Medical marijuana, out of joint

On Friday, New York became the 23rd state to pass a bill creating legal access to medical marijuana for patients with certain serious, debilitating conditions. Without question, this is a huge victory for New York patients with cancer, multiple sclerosis, epilepsy and other conditions who have been waiting many years for relief.

Still, the law leaves unchanged the unconscionable status quo in which tens of thousands of New Yorkers, most of them black and Latino, are put through the criminal justice system for mere possession of small amounts of marijuana.

And even within the context of medical marijuana, the legislation is the result of political compromises with the governor that were needed to gain final passage. Those compromises include serious limitations that will leave many patients behind and complicate implementation. It becomes clear that politics, not science, drove the final agreement.

For instance, the bill represents an extraordinary level of intrusion into the doctor-patient relationship by narrowly defining the list of conditions for which physicians can recommend marijuana for medical use.

And so, instead of your physician determining whether or not marijuana might be useful for your pain or illness, that decision has been made by politicians in Albany — none of whom, by the way, is a physician.

Further, the bill gives the governor’s administration sole discretion to define the types of medical marijuana that will be made available to patients, and the routes of administration they can use to consume it. Presumably, patients will have access to edibles, oils and lotions as well as vaporization. The only thing we know for sure is that the bill explicitly excludes smoking.

Banning smoking may have made for a good soundbite, but it doesn’t make for good policy . Back in 1999, the Institute of Medicine of the National Academy of Sciences spent two years reviewing the scientific data then available with respect to potential benefits of medical marijuana. The study team concluded that “nausea, appetite loss, pain and anxiety . . . all can be mitigated by marijuana.” The study team did not exclude smoked marijuana from its conclusions, noting instead that “there are even some limited circumstances in which we recommend smoking marijuana for medical use.”

The findings of the Institute of Medicine report have been corroborated by numerous peer-reviewed, randomized, double-blind controlled studies of smoked marijuana published in highly respected and credible medical journals. Notably, these studies were completed despite significant federal obstruction of research into the medical benefits of marijuana — the same federal obstructionism that has led states to pass medical marijuana laws in the first place. And, unlike tobacco, smoking marijuana does not increase the risk of lung cancer, according to longitudinal studies.

In contrast, we know very little about the long-term effects of vaporizing oils and extracts.

And while not explicitly banned in the legislation, Gov. Cuomo has made clear that patients will not be allowed access to the whole-plant form of marijuana on his watch.

This means that patients can’t consume raw marijuana and, when vaporizing, they will be forced to use concentrated extracts. The extracts used in many vaporizers may be too potent or may be missing therapeutically important components, like terpenoids.

Increasingly, researchers are learning that the hundreds of different compounds in cannabis act synergistically in what is known as the “entourage effect,” through which some chemical compounds may enhance others. It’s not clear if or how the process of creating oils and extracts impacts the entourage effect. As often happens in Albany, rhetoric outweighed reason, and politics trumped patients’ needs.

With the bill passed, we turn to implementation — a process entirely in the hands of the governor, who said it will take up to 18 months to set up the program. But many patients — especially children with severe epileptic diseases, like Dravet Syndrome — don’t have that long to live. They need access right now.

The bill’s sponsors, Assemblyman Richard Gottfried and Sen. Diane Savino, had included an emergency access provision in their proposal, but it was removed in the final negotiations.

The caregivers, patients and providers who worked so hard for this victory should celebrate. Even with its limits, thousands and thousands of patients will benefit from this legislation. And for some, the passage of this bill is literally life-saving.

But for New York to have the best marijuana policies in the country, we’ve got lots of work to do.

Netherland and Sayegh are deputy state director and state director of the Drug Policy Alliance.