CECIL COUNTY — Havre de Grace resident Connor Sheffield spent August in a hospital ICU, where he was fed intravenously because he wasn’t hungry and was unable to keep food down when he did eat.
For Connor, now 14, it was his latest setback living with dysmotility, a progressive disease of the muscles of the gastrointestinal tract, including the esophagus, stomach and small and large intestines, complicating the movement of food through his body.
The disease revealed itself in the form of acid reflux when Connor was a baby and then worsened over time to the point that surgeons were forced to remove Connor’s entire large intestines and one foot of his lower intestines in two operations.
Over the years, Connor had been on a myriad of prescription medications, but they barely brought relief to his chronic abdominal pain, nausea and related issues and often resulted in side effects that were sometimes worse than his symptoms.
“We tried all kinds of medication, but he’d have reactions and it didn’t work. He had a hard time eating. He was so nauseous. He was sleeping all the time,” his mother said, prompting Connor to interject, “I couldn’t even drink water. I’d get sick. I went long periods at times without eating. The longest was 14 days without eating.”
Hooking Connor up to IVs and feeding him, just to get him back on his feet again, also had its pitfalls. Because a considerable amount of his intestines had been surgically removed, it sometimes was hard for his body to keep up with the intake of liquid nutrients.
“When they fed him through his veins, it shot back out the tube,” his mother explained.
After his discharge in September, however, Connor and his parents reluctantly started considering replacing the prescription drugs with unconventional treatment: medical cannabis.
Plant brings back life
Medical cannabis became legal in Maryland in 2014, although it took a couple of years after then-Gov. Martin O’Malley had signed the General Assembly bill into law before the state established the existing regulatory Maryland Medical Cannabis Commission (MMCC), which falls under the Maryland Department of Health.
That, in turn, led to the issuance of state licenses to grow and dispense cannabis and to the creation of a system for participating physicians to recommend cannabis and for qualified patients to obtain medical marijuana cards.
“I will be honest. I don’t know about cannabis. I never smoked it,” said Tricia Sheffield, Connor’s mother. “People I know mentioned it to me (as an option), but all I could think of was someone smoking a joint and getting high. There is a stigma attached to it.”
As it turns out, a family friend of the Sheffield family owns a medical cannabis dispensary, Nature’s Care & Wellness in Perryville, and he strongly suggested that she obtain a medical cannabis card through his doctor as a consenting parent and allow Connor to try it.
“Connor is lying on the table, so sick and so tired, and (the dispensary owner) is saying, ‘I’m telling you I think it’s going to work.’ I told him, ‘You can’t be giving me false hope’,” Tricia recalled.
In December, after taking the proper steps through the MMCC, the Sheffields took Connor to that dispensary and discussed Connor’s disease and symptoms with one of the dispensing technicians — informally called “budtenders.”
The budtender determined which type of the countless strains of cannabis would best alleviate or possibly even eliminate Connors symptoms, in addition to how much and how often he should use it. He also decided the most effective way to take the medical cannabis, with the options including smoking it, eating it, drinking it, vaping it, wearing a patch, applying balm, and more.
Connor put a drop of tetrahydrocannabinol, or THC, oil under his tongue and also an oily drop of cannabidiol, or CBD, which is also derived from the cannabis plant.
“Literally, 20 minutes after I took it, I was really hungry and I didn’t feel sick anymore,” said Connor, who typically takes the drops about every four hours. “After I started taking it, I realized that I didn’t know how much pain I was really in all that time.”
Tricia remarked, “It was like seeing a withering, dying plant get watered and come back to life.”
Connor finally had a healthy appetite and the food stayed down, according to his mother, who noted, “Within a week, he was eating a burger. Eating is a necessity, but it is also a social thing and now Connor can do that.”
Asked what his favorite food is, Connor indicated that he is still making up for lost time when he replied, “I don’t have a favorite yet. I’m still trying out different foods.”
