It took eighteen months from the moment Governor Andrew Cuomo signed the bill that created the state’s first medical marijuana program until it finally launched on January 7. During that time there’s been plenty of hype, hand-wringing, and — at least among lawmakers trying to improve the bill — haggling. And yet the outcome remains a Compassionate Care Act that many argue is overly restrictive to the point of being unworkable: five medical marijuana growers to operate twenty total dispensaries throughout the state’s 55,000 square miles, only ten conditions that would qualify patients to receive treatment, and a ban on smoking cannabis in flower form or ingesting it in the form of edibles.
So what might appear to be a lack of interest in the program among doctors and patients may in fact be a reflection of the bill’s limitations. According to numbers released last week by the New York State Department of Health, so far, only 166 patients have registered with the state to obtain medical marijuana. Meanwhile, only 226 of the state’s 79,000 active physicians have completed the necessary steps to become eligible to recommend cannabis to patients.
“It’s hard for me to celebrate this as a success,” says Julie Netherland, New York deputy state director for the Drug Policy Alliance. “I don’t think, for those of us who fought so hard to pass this bill, this is what we were fighting for.”
In order to be able to recommend cannabis (the bill specifies that physicians cannot “prescribe” the drug, as it is still not approved by the FDA), doctors must first complete a $249, four-hour online training course before they can register with the state. The course outlines the effects, dosing, safety, and science of cannabis medicine and how it can be used to treat the ten debilitating or life-threatening conditions covered under the law. Roughly 500,000 patients across the state — around one in forty — qualify to receive treatment.
Netherland says a patient advocacy group called Compassionate Care New York asked the state to publicly release a list of registered physicians who qualify for the program. For privacy and security reasons, the health department instead plans to release a list only to doctors, she says. “That creates another barrier for patients,” Netherland adds. “They don’t have a way to find the physicians who are enrolled, and not enough physicians are enrolled in the first place.”
With a limited number of dispensaries — only eight out of the anticipated twenty are currently open for business — accessibility remains a significant concern. “There are significant geographic regions where there are no dispensaries. For instance, there’s nothing open on Long Island right now,” says Netherland.
Critics are also worried about affordability for low-income patients. As the law is written, health insurance does not cover medical marijuana. Reports estimate that a monthly supply can cost anywhere from $200 to $1,300, Netherland says. Advocates had pushed for the Department of Health to create a charity pool from medical marijuana sale revenues for qualifying patients who couldn’t otherwise afford cannabis treatment. “Now we’re left with the goodwill of the five producers. Whether they voluntarily choose to provide a discount or system for low-income patients remains to be seen,” says Netherland.
Ari Hoffnung, CEO of Vireo Health of New York, one of the state’s five companies licensed to grow and dispense marijuana, says Vireo’s four dispensaries will offer discounts for low-income patients. Depending on the patient’s condition and what kind of cannabis they need, prices vary: anywhere from $100 to $400 per product — capsules, vaporizers, oils, and tinctures.
While Vireo currently serves only a small handful of patients, Hoffnung says that based on the company’s experiences in other states that have recently legalized medicinal cannabis, low initial turnout shouldn’t be cause for too much alarm. “In the early days of a medical marijuana program, when it’s initially rolled out statewide, there’s typically very small numbers of patients and participating physicians,” he says. “Over time that tends to grow significantly. This is in line with what we thought the case would be.”
The companies licensed to grow and dispense cannabis budgeted very carefully for a slow start to the program, says Doug Greene, legislative director of Empire State NORML (the National Organization for the Reform of Marijuana Laws). Still, Greene was less sanguine than Hoffnung, arguing that the initial outcome of New York’s medical marijuana program has been worse than expected and admitting he worries that the patients will be suffering more than the businesses designed to offer them treatment.
“It’s great that [the companies] have the money to survive, but what about the patients surviving?” he says. “That’s more important to us. There will always be more applicants for those licenses.”