Scott Dieter is the marketing manager for Herbiculture, one of a number of recently opened Maryland businesses offering medical cannabis (marijuana) to eligible patients. Here he stands behind the counter at the Burtonsville dispensary, showing some of the many products they sell containing cannabis in a variety of forms. Dieter says vaping cannabis has helped control the chronic pain he has had since a surfing accident. Photo by Adam Ellis

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Howard County Beacon

After two surgeries and many downed opioid pills, Stephanie Brooks, 60, still suffered “spinal pain, depression, anxiety and difficulty sleeping,” she said.

So Brooks (not her real name) decided to visit Remedy Columbia, one of six state-licensed medical marijuana dispensaries in Howard County, to try one of the thousands of different strains of cannabis (the scientific name of the marijuana plant).

“I was skeptical about using cannabis,” she said. “I didn’t want to smoke it.” (The reluctance of many to smoking cannabis may be due to their feelings about inhaling the toxic byproducts of tobacco, many of which are also produced in smoking marijuana.)

But the active ingredient in cannabis lies in oils on the surface of the plant’s leaves, so Brooks chose to inhale the cannabis in oil form through a vaporizer (popularly known as vaping). These devices heat marijuana flowers or extracts short of burning, and atomize the result for inhalation.

Today, five months after starting the treatment, “I’m sleeping again, just like a normal person,” the former educator said. “During the day, I’m off the sofa and more active, and help with the housework. I get out of the house and do volunteer work several times a week.”

Dave Lyon, 65, has been going to the Columbia clinic since shortly after it opened in December 2017. Not only is he a patient there, but he is also a staff member trained in the medicinal use of cannabis.

A sufferer of arthritis in his toes and knees since he was in his early 20s, Lyon had been a longtime marijuana user. “I’m a product of the 1970’s,” he said, referring to the era when “smoking pot” was a rite of passage for many young people,

“About 10 years ago, my pain became more intense,” he said. Since going to the Columbia dispensary, he discovered that “certain strains of cannabis could override the pain.”

The five other medical cannabis dispensaries in the county, according to the Maryland Medical Cannabis Commission (MMCC), are Greenhouse Wellness, Nature’s Medicine and Trilogy Wellness, all in Ellicott City, Zen Leaf in Jessup, and Revolution Releaf in Laurel.

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 MMCC has licensed 65 dispensaries around the state, several others of which are near Howard County, such as Herbiculture in Burtonsville.

To date, 29 states have legalized marijuana for medical use, and nine (including the District of Columbia) have legalized small quantities for recreational use.

Is it safe and effective?

The rapid growth of the medical marijuana industry reflects the widespread acceptance by the public of marijuana as a medical treatment in recent years. A large survey recently found that 81% 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 as treatments for particular conditions. These include 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.)

Concerns for older users

Area dispensaries clearly see older adults as a population that can benefit from their products.

Lindsay Estes, the outreach coordinator at Remedy, estimates that “probably more than 50 percent” of their current customer base is 50 or older.

Officials at two dispensaries in Ellicott City, Greenhouse Wellness, which opened in December, and Trilogy Wellness, operating since late March, also report that about half their customers are 50-plus.

Some tout a recent U.S. News and World report that cited the research findings of Margaret Haney, a professor of neurobiology in psychiatry at Columbia University Medical Center in New York.

Haney is quoted there 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.”

— The National Institute on Drug Abuse warns that smoking marijuana raises heart rate for up to three hours, which could increase the chance of heart attack. It also warns of possible breathing problems, impaired memory and delusions, hallucinations and even psychosis, when the drug is taken in high doses.

— 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, as 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 prescriptions 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 patient 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.

“We cannot treat disease,” said Estes of Remedy Columbia. “We treat the symptoms, such as nausea, anxiety, depression, pain, inflammation.”

Dr. Leslie Apgar, co-owner and medical director of Greenhouse Wellness, said they are focused on smokeless varieties of medical marijuana. These include oils, elixirs, creams, tablets and vaporizers.

Apgar also noted that there are thousands of different strains of marijuana, so customers should understand it may take some time to work with their staff to find the strain that will best help them.

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

Remedy Columbia indicated the cost of cannabis to smoke is about $40 to $60 per 1/8 ounce, while oil cartridges that are vaporized cost $50 to $70. Tinctures and chewable tablets range from $20 to $50.

As for how many uses or days these quantities provide, Estes said she could not offer a comparison between the cost of cannabis for pain medication with the cost of prescription pain killers.

“Each person is different; there is no such thing as an average cannabis patient,” she said. “Depending on products, tolerance, frequency of use, purchasing habits, etc., there is an enormous variance in cost from person to person. There is also no average ‘dose’.”

But to those for whom it works, cost may be irrelevant.

Two years ago, Scott Dieter 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. He turned to cannabis “in desperation.”

“It worked the first time I used it. It handles my pain for several days and sometimes for a whole week,” he said. “I was completely surprised it works so well.”

Dieter, 66, is such a convert to medical cannabis that he now works as the marketing manager for the medical marijuana dispensary Herbiculture in Burtonsville.

“It’s been a wonder medicine for me,” he said.