The amount Connor takes is small enough that the THC, the psychoactive component of cannabis, doesn’t get him high — but it does relax him.
“Pain and nausea makes you anxious, and it relieves his anxiety. He actually has more clarity and is more focused because he’s not focused on the pain and nausea,” his mother said.
Connor and his parents wish they would have turned to medical cannabis much sooner than they did.
“We wasted so much time,” Tricia said. “It was like witnessing a miracle, the way it helped Connor. But it’s not a miracle, it’s just a plant that grows naturally, right here on Earth.”
By the numbers
There are 66,055 certified patients in Maryland and 27,036 others who have applied and are awaiting certification, according to MMCC statistics.
Of those certified patients, 161 of them are minors who acquired their medical cannabis cards through certified caregivers, which, in Connor’s case, was his parents. Meanwhile, 123 other minors in Maryland have registered and are awaiting certification.
Broken down, 1,800 of those 66,055 certified medical cannabis patients are in Cecil County, MMCC figures show.
There are 1,419 providers in Maryland, including 816 physicians, according to the MMCC numbers. The list also includes 494 nurses, 92 dentists and 17 podiatrists.
In Cecil County, there are 18 registered providers and 98 caregivers.
Of the 102 that have been pre-approved, there are 77 licensed medical cannabis dispensaries operating in Maryland, according to a list on the MMCC website. In Cecil County, in addition to Nature’s Care & Wellness in Perryville, there is PharmKent in Elkton. Dispensaries can sell medical cannabis that has been produced only by MMCC licensed grow centers and processors in Maryland.
A list on MMCC’s website indicates that there are 15 licensed growers in Maryland, including SunMed Growers LLC in Cecilton, and 17 licensed processors.
The cannabis produced in this state is meticulously monitored from “seed to sale” through an MMCC computerized tracking system, with growers, processors, dispensers and patients having to adhere to long lists of strict regulations that, if broken and discovered, could result in fines and other penalties. Growing and processing centers and dispensaries are subject to random MMCC inspections.
Medical cannabis grown and processed in Maryland be sold in the state and must undergo independent lab tests to ensure that it is entirely natural, free of pesticides, heavy metals and other impurities, according to MMCC regulations.
A doctor’s perspective
Dr. Joel Meshulam, who is associated with Mercy Medical Center in Baltimore, has been practicing internal medicine for nearly 30 years.
Since February 2018, Meshulam also has operated a separate office in which he examines, consults and sometimes recommends medical cannabis to his patients as a MMCC licensed physician.
He noted that the MMCC recommends that registered doctors educate themselves about medical cannabis, before adding, “But there is no requirement.”
“I actually recommend, not prescribe,” said Meshulam, who spends an hour with every patient at the outset before deciding if medical cannabis is a viable option.
Meshulam explained that when he prescribes pharmaceuticals he specifies a dose but when he recommends medical cannabis, based on his knowledge of it, he suggests a general plan to help the patient and the budtender when they confer at the dispensary.
For example, he knows that the various strains of medical cannabis that fall under the sativa category make patients more active while the ones classified as Indica are calming. Meshulam also knows the properties of particular types of medical cannabis and which ailments they can be effective at addressing.
Under MMCC regulations, physicians can recommend medical cannabis only to patients who have qualifying medical conditions. The list of qualifying medical conditions includes severe chronic pain, post-traumatic stress disorder, glaucoma, cachexia, anorexia, severe nausea, seizures, persistent muscle spasms and cancer.
Patients with chronic or debilitating diseases or medical conditions who have been admitted to hospice or are receiving palliative care also qualify, as well as those diagnosed with any condition that is severe, for which other medical treatments have been ineffective, and for which the symptoms “reasonably can be expected to be relieved” by the medical use of marijuana.
There also is an “other” category in which the recommending physician must detail on behalf of his or her patient.
