The Alt: Cannibalizing cannabis: Threats to New York’s medicinal aid

By Katie Cusack, 4/18/18

In 2009, Frances Keeffe–Granny Franny, as her grandchildren called her–of Scarsdale, New York was diagnosed with amyotrophic lateral sclerosis (ALS). By the end of her life, her granddaughter Hillary Peckham said, Franny was on more than 20 medications. Each one came with an onslaught of side effects.

“She had to be quarantined for the last few months of her life because of that,” Peckham said. “You’re not gonna cure ALS. It’s, ‘How can we can deal with these symptoms?’”

A doctor approached the family, asking, “Why don’t you try marijuana?”

“At that point it still wasn’t legal, my grandmother wasn’t interested and we had no idea where we could find something, so it wasn’t an option for her but it really sparked my mom looking into this industry to see if it might be a solution,” Peckham said. “We started learning about the quality of life improvement it was giving people without all the side effects of pharmaceutical drugs.” By the time she graduated college, Peckham and her mother set off building Etain, New York’s only women-owned medical marijuana company.

While New York state hasn’t reached recreational legalization, it is one of the 29 states to legalize medical marijuana, under the Compassionate Care Act of 2014. Patients suffering from debilitating symptoms of long-term and terminal illnesses have had the option to access “pharmaceutically familiar” marijuana available in the form of lotions, capsules, tinctures, sprays and vaporizer cartridges. Marijuana in any smokable or edible form is prohibited.

The program has gone through some considerable changes since its start. Gov. Cuomo and the Department of Health qualified conditions such as PTSD and chronic pain as well as allowing more “user-friendly” products and home delivery services, becoming less restrictive over time. However, New York’s program is still known as one of the most conservative in the United States.

At the federal level, U.S. Attorney General Jeff Sessions has rescinded three Obama-era memos opting not to interfere with state law on the matter of weed, including the notable Cole Memo, stating that federal prosecutors would not interfere with state marijuana laws as long as a state did not violate “priorities…important to the federal government,” including the prevention of marijuana sales and distribution to minors or states where the plant is not legal, revenue being given to criminal enterprises or industry activity being used as a cover for human trafficking and/or the sale of other illegal drugs. Instead, Sessions opted to “return to the rule of law” over states that have been raking in millions in taxes and fees from their newly cultivated commerce. Meanwhile, President Trump has promised to support congressional efforts to protect states that have legalized marijuana.

Regardless, New York state legislators have voiced concerns about possible interference from federal attorneys like Sessions in cases such as the 2001 Rohrabacher-Blumenauer Amendment (also known as the Rohrabacher-Farr Amendment) which essentially bars the federal government from prosecuting medical marijuana operators who are working legally under state law. Sessions has already made efforts to remove the legislation, but has been regularly ignored by Congress.

In November 2017, state Senator Diane Savino and Assembly Health Committee Chair Richard Gottfried wrote a letter to Congress urging them to continue renewing the amendment. “The threat of Justice Department interference will have a chilling effect on existing programs, damaging seriously ill patients and undermining provider participation and business investment,” the letter reads.

The amendment has since been extended to October 2018, but the uncertainty is still making people nervous. By then, legislators may have to petition for its renewal all over again. In the end, on paper marijuana is still a federally illegal drug–classified as a Schedule I substance under the Controlled Substance Act (CSA) which puts the plant at the same level as heroin, LSD and ecstasy.

In the meantime, the New York state program has continued to grow.

From their four dispensaries (Syracuse, Kingston, Yonkers and New York City) and Albany area delivery service, Etain serves roughly 38,000 patients, including 700 in Capital Region–from a 6-month-old suffering from severe seizures to a woman in the Hebrew Home in the Bronx who is over 100 years old.

“The baby is smiling now and the family is affected by things like that,” Peckham said. “When you’re dealing with a loved one, it has as huge of an impact on the family as on the person. When a person is able to walk again out of a wheelchair and can take train rides to NYC on her own, its really amazing to see that process–how this can be a completely life-changing medication.”

Peckham has also seen a positive effect of medical marijuana in curbing the opioid crisis.

