On July 7, New York became the 23rd US state to legalize medical marijuana. But New Yorkers can’t light up a celebratory joint yet. Indeed, many of those who for years pushed for medical marijuana legalization are complaining that the new law falls far short of what the state’s thousands of patients seeking the drug need.
There is no consensus amongst scientists, researchers and medical professionals across the country on just how many diseases can be treated with medical marijuana. However, researchers at the Center for Medical Cannabis Research at the University of California-San Diego say that patients that suffer from chronic pain most benefit from the use of medical marijuana. In the New York Compassionate Care Act, only a few of these chronic pain diseases are approved: cancer, HIV/AIDS, ALS (Lou Gehrig’s Disease), Parkinson’s Disease, multiple sclerosis, spinal cord tissue damage, epilepsy, inflammatory bowel disease (including Crohn’s Disease, neuropathies and Huntington’s Disease).
According to the Marijuana Policy Project, a national organization focused on marijuana policy reform in the United States, only a tenth of patients—an estimated 5,070 New Yorkers with rare diseases—will be eligible under these restrictions. The New York State Department of Health says that estimate is premature, since the department has the authority to add more diseases to the list.
“The reasons we chose those diseases was because those diseases there is scientific and anecdotal evidence that medical marijuana is beneficial for treatment,” said Dr. Howard Zucker, New York State Commissioner of Health. “We need to start at some point. As we move forward on this, we will conduct more research to see what new diseases we can add and we will modify accordingly.”
The law gives the New York State Department of Health the power to establish the bill’s core guidelines, most notably the pricing of the drug, which the state will tax at 7%.
“The New York state law is the first medical marijuana law in the country where the state will have control of the pricing,” says Karen O’Keefe, State Policies Director for the Marijuana Policy Project. “That could waste a lot of money on oversight and possibly create an unfair pricing structure.”
Under the new law, the Department of Health will select five private companies to open up to four dispensaries each. That’s far from enough, says O’Keefe.
“Just five producers is a very small number for such a big state,” she tells Quartz. “Arizona has a population of 6 million but has 98 dispensaries. New York, on the other hand, has a population of 19.5 million and will have 20 dispensaries, creating the lowest per-capita dispensary-population ratio of any medical marijuana state in the country.”
Commissioner Zucker dismisses the criticism that the state’s dispensaries won’t cope with demand. “We’re working on where we can grow,” he says. “We have to look at the demographics to determine where… If we notice that there’s an area of the state that’s not being well served, we’ll go back to the drawing board.”
The law could take up to 18 months to implement. Additionally, the health department will issue registry identification cards to eligible patients and to caregivers who submit valid applications, written certifications and fees of up to $50. Patients will need to renew these cards every year, unless they have a terminal illness. Those without these cards are granted no legal protection.
Patients will only be allowed to consume marijuana through food, oils, pills and vapors—not through what users say is the cheapest and most efficient way to consume the drug (as well as the most traditional): smoking it. Advocates say this will force patients who require instant pain relief through inhalation to either risk smoking it illegally or purchase a vaporizer that can often cost hundreds of dollars. Governor Cuomo has said that such provisions were necessary for the bill’s “balance” of risks. The only other US state that allows medical marijuana but prohibits users from smoking the drug is Minnesota.
Zucker says that legalizing more smoking, in any form, was a non-starter for him and for Gov. Cuomo. “We have spent, as a nation, billions of dollars and decades to do everything possible to stop smoking,” he says. “It goes against the ethos of public health to allow smoking when the active ingredient can be provided in other mechanisms. I feel very strongly about this.”
Under the new law, physicians could be charged with a felony for prescribing marijuana to patients who don’t fit the state’s narrow list of eligibility requirements. O’Keefe offers this example of how she fears this could play out: A patient who suffers from Parkinson’s disease, deemed eligible by the state to purchase, could request medical marijuana from their doctor to alleviate the high anxiety that comes from living with the disease. If the doctor then prescribed the medical marijuana for anxiety—and not specifically for the treatment of Parkinson’s Disease—that doctor could be charged with a felony and possibly lose his state license to practice medicine. “It could create a chilling effect,” O’Keefe says.
In a state where 83% of voters support medical marijuana, advocates have complained that lawmakers have been slow to act. The bill was the sixth piece of medical marijuana legislation written in recent years, but the only one passed by both houses in the New York state legislature, and that’s only after Gov. Cuomo added last-minute amendments. Among those changes is the governor’s executive power to completely disband the program at any time. Additionally, either Commissioner Zucker as head of the state’s department of health or the New York State Police Superintendent can recommend the program’s end if either deem it a risk to public health or safety.
“But,” Zucker says, “ultimately we believe in the program’s success. The first priority is setting up the regulations to determine what is safe for patients. And as we move forward, we will continue to listen to them and get feedback from them and advice. There’s a little bit of an art to the practice of medicine, and the communications aspect plays a very important part to crafting a law like this.”