The General Assembly is poised to pass legislation that would make Maryland the 19th state to legalize marijuana use for medical reasons -- though how quickly the state's cancer patients and others might benefit remains in question.
The state Senate gave the legislation preliminary approval Friday evening without debate.
The bill, which has passed the House, would allow the legal distribution of marijuana by doctors and nurses through academic medical centers. A commission would be set up to spell out the terms under which it would be grown and dispensed.
The O'Malley administration, which opposed medical marijuana legislation last year, withdrew its objections last month, giving a boost to legislation that has drawn bipartisan support.
But the administration qualified its support. Officials wanted the flexibility to pull out of the program if the federal government threatened legal action over what it still classifies as an illegal drug.
With that language now in the bill, Gov. Martin O'Malley is expected to sign it.
Dr. Joshua M. Sharfstein, the state secretary of health and mental hygiene, called the bill a "yellow-light" approach.
"I think it's a good framework to build an approach to this challenging issue," he said. He said several steps remain before marijuana can be dispensed to those patients whose doctors believe it would provide some relief.
The bill's sponsor, Del. Dan K. Morhaim, a physician, called it "landmark" legislation for Maryland.
Eighteen other states and the District of Columbia have medical marijuana programs. Although Maryland has passed a law authorizing medical necessity as a defense against marijuana possession charges, it has not created a legal pathway for patients to obtain the drug.
Morhaim, a Baltimore County Democrat, said the bill would create a "safe and responsible" program for dispensing marijuana, and one that will be closely monitored for its effectiveness through the bill's data collection requirements.
"I think we have a great opportunity to learn here, and that's really important," he said.
The bill, which is expected to receive final approval Monday, has drawn support from medical and nursing organizations, and from lawmakers of both political parties.
Senate President Thomas V. Mike Miller delivered his own endorsement this week. He told reporters his mother had died a "very lingering death" from cancer.
"If it helps people with cancer, I'm all for it," he said.
Dan Riffle, a lobbyist for the Marijuana Policy Project, which advocates legalizing the drug, called the Maryland bill "a baby step forward" and an indication that a broader shift may be occurring among state lawmakers in their attitudes toward marijuana. The General Assembly considered four bills this year that dealt with decriminalizing or legalizing marijuana.
But Riffle warned this bill's significance may be more symbolic than real unless the state's teaching hospitals get over their reluctance to participate.
The state's two leading academic medical centers, the Johns Hopkins University and the University of Maryland, have indicated they do not intend to get involved, according to a policy note on the bill prepared by legislative analysts.
"There are thousands of people in Maryland who have cancer, who have multiple sclerosis, HIV and AIDS," Riffle said. "If their doctors think marijuana can work for them, they should have access to it. Under the legislation passing now, the vast majority of those patients are still not going to be able to get access to it."
Other states do not rely on teaching hospitals to serve as conduits for dispensing medical marijuana.
A spokeswoman for Johns Hopkins Medicine indicated Friday evening that the institution is not unalterably opposed.
"Johns Hopkins is open to a conversation with the state about how a medical marijuana program could be implemented," spokeswoman Kim Hoppe wrote in an email. But she added that "right now, it would be premature to commit to administering or participating in such a program."
A spokesman for the University of Maryland, Baltimore, said that institution, too, would be willing to talk about a program. But spokesman Alex Likowski said the university still has "serious concerns."
"Regardless of whatever the state may do, dispensing marijuana is still a violation of federal law, and we would not want to do anything that would put our employees in jeopardy," Likowski wrote in an email. "So at this point, while the University is not foreclosing on the possibility of participation ... we cannot commit to involvement in a medical marijuana program."
Morhaim said he understood what he called a "cautious approach." He said one teaching institution, Sinai Hospital, has expressed interest, so "it could go faster than you think." He added that he hoped Hopkins and UM would warm to the program once they saw how it was working.
"I'm confident we'll get there," Morhaim said. "I think it's the right way to do it. The purpose of this bill is to help patients."