A system in limbo
Maryland’s dragging medical marijuana program and its stakeholders
As Amy Mellen sat outside on a sunny day in a suburb just outside the nation’s capital, she took a few puffs from a vape pen filled with CBD oil in between describing her former self as the typical “good girl.”
“I went to college, got a degree, got married, and had a family. The American dream is what everybody’s going for right?”
Right. But hormonal migraines that began with the pregnancy of her second daughter led to her being put on a regimen of 20 Percocet a month in addition to occasional Demerol and Phenergan shots. Then in 2006, Mellen was involved in a rollover car accident, caused by a mechanical issue with the vehicle, which forced her car to roll three times with her head hitting the pavement with each roll and leaving her left hand hanging by a small amount of tissue. That dream was put on hold.
She described the unsettling feeling of waking up in the hospital with multiple drugs being pumped into her body through IV’s.
“I had never done a drug in my life. I’d never even been drunk before,” Mellen said, “It was just a split second and that’s all it was that put me to the pills.”
Amy would describe “the pills” as a significant chapter of her life, about 10 years, in which she lost herself and her ability to function in any meaningful way.
“I had to have an in-home nurse. I couldn’t even go to the bathroom on my own,” Mellen said.
The combination of her conditions and ailments also led to about nine years of frequent surgeries and physical therapy. And by the time she came to the conclusion that something had to change, she was taking 2400 MG of Neurontin, 60 MG of Oxycontin, 50 mg of Percocet, 10-30 mg of Baclofen, and 1500 mg of Metformin for her diabetes. The list, Mellen said, goes on and on, and includes drugs like methadone and others that were needed just to get off another pharmaceutical.
“I had never done a drug in my life,” Mellen said, “and now I was practically a synthetic heroin addict, not by choice.”
In addition to the drugs prescribed by her doctors, Amy was also taking supplements to flush her kidneys and liver, fearing the buildup of toxins from the pills.
Add that to the anti-anxiety medication and anti-depressants and you get a complex mixture that leaves the human body in a fragile state.
“These drugs, they affect your bowels too. So you have to take laxatives and stool softeners as well,” Mellen said.
A few years later, as life had gotten back to as normal as it could have been, Amy’s concoction of opiates and pharmaceuticals culminated in a second car accident in which she blacked out at the wheel as a result of the drug, Gabapentin, she’d been taking. At the time of the accident, Mellen’s daughter and her friend were in the car with her. As she came to and emergency services arrived, Mellen was given a test to determine whether the accident was a result of her having been driving under the influence.
By most American legal standards, most would have determined the answer to be no. But Amy, who had begun thoroughly researching the interactions between the drugs she was prescribed by doctors to take, quickly realized that she may as well have been, based on the mixture of drugs she was prescribed.
“Now that I think about it, it scares me to think that there are people out there on these medications who are driving!”
As she was recovering from her second accident, Amy was still living in Oregon, a state where marijuana is legal for both medicinal and recreational purposes. A friend of her husband’s suggested she try using the plant, also known as cannabis, to treat her chronic pain and other conditions. Smoking it seemed to help but only a bit. Thanks to some friends who had recently opened up their own dispensary in Portland, she began trying topical creams and eventually, the infamous Rick Simpson oil.
The oil, pioneered by Simpson (who developed the recipe to treat his own cancerous growths) is an extract ingested orally that is extremely concentrated. Mellen and her husband began doing more research on the oil and found another source from which to obtain it, despite the steep cost.
But within two months of ingesting the oil, her type II diabetes had been reversed.
“It was almost every week, I had another medicine or supplement gone,” Mellen said.
She continued to increase her daily consumption of the oil and after three months of ingestion, she was no longer taking Gabapentin, Oxycontin, Percocet, or Baclofen. After six months, she had stopped taking Effexor, Celexa, and Klonopin in addition to dropping a significant amount of weight.
However, that American dream or normal life, though within reach, is not guaranteed just yet. Amy had what she would call her cannabis “awakening” while living as a patient in her home state of Oregon, a place where cannabis culture has strong roots…and legal protection.
Despite Maryland having passed the initial legislation that legalized marijuana for medicinal purposes in 2014, the ‘free state,’ like many others, faced a problem of access.
Mellen, who was given the opportunity to be the second patient listed on the Maryland Medical Cannabis Commission’s (MMCC) Patient Registry, ended up moving to Maryland for her husband’s job and has had to find ways around the lack of access in what feels like a quasi-legal state. But she worries for those in completely illegal states who face steeper legal repercussions, not to mention the lack of access to different forms and strains of the plant, which are often needed to treat multiple symptoms.
