Concerns about the impact of New York’s recently passed Compassionate Care bill, which legalizes medical marijuana, are likely to prove overblown in the coming decade.
The way the law is written, it will likely be a year and a half before any New York residents start using marijuana legally. And those who do will have cleared several hurdles in that time.
Many who lobbied for the law have criticized eleventh-hour changes to the bill that established an apparently 18-month speed bump and took away a provision that would have allowed the smoking of cannabis, which many believe is the most effective way to reap the benefits of the plant.
“We work with patients every day for whom they don’t have 18 months,” said Julie Netherland, with Compassionate Care New York and deputy director of the Drug Policy Alliance of New York. “There are people at the end of life right now who would like this to improve their quality of life and alleviate some of their suffering. There are a lot of children with various severe forms of epilepsy who want to get access to medical marijuana right away because the seizures they’re facing, any one of them could end their life. For them, 18 months is an eternity.”
It’s not just patients hoping to benefit from medical marijuana who will have to register with the state. The bill requires doctors who want to be able to recommend medical marijuana as a treatment to register, as well. And they must complete a two- to four-hour course beforehand.
Anyone seeking to use medical marijuana will also be required to have an established doctor-patient relationship with his or her physician, a requirement aimed at keeping people from “doctor shopping” to find someone willing to help them obtain marijuana.
And the bill requires the patient to have been diagnosed with any of several qualifying diseases or conditions.
Several area hospitals, physicians and hospice officials would not comment for this story, citing unfamiliarity with the law, the particulars of medical mairjuana’s efficacy or otherwise expressing discomfort with speaking about impacts the bill may have on their practices or organizations.
But some lessons can be taken from neighboring states where medical marijuana is already available.
New Jersey’s law
Dr. Howard Grossman, chairman of New York Physicians for Compassionate Care, opened a practice in New Jersey last year, after having practiced previously in Manhattan. He said New York’s law, despite not allowing patients to smoke the plant itself, is still likely to be more effective than the New Jersey law, which was passed in 2010.
“New Jersey severely limits (medical marijuana use),” Grossman said. “For example, for people with HIV and cancer, the only indication is chronic pain. There are very, very few conditions … on the New Jersey bill.”
Grossman said he’s got just two patients who are using medical marijuana in New Jersey.
He wasn’t surprised medical experts in the Glens Falls area chose to remain silent on the topic. But if doctors fear being inundated with calls if they speak out on the topic, that hasn’t been his experience.
Also, it hasn’t been difficult to educate those who do call with questions, especially since New Jersey’s law also requires an established patient-doctor relationship before medical marijuana can be obtained.
“I tell them, ‘If you want to become my primary care patient, and let me examine you and make a decision about whether I think medical marijuana will be helpful, then you’re welcome to do that,’” Grossman said.
That makes it clear to callers he’s not going to be a fast-and-easy route to legal pot, Grossman said.
“I think it’s going to take a lot of education of physicians that, one, that they won’t necessarily be inundated, that this can just be a benefit for the patients who are already in their practice, and two, that this is not that difficult to do. And that the science is there.”
In Vermont, where a medical marijuana law has been in effect for 10 years, a total of 995 people were registered to use medical marijuana statewide as of March 24, the latest date for which figures were available, according to Lindsey Wells, Marijuana Program administrator for the Vermont Crime Information Center, a division of the state’s Health Department. That equates to about 0.16 percent of the state’s approximately 626,000 residents.
Dr. Joseph McSherry, associate professor in University of Vermont’s Department of Neurological Sciences in Burlington and a longtime physician at Fletcher Allen Health Care, said he thinks New York’s medical marijuana law is a good start, but it will pose some challenges.
McSherry was among physicians who lobbied the Vermont Legislature on behalf of legalizing medical marijuana.
Unlike New York’s bill, Vermont doesn’t require doctors to register with the state in order to recommend medical marijuana for patients.
All they have to do is sign paperwork that confirms the doctor’s relationship with the patient and affirms the patient has one of the qualifying conditions. From there, patients can go to a medical marijuana dispensary to get a limited supply, and they’re also allowed to grow a limited number of plants in their homes, under specific conditions.
The plant can also be smoked in Vermont.
Vermont’s law, like the New York legislation, requires an established patient-doctor relationship before medical marijuana can be obtained. As a result, McSherry thinks New York can expect a similar participation rate.
“Just the other day, I was hearing from the Marijuana for Therapeutic Use oversight group that the average doctor prescribing cannabis in this state is filling out the paperwork for two or three patients,” McSherry said. “There are about 400 and some such doctors in Vermont, and it’s a little over 1,000 patients at this time.”
New York will have to clear several hurdles before people will be able to get medical marijuana in the greater Glens Falls region.
As in other states where medical marijuana has been legalized, exporting the plant is illegal, even to other states in which medical marijuana is legal.
The bill allows for up to five manufacturers of medical marijuana products, with a total of no more than 20 distribution locations statewide.
“They’re going to have to, first of all, set up their situations in which they can produce the plants, and that will probably cost a bundle, and then they’re going to have to get the plants from someplace, and they’re going to have to start making the extracts and so on,” McSherry said.
Grossman, with New York Physicians for Compassionate Care, said the lack of nearby dispensaries will be a hardship for many who might otherwise benefit from medical marijuana.
“Chronically ill people are going to have trouble traveling far,” he said. “They need something that’s going to be locally accessible.”
Both Grossman and McSherry said another hurdle will be educating doctors.
“Doctors haven’t been taught in medical schools about cannabis since the 1940s, other than as an illegal drug,” McSherry said.
And while New York’s bill requires doctors to take a course focusing on medical marijuana before being able to register, that’s a tall order for practitioners with lots of other continuing education requirements.
Grossman said he had to satisfy the coursework requirement to be able to recommend medical marijuana in New Jersey.
“It wasn’t that difficult, but it is a psychological barrier for many physicians,” he said. “Doctors are overburdened with the number of courses that we’re forced to take on infection control and liability and all kinds of other things by state mandate, so nobody wants another one. But I don’t think it’s an insurmountable barrier.”
A foot in the door
Netherland, with Compassionate Care New York, said New York’s legislation, while imperfect, is significant for the precedent it sets and because it will give the state a chance to experience the realities of medical marijuana, rather than speculating about negative impacts.
She didn’t have an estimate for whether New York would see a greater participation rate than the 0.16 percent rate seen in Vermont, though.
“I don’t think we know yet how many patients will, one, be able to access the system, and two, want to access the system,” Netherland said.
She said her group hopes the law can be broadened in coming years.
“We obviously have been advocating for a much more expansive law, and this bill does have serious limitations,” she said. “That said, we still believe it has the potential to help thousands of seriously ill New Yorkers, and that’s our ultimate goal: to make sure the people who are currently suffering get the relief they need.
“Will this be the last word on medical marijuana in New York? I don’t know, but it’s a very important first step.”
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