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What you need to know for 01/21/2018

New York medical marijuana program continues to grow

New York medical marijuana program continues to grow

Effect of harder line by feds against recreational pot hard to gauge
New York medical marijuana program continues to grow
Photographer: Shutterstock

CAPITOL — New York is taking steps to expand — and is prepared to protect — its young medical marijuana program, as the federal government takes a potentially stronger stance against the drug.

U.S. Attorney General Jeff Sessions on Jan. 4 ended an Obama-era policy that limited federal marijuana prosecutions. Guidance is lacking on what, if any, changes the medical marijuana industry may face as a result. The move comes as marijuana's acceptance is on the rise nationwide. As of Tuesday, eight states had legalized recreational marijuana use in some way. On Wednesday, Vermont became the ninth (the first to do so by legislative act).

A temporary provision barring medical marijuana prosecutions by the federal government in the 29 states where pharmaceutical marijuana is legal will expire on Jan. 19, though it has solid bipartisan support and has been extended routinely in the past. Sessions, in a 2017 letter to congressional leaders, said that provision impedes law enforcement activities.

“We will review any forthcoming guidance from the federal government with a goal of continuing the [medical marijuana] program and protecting the patients and providers who participate in it,” said Dr. Howard Zucker, New York state's health commissioner, in an emailed response to questions about the development.

As of Tuesday — two years and two days after the first marijuana dispensaries opened in New York — 1,405 medical providers and 40,934 patients have registered with the Department of Health to participate in the state program, a significant increase from just five months earlier (1,155 and 26,561) but still only a small portion of the state’s 100,000-plus eligible health care providers and nearly 20 million residents.

Only a handful of physicians, physician assistants and nurse practitioners in the Capital Region are certified to prescribe marijuana products. (Under New York law, the marijuana plant is not prescribed — just an extract in pill or other forms.) Two of those certified doctors spoke to The Daily Gazette for this story.

SEEING BENEFITS

Dr. Jacquelyn McLean Bennett, of the Center for Family Practice in Latham, has been prescribing marijuana since October 2016, and her patient roster is nearing 100, as patients of doctors who don’t prescribe marijuana come to the Center for Family Practice for the prescriptions. It got so hectic that she pushed a colleague at the practice, Dr. Theodore Hausler, to obtain certification as well.

“Over the summer, I got so busy, it took over our schedule,” Bennett said. “The both of us are really busy. We’re seeing not only patients from within our practice, but patients from within the community as well.”

Their patients have a range of problems, from chronic pain to inflammatory bowel disease to post-traumatic stress disorder. 

“We are seeing a lot of veterans who have PTSD,” she said.

There are also a lot of cancer patients coming in, since none of the oncologists in the Capital Region have opted to obtain marijuana certification.

Bennett has treated enough patients over a long enough period of time to be convinced of the benefits.

“I’ve seen people’s lives change because of this,” she said.

Another benefit: It’s a safer treatment than some painkillers.

“I would really like my patients who are on chronic opioids to be off them,” Bennett said.

One obstacle is cost, she said. Medical marijuana is expensive, and because it is classified as a Schedule I drug by the federal government — a drug with no currently indicated medical use and a high risk for abuse — health insurance will not cover it.

Despite its longstanding antipathy toward marijuana, she does not think the federal government will target medical uses under whatever harder policy it adopts under the Trump administration.

At the state level, Bennett does not find the regulations onerous. She took the required instruction on a Monday, found it easy, and had her certification by the end of that week.  

Bennett does see a problem in the limitation of dispensaries. New York doubled its registered providers of medical marijuana to 10 in 2017, but those providers are limited to having no more than four dispensaries each. There are large swaths of the state with no nearby locations to get prescriptions filled.

The heart of the Capital Region is well-served, with one dispensary each in Colonie and Guilderland, 1.5 miles apart. Another is planned in Saratoga County. The next-closest sites are in Kingston, Plattsburgh and Syracuse.

ONEROUS PROCESS

In Clifton Park, two health providers at Community Care Family Medicine recently became certified to prescribe marijuana: family nurse practitioner Julia Gross and Dr. Eric Schnakenberg, a family physician.

Schnakenberg was less enamored of the state certification process than Bennett, finding it time-consuming and, at $250 a head, a little expensive. There’s also a lot of paperwork involved in each prescription, he said.

Finally, he and Gross don’t want a lot of people walking in just for medical marijuana, so they’re writing prescriptions only for current Community Care patients.

That said, he’s eager to see the benefits of what he is convinced is a safe product.

“My main interest was if I could switch chronic pain patients off opioids,” Schnakenberg said.

He also found a number of pain patients self-medicating by smoking illegal recreational marijuana. Smoking anything is bad, he said, and marijuana sold on the street is worse, since it could be tainted with fungus. Worse yet is the apparent impact on the developing minds of younger smokers.

And, finally, it’s illegal.

“I don’t think the stuff they’re buying in the street is safe,” Schnakenberg said. He added that he does think the extracts sold statewide are safe.