“I can’t get here what I was getting at home. I was in a legal state there. I could walk into a dispensary if I needed to and get the best of the best,” Mellen said.
Now, Mellen and the growing number of patients registering for the program, must wait in legal limbo for approved growing/processing licensees to obtain their Stage Two approval and eventually get seeds in the ground. Many are predicting that the first crop will be available through dispensaries by early to mid-Fall.
So for the time being, patients are relegated to choosing between the black market or not ‘medicating’ at all.
The recent progression in the liberalization of marijuana laws in Maryland can be traced back to 2003 when the Darrel Putnam Compassionate Use Act was passed, allowing those who were accused of use/possession charges to use a physician’s suggestion for marijuana use as an affirmative legal defense.
“This meant that you had to be arrested and then go to court before you had a chance to prove that you were a medical user,” said Kate Bell, legislative counsel for the Marijuana Policy Project.
Before getting more into politics and advocacy, Bell represented patients as an attorney under this provision.
Then in 2011, Senate Bill 208 passed meaning that defendants would not face a conviction as long as they could prove that they truly needed marijuana for medicinal purposes.
Things took another step forward in April of 2013 when the Caregiver Affirmative Defense was passed, allowing caregivers to have up to an ounce of marijuana and be legally protected for administering it to a patient with a medical necessity.
During the next legislative session in April of 2014, Maryland joined 20 other states in legalizing medical marijuana with Bill 881. The Natalie M. LaPrade commission, named after the mother of Baltimore City Delegate Cheryl Glenn, was assigned to regulate the state’s program.
A deadline of November 6, 2015 for applications from growers and processors was set and the number of licenses that would be granted was voted to be 15. The commission enlisted the help of the Regional Economic Studies Institute of Towson University (RESI) to undertake a double-blind study in order to rank the applications.
The commission received a total of 146 applications for the 15 licenses to grow, 124 applications for the 15 available to processors, and 811 for licenses to operate a dispensary.
The Maryland Medical Cannabis Commission (MMCC) serves as a major resource for all stakeholders in the system, including instructions for patients, caregivers, and physicians, to obtain proper documentation to participate.
As for patients, they must first submit an application to and have it approved by the MMCC. Once this has been approved, a patient’s status with the commission is valid for two years. They must then obtain “a valid written certification from a physician registered with MMCC.” These certifications are valid for up to one year. At this point, patients may visit any dispensary within the state. Patients may choose to purchase an ID card for a fee of $50.
Caregivers are considered, by the MMCC anyone who is “able to purchase medical cannabis from a licensed Maryland dispensary on behalf of his or her designated patient(s) and transport the legally obtained medical cannabis to the patient(s).” Similar to patients, caregivers must register with the commission, be approved, and must purchase an ID card. The process is pretty standard for caregivers taking care of patients over the age of 18. However, for caregivers helping patients under the age of 18, they must also be the parent or legal guardian of the patient who is receiving care.
As for those who want to register to provide recommendations for patients, they must have a license with the Maryland State Board of Physicians and have a “bona fide physician-patient relationship” with said patient. Maryland law also requires that previous attempts at alternative treatment for the patient’s severe condition must have failed and the patient’s condition must fall within the range of the following conditions: “cachexia, anorexia, wasting syndrome, severe pain, severe nausea, seizures, severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder and chronic pain.”
However, if a physician thinks that a patient could benefit from medical cannabis, even if their condition is not listed, they can still write them a recommendation.
Though this seems like a robust system, a statement on the commission’s website reads:
“IMPORTANT MESSAGE: MEDICAL CANNABIS IS CURRENTLY NOT AVAILABLE IN THE STATE OF MARYLAND.
The industry is still being constructed and we expect availability by the end of summer 2017 depending on industry progress. The Commission will make a public announcement once medical cannabis becomes available to the public.”
Not all of the qualified applicants were as lucky as Wendy Bronfein, whose company, Curio Wellness, obtained a license to grow, process, and dispense cannabis. The company intends, and to a certain degree already has, to brand itself in such a way that it’s associated with premium medicinal cannabis products.
“As a processor, Curio Wellness will launch with a line of premium vape pens & tinctures and expand our product portfolio over the next year to release condition specific targeted treatment in traditional dosage forms,” Wendy wrote in an email, “We have assembled a world-class group of scientists to help guide our research & development. In addition, to our premium product offerings, we have secured an exclusive licensing agreement with Dixie Elixirs and Edibles to manufacture and distribute their line of products within the State of Maryland.”
