Pubdate: Mon, 30 Mar 2015
Source: New York Times (NY)
Copyright: 2015 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Authors: Jesse Mckinley and Catherine Saint Louis

NEW YORK STATE'S MEDICAL MARIJUANA RULES SHAPING UP AS UNUSUALLY RESTRICTIVE

ALBANY - When New York State's lawmakers were mulling legalizing the 
medical use of marijuana last summer, some proponents feared that the 
proposed law was so restrictive that it would prevent many patients 
from receiving the drug.

Now, with the state's Health Department close to issuing final 
regulations about the new program, the law's supporters say their 
fears may soon be realized.

The law itself is quite restrictive: Only 10 conditions qualify for 
medical use of marijuana; the drug may not be smoked; and New York 
will initially allow only 20 dispensaries across the state, run by 
five organizations.

The regulations go even further. Sales would be restricted to five 
so-called brands of medical marijuana, which concerns some supporters 
who say patients and doctors need flexibility to find out which of 
the hundreds of strains of marijuana works best for a particular 
condition. (The regulations even stipulate that brand names cannot be 
"coined or fanciful, and may not include any 'street,' slang or other name.")

Assemblyman Richard N. Gottfried, a Manhattan Democrat who was one of 
the law's sponsors, voiced deep frustration this month with "a long 
list of senseless burdensome restrictions on patients and organizations."

"There are people from very, very young children to very elderly New 
Yorkers who are going to continue to suffer unnecessarily," Mr. Gottfried said.

The regulations also impose constraints in unexpected ways. A plumber 
may not be able to unclog a sink in a dispensary without prior 
written approval. Drinking a Coke or even milk on the premises could 
be a violation.

All of which is surprising, advocates say, because of New York's 
somewhat late entry into the medical marijuana market: Nearly half of 
states nationwide already allow medical use of the drug, and 
California, the first to do so, has allowed it for almost two decades.

"The administration continues to operate as though medical marijuana 
programs have never been operated before," said Gabriel Sayegh, the 
managing director for policy and campaigns at the Drug Policy 
Alliance, which lobbies for more liberal drug laws. "If we were 
having this discussion in 1998, one would understand the extreme 
caution. But it's not the late 1990s, it's 2015."

Such caution threatens patient access, advocates say. No one knows 
how many people will qualify to use the drug in New York; estimates 
run from thousands to hundreds of thousands.

Monica Mahaffey, the director of public affairs at the Health 
Department, defended the law and the regulations, asserting that they 
ensure "appropriate access through comprehensive regulations and safeguards."

"The state developed the regulations through this very critical lens 
to ensure that the entire program would not be subject to enforcement 
action or legal challenges," she added.

At some point this year, the state will select the five registered 
organizations that will operate the dispensaries. Under the 2014 law, 
the medical marijuana program is supposed to be up and running by 2016.

But so few dispensaries, some say, may limit access for the infirm if 
they or their caregivers have to travel hours to get the drug, 
particularly in upstate New York, where big cities are more spread out.

"You're shoving it all through a narrow tube," said State Senator 
Diane J. Savino, the Staten Island Democrat who sponsored the law in 
the Legislature's upper chamber.

Advocates had hoped this stipulation would be remedied by allowing 
organizations to deliver the drug. But the regulations make that 
difficult, requiring written approval from the Health Department.

Margaret Hart, a retired minister in Central Square, N.Y., about 20 
miles north of Syracuse, said that multiple sclerosis prevented her 
from driving and that she had hoped delivery would be an option. "A 
lot of the law has come down from a place of fear," she said, "rather 
than compassion."

Ms. Hart, who lives on a fixed income, also worries about cost. Under 
the draft regulations, which were issued in December and are expected 
to be finalized this spring, pricing of medical marijuana will be 
determined by Dr. Howard A. Zucker, the state's health commissioner, 
rather than the market itself.

But the drug will not be covered by insurance or Medicaid, so many 
low-income patients could be shut out if it is priced too high. A 
high price could also send buyers back into the cheaper black market, 
while too low a price could lead to worker exploitation at 
dispensaries, which are to be unionized, per the law.

"It's like the three bears' porridge," said Ed Draves, a lobbyist 
with Bolton-St. Johns, a firm that represents members of the Retail, 
Wholesale and Department Store Union. "It can't be too hot, it can't 
be too cold, it has to be just right."

At first, only doctors will be allowed to recommend the drug, another 
issue for those who say that nurse practitioners - often the sole 
providers in rural communities - should also be allowed. They are 
also "frequently involved in palliative and hospice care," said 
Stephen Ferrara, the executive director of the Nurse Practitioner 
Association New York State. "We would want those patients to have access."

And some doctors are wary of being the lone recommender of marijuana 
in an area, because once word gets out, some people who are not 
legitimate patients seek them out, looking for no-questions-asked access.

The draft regulations, which run more than 100 pages, are often 
painfully precise. One section forbids patients to drink or eat on 
the premises of a dispensary, unless "necessary for medical reasons." 
Another says that other than patients and their caregivers, no person 
- - not even a plumber or a swaddled infant, for instance - would be 
allowed into a dispensary without the written consent of the Health 
Department and an employee escort at all times.

The Health Department has since clarified that written consent may 
not be uniformly required, provided that the guest's name and purpose 
for the visit is logged and an escort is provided. "The department 
recognizes that in some cases, prior authorization is not feasible," 
Ms. Mahaffey said.

Ms. Savino, a more moderate Democrat than Mr. Gottfried, is more 
supportive of the regulations thus far, saying that she had been 
pleasantly surprised by some - including a stipulation that a 
pharmacist be on the premises - and that such measures would help New 
Yorkers get comfortable with medical marijuana.

"We want to make sure we don't do anything to jeopardize the 
program," Ms. Savino said. "Is it inconvenient? Yes. But what's a 
bigger inconvenience is if we don't have these tight controls and the 
federal government comes in and shuts down the whole program and 
disrupts the flow of product to patients.

Some regulations could easily be remedied, Mr. Gottfried said, but he 
has been stymied in trying to get the Health Department's attention. 
"I have asked the health commissioner if he could talk to me," he 
said. "And that was not happening."

Mr. Sayegh, of the Drug Policy Alliance, credited the department and 
the governor for taking up the issue of medical marijuana, saying 
"there are people in the administration who care deeply about the issue."

But he said he feared that the proposed regulations would not serve 
those for whom marijuana is medicine.

"We're not holding our breath," he said, "that they are going to be 
dramatically better."

Jesse McKinley reported from Albany, and Catherine Saint Louis from New York.
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