What exactly is a medical marijuana dispensary?
On a recent tour of one, inside a converted Casual Male XL store next to the Queens Mall, Ari Hoffnung tried to make clear what a dispensary wasn't.
“When you walk in here, you don’t hear any Bob Marley music playing,” he said. “We don’t sell joints. We don’t sell pot brownies. We don’t sell products with names like AK-47.”
“When a 70-something year-old grandmother goes into a Vireo health dispensary or other dispensary, she won’t be greeted by a ‘bud-tender,” he said. “She’ll be welcomed by a New York State licensed pharmacist who will say, ‘Good morning, Mrs. Goldberg, how are you? What brings you here today?’”
Putting patients at ease and convincing doctors of its legitimacy are just two challenges facing the nascent medical marijuana industry in New York. About a month into it, there are very few takers: according to state figures, fewer than 400 doctors were registered and they certified about 800 patients to purchase medical marijuana.
This is not an accident. When Gov. Andrew Cuomo and state legislators passed the law legalizing medical marijuana they ensured it would be one of the toughest states in terms of pot regulation.
Cuomo made clear New York would be different from other states, “where it almost became a joke that if you had relatively common conditions, you could get medical marijuana.” He said he “wouldn’t name names,” but the governor was surely referring to Washington, Colorado and California, where dozens of illnesses qualify patients for medical marijuana.
In contrast, New York lists only ten qualifying conditions: cancer, HIV infection or AIDS, amyotrophic lateral sclerosis (ALS), Parkinson's disease, multiple sclerosis, spinal cord injury with spasticity, epilepsy, inflammatory bowel disease, neuropathy, and Huntington's disease. Patients also have to demonstrate they have cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasm.
And that's not all. New York included other restrictions:
- Doctors must take a four-hour online course, something no other state requires.
- The state has no public registry for patients to find registered doctors.
- Smokeable or edible marijuana buds are forbidden; producer-dispensaries can only offer oil extract for ingesting via syringes or capsules or inhaling via vaporizers or sprays.
Hoffnung said the restrictions were strengths for New York, giving its program more medical legitimacy which he hoped would persuade doctors to participate.
While there is some science behind medical marijuana, many New York clinicians said it’s limited and they remained skeptical.
“People take are taking anecdotes and pre-clinical data and claiming it’s evidence for marijuana’s effectiveness,” said Dr. Daniel Friedman a neurologist at NYU Langone Hospital who has surveyed the literature on cannabis and the suppression of epileptic seizures for the New England Journal of Medicine.
“There are some studies, but even when preliminary results look promising, I’m not sure how what they’re testing — which most often is isolated compounds known as cannabinoids — correlates with correct dosing of what people will be getting in dispensaries.”
He and other doctors are used to tracking new drugs as they come up through the federal drug review pipeline, or consulting the Physicians Desk Reference for existing drugs, to see what adverse reactions there might be with other medications.
“We do a lot of trial and error, but at least there’s a baseline of knowledge,” he said. “[With medical marijuana] everyone’s a lab rat.”
Like Friedman, Dr. Jason Gonsky has been evaluating the relatively scarce medical literature on marijuana and its effectiveness and clinical applications. He said he could envision prescribing marijuana to his cancer patients who don’t respond well to other palliative therapies, but he doesn't expect it to be the panacea that some advocates claim.
“I won’t say that I’ve been waiting eagerly for the approval of marijuana to fill a large gap in my toolbox to help my patients,” said Gonsky, an oncologist at Kings County Hospital whose patients often experience nausea, pain and lack of appetite due to chemotherapy. “But it may turn out that it’s more helpful than I anticipate.”
Many hospitals around the state are in the process of developing guidelines for physicians.
Another hurdle for the medical marijuana industry: cost. Insurance — whether from private companies or from government programs like Medicaid and Medicare — won’t cover medical marijuana because it’s still an illegal narcotic in the eyes of the federal government. For similar reasons, credit card companies won't process the transactions, making it a cash-only business.
Based on early input from marijuana-seeking patients, advocate Julie Netherland estimates monthly costs could run anywhere from $200 to $2,000 a month, at current prices.
“The last thing we want to see is a two-tiered system in New York where affluent patients are able to purchase marijuana from a medical dispensary, said Netherland, from the Drug Policy Alliance. “But low-income folks are forced to either go without or forced to purchase marijuana on the illicit market and face health and safety risks, not to mention possible involvement with the criminal justice system.”
Law enforcement of illegal marijuana, however, is the lowest it’s been in years. Chris Walsh, managing editor of the online trade journal Marijuana Business Daily, says it’s not difficult to imagine cheaper street pot cutting into demand for dispensary cannabis, limiting the overall market size.
“I think as everyone knows, especially in New York City, it’s fairly easy to get marijuana right now, for whatever purpose,” Walsh said, “so the industry is going to have some challenges there and the patient base might be artificially lower than you’d find in other states."
Over time, as both supply and demand mature, legal marijuana prices in New York could come down. Walsh said getting more doctors and patients involved would help – and the best way to do that would be to expand the state’s short list of eligible medical conditions.