Shortly after legislation establishing Maryland’s medical marijuana program was passed, Wendy earned her MBA and was looking for an opportunity to build out a brand in her own vision.
“I’d spent the prior eight years marketing network television and although I’d built my career in both LA and NYC, I always remained a hometown girl. I knew how transformative medical cannabis had been for patients, in other states, and felt there was an exciting opportunity back home.”
It didn’t take much to convince her father, who has experience with institutional and retail pharmacies, to get on board. After doing market research, Wendy and the rest of the company’s founders got to work on creating the brand, working with Baltimore-based marketing agency, Planit.
Wendy emphasized her passion for not only providing safe, high-quality access to medicine for patients, but also for creating a company where, “Marylanders could build a career and grow all aspects of their life. I wanted to change lives for not just patients, but employees, too.”
Donning a black, Curio Wellness-branded hardhat, Wendy wound her way through the 56,000-square-foot warehouse in the Lutherville-Timonium area, pointing out the security checkpoint all employees must enter through before hitting the showers before work. Still under construction, the facility was bustling with activity on an otherwise calm, Friday morning in early May.
While many in the industry have sought locations for their facilities in rural areas, or places that are hard to view from the road, Wendy says she wanted to be in a central location for the sake of transparency and in order to attract some of the best talent.
46,000-square-feet of the space will be devoted to growing the actual cannabis, with nine different climate controlled rooms allowing for ideal growing conditions depending on the strain. The 10,000-square-feet at the front of the building will be used for the company’s processing operations.
Other efforts at associating the brand with premium products and sophistication include the company’s scientific advisory board as well as the inclusion of pharmaceutical-grade equipment in the processing department.
“Our best in class facility featuring a clean room & on-site analytical laboratory employs the best practices of highly experienced agronomy and pharmacology professionals. Designed and built using both FDA and GMP guidelines, we will process the finest plant material using the state-of-the-art Waters Corp. BioBotanical Extraction System and employ cutting edge in-house analytical capabilities using the Alliance HPLC systems & the SFC350 Prep,” Wendy wrote.
But while Wendy is being given the chance, along with her family who’s backing her, to fulfill a dream, not everyone interested in getting involved in the legal cannabis industry has had the chance.
Maryland is said to have had the longest and most painstaking rollout of their medical marijuana program in the country.
“Maryland has become a shining example of what not to do,” Kate Bell said, “It’s an embarrassment to the state of Maryland.”
These delays have come from multiple areas of concern, according to Bell.
One issue was that the commission was set up under the 2013 law that was passed, which didn’t change its structure after adding the licensing system.
“The commission was just a group of people who were basically volunteers with not much experience. It was also severely understaffed,” Bell said.
The group also apparently did not anticipate the volume of applications that they received.
Another problem was the lack of transparency in the evaluation of the applications for licenses. While RESI was expected to have been the group responsible for doing so, they ended up contracting with other experts.
“Instead of handling it themselves, the Towson commission cost taxpayers money leading to a further delay and contracted it out to subject matter experts. RESI divided applications into chunks and redacted names,” Bell said.
Another major issue was that of diversity. It wasn’t until the licensees for growers were named that people realized there were no businesses awarded licenses that were owned by African Americans or from communities “that have been predominantly affected by over policing” and disproportionate prosecution from marijuana charges, Bell says.
Although many had believed racial diversity to be a key factor considered by those evaluating the applications, the state’s Attorney General, Brian Frosh, had actually advised RESI not to consider race due to the lack of a racial disparity study having been conducted.
Instead, geographic diversity was put forth as important criteria, even though the commission had told applicants that it was irrelevant. This led to uproar from both the predominantly African-American owned businesses that were denied and the Legislative Black Caucus, led by chairwoman Del. Cheryl Glenn, as well as the two companies that had their pre-approvals revoked after the invocation of the geographic diversity clause.
As Maryland’s legislative session for 2017 came to an end on April 10, a bill that had passed the House of Delegates and the Senate that would have called for the inclusion of African-American licensees failed to pass in time before the legislative session ended. The bill had yet to pass and ran up until the last day of the session due to arguments over amendments. Many, like Del. Glenn, blame House Speak Michael Busch for having delayed the process while other lawmakers gave long, drawn out speeches.
In the meantime, Governor Hogan has since ordered a racial disparity study to be conducted on Maryland’s medical marijuana industry. In the order to the commission he writes:
“As the issue of promoting diversity is of great importance to me and my administration, your office should begin this process immediately in order to ensure appropriate opportunities for minority participation in Maryland’s regulated medical cannabis industry.”
