Shane Mayberry counsels a customer on medical cannabis options at Herban Legends in Towson. Dozens of such dispensaries of medical marijuana products have opened recently around Maryland since the state’s Medical Cannabis Commission starting issuing licenses at the end of last year. Photo by Christopher Myers

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Baltimore Beacon

Two years ago, Scott Deiter ruptured several discs in his neck. Four neck surgeries later, “between the residual pain from the surgeries and daily migraines, I really couldn’t function because of the pain,” he said.

He felt opioid pain medication impaired him too much to work, so Deiter turned to medical marijuana “in desperation.” But he found relief almost immediately and now calls cannabis (the plant’s scientific name) a “wonder drug.”

Deiter, 66, is one of the many Marylanders turning to medical cannabis when more conventional medications haven’t done the trick.

At Herban Legends of Towson, general manager Shane Mayberry said that they are seeing a steady flow of patients and that the number is increasing weekly. Among those are a lot of older clients who have tried various medications in the past that either have not worked, have run their course, or are causing unwanted side effects.

“A large portion of our older patients are looking for relief from chronic pain caused by various conditions and ailments,” said Mayberry.

For example, Sophia, 57, (a customer at another facility who did not want her last name to be used), turned to cannabis to address anxiety, panic attacks and insomnia.

“I have been having a lot of trouble sleeping at night,” she said. “I didn’t want to keep taking sleeping pills because when I wake in the morning, I am very groggy, and it takes a long time for me to fully wake up,” she said.

“Now that I have been using [cannabis], I am able to relax and get the much-needed sleep I need. I now wake up refreshed and ready to start my day,” Sophia said.

She added that cannabis helped her deal with the recent death of her brother as well.

Is it safe and effective?

In recent years, laws legalizing the use of cannabis for specific medical conditions have been enacted in 31 states. Nine states plus the District of Columbia permit its recreational use in some fashion. In October, Canada legalized marijuana throughout the country.

The Maryland legislature voted to legalize medical marijuana in 2012, but five years passed before it became available at state-licensed facilities. Since Dec. 1, 2017, the Maryland Medical Cannabis Commission (MMCC) has licensed 67 dispensaries around the state. There are currently 21 in the Baltimore area.

The rapid growth of the industry reflects the widespread acceptance by the public of marijuana as a medical treatment in recent years. A large survey recently found that 81 percent of Americans believe cannabis offers medicinal benefits.

However, in reporting on the survey, the Annals of Internal Medicine, a publication of the American College of Physicians, noted that “Americans’ view of marijuana use is more favorable than existing evidence supports.” The risks and benefits of use have not been widely studied.

To date, the U.S. Food and Drug Administration, which has authority to determine the safety and effectiveness of drugs sold in the U.S., has approved only a handful of marijuana derivatives (or synthetic cannabis). All are treatments for particular conditions, including seizures in certain forms of epilepsy, anorexia in AIDS patients, and nausea and vomiting caused by chemotherapy.

One of the reasons for so few approved uses may well be the fact that, since 1970, federal law has classified marijuana as a “Schedule 1” illegal drug — the same category reserved for heroin, LSD and other drugs “with no currently accepted medical use and a high potential for abuse.”

This makes it difficult for researchers to obtain the product legally, limiting their ability to conduct studies and find other uses.

Nonetheless, nearly half of U.S. cancer doctors who responded to a survey said they’ve recommended medical marijuana to their patients, even while most of them admit they haven’t seen enough medical evidence to support it.

Their recommendations appear to be driven by the desire to help ease patients’ nausea and pain, while limiting the use of opioids.

Some doctors, for example, prescribe a low dose of opioid pain medication together with medical marijuana, which may be both more effective and safer for some patients than the regular dose of opioids alone. (Recent studies go both ways on the question.)

No need to smoke

The initial reluctance of some to using cannabis is due to their feelings about inhaling the toxic byproducts of tobacco, many of which are also produced in smoking marijuana. For example, Lynda, 76, said her husband, 80, is a lung cancer survivor, so they wouldn’t consider smoking anything.

But the active ingredient in cannabis lies in oils on the surface of the plant’s leaves, so there are many other ways to consume it.

For example, Herban Legends, in Towson, focuses on smokeless varieties such as vaporizing cartridges, dabbable concentrates, transdermals (which have ability to enter the blood stream and provide all over relief), and dermals (which do not enter the blood system and act only on local receptors).

