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Source: www.baltimoresun.com

The Baltimore County Council has set the zoning rules that will govern where medical marijuana businesses can open in the county.

The unanimous passage of Councilwoman Vicki Almond‘s bill makes Baltimore County the first jurisdiction to tackle zoning issues surrounding medical marijuana, in advance of the state issuing licenses to growers, processors and dispensaries.

The growing and processing facilities also would be allowed in certain rural zones. In the agricultural zone, the facilities would be allowed without extra approval. In the resource preservation and environmental enhancement zones, the facilities would be allowed with a special exception.

Medical marijuana dispensaries will be allowed in business districts, provided they are 500 feet away from schools and 2,500 feet from one another. However, to locate in one of the county’s commercial revitalization districts, the business must get a special exception. The county’s 17 commercial revitalization districts are located in older commercial districts where the county is trying to spur improvements and new businesses.

Almond, a Reisterstown Democrat, praised her fellow council members for working on the bill in a “thoughtful and nonpartisan spirit.”

“This council is to be commended for doing what is was elected to do, and in my opinion, doing it very well under difficult circumstances that have been thrust on us by forces outside of our control,” she said.

Councilman Todd Crandell, a Dundalk Republican, co-sponsored some of the changes that require the special exception approval. He noted that the county is wading into “unknown territory.”

“We really don’t know if medical cannabis dispensaries, depending on where they are based, will be good for communities,” he said. “We don’t know if medical cannabis dispensaries will be the de facto dispensaries for recreational cannabis — should that be legalized.”

Councilman Wade Kach, a Cockeysville Republican, noted he sponsored a bill to legalize medical marijuana back in 1980 when he was a state delegate.

“Finally, in Baltimore County, in the state of Maryland, we’re finally going to have marijuana available to people who are sick,” he said.

Baltimore County Executive Kevin Kamenetz has said he doesn’t believe the zoning bill is necessary, but has praised the council “for taking its responsibility very seriously.”

pwood@baltsun.com
twitter.com/pwoodreporter

FDA Warnings Could Signal Start of Heavier Scrutiny on Cannabis Industry
By John Schroyer

In late February, the U.S. Food and Drug Administration sent stern letters to six companies peddling CBD products over what the agency said were unfounded medical claims.

The letters charged that the companies “misbranded” the products and warned that failure to correct the violations “may result in regulatory action without further notice, such as seizure and/or injunction.”

The move appears to mark the first time the FDA has cracked down on cannabis-related companies, raising concerns in the marijuana industry that this is the first shot across the bow.

Though cannabis professionals are used to federal intervention – such as raids from the Drug Enforcement Administration and lawsuits by U.S. district attorneys – the FDA has typically kept out of the cannabis fray.

Some insiders now wonder if the FDA’s recent action signals a larger policy shift at the federal level.

“Once you come out with this sort of acknowledgement, now you’re faced with, ‘What is the plan of the FDA to oversee this issue?’” said Avis Bulbulyan, a cannabis consultant based in California.

[DinaRollman300 FDA Warnings Could Signal Start of Heavier Scrutiny on Cannabis Industry] Bulbulyan noted that only CBD companies had received warning letters – not infused product manufacturers, some of which make similar claims about their products. He speculated that the FDA probably wanted to target smaller fish first and avoid a potentially much bigger battle with well-funded companies.

“If you take on one or two of the THC-infused product manufacturers, then you have a real fight on your hands,” Bulbulyan said. “I think (the FDA is) feeling their way around it.”

Zeta Ceti, of Green Rush Consulting in California, said this is likely a sign of things to come.

He advises infused products businesses and CBD companies to follow general FDA standards to avoid potential conflicts with the federal government down the road, and to prepare for the eventuality of oversight.

That way, “they at least have a fighting chance to prove they’re not breaking the law” if the FDA does initiate a crackdown.

“The FDA is going to step in eventually. It’s going to happen,” Ceti said.

Regardless, the issues brought up by the FDA will probably be fairly easy for most – if not all – of the six companies to resolve. The complaints mostly centered on online advertising regarding claims of medicinal benefits.

