Sixteen months ago, Iggy Stefanski began a grueling journey to kick his addiction to opioids. Suffering from Crohn’s disease, sciatica and other health issues that give him chronic pain, Stefanski’s physician wrote him a prescription for oxycodone. But, as with many users, the painkiller’s efficacy quickly wore off. He told the doctor, but little changed.
“My doctor kind of stopped working with me at that point and just told me, ‘Here take the oxy’s,’” says Stefanski, who lives in Baltimore County. “The next thing I know, two became four and four became eight… It became a problem. I didn’t realize it had become a problem by the time it was a problem.”
After a family intervention, in July 2017 he went clean—with the aid of marijuana, he says. While not yet for sale in medical dispensaries at the time, Stefanski found using the cannabis helped to tackle severe withdrawal symptoms—tremors, nausea, stomach cramps, diarrhea—not to mention the very pain he’d been suffering from in the first place.
Since Maryland’s regulated cannabis industry got off the ground last December, his options have improved. A registered patient who also works as a dispensary agent for Nature’s Care and Wellness in Perryville, Stefanski says he’s since transitioned mostly to concentrates, like oils and distillates, and tablets, finding they’re more therapeutic for him than the buds most people consider when they think of marijuana.
“Once the program started for me and I started using those options, I noticed that my issue started to become a non-issue,” he says. “Now I don’t even think about it.”
And Stefanski wants others suffering from addiction to have the same chance, as registered cannabis patients. He and Aaron Shepherd, who also used cannabis to press through withdrawals from opioid addiction years ago, today are filing a formal petition to ask the Maryland Medical Cannabis Commission to put opioid addiction on its list of qualifying conditions for patients.
The regulatory agency allows such requests. MMCC guidance says it “will conduct at least one public hearing each year to evaluate any petition(s) submitted to consider other medical conditions, medical treatments or diseases.” Any petition must lay out why other treatments are ineffective, cite evidence or research and include letters of support.
The pair have done just that, calling out to a handful of studies about the efficacy of cannabis in treating opioid addiction compared to other medications like methadone, buprenorphine, benzodiazepines and naproxen. “A person cannot overdose from the use of cannabis,” their letter notes.
They’ve gotten letters of support from lawmakers, including Sens. Ronald Young (D-Frederick County) and Brian Feldman (D-Montgomery County) as well as doctors registered as providers (those state-certified to recommend a patient for medical cannabis), Libertarian gubernatorial candidate Shawn Quinn and, maybe most notably, the national medical cannabis advocacy group Americans for Safe Access.
“For the sake of Marylanders suffering and dying from opioid addiction, it is necessary that we consider all methods and resources that have the potential to save lives and assist in recovery,” Young wrote in his supporting letter to MMCC Executive Director Joy Strand.
As enacted in 2014, Maryland’s medical marijuana law allows registered providers to prescribe cannabis for 10 conditions: cachexia, anorexia, wasting syndrome, severe pain, severe nausea, seizures, severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder and chronic pain. Per the most recent state figures, as of Oct. 5, more than 64,000 patients and 3,900 caregivers have registered with the commission.
But Shepherd and others say opioid dependency is glaringly absent, and adding it could help address a public health issue for which Maryland’s governor has declared a state of emergency. Last year alone, 2,009 people died of opioid-related overdoses across the state, nearly double the tally from 2015 and quadruple that of 2010.
“I’m just looking at it from a saving lives point [of view],” says Chris Levelle, manager of CannaBay Docs in St. Mary’s County, who also penned a letter of support. “Obviously it’s not ideal, in a perfect world, to just replace one drug with another. If someone could just come off a drug then it’d be perfect. But this is an immediate stopgap in the addiction epidemic.”
Studies have tied the legalization of medical marijuana to drops in opioid-related overdose deaths, and patients have told researchers they felt reduced side effects or, per a study of drug users in Vancouver, Canada, were more likely to remain in treatment. A RAND Corporation study published this year found, in particular, that overdose fatalities dropped in medical cannabis-legal states with actual dispensaries, rather than just legalized home growing.
