Almost 25 years after Maine legalized marijuana’s medical use, the state may soon be cashing in on it – in a new way.

A wave of scientists, medical professionals and industry members are trying to discover new therapeutic applications for cannabis. So far, the results are promising.

Cannabis has been used as a medicinal plant for centuries, and a growing body of evidence suggests the drug could be used to treat a host of conditions. They include anxiety, chronic pain, nausea, epilepsy, Parkinson’s disease and opioid use disorder.

But because of a longstanding taboo and the plant’s federal designation as a Schedule I drug, the quantity and quality of research has been paltry. Studies that have been done are inconclusive, even contradictory.

Scientists call the situation a “Catch-22”: They can’t conduct research on cannabis until they demonstrate it has a medical use, and they can’t show the plant has a medical use until they conduct research.

But the catch may soon go away.

Since 2015, the National Institute on Drug Abuse has funded research surrounding cannabinoids and their therapeutic benefits. Spending on the studies has more than doubled since then. In 2015, the institute devoted $141 million to the research. It’s estimated that 2023 spending will total $328 million.

Eben Sumner, founder of Casco Bay Hemp and 1780, a medical cannabis provider in Biddeford, hopes Maine can capitalize on this growing interest and believes more research could help boost the floundering medical program. Sumner is also a founding member, legislative chair and lobbyist for the Maine Growers Alliance, and helped draft a bill he thinks will establish Maine as a leader in cannabis research.

“Medicine is based off of research. I think we absolutely have to have this to be able to call this a medical program,” Sumner said. “We’ve got so many claims everywhere. We need to start busting myths or proving theories.”

As they do that, he hopes more doctors will at least discuss cannabis with their patients. More prescribing doctors will bring more patients and then more providers.

“That research is going to be the rising tide that lifts all boats,” he said. “Eventually, there will be federal legalization, and someday it would be nice for the (Food and Drug Administration) to look at Maine as some sort of a model.”

The bill, sponsored by Sen. Craig Hickman, D-Kennebec, and on the docket for the Maine Legislature’s next session in December, would open a dormant pool of money designated in part for medical cannabis research.

Despite the delay, experts say it’s the perfect time to jump into medical cannabis research, both for the sake of science and Maine’s struggling medical marijuana market. It’s been hemorrhaging providers – known in the industry as caregivers – for the last few years.

An April report from the Maine Office of Cannabis Policy examines the “mass exodus” of 1,350 caregivers from the end of 2021 to the beginning of 2023.

Accounting for those who joined the industry, there’s been a net loss of about 950 caregivers over that time period. There were 2,070 caregivers as of March 31, according to state data. In 2021, there were 3,032. At its peak in 2016, the number was 3,257. There are about 106,000 patients with cards that allow them to receive cannabis for medical treatment.

‘A PERFECT DIRIGO MOMENT’

The proposed bill would create the Maine Medical Cannabis Advisory Commission, a group tasked with studying, analyzing and reporting findings about the use of medical cannabis to the Legislature. 

The bill would also create the Medical Cannabis Alternative Health Board, which would collect information and administer grants to researchers studying the efficacy and health effects of medical cannabis. The nine-member board, appointed by the commission, would evaluate “complementary health plant-based medicines and practices” that are, according to the draft language, “beyond the scope of conventional medicine.”

The Legislature’s Committee on Veterans and Legal Affairs ultimately tabled the bill with the intent for supporters to workshop it more this summer.

The mission of the advisory commission and alternative health board is not unfamiliar in Maine.

The state intended to sanction medical cannabis research five years ago. In 2018, state statute established the medical cannabis research grant program, which authorized the department to provide grant money from the state’s Medical Use of Cannabis Fund to “support objective scientific research” on the efficacy and health effects of harvested cannabis as part of medical treatment.

John Hudak, new director of the Office of Cannabis Policy, said the program didn’t get a lot of attention from his predecessor, Erik Gundersen, because there was so much else to do around the medical and adult-use programs.

But it’s a priority for Hudak, now five months in, to get the research program off the ground.

Prior to his appointment heading that state office, he led cannabis policy research for the Brookings Institution in Washington, D.C., and believes there’s still much potential for that work.

“I think it could be a great thing for Maine,” he said.

But Hudak said he is “vehemently opposed” to L.D. 1819 as written. He said the “industry-dominated” approach poses threats to the legitimacy of research conducted by the board, excludes advice from anyone outside the medical cannabis industry, and presents myriad potential conflicts of interest.

“As a Ph.D.-trained researcher who has had government grants fund my scientific research, I would be deeply skeptical of work being produced and/or funded by institutions like the ones designated here. This legislation falls short of any measure of scientific standards,” he told the committee in written testimony. 

Sumner isn’t deterred by Hudak’s opposition to the bill and said he’s amenable to adjusting who is on the board, though he wants to make sure the research funding would be available to people across the industry, not just universities or institutional review boards.

“I think this is a perfect ‘dirigo’ moment for Maine, and I hope we can get the Legislature on board,” he said. “It just needs some ironing out.”

CHANGING HEARTS AND MINDS 

And despite Hudak’s concerns, he supports the spirit of the bill.

“I believe increased research into cannabis or other plant-based products as a medicine should not be hindered, manipulated or impeded,” he said. 

There are a slew of unanswered questions and conflicting studies when it comes to medical cannabis, and researchers have the opportunity to find some really critical answers, he added. 