“We’ll absolutely modify our website to comply with the FDA,” said Moe Asnani, co-owner of CBD Life Holdings and the company’s web site, ultracbd.com, which was one of the targets of the FDA letters. “At this point, we’re just going to omit whatever information they want us to.”

Asnani is also a partner at Arizona Dispensary Solutions, which manages several dispensaries and also provides consulting services. He added that his attorney is crafting a formal response to the FDA warning, but that it won’t be a major problem to comply with the agency’s directives.

“We only had links to research articles, and we’re going to modify that,” Asnani said.

Sarah Brandon, a principal at Canna Companion, a Washington State-based company that also received a warning letter, said only in an email that her company is “working closely with the FDA…in order to take appropriate corrective action.”

Asnani and Brandon were the only principals at any of the six companies that agreed to comment on the story, and the FDA did not return a call seeking comment.

Another company that was served with a warning letter, South Carolina-based Twin Falls Bio Tech, now has a disclaimer on its site,arisitol.com, to clarify that its products are not FDA-approved. (It’s not clear whether the disclaimer predates the FDA warning or was recently added.)

Bulbulyan, for one, expects to see many more such notices from the FDA over the coming year.

“Now they’re in the fight,” Bulbulyan said.

John Schroyer can be reached at johns@mjbizmedia.co

By Dr. David Nagel
Source: nationalpainreport.com

Before we answer the question, we must first define what we are talking about, as the answer differs depending on what type of pain we are talking about. The goals of pain management are different for acute, chronic, and end of life (palliative medicine) pain care. For our discussion, we are talking about chronic pain, which we arbitrarily define as being refractory to tincture of time and our treatments, and having lasted more than 3 months.As many of you have probably been referred for “pain management” defining it is quite important. The answer, unfortunately, is not as obvious as it would seem. Even medical professionals struggle to agree with what pain management is, and that creates a big problem. There is a perception that pain management is all about needles and opioids, a perception that is unfortunately based on what happens in the real world. Needling and prescribing pay well, managing pain does not, so too often pain patients are needled and drugged in a piecemeal fashion with no attempt to look at the big picture of their lives. Many patients seem bewildered and disappointed with the process. What they receive is not what they were promised, that being a cure, and this upsets them. This creates an agenda crisis, one which threatens the success of treatment. So, we need to get on the same page. That is where the challenge begins, and this is my modest attempt to accomplish this lofty goal. As 100 million Americans are affected by chronic pain, 35 – 40 million with “high impact chronic pain,” this is not a trivial topic when it comes to human lives and dollars.

The challenge begins with the party line of the medical profession, those who supposedly offer this treatment. Several years ago, I stood up at a national meeting and asked my colleagues what we mean by pain management. The reason I asked the question is all that we had talked about for several days is where to put needles, scalpels, electrical stimulators in patients’ (and mouse’s’!) in order to eradicate(?!) their pain. The proponents proudly referred to themselves as “interventional pain management specialists,” a pronouncement which immediately shot their noses in the air relative to their less invasive colleagues. They promised such wonderful results. The shine off their needles blinded them to the reality that the success rate of any of their procedures is really not that great. It certainly does not even come close to matching the reimbursement potential. Cure almost never happens. More often than not patients spend incredible amounts of time and money only to end up right where they started, no better, perhaps worse.

So, the question I posed to my colleagues was important. They struggled to answer, and there really was no consensus. Recently I attended another national symposium where the same question was again asked, again with the same lack of consensus.

Last year I attended a meeting to discuss and plan the National Pain Strategy. Towards the end of the meeting, we broke into groups to separately discuss the six parts of the strategy. I chose to attend the community advocacy meeting. In our group, I was one of only two physicians, the other an academician, I, a clinician. The others in our group shared three things in common. First, each suffered from some form of chronic pain. Second, each had been through the medical mill and had come to some form of acceptance of his or her pain and the altered lifestyle so created. Third, each served as the leader of a community advocacy group. In sometimes not so subtle ways, in our discussion they provided the definition of pain management that had eluded the supposedly more learned medical experts.

