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NYers Struggling To Get Medical Marijuana Suspect Cuomo "Set This Up To Fail"
By
Steven Wishnia
Published Jan 14, 2016
Modified Jan 15, 2016
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By
Steven Wishnia
Published Jan 14, 2016
Modified Jan 15, 2016
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A week after New York State’s medical marijuana program officially opened January 7, it’s slowly expanding—but none of the 25 to 30 activist patients who campaigned hardest for it have been able to get any medicine.
“I have not yet found any who were able to enroll,” says Julie Netherland, deputy state director of the Drug Policy Alliance. As of January 12th, only 105 patients had registered, according to state Department of Health figures—and the number who actually bought medicine may have been as low as one: a 27-year-old woman with advanced ovarian cancer who went to the dispensary in White Plains.
Missy Miller, whose seizure-ravaged teenage son, Oliver, was the poster child for the emergency-access measure Governor Andrew Cuomo signed in November, laughs sardonically when asked if she was able to get him enrolled. “Nooo… it’s beyond frustrating,” she says. “We’ve fought and fought. I schlepped Oliver to Albany. I just can’t believe that none of us have access.”
When Cuomo signed the state’s medical-marijuana law in July 2014, it stated that the program would be up and running within 18 months. For that to happen, companies had to be licensed to manufacture the medicine—extracts only, not cannabis flowers or food made from cooked buds—and to run the 20 dispensaries permitted. Doctors had to be certified to recommend it, by passing an online course developed by the state Department of Health. Patients had to find a doctor licensed to recommend it and then be certified by the department.
As of January 12, eight of the 20 dispensaries had opened: one of the two in Manhattan, one of the two in Westchester County, and none of the four slated for the Bronx, Queens, Nassau, and Suffolk. Only 203 of the state’s more than 80,000 practicing physicians had signed up; the online class, which costs $249, wasn’t available until October. Patient certification didn’t begin until December 23rd.
The Health Department says the other 12 dispensaries “will open on a rolling basis” later this month. “Everything will be open by the end of the month,” says Nicholas Vita, CEO of Columbia Care, which opened its dispensary on East 14th Street in Manhattan last week. The company will operate three others, in Rochester, Riverhead, and Plattsburgh.
The department has also asked the five companies running the dispensaries to develop a delivery system for patients who can’t travel. That’s a major concern on Long Island, where there’s weak public transportation and the two dispensaries will be in Lake Success, just over the Queens border, and Riverhead, 60 miles further out beyond the end of the Long Island Expressway.
State law requires that dispensary operators agree to “labor peace,” not interfering with union-organizing campaigns. “Our position is that all medical-marijuana jobs should be good jobs with a living wage, benefits, and a union voice for working New Yorkers,” a spokesperson for the health-care workers union 1199SEIU says. While Nicholas Vita says he hopes Columbia Care employees choose to be represented by 1199, “as we are in the health-care industry,” they haven’t decided yet.
Vita is enthusiastic about the program. “The level of interest we’ve seen from physicians and patients has been incredibly encouraging,” he says. “We’ve had doctors’ groups calling from all over the area.”
He says the delays in getting the program going were not unreasonable. Columbia Care had six months to build its manufacturing center, in the Rochester area, including security, lights, and an organic gardening system, and then wait for the plants to flower, so it could produce the extracts. By the end of the month, he says, it will offer two tinctures for sublingual administration and two extracts for vaporization.
One version of each will have a ratio of two parts THC, the plant’s main psychoactive ingredient, to one part of CBD, cannabidiol, the compound believed to be an effective painkiller. The other will be 2-1 CBD over THC. A standard dose will be 1 milligram, with patients being able to take more or less as needed, and a month’s supply will cost $100 to $300, the company says.
“It can be measured for dose and consistency. That’s an amazing achievement,” Vita says. (One reason American doctors largely abandoned medical marijuana well before it was outlawed was that doses were difficult to quantify, and the herb could go stale.) He believes “patients are going to find this an alternative” for conditions like neuropathy, as cannabis doesn’t have the deleterious side effects of prescription pain medications, such as addiction and gastrointestinal issues.