“Any way that OCP can facilitate that (research), I’m on board with it,” he said. 

The program is funded through industry participation registration applications and penalties for rule violations, as well as public or private donations. 

It was not immediately clear how much money is currently in the fund. Multiple requests from the Press Herald for the information were unanswered. 

Hudak said the agency is in the very early stages of rulemaking for the program, which will require legislative approval. He didn’t say what sort of research he would like to see come out of the program, as the office would help administer the funds but would not steer research in one way or another.

But he did say he sees it as an opportunity for researchers in government, hospitals and colleges to have access to a pot of funding that, due to the subject matter, can be hard to come by.

Because cannabis has so long been taboo, finding people to fund research was frequently a “brutal uphill battle” during his time conducting cannabis policy research. 

“Nobody wanted their name associated with cannabis,” Hudak said. But the more research is conducted, the more medical cannabis is normalized and the more people will be willing to consider its legitimacy.

“We’re not going to be funding a billion dollars out of OCP, but every little bit helps,” he said. “Additional research can change hearts and minds in the medical community.”

FEDERAL, STATE RESEARCH INCREASING

Far from Maine, the University of Mississippi had a monopoly over the cultivation of cannabis for federally sanctioned research for more than 50 years.

But in 2016, with interest in cannabis research climbing, the U.S. Drug Enforcement Administration announced it would be opening up its marijuana cultivation contract to other growers. 

After more than four years of delays, Brunswick-based Maridose LLC last spring was one of eight companies and institutions approved by the DEA to grow cannabis for federal research. There are only about 600 scientists across the country, including at least two in Maine, who have federal approval to study marijuana. 

“Although no drug product made from marijuana has yet been shown to be safe and effective in such clinical trials, DEA … fully supports expanding research into the potential medical utility of marijuana and its chemical constituents,” the agency said in its policy statement.

Paradoxically, the DEA wants licensees to have experience working with controlled substances but is reluctant to do business with applicants who are growing or working with cannabis – even in Maine, where the drug is legal. Growing in a state market doesn’t violate state law, but it’s still a federal crime.

Richard Shain, a former Procter & Gamble executive and product development specialist, teamed up with Tikun Olam, Israel’s largest legal grower and supplier of medical pot, to launch Maridose.

They’ve set up shop in TechPlace, the business incubator facility at Brunswick Landing. For now, the roughly 2,200 square feet is more than enough to get them started, but Shain said he has plans for a larger facility at Brunswick Landing that he hopes will get underway next year.

Shain said he envisions Maridose as “the Jackson Lab of cannabis research,” by supplying products to the 600 other federally licensed researchers while also doing its own. 

“We are focusing on the development of pharmacy and over-the-counter drugs,” Shain said, rather than trying to get into a state market.

He wouldn’t get into specifics of what Maridose-supplied research might entail. But he said the company plans to focus on areas such as opioid use replacement, pain management, arthritic and neuropathic pain, sleep, and anxiety.

Shain stressed that more research will be key to getting U.S. Food and Drug Administration approval, a necessary step in helping take marijuana “from the dispensary to the pharmacy.”

Some steps have already been taken.

The FDA has approved THC-based medications – dronabinol (Marinol) and nabilone (Cesamet) – for the treatment of nausea in patients undergoing chemotherapy and to increase appetite in patients with wasting syndrome due to AIDS.

The FDA also approved a cannabidiol-based liquid medication called Epidiolex for the treatment of Dravet syndrome and Lennox-Gastaut syndrome, two forms of severe childhood epilepsy. Cannabidiol, also known as CBD, is another chemical found in cannabis but does not provide the same intoxicating effect as THC.

According to the National Institutes of Health, several other marijuana-based medications have been approved or are undergoing clinical trials. For example, Nabiximols (Sativex) is a THC- and CBD-based oral spray that is currently available in the U.K., Canada and several European countries for treating pain that can accompany multiple sclerosis.

A ‘CATCH-22’

Outside of the federally permitted research, cannabis-focused academic centers have been popping up across the country. Maine colleges and universities teach cannabis courses but so far aren’t doing research.

In 2018, Pennsylvania became the first state to include a research component in its marijuana program, authorizing its medical schools to conduct studies with a state-licensed grower.

At Philadelphia College of Osteopathic Medicine, researchers are studying the drug’s impact on behavior, quality of life, cognition, chronic pain and opioid management. Doctor of pharmacy students at the college’s Georgia campus can pursue a concentration in medical cannabis.

Dr. Michelle Lent, director of psychosocial research for the school’s medical marijuana research program, said there’s a huge gap in the knowledge of what medical marijuana can be used for and how effective it is.

“As a medical school, we want to know from the evidence base what we should talk to patients about (concerning cannabis), but that’s very hard to do when there’s no data,” Lent said.

But the federal prohibitions on cannabis – and the state’s own restrictions – make it impossible for real clinical trials, or the “gold standard” of research, she said.

Instead, they’re focusing on observational studies for now, and they’re still “adding to the evidence in an important way.”

One of Lent’s recent studies looked at whether medical cannabis consumption had any impact on weight for patients with obesity. It didn’t, which Lent said could help alleviate concerns for patients and doctors worried that using cannabis could adversely impact a patient’s weight.

Lent said she expects results from some of the larger studies to be available in 2025. She’s excited about the work they’re doing and the opportunities it will open.

“Policy has moved faster than science,” she said, “but now we can catch up.”

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