Bills would bring cannabis to more patients, may help with opioid crisis

— Photo from the New York State Senate
Senator Diane J. Savino is currently backing three bills to expand the use of medical marijuana. She was the lead sponsor of the Senate’s Compassionate Care Act, which went into effect in 2016.

Since New York’s Compassionate Care Act went into effect in 2016, both the State Senate and Assembly have considered bills that would expand the use and availability of medical marijuana.

And, the state’s Department of Health “is committed to growing New York’s Medical Marijuana Program responsibly,” according to department spokeswoman Jill Montag, who emailed responses to Enterprise questions this week.

Currently, state-approved practitioners can recommend marijuana for patients suffering from any of a number of severe and debilitating illnesses. The list includes cancer, positive status for HIV or AIDS, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), Parkinson’s disease, Huntington’s disease, multiple sclerosis, epilepsy, irritable bowel syndrome, post-traumatic stress disorder, and chronic pain that meets state regulations.

For the patient to be eligible for medical cannabis, the illness must also be accompanied by an associated condition: wasting syndrome, severe or chronic pain, severe nausea, seizures, or severe or persistent muscle spasms.

Montag listed these recent enhancements:

— Adopting new regulations to improve the program for patients, practitioners, and registered organizations;

—Authorizing five additional registered organizations to manufacture and dispense medical marijuana;

— Adding chronic pain as a qualifying condition;

— Permitting home delivery; and

— Empowering nurse practitioners and physician assistants to certify patients continue to help improve access for patients and increase choice.

Pending legislation

There are currently 10 license holders — which the Department of Health refers to as registered organizations, or ROs — authorized to open a total of 40 dispensaries among them, statewide. A bill introduced in the state senate by Democrat Diane J. Savino, whose district spans parts of Staten Island and Brooklyn, would increase this number, allowing a maximum of 25 dispensaries per license holder, for a total of 250.

Savino was the lead sponsor in the senate of the Compassionate Care Act.

According to Bryan Clenahan of Guilderland, who is of counsel to Savino, there are 22 dispensaries open now. Five of the 10 license holders are newer, and they are still working on getting their dispensaries open, he said.

There are two dispensaries in all of Albany County, located only a mile-and-a-half apart: one is behind Stuyvesant Plaza and the other is on Fuller Road near Central Avenue.

With 40 dispensaries allowed in the state, Clenahan said, a sick patient could travel for hours and then get to a dispensary and realize it doesn’t have the exact product he or she needs.

There is only one lab in the state, now, that can test the content and the safety of cannabis products. Savino’s bill would also expand the number of labs that can test medical marijuana, bringing the number up to at least four.

The Wadsworth Center Medical Marijuana laboratory, which conducts testing free of charge to New York’s registered organizations, has made procedural changes and, as a result, has increased laboratory testing capacity by 25 percent, according to Montag.

“There is currently no backlog of testing requests,” she said, adding, “Commercial laboratories are encouraged to obtain approval from the NYSDOH Environmental Laboratory Approval Program to test medical marijuana in New York State.”

There are now about 1,500 state-approved practitioners, including doctors, nurse practitioners, and physician assistants, who can recommend medical marijuana to patients, said Clenahan.

Savino is also sponsoring another bill, which would add “opioid-use disorder” to the list of conditions that would qualify patients for the medical marijuana program. She is considering amending this bill to add anxiety as another qualifying condition, Clenahan said.

A third bill, Clenahan said, not yet introduced, would expand the definition of “practitioner” to encompass practitioners who are authorized to prescribe controlled substances, which would include podiatrists, who often treat neuropathy.  

The number of patients in the statewide medical marijuana program was, as of April 24, about 52,000, with about half of those, at most, as actual, active patients, Clenahan said. The reason for the discrepancy between the listed and actual numbers is that some patients still on the list have died and others have found the medication is not effective for them.

