The potential medical benefits of marijuana are clear to Annapolis physician Richard Bernstein.
The drug can bring a bit of relief -- curbing nausea and increasing appetite -- from the impact of chemotherapy on cancer patients, and it does so without the side effects of many other drugs on the market, Bernstein said.
What's not so clear -- even as the House of Delegates gave a preliminary OK to a medical marijuana measure on Saturday -- is what health professionals should tell patients about marijuana and its effect on health when the inevitable questions pour in.
The drug that has been lauded for helping extremely sick patients is also banned by the federal government, carries a high potential for abuse and has not had the sort of high-quality research that has gone into other available drugs.
From some doctors, Bernstein said, when the subject of medical marijuana is raised, "You get a 'Wink-wink, yeah, I think that's OK.'"
The situation, he said, "puts physicians in an uncomfortable position because you have a drug that's extremely effective at treating the symptoms associated with chemotherapy and comes with fewer side effects and you can't recommend it."
As Maryland's legislators debate bills that would allow medical marijuana at academic medical centers and minimize penalties for possessing small amounts of pot, the state's health professionals are having a debate of their own.
And the issue is far from being resolved.
"It's been a very heated discussion in MedChi (the Maryland State Medical Society)," said Dr. Ronald Sroka, a primary care physician in Crofton. For the third year in a row, the physicians' group has wrestled with the topic but decided not to take a stance.
"There are some physicians who are very much in favor (of medical marijuana) in end-of-life treatment," Sroka said. "But on the other side, doctors are afraid because we don't want to be stuck in the middle of patients and the law."
He said most doctors have kept an eye on the situation in California, where medical marijuana laws have been widely abused.
"It does become difficult for physicians because they become the legal gatekeeper," said Molly Weedn, spokeswoman for the California Medical Association.
More than a year ago, a research paper from the state association on the impact of marijuana led to the association calling for the legalization and regulation of cannabis.
"The way it is scheduled federally means you can't do the kind of research we need because there are so many restrictions," Weedn said. "Before doctors can say there are real benefits or there are real risks, they have to understand it."
As things stand with California's medical marijuana laws, Weedn said, doctors can recommend marijuana but can't be sure what patients are actually getting. She likened the situation to physicians giving recommendations to patients and sending them off to the pharmacy to have them pick out what they want.
"A doctor would never do that with a prescription," Weedn said. "For us, it's about patient safety."
At Anne Arundel Medical Center's oncology center, questions about medical marijuana come up "very occasionally" at this point, said Barry Meisenberg, director of the hospital's Geaton and JoAnn DeCesaris Cancer Institute.
Most of the time, alternatives are available for patients, Meisenberg said.
"It's important the public understands, for most people, there are drugs that control symptoms, including an oral form of THC (the active ingredient in marijuana)" he said.
"We'd be happy to have more information about the use of medical marijuana, because there's a lack of good information about it," Meisenberg said.
Meanwhile, MedChi has also pushed for academic institutions to be able to study medical marijuana's value. The organization is in favor of decriminalizing small amounts of marijuana.
The medical community is also watching how medical marijuana laws are implemented in states like New Jersey, Sroka said.
Dr. Joshua Sharfstein, the state secretary of health and mental hygiene, has supported the current legislation, which he said would give Maryland the strictest medical marijuana laws in the U.S.
That support seems to run counter to traditional public health messages against marijuana.
The county Health Department, overseen by Sharfstein's state Health Department, said its education materials won't be changing anytime soon.
The department wouldn't discuss whether school-aged children have raised questions about marijuana's health benefits in light of the state and nationwide debate about medical marijuana.
"The same message stands. We don't have any information about using marijuana as a pharmaceutical in our educational tools," said county Health Department spokeswoman Elin Jones.
At Pathways, an alcohol and drug rehabilitation center, experts have seen the damage done by illegally obtained marijuana.
Dr. Rhonda Allen, the center's medical director, said she worries that all the national talk about making pot more available muddies the message that marijuana is still a drug.
"My concern is young people who say, 'Oh, it must be OK,'" Allen said.
The substance does have a potential for addiction and is also often cited as a gateway drug, Allen said.
"The literature documents it can lead to amotivational syndrome, with chronic apathy, chronic dullness, a decrease in motivation, judgment, concentration," Allen said. "It can affect your heart rate, blood pressure, pulmonary function, drop in testosterone ... it's not a benign substance."
Bernstein, a specialist in internal medicine, acknowledged the risks -- and the amount of work it would take to regulate marijuana if it were made available for treatments. He is among the physicians who believe medical marijuana should be reserved for patients who have cancer or are terminally ill.
"If you do use it, you have to be responsible for it," he said. "It's not a benign drug. It can be a hallucinogen, it can impair your judgment, your ability to drive. It does have potential for abuse ... in a certain subset of people, it takes away inhibition."
But marijuana's efficacy for cancer patients, along with its relatively low potential for side effects when compared to other available drugs, makes it hard for the medical community to ignore, Bernstein said.
"There are more drug deaths from Tylenol around the world than any other drug. In terms of harm from a drug, it (marijuana) is much less harmful than many of the drugs we use on a regular basis," Bernstein said. "I think marijuana needs to be in the discussion." ___