“More than 95% of the patients are cannabis naive. They used it in high school to get high. Many have no idea what they’re doing. I try to give them a recipe to follow,” Meshulam said.
Under MMCC regulations, a recommending physician must have at least one annual follow-up with a medical cannabis patient. Meshulam, however, readily avails himself to his medical cannabis patients.
The approach Meshulam takes in his dosing recommendations mirror the one he uses when prescribing painkillers and other pharmaceuticals.
“I micro-dose. It doesn’t take a large amount. Why use 50 milligrams to treat high blood pressure when 10 milligrams works?” Meshulam said, adding, “I give them guidelines to follow, and I try to be as specific as I can. If someone has severe anxiety, they should avoid sativa. I give them a hard copy of what I am trying to do to help when they go to the dispensary.”
Meshulam also considers his patients’ finances when recommending medical cannabis.
Insurance does not cover medical cannabis, which varies in price from dispensary to dispensary. At the dispensary in Perryville, a gram of dried flower cannabis is $12 to $16, according to Abby LaVigne, general manager at Nature’s Care & Wellness.
Meshulam is less concerned recommending medical cannabis than prescribing other medications, particularly opiates, which come with a long list of side effects, some severe, including depression and gastrointestinal issues, which lead to more prescription drugs. It’s also possible that a patient using prescribed painkillers could fatally overdose or become addicted.
“The question I get all the time with patients is, ‘Is this going to work?’ and I say, ‘Maybe, but it’s not going to cause harm.’ No one has ever died from a cannabis overdose. It will wear of in six to eight hours,” Meshulam said, explaining that adjustments to dose amount, cannabis type and so forth takes place if a patient has a bad experience with the original dose.
Meshulam also advised patients to be careful of those who claim medical cannabis is a surefire alternative to conventional medicine though.
“Every person is different, and so is every patient. I’ve seen some patients miraculously improve and not have to take their (prescription) medicine anymore. Some patients have tried it, and it didn’t work. It’s more in the middle. If a patient is taking eight pills a day and (medical cannabis) takes it down to six pills, that’s a 25 percent — that’s a win,” he explained.
Meshulam also sympathized with his colleagues who are concerned about the psycho-active effects of cannabis.
“There are many doctors who are still against (medical cannabis) because they don’t believe it. They believe that the patients just want to get stoned — and that may be true in some cases,” he said, before emphasizing that the goal is to strive for the lowest dose with the best benefits. “It doesn’t get you stoned, but it is psychoactive.”
In extreme cases, the improvement of a patient’s quality of life outweighs the psychoactive effects of medical cannabis, Meshulam opined.
“If you’re staring down the barrel of cancer and you have severe pain, stomach issues and a loss of appetite and this (medical cannabis) enables you to reintegrate with your family and improves your quality of life, that’s good,” he said.
Meshulam comes by his advocacy of medical cannabis, in part, because he is the nephew of Raphael Mechoulam, an 88-year-old Israeli who is an organic chemist and professor of medicinal chemistry at Hebrew University of Jerusalem and is widely known for his decades-long research in the medicinal benefits of cannabis.
“I believe in the science and I promote that because I love my uncle. He is widely revered as the grandfather of cannabis. I talk to him every few weeks,” said Meshulam, who spells his last name differently.
MMCC patient rules
A certified patient must purchase a $50 identification card from the commission before he or she can buy medical cannabis, according to MMCC regulations. They must show that card, which gains them access to the locked dispensary sections of dispensaries.
The card allows patients to purchase up to 120 grams of medical cannabis — about 4 ounces — or 36 grams of THC within a 30-day period. To avoid criminal charges, a patient must produce his or her medical cannabis card if a law enforcement officer catches him or her with the drug.
Patients are prohibited from operating vehicles, boats and aircraft while under the influence of medical cannabis, and they must sign a document to acknowledge that regulation. They also are forbidden to consume their medical cannabis in public places, including inside or on the grounds of dispensaries, and in vehicles, boats and aircraft.