Other states are giving cannabis a shot as an addiction solution. Pennsylvania in May became the first one to allow the plant as a treatment for opioid abuse disorder. New York followed in September, and New Jersey is considering a similar change. Others, such as Illinois, are now allowing it as a substitute for prescription pain medication.
Cannabis gave Shepherd much-needed relief when he was having withdrawals from pain pills more than a decade ago. “When you’re coming off opioids, you get tremors and cold chills running through you all the time,” he says. “Cannabis totally calms you down. Take a puff off of a joint or whatever and you go from 1 to a 10, totally opposite.”
Fellow patients have expressed support for the petition, citing their own experiences weening off of prescription drugs, he says.
After today’s meeting—he and Stefanski are set to meet with Strand this afternoon at the MMCC’s Linthicum headquarters—the agency can schedule a public hearing. Thereafter, it can approve the petition or deny it on the grounds that it’s “facially insubstantial” or involves a condition, treatment or disease that the commission has already rejected.
Stefanski and Shepherd aren’t the first to pursue this cause in Maryland, though they’re confident their petition will be the most comprehensive one submitted yet.
The Maryland Medical Dispensary Association announced it would submit one this past summer, in partnership with another industry group, the Maryland Wholesale Medical Cannabis Trade Assocation (CANMD), to add opioid abuse disorder as a qualifying condition.
MMCC spokeswoman Jennifer White confirmed the agency received a letter calling for that condition to be added to the list, but did not say from whom. Baltimore Fishbowl has reached out to both industry groups for more information on their petition and its outcome.
White says she’s heard similar testimonials to Shepherd’s and Stefanski’s at public and outreach events.
“I constantly have folks that come up and tell me—and a lot of times it’s veterans—that they have been on opioids for years, and they have found so much relief by using cannabis instead of opioids. I can’t tell you how many people have told me that, more so than any other condition.”
Still, she says what’s missing to back up those testimonials is federally funded research. Despite 29 states and D.C. having legalized medical marijuana, federal drug policy still classifies cannabis as having “no currently accepted medical use and a high potential for abuse.”
As NPR reported in April, this stubborn policy has hamstrung research, with only one facility in Mississippi growing federally sanctioned marijuana (and testing it in a less potent, strange powder form, no less), and stopped scientists from gaining FDA approval for treatments utilizing medical cannabis. (The lone exception: Epidiolex, a purified form of cannabidiol, commonly known as CBD, to treat two rare forms of epilepsy.)
And while federal lawmakers have mounted their largest-ever push this year to remove barriers to research marijuana as medicine, the Trump administration has resisted those efforts, with Health and Human Services Secretary Alex Azar even opining in March, “There really is no such thing as medical marijuana.”
White says federally funded, documented research would help to bolster testimonials that this really could be a solution for opioid addiction. Personally, she says, “I haven’t heard any reason that it shouldn’t be.”
Not all states that considered such a change went along with it. In Hawaii, Gov. David Ige vetoed a measure passed by state lawmakers this spring to authorize medical pot as a treatment for opioid addiction, saying any such effort should happen through the state’s petition process (as Shepherd and Stefanski are trying here).
And in Connecticut, a board of physicians that sets rules for the state’s medical marijuana program rejected such a move, citing a lack of research and concerns that allowing cannabis as an addiction treatment could interfere with proven alternatives like buprenorphine or methadone, or cause patients to relapse.
“The anecdotal evidence is compelling,” UConn Health professor and state physician board member Linda Barry said according to the Hartford Courant, but “it’s single stories rather than a large pool of people that shows a trend, a trend that’s repeatable and substantiated.”
Here in Maryland, Levelle, manager of CannaBay Docs, questions the logic of rejecting a treatment that could help users come off of opioids when people are dying of overdoses everyday. Addiction is prevalent in Southern Maryland, he notes. He’s seen people die in front of him.
“Anybody who stands in the way is standing on the wrong side of the fence,” he says.
As the state approaches one year of having its industry off the ground, Shepherd says regulators should re-examine their list of conditions to help people seeking to get unhooked from pain medication.
“They’re missing out,” he says. “Maryland citizens are missing out on a big opportunity to get their lives together.”