However, the Legislative Black Caucus and others within the Democratic party have been calling for a special session to be held in order to pass the bill that failed at midnight. Though Governor Hogan has the ability to call a special session, he has removed himself from making that decision and left it between House Speaker Michael Busch, who is against the idea of the Assembly deciding who receives a license, and Senate President Thomas Miller, who supports it on the condition that there is no political haggling and the vote takes place swiftly.
Whether or not a special session will be called remains to be seen.
For Amy, such dysfunction and contentious debate makes the dream of safe access for patients, despite having a law on the books and growers building out their physical facilities, seem even more worth fighting for.
In the meantime, while the legal and political battles continue and legal products are projected to not be available until the early Fall for most dispensaries, Amy has passed the time with both advocacy work and patient outreach.
As a friend or ‘follower’ of Amy on Facebook, log on any day and you’re likely to come upon her broadcasting live from her backyard discussing anything from the opioid epidemic to telling her own story (or “journey” as she calls it) or in the kitchen making some new cannabis infusion.
There are many others patient/activists that have taken to the realm of social media not just to vent and ask or answer questions, but to connect with like-minded people.
“If I wasn’t doing this, there are so many people I wouldn’t have met,” Mellen said.
As well as sharing similar content from others that have formed a community with different pages and forums online, Amy runs a page called “#SquashTheStigma” where she provides advice and a safe place to talk for those suffering from chronic conditions in both legal and illegal states.
Part of the description of the group reads: “By networking with over 3,000 people here on FB, just since January of this year, I have created a team of folks that want to help you heal. I know many of you want to know how to be a #cannabisnewbie, so to protect your privacy I have made this group Closed…The other admins I have chosen, have various backgrounds in cannabis; I did this on purpose. So lets to foster education, because that is my main goal with this page!!!”
Having had such a transformative journey that falls outside of the bounds of what can be reported and acted upon in medical reports in federally-funded hospitals, like the one she was in while first detoxing herself back in Oregon, Amy stresses the importance of journaling and encouraging others to do so as well.
She stressed this practice while trying to get off of the pills but also when she moved on to using cannabis to treat her conditions.
“I knew that if this worked, I wanted somebody to know because they weren’t going to look at me as a stoner. They weren’t going to use the typical stigma with me that other people had because I had done what I was supposed to do. I had crossed my t’s and dotted my i’s and I still ended up like this. So I just started writing everything down.”
Now, Amy says she’s currently developing a digital journal for patients to use to track what strains and consumption methods work best for them.
Cristina Castro, a friend that Amy had met through her advocacy work, also believes in the importance of sharing stories but has a slightly different perspective.
Castro spent seven years in the air force as a clinical supervisor at a VA clinic, where she witnessed firsthand the multitude of problems facing veterans not just in obtaining the correct benefits that were due to them, but in obtaining proper care in conjunction with their medicinal cannabis use (provided they are in a legal state).
“A lot of what I do is based around fact that I want to be a helper. I want to give people the tools to do the job themselves. If I can teach someone then they can teach someone,” Cristina said.
Cristina does patient advocacy work, primarily for veterans, as well as patient training on issues dealing with work environments, life in the military, finding cannabis-friendly health care providers, helping patients obtain their medical records, and much more. She’s able to provide valuable insights to veterans after having learned firsthand how the VA’s healthcare system works, or does so rather inadequately, according to her.
Cristina has also gotten involved occasionally in the legal/political effort at cannabis reform, testifying at zoning hearings and having a strong presence in different cannabis-focused organizations including Women Grow, an organization whose goal is to serve as “a catalyst for women to influence and succeed in the cannabis industry as the end of marijuana prohibition occurs on a national scale,” according to the organization’s website.
As for the long-term, Cristina doesn’t envision her current work as a possible avenue.
“I would really love to not have to do what I’m doing now,” she said.
Her dream would be to have the VA open a cannabis education center and have the chance to be in charge of it. Though federal drug laws would most likely prohibit the distribution of cannabis at these centers (even in legal states), Cristina envisions these centers as places where not only patients can receive advising and information about cannabis but doctors and caregivers could as well to address the gap in education about the way the plant works with the body and other medications resulting from its legal status.
But eventually, both Amy and Cristina wouldn’t mind seeing themselves both put out of the advocacy/activism business in a world where cannabis is incorporated into the mainstream legally, socially, and medicinally.