Nor are they allowed to share and, or, sell their medical cannabis with other people, including fellow patients. Patients also are prohibited from transporting their medical cannabis across state lines. They also are not allowed to return unused medical cannabis to dispensaries.
Because employers have their own standards and rules, a medical cannabis card does not prevent an employee from firing that person if he or she fails a drug test.
The dispensing technicians, or budtenders, are the ones who direct patients to the type of medical cannabis they believe will best address their health issues, as well as the appropriate dose and the most beneficial way to introduce it into their bodies.
“Not unlike any medicine you prescribe, dosage-wise, you might have to play around with it. My first questions to a new patient is how much experience do you have with cannabis and what method of consumption do you want,” said LaVigne, from the Perryville shop. “We always say, ‘Start low and go slow.’”
After Nature’s Care & Wellness opened in January 2018, it serviced about 20 patients a day for a while, according to LaVigne. Now, between 100 to 150 patients buy their medical cannabis at that dispensary each day, she reported. Nature’s Care & Wellness now has 15 certified dispensing technicians.
“The stigma had been a huge hurdle,” LaVigne said, opining that the stigma has been decreasing as the number of people learning about medical cannabis continues to increase.
The only criticisms LaVigne has of the medical cannabis program in Maryland is that physicians are required to have only one follow-up per year with a patient and that most doctors don’t take a more interactive role in the dosing process.
“I don’t know what to call it, but ‘wrong.’ It’s backward,” LaVigne said. “I want to see doctors get more involved and do conferring.”
Dispensing technicians must be at least 21 years old, must be fingerprinted and must clear a criminal background check before they can be licensed through MMCC.
Once licensed, a dispensing technician must be educated annually on the most recent data regarding an array of topics, including “the pharmacology of cannabis and its active component, the potential therapeutic and adverse effects of medical cannabis, dosage forms of medical cannabis and their pharmacodynamic impact and potential drug interactions and consumer safety issues with medical cannabis,” according to MMCC regulations.
Dispensing technicians must “retain training materials and attendance records” and make them available to the MMCC for inspection.
Many of the budtenders in Cecil County have a personal knowledge of how medical cannabis can help with certain types of ailments, having gone through trial-and-error processes to address their own health issues.
“All of our staff are also patients. It gives them the upper hand when purchasing the (inventory) product and (advising) patients. We have to know the properties of each strain,” said Mary G. Giberson, assistant manager of PharmKent Wellness in Elkton. “The commission recommends yearly training, but we encourage our staff to constantly read, study and keep up.”
Reflecting the dispensing technicians’ training and personal research, their shop vocabulary when speaking to each other or when advising patients is quite extensive. It is not uncommon to hear words and terms like “cannabinoid,” “terpenes,” “RSO (Rick Simpson Oil),” “entourage effect,” “Delta 9,” “limonene,” “beta-myrcene,” “tetrahydrocannabinol” and many others.
To those who are not well-versed in medical cannabis, their explanations for how the components of the plant function and how they interact with other each other and the human body in certain situations seem quite complicated. It is evident that the dispensing technicians know a great deal about medical cannabis and are interested it. They also appear to be patient when it comes to educating patients.
“With new patients, we spend about an hour with them. For many of the patients we see, it’s often as a last resort that they’re here. They’ve tried prescription medicine. Pharmaceuticals will poison your body over a long period of time,” Giberson said. “We want to educate them. We want to improve their quality of life.”
Her general manager, Sharleen Kaiser, reported that PharmKent Wellness sees patients from all walks of life and of all ages.
“We have retail managers, teachers, military veterans, truck drivers, etc.” Kaiser listed. “We’ve even had retired out-of-state troopers come in here and say, ‘I never thought I’d ever be in a place like this.’”
Some of those patients, Boebel and Giberson believe, have discovered what the dispensing technicians already know — that medical cannabis can help in some cases.
