Moving to address complaints about New York’s new medical marijuana program, the state’s Health Department is making substantial changes to expand access to the drug, including allowing home delivery, quite likely by the end of September.
The program, which saw its first dispensaries open in January, has struggled to gain broad traction in the medical community and with potential patients. Advocates for the medical use of marijuana have said the program, allowed by a 2014 law signed by Gov. Andrew Cuomo, was too restrictive, and its regulations too cumbersome to fulfill its mandate.
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On Tuesday, however, the administration of Cuomo, a Democrat, announced several new policies, including authorizing delivery to patients too ill to travel, and enabling nurse practitioners to certify patients as medically qualified for the drug. Unlike some other states, New York does not allow marijuana to be smoked, but it can be made into a variety of tinctures, sprays and other forms.
The governor’s counsel, Alphonso David, described the changes as legally prudent, made only after the state had sufficient information about how many patients were using the drug, which is still an illegal substance in the eyes of federal authorities.
“We don’t want the federal government to come in and exercise an enormous amount of oversight and shut the entire program down,” David said in an interview Monday. “We’ve always been interested in expanding the program. We just wanted to make sure we had the data to support it.”
Several of the changes, which the Health Department recommended in a report issued two weeks ago, will take place almost immediately; for example, the state will issue requirements to companies to begin delivery within the week, with such services anticipated to begin by the end of next month, David said. Additionally, regulations will be filed Tuesday to allow the expanded role for nurse practitioners, though such regulations are subject to a 45-day comment period.
Other changes include streamlining restrictions on manufacturing medical marijuana, and considering expanding the number of conditions that qualify patients to use it, including mental health issues like post-traumatic stress disorder and debilitating illnesses like Alzheimer’s disease. Residents are currently eligible if they have conditions like cancer, AIDS and epilepsy, though that roster of ailments has been considered too narrow by some advocates.
All told, David said the state intends to integrate all 12 of the Health Department’s recommendations, though several were still being reviewed, including a suggestion that the roster of five companies doing business in the state be doubled to 10. Each of those five extant companies are allowed to run four dispensaries, a scale that some have said is too small for a state with nearly 20 million residents. (Only 17 dispensaries are currently open.)
More brands of the drug will also be considered, David said, as will ways to ease access at health care facilities associated with educational entities, which may be wary of federal oversight.
Advocates for the medical use of marijuana said the governor’s actions were welcome. “A lot of the recommendations that the Department of Health made are things that the patients have been asking for for a year and a half,” said Kassandra Frederique, the state director of the New York office at the Drug Policy Alliance, which advocates more liberal drug laws.
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In particular, Frederique said delivery options could ease the problems posed by the state’s size and the lack of geographic diversity in the current dispensaries.
Indeed, delivery could make a huge difference for patients with debilitating pain, like Jessica Hargrave of Rochester. The closest dispensary is a 10-minute drive from her home, but it has only tinctures, which are meant to be put under the tongue. She bought $155 worth of tinctures, but said she got no relief. “It did nothing; it was like putting water under my tongue,” she said. “It was a big waste of money.”
Hargrave, 34, would like to try other formulations but cannot sit in a car for three hours to get to the next closest dispensary in Syracuse. “I need more options at my local dispensary,” she said.
The cost of the drug will not be addressed, though for those suffering from financial hardship, the state does intend to extend a waiver for a $50 registration fee. Unlike most medicines, marijuana is not paid for by insurance, so it is an entirely out-of-pocket cost for patients who are sometimes on disability and struggling to make ends meet; patients and providers say the cost of the drug can run anywhere from $200 to $1,000 a month.
“That’s a lot of money for an MS patient because many are unemployed,” said Dr. Michelle Fabian, an assistant professor of neurology at the multiple sclerosis center at Mount Sinai Hospital, where she has several patients taking cannabis for excruciating muscle spasms.
The five companies that have been operating in the state since January have also reported that it has been difficult to be profitable with the current volume of patients. According to the Health Department, about 675 physicians have been registered, with about 7,000 patients certified. But not all of those patients are necessarily consistent customers.
Potential patients have also complained that there is no publicly available list of physicians to consult, even though doctors can sign into the department’s website and find a list of participating doctors who are certified to recommend the drug.
Some doctors remain reluctant because marijuana remains a Schedule I drug, which means the federal government classifies it as having no medical use. Dr. Amy Piperato, an internist in Stony Point, New York, who has certified a couple of dozen patients for marijuana, said some doctors think, “Why put yourself at risk of liability of recommending a Schedule I product?”
David said he believed that the expansion of duties for nurse practitioners — as well as a new public list of participating practitioners, another proposal — would help the situation.
Moreover, he emphasized that the changes to the program were the natural next steps for a system that was designed to evolve. “This is enhancing the program,” he said, “so that we meet patient need and patient access.”