Three years after the state adopted a law enabling the use of medical marijuana, some 900 doctors are prescribing cannabis oil to more than 5,000 patients. But state health officials and lawmakers on both sides of the aisle say that more can — and should — be done to make the treatment more widely available.
New York joined the ranks of medical marijuana states in June 2014 following years of negotiation between the Democratic-controlled Assembly and the Republican-controlled State Senate. After a year and a half spent drafting regulations and vetting applications, the state’s first dispensary’s opened in January 2016. The resulting medical marijuana infrastructure is one of the most restrictive in the nation, narrowly tailored to allow only a select few, very sick, people to get it.
Medical marijuana prescriptions are available only to patients with one of ten “qualifying conditions” that include cancer, HIV/AIDS, ALS (commonly known as Lou Gehrig’s disease), Parkinson’s disease, multiple sclerosis, spinal-cord injury, epilepsy, irritable bowel disease, neuropathies and Huntington’s disease. An eleventh condition, chronic pain, was recently added to the list at the urging of health officials.
A simple diagnosis, however, is not enough to qualify for a New York State medical marijuana card. The condition must be linked to a qualifying symptom like lack of appetite, nausea, seizures and muscle spasms. The regulations extend to doctors who must take a course and obtain a special permit to prescribe marijuana.
Dispensing of medical marijuana is also tightly regulated. Out of 43 applicants, state officials authorized just five to open operations in New York State. Each company must be vertically integrated with its own manufacturing facility that can only supply its own dispensaries. The marijuana companies are forbidden to advertise, make any claims about their products or use on-staff physicians to evaluate patients. Other regulations govern everything from the use of specially designed safes to secure products to 24-hour video surveillance accessible to state health department officials at every dispensary. Manufacturing facilities can produce a maximum of five “strains” with differing ratios of the two of the most active ingredients of marijuana — tetrahydrocannabinol and cannabidiol. And, medical marijuana in New York may only be sold as an oil, not in its more common smokeable form.
“It’s the most restrictive law in the nation,” said Hillary Peckham, CEO of Etain, which runs four dispensaries in New York, including one on Route 28 in the Town of Ulster. “I think we would see more enrollment but it can be hard to find a physician. You have long waits to get an appointment, long drives to get there.”
One out of every hundred docs
Indeed, of roughly 90,000 licensed physicians in New York State, just 900 — about one percent — have obtained permits to prescribe marijuana. As of June 2016, 18 months after the first dispensaries opened, just 5000 people were enrolled in the program, a per-capita rate that lags behind other medical marijuana states. State assemblyman Kevin Cahill of Kingston said that the restrictive program was the result of real reluctance by Senate Republicans to consider medical marijuana at all. That reluctance, he said, was overcome by lobbying efforts of mothers of sick children with rare seizure disorders and other medical issues, but only at the cost of a less restrictive program that would allow easier access and a broader range of uses.
“In spite of our reputation as a liberal state, New York is really more puritan than cowboy,” said Cahill. “We were very slow on the draw on this, it was an uphill fight and the final results have been underwhelming.”
In a June 2016 report, the state Department of Health made a series of recommendations for expanding access to the medical marijuana program. Along with adding chronic pain on the list of eligible conditions, the recommendations include allowing for home delivery of medical marijuana, adding up to five new authorized distributors and streamlining the process for doctors to receive medical marijuana permits.
While Cahill lamented the restrictions on medical marijuana in New York, the regulations appear to have prevented the outcome many medical marijuana opponents most feared — medicalization of the drug as stealth legalization. In California, for example, before voters last year approved full-on legalization for recreational use, dispensaries in the state advertised heavily, offered an array of smokeable strains with names and attributes more commonly associated with dorm rooms than exam rooms, and employed physicians who could write a prescription on the spot before directing patients to the next room to fill it.
The relative laxness of the California law led opponents to deride “medical marijuana” as a fig leaf. They noted that the largest cohort of marijuana cardholders, according to a 2011 university study, were males in their twenties and thirties — a group known more for their enthusiasm for a good time than for suffering from an abundance of chronic illnesses. In New York State, meanwhile, the biggest single group of authorized medical marijuana users were between ages 51 and 60, while 18-to-40-year-olds made up just 23 percent of all cardholders.