First, pain management is NOT a CURE! While it may be reasonable to never abandon hope for a better future, one must learn to accept the current reality and adapt as best as possible. There is no universal understanding of pain, nor a universal solution. As long as these elude us, cure is not possible.

Second, acceptance is never easy. Giving up the past creates a sense of loss. And so, the sufferer grieves. That is a normal process that entails feelings of denial, guilt, anger, and depression, not in any specific time frame or order. For one to come to an acceptance, one must go through this process, and it is the role of pain management to assist the sufferer in this process.

Third, chronic pain affects the whole of the person, biologically, psychologically, socially, and spiritually, and it is incumbent on pain management professionals to acknowledge each of these areas of the person’s life in the treatment plan.

Fourth, there is no professional who has cornered the market on an understanding of how pain affects all of these aspects of a person’s life. Therefore, pain management must be interdisciplinary, meaning pain management requires a team of professionals who work, not in parallel, but together, communicating readily so all are on the same page. There is no “I” in “team,” and in my experience, it only takes only one individual acting outside the team to sabotage the whole process. It is crucial all accept that the patient’s best interests are always paramount, not those of any member of the treatment team. Sometimes the patient will have to hear things he doesn’t want to, but that is the role of tough love. In this model, interventional pain therapies may be a part of pain management, not the whole. Therefore, interventional pain treatment, by itself, is not pain management.

Fifth, and related to four, the patient and her family are very important members of the team. Unlike the more common medical model of “guidance-cooperation,” “mutual-cooperation” is the goal in pain management. Each member of the team is equally valuable, all have something to contribute, and all should be valued, especially the patient and family.

Sixth, the team is not limited to those in the immediate vicinity of the sufferer. While we accept the patient, family, various health care professionals, counselors, therapists, vocational planners, etc. as part of the team, the team actually involves all of society, and that is crucial to understand in planning public policy. Those in the workplace, insurers, government regulators, public policy makers, neighbors, and many others have an incredible ability to help or harm those who suffer. In my book, Needless Suffering; How Society Fails Those With Chronic Pain, (University Press of New England, July, 2016, http://www.upne.com/1611689624.html) I argue too often these “team members” to often harm more than they help, and that must be addressed in creating public policy to address crisis of chronic pain.

Seventh, the long term goal of pain management is self-management. Pain will probably present for the remainder of the patient’s life. Over time, the role of the treatment team will diminish and that of the patient increase. The patient must be given the skills to self-manage their problem and those around them given an understanding of how to help, understanding that the extremes of abandonment and enabling are equally un-productive and potentially harmful. In this model, support groups can be very helpful, in assisting the sufferer. Empowering the patient in this way is very powerful.

I propose, then, this seven part definition of pain management. The problem is this complex definition challenges the simple we wish for, but our failing to acknowledge the complexity of pain management is why we fail in our current ministrations. From a practical standpoint, this model challenges the financial status quo of many of the team members. I fear that is why such a model fails in practice. However, at some point, for us to succeed, we must put aside our own needs for the good of others. Hmmm. Sounds like the Golden Rule my mom and others taught me in kindergarten. Some things never change.

Dr. David Nagel is a New Hampshire specialist in physical medicine and rehabilitation, who been practicing pain management for 28 years in private practice in Concord, New Hampshire. His book Needless Suffering: How We Fail to Manage Chronic Pain will be released in 2016.

Download PDF of presentation by Eric Sterling to Anne Arundel Medical Center on Medical Cannabis in Maryland.

Rescheduling Marijuana: Panacea or Red Herring?
By John Schroyer
http://mmjbusinessdaily.com

A fair share of cannabis professionals have long believed in a relatively simply solution for the industry’s problems: Reschedule marijuana at the federal level.

Despite some apparent recent progress on this front, other industry veterans think it’s not going to be quite that easy.