Dina Boebel, a certified medical cannabis consultant at Nature’s Care & Wellness, knows firsthand how dramatically medical cannabis sometimes can help.
Diagnosed with scoliosis as a child, Boeble, now 45, had her first back surgery at 12 and she underwent five more operations in the following years. They left her with titanium rods in her back, a fused neck, severe pain and 17 prescriptions for an array of painkillers and antidepressants — all of which caused adverse side effects.
“I was in bed 20 hours a day,” Boeble said, adding that she was depressed, overweight and on disability. “The pills destroyed my liver, and I never drank (alcohol). My liver started bleeding so bad. The veins to my liver backed up and it affected my esophagus.”
For Boeble, who already had found some relief through her recreational use of ofttimes-hard-to-find marijuana, her agonizing liver issue was “a turning point.” She started researching cannabis, eventually quit her prescription medications and obtained a medical cannabis card.
“The pain went away — almost immediately. My depression went away. I lost 70 pounds and I got off disability,” said Boeble, who now consumes about 4 grams of medical cannabis a day. “I was 100% better, night and day. I didn’t know how bad I felt, until I felt better.”
One medical cannabis patient, who asked to be referred to as Bob due to the persistent stigma, is convinced that the plant he enjoyed during his youth more than four decades ago saved his life as an older man — in the wake of two bouts with cancer that led to chemotherapy, 32 one-hour sessions of radiation, the loss of one of his kidneys and a host of prescription medications.
“I was a child of the Sixties,” Bob admitted, before explaining that his use of cannabis these days is only to improve the quality of his life. “I wouldn’t have made it with the cannabis; I would have died. I couldn’t eat anything anymore. You go into a deep depression. The cannabis kept my head straight and I saw my appetite come back.”
Ron Smith, 45, said medical cannabis has helped him treat his social anxiety disorder.
“You see, I can’t even stop fidgeting, just sitting with you here right now. It’s very bad anxiety. My heart’s racing right now,” Smith said, squirming in his chair as he spoke. “This (medical cannabis) relaxes me. It calms me down.”
A 54-year-old Cecil County woman, who asked to be anonymous, would have never dreamed of smoking cannabis when she was younger — because she had a career as a nurse.
She retired after 35 years, 24 of which she spent working in an intensive care unit, and her career left her with a work-related ailment.
“Every nurse has a bad back,” she noted.
Her back problem caused chronic pain, for which physicians prescribed painkillers that brought some relief at a physical and emotional price.
“It caused a whole bunch of other health problems for me. It was awful. One day, my son said, ‘You need to get off all of those pills and smoke weed,’” she recalled.
Worn down by all of the side effects of her prescription meds, she explored medical cannabis as a possible alternative, obtained her MMCC identification card and found an appropriate dose with the help of Cecil County dispensing technicians.
“I am healthy now and off the pills,” she said.
A Harford County man, who also declined to give his name, said he “played around” with marijuana in the Seventies, decades before he turned to medical cannabis for relief after surgeons removed his toe due to a diabetes-related infection.
He, too, wasn’t pleased with the results from his prescribed pain medication and with the side effects they caused. Because of the throbbing foot pain he experienced at night, he took measures to replace his painkillers and sleeping pills with medical cannabis.
“It didn’t bother me during the day, but at night it hurt so bad I couldn’t sleep. So now, before I go to bed at night, I smoke a little bit (of medical cannabis) and it relaxes me and stops the pain. I can’t say either way if it stops the pain or helps me forget about it. All I know is it helps me sleep,” the man said.
He is certain there are a lot of people going through the same struggle that he endured, before trying medical cannabis, and is equally sure that it could help many of them.
“If they would stop and try it, it will help their lives tremendously,” he said.
Editor's note: This story corrected the scattered usage of the wrong name of the dispensary located in Perryville. It is Nature’s Care & Wellness, not Nature’s Way & Wellness. We regret the error.