NEW YORK — Karen Rodriguez used opioids to manage her crippling pain, but when the powerful drugs and the chemotherapy medication she used to treat her rheumatoid arthritis teamed up to damage her liver and kidneys, the 43-year-old Hyde Park, N.Y., woman turned to a safer alternative: cannabis.
Rodriguez became a participant in New York state’s medical marijuana program in the spring of 2016. But she was eligible to participate in the program only because she suffers from neuropathy linked to diabetes — not because of her debilitating chronic pain.
“There are days when I can’t move in the morning when I get out of bed, because of the joint pain and the nerve pain,” Rodriguez said. “But if I didn’t have neuropathy, I would not have been able to get a medical marijuana card.”
New Yorkers who suffer from chronic pain will finally be able to find relief with cannabis without violating state laws later this year, after the state Department of Health (DOH) finalizes the steps it began on Dec. 1 when it announced that it is adding chronic pain to a list of qualifying conditions for the state’s medical marijuana program.
State officials and cannabis industry analysts agree the move will open up access for thousands of chronic pain sufferers to the state’s medical marijuana program, which already included neuropathy, cancer, AIDS and other diseases as qualifying conditions. It is also expected to boost business for New York’s struggling medical cannabis providers.
Most importantly, according to Dr. Stephen Dahmer, the chief medical officer for Vireo Health, the move will provide state residents with an alternative to the addictive drugs that have fueled the nation’s painkiller crisis.
“We’ll see patients using medical marijuana as a way to get off opioids,” said Dahmer, whose company is one of the five firms licensed to grow and dispense medical cannabis in New York.
Other industry executives, however, fear the DOH chronic pain proposal, which will be finalized after a 45-day public comment period ends early next month, is only another baby step in New York’s tentative, conservative approach to medical marijuana. New York’s medical marijuana program remains one of the most restrictive in the nation.
Kate Bell, legislative counsel for the Marijuana Policy Project, worries the state will set the bar too high. The DOH proposal to add chronic pain as a qualifying condition would allow medical professionals from recommending cannabis for pain only after other therapeutic options — such as opioid painkillers — have failed. Practitioners would be forbidden from recommending marijuana if they believe their patient’s pain will ease in three months or less.
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Bell said she fears these restrictions will prevent patients from seeking pain relief with cannabis — and encourage them to use addictive painkillers. “New York adding chronic pain is somewhat misleading,” she said. “What they are really saying is ‘We are going to let some people with chronic pain use medical marijuana.'”
Diane Jackson Czarkowski, a founding partner of the consulting firm Canna Advisors, said these constraints could also encourage medical marijuana candidates to seek relief in the black market. Without easier access to doctors and dispensaries, they may struggle to find products appropriate for their pain or illness. They might also be exposed to moldy or pesticide-laden flowers produced in illicit grows.
“But it’s still easier,” she said, than qualifying and finding a registered practitioner and dispensary. “The hassles New York has imposed make it worth it.”
New York’s medical marijuana program, approved by state legislators and signed into law by Gov. Andrew Cuomo in 2014, was launched in January 2016. Nearly 12,000 patients have been certified to use medical marijuana, according to the Department of Health. That’s .04 percent of New York’s 19.79 million people, and according to the Marijuana Policy Project (MPP), the lowest participation rate in the nation.
In comparison, just over 2 percent of Michigan’s 9.9 million residents are enrolled in its medical marijuana program, according to MPP. More than 51,000 people in Maine — 3.84 percent of the state’s 1.3 million people — use cannabis for medical reasons. In California, where the medical marijuana revolution began in 1996, 1.84 percent — more than 720,000 people out of 39 million — have medical marijuana cards.
New York’s Department of Health has taken steps in recent months to boost participation in the program. In addition to adding chronic pain as a qualifying condition, officials decided last year to also allow nurse practitioners and physician assistants who are registered with the program to recommend medical marijuana to patients. The state has also agreed to permit home delivery and let the five licensed providers wholesale their products to each other.
“Improving patient access to the medical marijuana program is a top priority for DOH,” the department said in a statement to The Cannabist.
Still, industry sources say more needs to be done. Hillary Peckham, the chief operating officer of Etain Health, another of New York’s licensed cannabis companies, said prospective medical cannabis patients struggle to connect with the 800-plus practitioners registered with the state.
“That is where the bottleneck is,” she said. “There is no public list of certified physicians. I wholeheartedly applaud the Department of Health decision, but it needs to go hand-in-hand with making access easier.” (In order to access the list provided by the state, patients must log into the state’s Health Commerce System.)
Rodriguez said it was difficult to find a medical provider who could give her a cannabis recommendation, but she finally connected with a physician through a website called MarijuanaDoctors.com.
“If you don’t know about that website, you can’t find a doctor,” the mother of two said. “There’s nothing else out there.”
Jeremy Unruh, the general counsel and chief compliance officer at PharmaCann LLC, another New York medical cannabis provider, says New York medical marijuana candidates, especially those in rural areas, frequently find it difficult to find dispensaries near their homes. “There are clusters,” he said. The state currently has 19 dispensaries: Syracuse and Albany each have three, and the five boroughs of New York City have three dispensaries among them, with another whose opening is pending.
You can see the “clusters” in this map of medical marijuana dispensaries in New York (story continues below map)
Rodriguez purchases vape cartridges at PharmaCannis, a PharmaCann dispensary in Albany, twice a month. While she praises the staff as friendly and informative, it’s a hassle to make the 90-minute drive from her home in Hyde Park every two weeks — and since Rodriguez can’t drive, her husband has to take her.
Department of Health officials have talked about doubling the number of medical marijuana producer-providers in the state, from five to 10, over the next two years. But Unruh said that will simply boost supply, not demand, as the five current providers are operating at just a fraction of their capacity. Adding chronic pain as a qualifying condition, he said, won’t help the industry or patients unless the state also helps all those chronic pain sufferers connect with medical practitioners and dispensaries.
“They need to make those fixes before before they let new organizations in,” he said.
Prices for medical marijuana products is another factor that has discouraged patients from enrolling in the program. Rodriguez pays $100 for a vape cartridge that costs $35 in Colorado.
“It’s expensive,” she said.
But Rodriguez, who belongs to a 1,700-member Facebook support group for women who struggle with chronic pain, says New York is heading in the right direction.
“I am very happy they added chronic pain, because so many people who suffer from pain are on medications that could affect their livers and kidneys,” she said.
Cannabis industry officials also applaud the state’s decision to add chronic pain as a qualifying condition, but say further measures are needed before the program reaches its potential.
“Adding chronic pain is wonderful,” said Unruh. “But it is only one of the things the DOH needs to do.”