While New York’s medical marijuana program is scheduled to go into effect this January, it is uncertain whether enough doctors will be able to recommend cannabis to the patients who need it most.
As written, the Compassionate Care Act — signed into law last year by Governor Andrew Cuomo — requires physicians who wish to recommend cannabis to register with the Department of Health, take a four-hour educational course, and maintain an ongoing relationship with the patients for whom they write recommendations. Additionally, the doctor must be treating the specific condition for which he or she is recommending cannabis; for example, only an oncologist can write a recommendation to a cancer patient for medical marijuana. These requirements are among the reasons why, for many doctors, medical cannabis remains a nonstarter.
The Compassionate Care Act has been derided as prohibitively restrictive. It covers just ten “severe, debilitating, or life-threatening” conditions, such as cancer, epilepsy, and AIDS, and permits only five companies to operate a total of twenty dispensaries throughout the state. Those dispensaries will be allowed to carry just five “brands” of medical cannabis in the form of vaporizable oils, capsules, tinctures, and other non-smokable products. And many doctors and medical marijuana activists fear that there’s still too much work to be done between now and the law’s implementation to assume that the program will be even nominally effective come January.
“I think that’s the most pressing issue,” says Melissa Meyer, founder of HealthMJ, a company that educates patients about cannabis. “We want to give patients access as quickly as possible. These patients who have terminal conditions, conditions from which they might die, have already waited several years. Some of these patients are in a lot of pain right now. Three more months is a really big deal.”
She adds that it’s still up in the air whether all twenty dispensaries will be operational by January 1.
“January is pretty aggressive considering the licenses [to grow and dispense medical marijuana] were just awarded [in July],” Meyer says. Without being able to ship marijuana plants from other states, which is illegal under federal law, licensees will have to start from scratch, with little knowledge of how the first growing cycle will work out.
Many also worry about doctors not having an adequate working knowledge of the benefits and uses of a drug that spent so much time on the fringes of medical science. Dr. Jack D’Angelo, medical director of Citiva Medical, one of the companies that applied for a New York license, is among many who believe a four-hour course may not be sufficient to train physicians about cannabis medicine. “In essence, it doesn’t seem like the patient has really been put first,” he told the Voice in August. “[Doctors] are going to have to get educated on their own.”
Patients, too, are going to have to do much of their own research, Meyer says. “Cannabis is the safest drug, technically, out there,” she says. “So any amount of training is enough needed to get patients access. [Only four hours] does a disservice to the patient. Medical cannabis is so nuanced — there’s a lot of depth in it, a multitude of different strains and cannabinoids, and I would love to see physicians taking a concentrated effort to understand what that means for patients. That’s a huge job for four hours.”
The specifics of the four-hour course, which costs $249 and is called “Practitioner Education for the Medical Marijuana Program,” were released this week and include information on cannabis pharmacology, side effects, adverse reactions, drug interactions, dosing, abuse/dependence, and overdose prevention (for a drug with exactly zero reported instances of death by overdose).
Up until now, doctors have simply been waiting on training, says John Nicolazzo, co-owner of the Medical Cannabis Network, under which MarijuanaDoctors.com operates to help connect patients and physicians. But even with training, many doctors are still reluctant to recommend medical marijuana, largely because of its federal status as a Schedule I substance (putting it in the same category as heroin). In fact, doctors cannot write “prescriptions,” but only “recommendations,” for marijuana because under the federal Controlled Substances Act, it has “no accepted medical use.”
In a recent study, MarijuanaDoctors.com spoke to 500 doctors across New York about the Compassionate Care Act, only one of whom stated a willingness to participate in the program. Many doctors, Meyer suggests, simply do not want to be associated with marijuana.
Nicolazzo says his company is working with about 35 doctors throughout the state. “All those doctors are going to be taking this course,” he says. Originally, MarijuanaDoctors.com had made a statement recommending that the course be expanded to at least eight hours.
Of the 12,000 New Yorkers who were registered on the website’s waitlist for cannabis treatment, about 73 percent qualify under the law, says Nicolazzo. It’s a good number to start the program, he adds, but for the twenty dispensaries to be profitable, they would have to see an average of 2,000 patients a month.
If you take 73 percent of 12,000 — almost 8,800 patients — and divide it among twenty dispensaries, that’s not enough, he says. “If you’re doing the math, then the program is destined to fail. It goes back to supply and demand.” The only way to make the program a success, Nicolazzo says, is to add conditions or loosen regulations.