He said there is a ready audience for medical marijuana in New York.

“I’m seeing enthusiasm for it, but I’m not really seeing a lot of clinical improvement,” he said. Three potentially key factors in not seeing improvement: He just started prescribing it only a month ago — Gross about three months ago. Between them, they’ve written prescriptions for only six patients. And he’s prescribing the minimum possible strength to start with, not knowing the potency and effects.

“This is uncharted territory for us," he said.

But it’s something Schnakenberg wants to continue with, despite the obstacles. In a hopeful sign, one chronic pain patient is able to sleep better now, having been prescribed marijuana, he said.

He doesn’t think the federal government will put on the brakes.

“I think the feds are going to be more concerned about illegal use of the weed,” he said. “I don't really see this as an issue.”

INDUSTRY OUTLOOK

Vireo Health of New York was one of the original five companies registered to provide medical marijuana in New York. As per state law, it is vertically integrated, growing marijuana and processing its extracts at a facility in Fulton County, then selling the medicine from dispensaries in Albany, Broome, Queens and Westchester counties.

Its CEO, Ari Hoffnung, said New York’s program has made good progress but has a way to go before it can be called a strong program or support a strong medical marijuana industry.

“We’d like to see a lot more growth in the months and years to come,” he said, noting that barely 1 percent of the medical providers able to obtain certification to write marijuana prescriptions have done so.

The issues are complicated and not unique to New York state, Hoffnung said. They range from medical marijuana not being covered by insurance to health care providers not knowing how, if or when to prescribe it.

It is essentially absent from medical school curricula, he added.

Vireo works with the Department of Health and other stakeholders to try to address these issues, he said, and the fundamental differences between state and federal marijuana policies complicates the effort.

“The conflict between state and federal law is always a concern,” he said. As long as the feds classify marijuana as a Schedule I drug — like heroin, LSD ecstasy and peyote — there will be an obstacle to wider acceptance of medical marijuana.

He offered no prediction about the impact of Attorney General Sessions’ Jan. 4 announcement that prosecutors could resume bringing marijuana cases to trial in states that have legalized its use.

STATE PROGRAM

The state of New York legalized marijuana for medical purposes in July 2014 but took time setting up the regulatory structure for its use.

The first dispensaries opened Jan. 7, 2016, and they initially were quiet places, as few patients or medical providers were registered with the state.

Officials have taken steps to expand legal use of the drug:

  • Originally, only doctors could prescribe it. But now, nurse practitioners and physician assistants can, as well.
  • More medical conditions have been added to the list of those that qualify for treatment, including chronic pain and post-traumatic stress disorder.
  • Home deliveries are now allowed.
  • Prospective patients and providers can now enter dispensaries to learn more about the products.
  • Additional products, such as ointments and patches, can be sold.
  • And five more companies were registered to manufacture and sell medical marijuana in 2017.

Commissioner Zucker told The Daily Gazette via email that the state is committed to further growth of the program.

“Medical marijuana has helped thousands of adults and children suffering from debilitating and painful medical conditions find relief and therapeutic benefit,” he said. “In just two years, New York state has launched and grown a thoughtful and responsible Medical Marijuana Program, added new eligible conditions and brought the number of certified patients to more than 40,000. These patients need help, and we cannot turn our backs on them. We are committed to ensuring that all New Yorkers who qualify are able to access this therapy.”

He did not directly address a question about whether the program faces a threat from the revised stance by the federal government, saying only that the state would protect its program, patients and providers.

Even the top Democrat in the U.S. Senate, Charles Schumer, said he didn’t know enough about Attorney General Sessions’ decision to gauge its effect. 

He told The Daily Gazette on Wednesday that he feels it should be up to each state to regulate medical marijuana use within its borders, though.

Schumer said he was focused Wednesday on securing funding to fight opioid abuse during budget negotiations. 

There were 63,300 drug overdose deaths nationwide in 2016, 21 percent more than in 2015, and two-thirds of those were from opioids, Schumer said. He singled out upstate New York — with a 23 percent jump from 2015 — as particularly hard-hit.

“That’s a jarring wakeup call,” he said.

Asked if medical marijuana could be a viable alternative to prescription opioids for pain management, he said it would be up to doctors to decide.

THE NEWCOMER

About to enter the New York medical marijuana industry is Fiorello Pharmaceuticals, a new company out of New York City that was among the five state medical marijuana providers added to the registry last summer.

Fiorello is building a production facility in Glenville and dispensaries in Saratoga, Monroe, Nassau and New York counties.

The company would not comment on federal marijuana policy, or whether it could have a chilling effect on the industry, but it said in an emailed statement that it is looking forward to being part of “the most robust and scientifically responsible medical marijuana program” in the nation.

“We’re excited to have the opportunity to provide New Yorkers with industry-leading medicinal products to address chronic and life-threatening conditions. Our work on our manufacturing facility and dispensaries is ongoing and moving at a rapid pace. We look forward to announcing more details on our statewide rollout soon.”

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