Assemblyman Pete Lopez of Schoharie County said assurances of a well-regulated and strictly medical marijuana system helped him overcome an initial reluctance to support the bill. Lopez said that his ideal solution to the issue would be a move to switch marijuana from its current federal classification as a narcotic with no medical use, like cocaine and heroin, to a medical use like OxyContin that could be prescribed, regulated and researched while remaining illegal on the streets.
“If you stick with those controls, if it’s being used as a medication,” said Lopez. “It takes all of the sensationalism out of it.”
It does help, says MD
Dr. Maggie Carpenter said this week she’s seen first-hand both the benefits of medical marijuana and the difficulties in patients getting it. Carpenter is a New Paltz-based family physician whose practice is based on home visits. She recently began keeping office hours, in part to accommodate patients seeking medical marijuana prescriptions.
Carpenter said she sought a medical marijuana certification to help her own patients, many of whom suffer from chronic or terminal illnesses. But after hearing of critically ill patients who had to travel hours and sometimes pay hundreds of dollars out of pocket for consults with marijuana-certified doctors, Carpenter expanded her practice. Now, she said, she serves as a facilitator to enroll patients in the state’s medical marijuana program who have received valid diagnoses of qualifying conditions from local doctors who lack the state certification. Currently, Carpenter said, she has about 40 medical marijuana patients.
“Most of the patients I see are people in their 70s and 80s who have never used marijuana before,” said Carpenter. “It’s really for the medical benefits.”
Carpenter said that she’s seen the cannabis oil effectively treat conditions like Parkinson’s-based movement disorder and Crohn’s disease. She added that the oil was also helpful for patients trying to cut back their high doses of opiates used to control pain.
“The craziest thing for me is that I can very easily write a prescription for opiates, which are killing people left and right, but for marijuana there are all of these restrictions,” said Carpenter.
Legal for recreational here?
While New York has just joined the medical-marijuana era, other states have already moved on to the final frontier — legal recreational use. In November 2016, California, Nevada, Massachusetts and Maine voted to join Alaska, Washington, Oregon, Colorado and the District of Columbia in broadly legalizing recreational use and possession of marijuana. When state-licensed pot shops open in Massachusetts, currently scheduled for July 2018, millions of New Yorkers will be within easy driving distance of legal marijuana. Cahill, meanwhile, said that he had “no doubt” that legal recreational marijuana would win handily if it were put up for a vote in a referendum in New York State.
Pospects for full legalization in the state appear dim. Politicians have lagged behind voters in the long march of public opinion towards the idea of marijuana as a lid recreational high similar to alcohol. So far every state that has legalized it has done so through initiative and referendum, a method which does not exist in New York. Whatever enthusiasm did exist for a legislative push towards legalization, Cahill said, has dimmed with the election of Donald Trump as president and the appointment of old-school drug warrior Jeff Sessions as attorney general.
Cahill said that it was unlikely that Albany lawmakers would want to step into a potential showdown with federal authorities over the issue. Cahill said that while he and many fellow Democrats support legalization, their Republican counterparts have expressed reluctance to take up the issue.
“I think marijuana has some very important health applications and the prohibitions against it are overblown and perhaps reflect the prejudices of a different era,” said Cahill. “The reason the New York State Assembly has not advanced full and complete legalization is because there is no appetite for it in the State Senate.”
Instead, Assembly Democrats are pushing for broader “decriminalization” of marijuana, making possession of larger quantities or public smoking a civil offense similar to a speeding ticket. Even relatively conservative lawmakers like Lopez can envision a day not too far in the future where “smoke ’em if you got ’em” becomes the law of the land. “It’s a progression where every succeeding generation there’s less and less resistance to the idea,” said Lopez. “Ultimately the issue is whether it’s used in a controlled fashion and properly overseen, even if it’s used recreationally.”