Currently the state of Maryland does not allow for “edibles” but Herban Legends does have troches (small lozenges) and tablets that dissolve under your tongue.

The wide variety of products containing medical cannabis opened a whole new vista to Lynda and her husband.

“Cannabis capsules have really changed our lives,” she said. “I haven’t had a migraine in a month, and both my husband and I are sleeping better without taking other medications.

“With today’s products, you know exactly what [amount] you’re getting. We took some free classes at Curio Wellness in Timonium, and learned how to use them; what works for what. Also, they have a pharmacist on staff, which was very helpful.”

Typically, dosing amounts are decided by the patient, according to Mayberry. “Everyone’s bio-psychology is vastly different and taxed in different ways depending on their illness/ailment.”

Mayberry said that he always recommends to patients who are new to cannabis to start low and go slow. “Move up your dosage only as you feel comfortable. Keeping a dosing log is a great way to find the therapeutic dosage that is right for you,” he added.

Concerns for older users

A recent article in U.S. News and World Report reported on the research findings of Margaret Haney, a professor of neurobiology in psychiatry at Columbia University Medical Center in New York.

Haney is quoted as saying that “there is some suggestion that cannabinoids can be useful for a type of pain that isn’t well-treated by other drugs — neuropathic pain.” This type of pain, which is caused by nerve damage, is associated with diabetes, HIV infection or medications, and cancer chemotherapy.

Haney also is quoted as saying “it’s certainly reasonable to try [cannabis] for [poor] appetite….Just be cautious.”

Among the cautions older adults should be particularly aware of are the following:

— Do not drive when under the influence of marijuana. “It doubles the risk of accidents,” Haney said.

— Haney also noted that while some use marijuana for anxiety relief, “many others find it enhances anxiety tremendously.”

— Fall risk is a serious concern for older adults. In connection with this, the U.S. News article quoted Laura Borgelt, a professor at the University of Colorado Skaggs School of Pharmacy, saying, “We know that marijuana can create cognitive impairment and slow cognitive processes. It has also shown some [short-term] memory impairment.”

— Also, marijuana may interact dangerously with a number of types of prescription drugs commonly taken by older adults. These include sleep medications, blood thinners, blood pressure medications and diabetes drugs.

“Edible marijuana products pose the most risk for interactions with prescription medications,” Borgelt said.

The buying process

For those who want to give medical marijuana a try, purchasing it is a little more complicated than just walking into a dispensary.

A Maryland resident must first register with the MMCC and get an ID number. Then the patient visits a physician registered with the MMCC for an evaluation and recommendation. (Some dispensaries have a physician on staff.)

The patient then brings the doctor’s recommendation and their ID number to a dispensary, where the patient’s case is discussed, and recommendations about particular products are made.

Among the medical conditions that qualify for treatment at Maryland dispensaries are anorexia, wasting syndrome, severe and chronic pain, severe nausea, seizures, persistent muscle spasms, glaucoma and post-traumatic stress disorder.

At Nature’s Therapy in Parkville, co-owner Meredith Shelton, a nurse practitioner, assists patients in achieving safe access to medical cannabis. She does not sell any cannabis products.

“We provide medical cannabis evaluations,” said Shelton. An evaluation will include a thorough medical history, a review of medications you’re taking, and a discussion of potential benefits and risks of using medical cannabis.

Because many patients have an extensive medical history and take a number of prescriptions, Shelton strongly advises users to keep their medical practitioners advised of any cannabis use.

What does it cost?

At this time, neither Medicare nor private insurance cover medical marijuana, so customers must pay privately for the products.

Most dispensaries list the price of the various forms of cannabis they sell on their website. The cost of cannabis to smoke typically ranges from $35 to $65 per 1/8 ounce, while oil cartridges that are vaporized cost $40 to $80. Tinctures and chewable tablets may range from $30 to $80.

In all these cases, the number of doses one gets from these types of purchases will depend on the condition being treated and each person’s reaction to the various products. For example, those transitioning off opioids will get fewer days’ use from a given amount than those with less severe needs.

For Lynda and her husband, “it’s not cheap, it’s not exorbitant. But it’s been marvelous. We’re very active and play couples tennis. There are a lot of people out there with aches and pains. We encourage our friends to try it,” she said.

Having been young adults in the 1960s and 70s, “with all those years of whispering,” it’s exciting to be able to legally obtain and benefit from cannabis today, she added.

“I can’t believe this is really happening. I love the freedom of being able to say, ‘Oh, yeah, want to see my card?’ That’s a high!”