The medication is expensive to produce, Clenahan said, especially since it needs to be produced in a variety of products of different kinds and with different compositions.

Health insurance cannot be used for the medicine, because, while marijuana is allowed for medical use in some cases in New York State, under federal law it is still considered a Schedule-1 controlled substance and, so, not approved by the Food and Drug Administration.

Having a larger pool of providers and patients involved in the program could help to bring costs down for everyone, Clenahan said.

Clenahan said Savino hopes to get her bills onto the Senate Health Committee agenda in the next month or so. Clenahan added, “It’s been more challenging in the Senate.”

One of Savino’s bills originated in the State Assembly, said Daniel J. O’Donnell, a Democrat who represents Manhattan’s west side from 80th to 125th streets. The idea first came from his staffers, he said, and the statistics were all there: “something like a 25 percent reduction in deaths from opioid overdoses where it’s available.”

He was a public defender in Brooklyn during the crack cocaine years when the common treatment for addiction was to provide “another opiate, methadone,” he said.

“If I had a child that was going through something like that, I’d rather see them try medical marijuana than methadone,” he said.

During the 1970s and 1980s, O’Donnell said, the people dying of overdoses were those who had started with other drugs and gone on to heroin for the high it gives, contrasting that with the present day. What is happening today, he said, is that people are being given opioids by medical doctors and then segue into heroin, because it’s cheaper.

Senator Savino saw his bill on the agenda of the Assembly Health Committee and said, “That’s a good idea,” O’Donnell said.

He is not putting forward a package of bills on medical marijuana in the Assembly, as Savino is in the Senate, he said. His main concern is trying to do something to stem the opioid crisis.  

This bill will pass in the assembly, O’Donnell says.

Pharmacist’s role

Alisha Betti, a pharmacist, raised in Guilderland, who is also state-certified to dispense marijuana, said her patients at the local dispensary where she works part-time are in their early 20s through their 90s.

The role of the pharmacist in dispensing medical marijuana, Betti said, is very different than it is with FDA-approved medications at a retail drugstore where pharmacists fill the prescription according to a doctor’s orders.

One reason for this, she said, is that prescription medications are approved by the FDA and have been tested for years, so doctors know precisely what medication and dosage to prescribe for various conditions.

With marijuana, there’s more limited research, she said.

Practitioners will often suggest that the medication have a certain ratio of the cannabinoids THC (tetrahydrocannabinol) and CBD (cannabidiol), but will also allow for pharmacist recommendation.

This gives dispensing pharmacists some flexibility, she said, as they talk with patients and try to figure out what product and what ratio might work best for them.

Also, they can dispense a maximum of one month’s supply in one visit, and many patients buy less at one time and come in more often, because they must pay out-of-pocket. Depending on the product and the amount, cost can vary from less than $100 to hundreds of dollars per month, she said.

Pharmacists who dispense marijuana, she said, see patients often, listen to their thoughts about the effects of the medication, and work with them to adjust treatment plans as needed.

“I just like to see people enjoying their life a little more,” Betti said, “without the constant pain.” Medical marijuana is “just another alternative for people to try,” she said.

Does cannabis make patients high?

It could; a pharmacists’ goal is “never to have you feeling high,” Betti said. “If people feel high, they need a lower dose.”

Patients could have the same problem with too high a dosage of opiates, she said.

“We want people to be able to do their ordinary daily activities, without feeling high,” Betti said.

One reason for including both cannabinoids in medication is that only THC has the ability to alter mental states, while CBD actually counteracts that particular effect of the THC.

Also, each cannabinoid has its own unique properties. In general, with some exceptions, CBD helps to alleviate more body-related issues, Betti said, while THC tends to work on the brain.  

For example, she continued, THC is good for, for instance, pain relief, nausea, appetite stimulation, and sleep, while CBD is effective against inflammation, muscle spasms, anxiety, epilepsy, and irritable bowel syndrome.

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