Susan Rusinko, a 54-year-old multiple-sclerosis patient from the upstate city of Auburn, agrees. A former office manager and mother of three boys, she was diagnosed in 2000 and found that even a small dose of drugs like Neurontin and Xanax would leave her unable to function “until 2 in the afternoon.” Cannabis oil, on the other hand, “gave me the most complete relief that I’ve had from my symptoms in 15 years.”
However, the law requires that the doctor recommending cannabis to a patient has to be the one actually treating them for the qualifying condition—and Rusinko’s neurologist isn’t participating in the program. Trying to find a new doctor would be “a nightmare,” she says, and would likely be futile. The Syracuse-area patients’ group she works with sent letters to 60 neurologists about the program and got one response.
“New York totally overregulated this program. I’ve asked from the beginning: Did Cuomo set this up to fail?” Rusinko said. “Unfortunately, I’m going to have to keep my little black market friend for now.”
Inside Columbia Care (Miranda Katz / Gothamist)
Missy Miller was unable to find a neurologist willing to recommend cannabis for her son, who suffers from Lennox-Gastaut syndrome, a severe form of epilepsy that usually afflicts young children. Neither his regular doctor nor the epilepsy specialist who first recommended that he use cannabis are willing to sign up for the program.
“The biggest barrier remains trying to find physicians,” says Julie Netherland. “There’s a huge demand and a very limited supply.” That shortage can leave patients vulnerable to quacks, she adds.
According to the Daily Beast, the only doctor in Brooklyn certified to recommend medical marijuana has been reported to have run up thousands of dollars in Medicaid bills by doing unnecessary tests on residents of for-profit homeless shelters. He charges $150 in cash for a half-hour appointment and requires four visits before he’ll give a recommendation, the story said.
The Department of Health said earlier this month that it would “soon post a list of those registered physicians who consent to providing their names and specialties” on its website, but has since decided, Netherland says, to put the list on the Health Commerce System, an online portal available only to other doctors, and it hasn’t done that yet. It recommends that patients “speak with their treating physician” if they think medical marijuana might help them.
The conundrum of publicity is that if the list of doctors in the program isn’t easily available, patients will have a hard time finding them, but if their names are posted online, “they’ll have lines of patients begging at their door,” as Missy Miller puts it.
Doctors also fear legal problems, although the state law establishing the program explicitly protects them from criminal, civil, or professional penalties for participating. Justice Department memos in 2009 and 2013 instructed federal prosecutors that medical-marijuana activities legal under state law should not be a priority, but cannabis remains a Schedule I drug under federal law, classified as a dangerous drug with no valid medical use.
A larger concern, says Julie Netherland, is that between the low number of ailments cannabis is allowed for, the only 20 dispensaries for the whole state, and that each dispensary is allowed to sell only five forms of medicine, the program is “just so narrow and restrictive.”
Unlike California, which permits cannabis for any use a doctor authorizes, or Illinois, which allows it for migraine headaches and is considering adding chronic pain and post-traumatic stress syndrome, New York limits eligibility to people with one of 10 “severe, debilitating, or life-threatening conditions”: cancer, HIV infection or AIDS, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, spinal-cord injury with spasticity, epilepsy, inflammatory bowel disease, neuropathy, and Huntington's disease. These conditions must also be accompanied by an “associated or complicating condition” such as severe or chronic pain, severe nausea, or seizures.
The limited varieties of medicine permitted, Netherland explains, means New York patients and doctors can’t take advantage of the “dozens of therapeutic strains” bred in states with established medical-marijuana programs and less restrictive laws. In places like California, she says, dispensaries have gained a pretty good idea of what strains are good for what conditions, through experience with patients.
“Too many of those who stand to benefit the most from medical marijuana will face the highest barriers to access,” City Councilmember Mark Levine said in a statement last week. “The lack of any insurance coverage for medical marijuana will mean that low-income New Yorkers across the state will face financial barriers to accessing this important treatment. We must move quickly beyond the pilot stage and expand this program—geographically, financially, and clinically—to provide relief in the most equitable and widespread way possible.”
“I’m so disappointed. I’m shocked. How did we end up like this?” says Missy Miller. But, she adds, “we didn’t come this far to give up.”
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columbia care
governor cuomo
medical marijuana
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Steven Wishnia
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