“Every day, the most standard story we get is, ‘I wasn’t able to work, I was on a really high dose of opioids and now I’m not taking any opioids. We really strongly believe that this could be an alternative,” she said. “It doesn’t work for everybody, definitely. We’ve had people come to us and unfortunately this isn’t right for them but the majority of our patients see a significant decrease in their opioid use, if not halting the need for it altogether. This can be people who have been on opioids for years, like a decade or more.”

The use of medicinal marijuana as a substitute for opioids has been a common topic in the legalization debate. In early April, two papers published in JAMA Internal Medicine shared “results suggesting that cannabis legalization may play a beneficial role in the opioid crisis.”

Studying Medicare Part D and Medicaid prescription data from 2010 to 2016, the authors found that following the implementation of state medical cannabis laws, the number of opioid prescriptions for Medicare patients decreased by 14 percent. For those under Medicaid, 40 fewer opioid prescriptions were filled per 1,000 people each year. On a day to day basis, opioid prescriptions fell by 3.74 million daily doses per year after the opening of a medical marijuana dispensary.

Access to medical marijuana isn’t exactly a breeze. Patients in search of the drug must get a consultation with a state-certified doctor–meaning that the doctor has taken a state-regulated online $250 four-hour course to prescribe marijuana. From there, the patient gets a special certification–not a prescription yet–to register with the DOH and be issued an ID card. With proper registration and identification, a patient may then be prescribed medical marijuana. On average, Peckham said, it takes a minimum of three months for a patient to get from their appointment to a dispensary.

Another major block to accessing marijuana can be the doctors themselves.

“It’s had a very low physician acceptance,” Peckham said. “There can be a huge barrier where they just don’t think it’s medicine. One of the huge problems in the industry is that there’s no federal FDA studies on this so we couldn’t show them that standard data that they would be expecting for any other kind of pharmaceutical so it’s really difficult to make a convincing argument that they would respond to.”

“They don’t realize that what we produce, what everyone produces in New York State, is pharmaceutical grade cannabis. It’s free of pesticides, its tested by the Department of Health before we can sell it,” she adds.

New York State has at least 75,000 licensed physicians but there only about 1,500 medical marijuana prescribers serving the state’s 49,780 certified patients that have been registered as of April 3, 2018.

“You’re looking at a huge potential population of physicians who could be at least educating themselves on this,” Peckham said. “We have been doubling down on our efforts to raise awareness and get physicians involved and engaged with the program because I think that’s what’s gonna be the key to this program really taking off.”

Multiple calls made to the Medical Society of the State of New York for comment were not returned, but a spokesperson from Assemblymember Gottfried’s office told The Alt that New York state doctors may hesitate to engage in the program due to the threat of federal crackdown. Physicians may fear losing their license to prescribe controlled substances, with which they must register with the Drug Enforcement Agency.

“In terms of New York’s medical-use program, we have taken significant steps forward but it’s still too narrow and restrictive for patients, health care providers, and registered organizations,” Gottfried said in an email to The Alt. The Assembly Health Committee chair has been active in sponsoring and co-sponsoring a number of marijuana bills in an effort to “move beyond our completely broken prohibition model … to a sensible tax-and-regulate system.”

Gottfried suggested the program could be more “workable” if all medical practitioners, such as dentists and podiatrists, who are legally allowed to prescribe controlled substances, or opioids, were allowed to certify patients for medical marijuana. Currently, only physicians, nurse practitioners and physician assistants may do so.

The Assemblymember also suggested that New York state repeal the specifying list of conditions condoning the use of medical marijuana, arguing that there is “no other drug for which State law restricts the conditions it can be used for.”

At the end of the day, the medical marijuana industry in New York state is cornered–not only by the threat of federal crackdowns and cumbersome prescription processing but by the blossoming industries of neighboring states. In states like Massachusetts and Vermont, state governments are pursuing recreational programs and allowing residents to grow plants within their own homes.

“It’s gonna be really difficult to combat because, are you really gonna double down on border control? How are you gonna stop this and can you?” Peckham asks. “We’re worried about it cannibalizing the medical market. It’s something that we pay a lot of attention to and New York has the opportunity to be a leader in this race.”