Calls to remove the plant from its current classification as a Schedule I drug on the Department of Justice’s list of controlled substances have come from all corners of the political sphere. Most recently, abipartisan bill introduced in the U.S. Senate would move marijuana from Schedule I to Schedule II. President Obama has also commented in general terms on the rescheduling issue in recent days.

The bill follows a policy memo in January from the American Academy of Pediatrics urging the Drug Enforcement Administration to make such a move on its own and thus pave the way for medical research.

Additionally, many advocates argue that cannabis obviously doesn’t belong in the same category as heroin, LSD and ecstasy, which are all widely agreed to be much more dangerous than marijuana.

But what practical effects would rescheduling have for businesses already operating in the marijuana trade?

Taxes, Medical Research Benefits

“In terms of the industry, the most important thing is the way it would affect taxes,” said Jacob Sullum, a senior editor at Reason magazine who penned an in-depth look at the question last year.

Sullum noted that the 280E section of the U.S. tax code, which prevents marijuana companies from deducting many ordinary expenses from their federal taxes, only applies to businesses that deal in Schedule I or II drugs, but not Schedule III or lower (the DEA has five schedules for controlled substances).

“It would be huge, huge, huge,” said Dave Spradlin, a board member of Magnolia Wellness in Oakland and River City Phoenix in Sacramento.

Spradlin, who is a former director of both dispensaries, estimated that if the DEA did take the step of recategorizing marijuana as a Schedule III substance or lower, his two dispensaries could save half a million dollars a year in taxes.

“It would be a game changer, for sure,” Spradlin said.

Rescheduling would also free up researchers to begin looking more seriously into the health benefits and drawbacks of MMJ and protect businesses and patients from prosecution.

Many advocates in favor of the change point to the growing amount of scientific evidence that marijuana does have – contrary to the Schedule I definition – numerous medical benefits.

But that doesn’t mean rescheduling marijuana would solve all of the industry’s problems, said California attorney Khurshid Khoja.

Even if lowering marijuana’s place on the schedule did grant major tax breaks to cannabis companies and open the door for more medical research, that might be about the only two real noteworthy benefits, Khoja said.

And other noted cannabis activists agree with him.

Rescheduling vs. No Scheduling

“The whole idea we should reschedule marijuana is just a red herring,” argued Dan Riffle, director of federal policies at Marijuana Policy Project. “Obviously, it has no business being Schedule I. But our point is that shouldn’t be scheduled at all. And moving it to Schedule three or four or five wouldn’t change the fact that it would still be illegal to possess and use marijuana, whether for medical purposes or adult use.”

Riffle argued that the political reality is that marijuana activists will only get “so many bites at the apple,” especially at the federal level, so the focus should be either full legalization or a bill that grants states exemption from the Controlled Substances Act, such as the new Senate measure.

Furthermore, while the current Senate bill would solve the 280E tax deduction problem for medical cannabis companies, rec vendors would remain exposed.

In other words, what’s really needed is formal congressional approval for marijuana industries in states such as Colorado and Washington, as opposed to the current administration’s approach of issuing guidelines for avoiding federal intervention.

Eyes on 2016

Khoja guessed that at the soonest, rescheduling might become politically feasible after 2016, when more states are expected to either legalize recreational use or join the 32 others that have some form of legal medical marijuana.

“The more electoral votes are represented by that cannabis majority, the better. It’s more likely than not that we’ll have a serious discussion about it after the 2016 elections,” Khoja said.

Rescheduling probably wouldn’t have any bearing on the problems cannabis companies have obtaining banking services, Khoja said. And even if the new Senate bill passes, with its provisions regarding protections for bankers who work with the cannabis industry, that doesn’t guarantee that banks will jump at the chance to provide services for marijuana companies.

Regardless, it’s unlikely that cannabis will be reclassified anytime soon by the DEA, and it’s hard to say what the chances are for the new Senate bill that would move cannabis to Schedule II.

All of which makes 2016 so important, according to many in the industry. If several more states legalize rec next year, then cannabis companies could truly become an industrial and political juggernaut.

John Schroyer can be reached at johns@mjbizmedia.com