryland. This is related to complexities and legal disputes that are still going on about the licensing systems for growing, processing, and distributing marijuana. As long as no one is able to legally grow and distribute marijuana in Maryland, doctors will not be able to prescribe it. Because marijuana is still classified as an illegal drug under federal law, it is not legal for people in Maryland to buy medical marijuana from states where it is legal, like California and Colorado.

Another factor is that many physicians are reluctant to prescribe marijuana. Only 1% of Maryland’s 116,000 licensed physicians have registered to be able to prescribe it. There are two major reasons for this reluctance. In the first place, many doctors are afraid that if they begin prescribing medical marijuana, their offices will be overwhelmed by patients requesting it. Because of past bad experiences with drug abusing patients and because of the negative image associated with addiction, most physicians would rather not deal with patients who use illegal drugs. The fact that marijuana is now legal to use for medical purposes will not change these attitudes.

There is a parallel to this situation in the history of the introduction in Maryland of the medicine Suboxone (buprenorphine.) Suboxone is sometimes called the “new methadone.” It was legalized for use in the U.S. for the treatment of opioid addiction about ten years ago. It is prescribed to help people stop using and stay off opioids such as prescription pain pills and heroin, and it is quite effective. Unlike methadone, Suboxone can be prescribed by any physician. The physician need not be associated with a drug treatment center. For states such as Maryland which have a very high rate of opioid dependency, Suboxone should have been a major breakthrough. However, only a small number of physicians signed up for the special license needed to prescribe it. Again, the main problem was that most physicians do not want to deal with drug addiction. A second reason that became obvious after Suboxone was introduced: much of the Suboxone that was prescribed by physicians ended up being passed on by patients to drug dealers who sold it on the street. If medications sold illegally can be traced back to the doctor who originally prescribed them, that doctor can lose their license to practice and become unemployable.

Marijuana is an even less attractive drug to prescribe than Suboxone. First, there are few medical conditions for which marijuana has been proven to be helpful. Second, unlike Suboxone, marijuana causes a “high” or intoxicated feeling. Prescribers are not used the idea of prescribing intoxicants. Third, just like with Suboxone, there is a very high risk of medically prescribed marijuana being diverted to the streets, to the black market.

Dr. Deepak Cyril D’Souza, a professor of psychiatry at Yale University School of Medicine who studies marijuana, reports that there is evidence of marijuana’s effectiveness for only four conditions: neuropathic pain, where nerves are damaged such as in diabetes or HIV; the rare neurologic disease multiple sclerosis; weight loss related to AIDS; and nausea caused by medicines used for treating cancer. Although there have been many individual cases of people reporting that marijuana is effective for conditions such as seizures and various kinds of pain, it is a basic principle of evidence-based medicine that treatment decisions should be based on research rather than on individual reports.

Given the limited medical usefulness of marijuana, many people feel that the push to legalize marijuana for medical use is mainly an opening step towards complete legalization. Personally, I would favor legalizing marijuana for recreational use rather than legalizing it only for medical use. People who want marijuana for recreational use could simply buy it from a marijuana shop as they do in other states where it is legal. People who want to try marijuana for medical use could also buy it from a marijuana shop, just as people now buy chamomile, echinacea, ginseng and many other natural herbs and roots over the counter.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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