Today the Maryland Senate passed SB 923, which would authorize the Natalie M. LaPrade Medical Marijuana Commission ("Commission") to license and regulate medical cannabis growers and "medical marijuana treatment centers" where patients may purchase their medicine. The law passed by a vote of 45-1 and would fix the Maryland's current but non-implementable medical cannabis law, and substantially improves upon the legislation passed last week by the Maryland House of Delegates (HB 881) to fix the current program. We are urging all of our Maryland members to support the Senate version of the bill when it goes back to the House (see action alert below).

While both the House and Senate versions of the law would correct the catastrophic flaw in the current program, which only allows patients to enroll in programs run by an "Academic Medical Center" (or "AMC," which are hospitals that can do research on human subjects). However, due to federal funding and accreditation, no AMC appears willing to participate so long as marijuana falls under Schedule I of the Controlled Substances Act. Even if marijuana were removed from Schedule I, the program would be extremely limited and likely would exclude many Marylanders would benefit from medical cannabis therapy. However, the current Maryland law has at least one true positive, and that is the creation of the Commission, which has been working attempt to implement the current program in a thoughtful manner, in spite of the legal and bureaucratic hurdles that stand in their way. The Commission has already issued draft regulations for the current law, and appears to be well-positioned to issue regulations and implement the new law. Additionally, Governor Martin O'Malley indicated back in January that he will sign legislation to fix the current program.

Early in the 2014 Maryland legislative session, there were two bills introduced in the House, HB 881 introduced by Delegate Dan Morhaim, and HB 1321 by Delegate Cheryl Glenn. While ASA expressed support for both pieces of legislation because they each would have fixed the major problem with the current law. Among the reasons why ASA testified in favor of HB 1321 over HB 881 was that it did not require recommending physicians to be on staff at a hospital or hospice, and it provided greater instruction for the Commission to implement the law, and would have created greater competition among medical marijuana providers to increase affordability. The hospital staff requirement would have reduced the number of primary care physicians who could participate in the program by 50%, and would have also reduced the number of available specialists.

Last week, the House passed an somewhat improved version of 881, but it still had the hospital staff requirement along with some extraordinarily long periods of licensure for growers, which would have been 5 years initially and 10 years at renewal, with only 10 growers licensed in the state. These entities would be vertically integrated such that the growers would be allowed to open retail dispensing locations, although the language likely would have only permitted one satellite location per grower. Many, including ASA and Commission Chair Dr. Paul Davies, expressed great concern that the language in 881 would have limited the number of retail locations where patients could obtain their medicine (meaning long journeys for some patients), and potentially could have resulted in artificially high prices due to the near-monopoly it would create.

ASA and Maryland patient advocates worked with Senator Jamie Raskin and offered suggested amendments to the Senate Judicial Proceedings Committee to not include the hospital staff requirement and make changes to increase affordable access to medicine. Under the Senate version of 881, the Commission can license up to two medical marijuana treatment centers in each state legislative district, which means no more than 2 dispensing locations per approximately 125,000 Marylanders. Additionally, ASA urged the Senate to include a provision to allow for military veterans who receive their medical care from the Veterans Administration to be able to enroll in the program, as VA physicians are not allowed sign medical marijuana authorization forms. While the Senate stopped short of authorizing access to veteran patients who get the medical care from the VA, they did include a requirement for the Commission to study the issue and make recommendations to the legislature on how to include them.

ASA is confident that the Commission and General Assembly will resolve the veterans issue by the time treatment centers are selling medicine, probably sometime in late 2015 or early 2016. We are hopeful that when they revisit the veterans issue that they will adopt the civil discrimination protections for housing, employment, organ transplants and child custody that ASA has been seeking to include. One unfortunate change in the conditions language is that the term "chronic" was removed from "severe or chronic pain;" however, patients with chronic pain may still obtain access through a clause in the law that allows the Commission to authorize individual physicians the right to recommend for chronic pain. This provision notwithstanding, ASA thanks Senator Raskin and Senate Judicial Proceedings Committee for their thoughtful amendments to improve safe access in Maryland.

At this stage, the Senate version of the bill now must be adopted by the House or else the improvements to 881 may fall by the wayside. We are now asking that all patient advocates in Maryland to contact their House of Delegates members to urge them to vote yes on the Senate version of HB881/SB923 (see action alert)!