"We’re trying to develop a sustainable system.”
Although it has been praised for its innovative structure, New Mexico’s medical marijuana program, which debuted this year, has also been criticized for not providing enough of the drug to meet demand and for allowing high costs that could be prohibitive for some patients. The state’s first licensed nonprofit provider, The Santa Fe Institute of Natural Medicine, had its first crop ready to sell to patients in August — two and a half years after the state law was passed. It promptly sold out of its $11-$14 a gram product.
But after the New Mexico Department of Health approved four new producers last week, Secretary Alfredo Vigil told The Independent the difficulties of the program aren’t all that unique, if taken in the broader context of health care. The state’s program has a unique design and unique legal problems, but it faces the same barriers of provision and access as other health care services.
Pointing to the fact that New Mexico is the fourth largest state by geography, with a large rural and poor population, Vigil explained, “There are all kinds of services that aren’t adequately penetrated in all parts of the state, like behavioral health or trauma care, for instance. There are parts of the state that aren’t served like we want them to be served.”
In this respect, he said, the debate over access to medical marijuana is in line with the national debate over health care access in general.
Most of the state’s medical marijuana patients are in northern counties, which is why none of the four additional providers he approved this week is located in the southern portion of the state, he said, stressing that the program is in a development stage.
“The way the program is today is not the way it will always be,” he said. “We’re trying to develop a sustainable system.”
“It’s not the kind of thing where you pull a program out of a box and it works perfectly. It’s a program that’s never been developed before that has interesting legal dilemmas.”
Legal context unlike any other
Despite the fact that 13 states now allow the use of medical marijuana, it is still classified as a Schedule One drug by the federal government. That means that, according to the feds, it has no accepted medical use and can’t be prescribed by a doctor as medicine.
So technically, New Mexico’s program is in direct violation of federal law. Or, depending on how you view it, it’s blazing a path toward acceptance of marijuana as a valid medicine.
“The federal system is beginning to give some thought to striking a long range balance between federal policy and state policies,” Vigil said. “There are enough states that have gone down this road now that it seems the federal government will have to look at how to bridge the difference. We want to work in tandem with that [as we develop the program] so that everything is good and right.”
Each state has a different set of rules for how it allows its citizens to access marijuana. New Mexico’s approach is a trailblazer in that the law calls for the creation of a state-licensed production and distribution system. But rather than actually produce the drug itself, the state Department of Health licenses and regulates non-profit organizations or patients themselves as producers.
Vigil said safety issues require his agency to be very careful about how the program develops, which is one reason it may seem slow to the general public.
“Marijuana is a major source of income to major criminal elements,” Vigil said, “and in California they are beginning to see serious issues of violence and safety as the Mexican cartels begin to see the medical industry as a competitor, as encroaching on their territory. We don’t want to ever see anything like this in New Mexico, which is the reason for our confidentiality provision [in which the names and locations of non-profits and patients are not given to the public].”
Plus, because marijuana is used by many as a recreational drug, too much of it in circulation at any given time might lead to it being sold on the black market. But again, this doesn’t make medical marijuana unique, Vigil said.
“We already have a significant problem with diverted prescription medicine,” he said. “Kids swipe grandma’s medicine because they think it will make them high. We can’t totally protect against this, but we don’t want to create that problem with excess product which will certainly get diverted.”
Pricing too high?
One critique of the state’s medical marijuana program is that the initial crop was available for sale at black market prices. If more of the drug was made available, it might cost less, critics say.
But Vigil said this isn’t necessarily true. The experience in California hasn’t shown that readily available medicinal marijuana is priced lower than the drug available on the black market, he said. There are a lot of other factors involved in pricing of medical marijuana from non-profit producers, he explained, including overhead and salaries.
“As far as I know,” he said, “the Department of Health doesn’t have a spigot it can turn on to lower the price. This is what the national conversation about health care reform is about. Many can’t afford health care. And in the context of a revolutionary and new program, a lower price isn’t likely to happen in the short term.”
As he made these comments, Vigil stressed that everyone involved in developing the medical marijuana program care deeply about patient care. While some may be interested in medical marijuana because it might eventually lead to the legalization of marijuana in general, he and his fellow workers are involved because they are interested in alleviating human suffering, he said.
“The main thing about this is that its an attempt to be responsive to an experience that people have with their chronic or terminal condition,” he explained. “This is about human suffering and improving the quality of life for that small group of people who haven’t gotten relief from other interventions. It’s not a panacea that works for everyone — it’s a medicine like any other medicine.”
November 16, 2009
The New Mexico Independent
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Marijuana is a ‘medicine like any other medicine’, DOH secretary says