Pubdate: Tue, 30 Aug 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Authors Jesse McKinley and Catherine Saint Louis


ALBANY - Moving to address complaints about New York's new medical 
marijuana program, the state's Health Department is making 
substantial changes to expand access to the drug, including allowing 
home delivery, quite likely by the end of September.

The program, which saw its first dispensaries open in January, has 
struggled to gain broad traction in the medical community and with 
potential patients. Advocates for the medical use of marijuana have 
said the program, allowed by a 2014 law signed by Gov. Andrew M. 
Cuomo, was too restrictive, and its regulations too cumbersome to 
fulfill its mandate.

On Tuesday, however, the administration of Mr. Cuomo, a Democrat, 
intends to announce several new policies, including authorizing 
delivery to patients too ill to travel, and enabling nurse 
practitioners to certify patients as medically qualified for the 
drug. Unlike some other states, New York does not allow marijuana to 
be smoked, but it can be made into a variety of tinctures, sprays and 
other forms.

The governor's counsel, Alphonso David, described the changes as 
legally prudent, made only after the state had sufficient information 
about how many patients were using the drug, which is still an 
illegal substance in the eyes of federal authorities.

"We don't want the federal government to come in and exercise an 
enormous amount of oversight and shut the entire program down," Mr. 
David said in an interview on Monday. "We've always been interested 
in expanding the program. We just wanted to make sure we had the data 
to support it."

Several of the changes, which the Health Department recommended in a 
report issued two weeks ago, will take place almost immediately; for 
example, the state will issue requirements to companies to begin 
delivery within the week, with such services anticipated to begin by 
the end of next month, Mr. David said. Additionally, regulations will 
be filed on Tuesday to allow the expanded role for nurse 
practitioners, though such regulations are subject to a 45-day comment period.

Other changes include streamlining restrictions on manufacturing 
medical marijuana, and considering expanding the number of conditions 
that qualify patients to use it, including mental health issues like 
post-traumatic stress disorder and debilitating illnesses like 
Alzheimer's disease. Residents are currently eligible if they have 
conditions like cancer, AIDS and epilepsy, though that roster of 
ailments has been considered too narrow by some advocates.

All told, Mr. David said the state intends to integrate all 12 of the 
Health Department's recommendations, though several were still being 
reviewed, including a suggestion that the roster of five companies 
doing business in the state be doubled to 10. Each of those five 
extant companies are allowed to run four dispensaries, a scale that 
some have said is too small for a state with nearly 20 million 
residents. (Only 17 dispensaries are currently open.)

More brands of the drug will also be considered, Mr. David said, as 
will ways to ease access at health care facilities associated with 
educational entities, which may be wary of federal oversight.

Advocates for the medical use of marijuana said the governor's 
actions were welcome. "A lot of the recommendations that the 
Department of Health made are things that the patients have been 
asking for for a year and a half," said Kassandra Frederique, the 
state director of the New York office at the Drug Policy Alliance, 
which advocates more liberal drug laws.

In particular, Ms. Frederique said delivery options could ease the 
problems posed by the state's size and the lack of geographic 
diversity in the current dispensaries.

Indeed, delivery could make a huge difference for patients with 
debilitating pain, like Jessica Hargrave of Rochester. The closest 
dispensary is a 10-minute drive from her home, but it has only 
tinctures, which are meant to be put under the tongue. She bought 
$155 worth of tinctures, but said she got no relief. "It did nothing; 
it was like putting water under my tongue," she said. "It was a big 
waste of money."

Mrs. Hargrave, 34, would like to try other formulations but cannot 
sit in a car for three hours to get to the next closest dispensary in 
Syracuse. "I need more options at my local dispensary," she said.

The cost of the drug will not be addressed, though for those 
suffering from financial hardship, the state does intend to extend a 
waiver for a $50 registration fee. Unlike most medicines, marijuana 
is not paid for by insurance, so it is an entirely out-of-pocket cost 
for patients who are sometimes on disability and struggling to make 
ends meet; patients and providers say the cost of the drug can run 
anywhere from $200 to $1,000 a month.

"That's a lot of money for an MS patient because many are 
unemployed," said Dr. Michelle Fabian, an assistant professor of 
neurology at the multiple sclerosis center at Mount Sinai Hospital, 
where she has several patients taking cannabis for excruciating muscle spasms.

The five companies that have been operating in the state since 
January have also reported that it has been difficult to be 
profitable with the current volume of patients. According to the 
Health Department, about 675 physicians have been registered, with 
about 7,000 patients certified. But not all of those patients are 
necessarily consistent customers.

Potential patients have also complained that there is no publicly 
available list of physicians to consult, even though doctors can sign 
into the department's website and find a list of participating 
doctors who are certified to recommend the drug.

Some doctors remain reluctant because marijuana remains a Schedule I 
drug, which means the federal government classifies it as having no 
medical use. Dr. Amy Piperato, an internist in Stony Point, N.Y., who 
has certified a couple of dozen patients for marijuana, said some 
doctors think, "Why put yourself at risk of liability of recommending 
a Schedule I product?"

Mr. David said he believed that the expansion of duties for nurse 
practitioners - as well as a new public list of participating 
practitioners, another proposal - would help the situation.

Moreover, he emphasized that the changes to the program were the 
natural next steps for a system that was designed to evolve. "This is 
enhancing the program," he said, "so that we meet patient need and 
patient access."

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