New York's medical marijuana program is due to launch next month, but the question of when all qualifying patients — roughly 500,000, or one in forty residents across the state — will be able to purchase cannabis still has advocates concerned. While the patients themselves are ready, most doctors, it turns out, are not.
The steps to getting a medical marijuana card in New York are fairly straightforward, but the timeline to execute them is contingent on whether doctors themselves are already trained to recommend cannabis to qualified patients. "People would love to start getting their recommendations, but the challenge is that the [doctors] educational course was just released," says Melissa Meyer, founder of the patient education company Health MJ. "Patients are ready but have to be able to get doctors on board," she says.
Before anything else, patients must first determine if they qualify under the Compassionate Care Act, which covers just ten "severe, debilitating, or life-threatening" conditions: epilepsy, cancer, AIDS/HIV, Parkinson's, ALS, multiple sclerosis, spinal cord damage, inflammatory bowel disease, neuropathies, and Huntington's. Next, patients must get a recommendation from the doctor who treats them for their qualifying illness. Doctors cannot "prescribe" medical marijuana, but only "recommend" it, because under the federal Controlled Substances Act cannabis is devoid of any medical uses. In order to recommend cannabis, doctors must complete a four-hour training course and be accredited by the state.
Once they receive a recommendation, patients can apply for the $50 medical marijuana card from the Department of Health. From there, patients or their caregivers must wait for the medicine to become available before they can pick out what strain of cannabis, or "brand," they need to treat their condition. Patients can buy up to one month's supply at a time. So far, none of the five companies licensed to grow and dispense medical marijuana in New York have announced which brands they will produce.
Some patients are still trying to figure out which doctors have taken the course or are willing to recommend medical marijuana. "There's no information yet for us, that's part of the issue," says Maryanne Houser, whose daughter Amanda suffers from epilepsy and would need a type of cannabis high in cannabidiol, or CBD — a non-psychotropic compound known to treat seizures.
The fact that neither doctors nor patients know what kind of cannabis will be available in dispensaries is another obstacle, says Meyer. The doctors training course might help doctors feel more generally comfortable recommending cannabis, she says, but they may not yet feel empowered to recommend specific brands to patients. Meyer says the onus will likely be on those behind the dispensary counter to educate the patients.
Dr. Amy Piperato, who practices internal medicine in Rockland County, took the requisite course for "personal benefit," though her patients' conditions are currently not covered under the Compassionate Care Act. But she says that for many doctors, medical marijuana is not even on their radar as a reasonable treatment choice. "There's going to be more advocacy from patients asking their doctors if they are comfortable," she says. "It must be a lack of exposure and education. New York as a state is so far behind."
Moreover, doctors who work with hospitals that receive federal funding may face an added level of resistance because marijuana is an illegal Schedule I substance, in the same category as heroin. "I can prescribe opiates and benzodiazepines, which are more addictive. Nobody is checking the diagnoses for using these medications," says Piperato. "But the level of caution for recommending cannabis is so above and beyond."
Dr. Stephen Corn, founder of the Answer Page, the medical education website that provides New York's physician training course, says despite plenty of doctors having signed up for or completed the training, most knew so little about medical marijuana that they still understand woefully little about how it can be used to treat patients. "The barrier for doctors recommending medical marijuana is the lack of formal education on medical marijuana," he says. "Doctors, pharmacists, and other healthcare providers want to provide the best care for their patients, but they do not want to do so blindly, with no education — for ethical, moral, and also legal reasons.
"Whether or not they plan on recommending medical marijuana, their patients will be asking about it and utilizing it. One way or the other, if they're gonna stay as expert guidance for their patients, they should get this education."
By Madison Margolin - The Village Voice/Dec. 10, 2015
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