Problem Memorandum - City University of New York



Problem MemorandumTo: Governor Andrew CuomoFrom: Trevor Hackett and Ruth Zisblatt, MPA Students at Baruch CollegeRe: Medical Marijuana Under the Compassionate Care ActDate: March, 10, 2016Emerging research has shown that the therapeutic properties of cannabis can be used to treat a range of illnesses and their symptoms. In June 2014, the New York State legislature approved the Compassionate Care Act which legalized the use of medicinal marijuana for qualifying patients. New York joined twenty-three other states which have implemented laws to allow the medicinal use of marijuana. So far, eight dispensaries have opened across the state with another twelve scheduled to open over the next several years. New York’s medicinal marijuana law is one of the most strictly regulated in the country. These regulations have not only prevented many eligible patients from accessing the program, but have also excluded patients who would be able to receive treatment in other states. Many advocates of the law believe that the program is too restrictive to properly serve the people it was intended to benefit. Under the The Compassionate Care Act, only ten conditions, which are considered debilitating or life threatening, are covered by the law. During the first eighteen months of the program, the CCA allowed for several other conditions to be considered for treatment. The State Health Commissioner has discretion over which illnesses can be covered under the law. But, as yet no additional conditions have been approved. This has excluded thousands of potential patients from receiving the treatment they need. Many people who are eligible to participate in New York’s medicinal marijuana program have found it to be inaccessible. Meaning Patients who qualify to receive treatment have difficulty finding a physician who is enrolled in the program. In order to receive the required certification to prescribe medicinal marijuana, doctors must opt to take a $250 dollar online training course. So far, only 350 of a total 79,000 doctors in the state have been certified. Additionally, many doctors are simply unaware of the CCA, or are unsure of the steps they need to take to participate in the program. The search for a certified physician is further complicated by the fact that the list of participating doctors is not available to the public. There are many strains marijuana, each of which have unique properties that are effective in treating different diseases and their symptoms. However, the law only permits the manufacturing of five strains of cannabis. In effect, these few strains are limited in their ability to treat the wider range of symptoms a patient may be experiencing.Additionally, the drug can only be prescribed in oil-extract form and can only be taken through oil-filled syringes, vapor pens, and pills. Smoking of the cannabis flower as well as consuming it in edible form is still prohibited under the law. A group of doctors known as the New York Physicians for Compassionate Care are urging the state legislature to pass policies which would legalize prescriptions for both smokable and edible forms of marijuana. They believe that the current limitations placed on the variety of usable strains and consumption methods restrict the benefits of the drug. They also argue that the approved forms of consumption present certain health risks which are not associated with smoking or eating the drug. The potency of oil-extracts can be too strong for patients to tolerate. An additional concern is companies using irradiation to sterilize their cannabis during the manufacturing process. Doctors believe that the consumption of irradiated material can have possible carcinogenic effects.The cost of purchasing medicinal marijuana is another factor complicating the current system. Only five organizations have been authorized to manufacture cannabis products. The lack of competition has contributed to the high price of these products. The additional cost of converting raw marijuana for use in vape pens, pills, and oil-syringes allows companies to further increase the price of their products, making it difficult for lower income patients to afford. Since there are a limited number of dispensaries operating in the state, some patients need to drive several hours in order to pick up their prescriptions. As a result, many patients give up, choosing to purchase marijuana illegally at a lower cost.The legality of state level medical marijuana programs is another factor which contributes to the restrictive policies of the Compassionate Care Act. Although the Justice Department has announced that it will not interfere with state laws concerning medical and recreational marijuana use, cannabis is currently illegal under federal law and is classified as a Schedule 1 Controlled Substance under the Controlled Substance Act of 1970. The CSA separates controlled substances into five different categories. Schedule 1 substances include the most dangerous drugs which have the highest potential for abuse. The CSA has identified the substances in this category as having "no currently accepted medical use in treatment in the United States," and "a lack of accepted safety for the use of the drug...under medical supervision.” Other drugs listed in the same category include heroin, LSD, and ecstasy. Despite the scientific evidence which supports the medical benefits of marijuana, attempts to petition the DEA for its rescheduling have been unsuccessful. Because schedule 1 substances cannot be approved by the Food and Drug Administration, health insurance companies are unwilling to cover medical marijuana products. As a result, patients bare the full responsibility of paying for this costly treatment. The current classification of marijuana as a schedule 1 substance also perpetuates the myth that it leads to the abuse of harder drugs also in the same category. Before the the State Legislature passed the CCA, Andrew Cuomo fought to include many of the conditions which currently prevent qualifying patients from accessing the program. Despite scientific evidence, Cuomo has defended the restrictive policies in the CCA by arguing that marijuana is a gateway drug and may exacerbate New York’s continuing heroin and opiate abuse problem. Acquiring approval to study a schedule 1 substance is extremely difficult. Any application for the scientific research of marijuana requires approval from the Food and Drug Administration, the Drug Enforcement Agency and the Department of Health and Human Services. Unlike other substances in this category, the DEA has created a monopoly by exclusively licensing the legal production of marijuana to the National Institute of Drug Abuse. Because NIDA’s mission is concentrated on identifying the hazards involved in the use of specific drugs, the agency has largely ignored studying the potential medicinal benefits of cannabis. In 2013, only 6% of studies on marijuana were focused on its possible medical uses as opposed to its harms.Policy option one: Reclassify marijuana to a lower schedule of controlled substances. Repealing federal marijuana prohibition would remove the current contradictions between state and federal laws. This idea is gaining national support as 23 states have legalized the medical and recreational use of the drug. However, repealing federal prohibition is politically unrealistic at the moment. A more feasible option would be for Congress to require the DEA to reclassify marijuana as a schedule 2 controlled substance. Marijuana is currently classified as a schedule 1 controlled substance. Drugs in this category are identified as extremely dangerous and highly addictive. These substances are considered to have no potential for medical use. However, it is difficult to argue that marijuana belongs in this category as it doesn’t meet the criteria for a schedule 1 substance. Unlike other drugs in this category, marijuana is not physically addictive. Studies show it is safer than the majority of drugs listed in the 5 schedules of controlled substances. In addition, limited scientific evidence has shown that it does, in fact, have medicinal properties. While reclassifying marijuana as a schedule 2 controlled substance wouldn’t legalize its use in all forms, it would benefit states with medical marijuana programs in several ways. A rescheduling would loosen the restrictions on scientific studies into the potential hazards and benefits of the drug. The expansion of research opportunities into the various medical uses of cannabis would allow states, such as New York, to make their programs less restrictive and more accessible to patients. The medical use of other schedule 2 substances such as OxyContin, codeine, and Adderall, have been approved by the FDA and are commonly prescribed by physicians. Rescheduling would allow for medical cannabis to receive approval from the FDA. Approval from the FDA would increase the likelihood of insurance companies including marijuana products on their lists of covered medications. This would help to decrease the high cost of products which are currently available in New York. Although moving marijuana to the schedule 2 list of controlled substances would not resolve the issue of contradicting state and federal laws, it is one step in the gradual process of expanding the medical uses of cannabis. Most importantly, lowering the drug to a different schedule would promote more open and honest political debates in the future. Policy Option 2: Better access to medical marijuana for qualifying patientsThe Compassionate Care Act legalized cannabis, commonly known as medical marijuana, for patients who qualify, but a majority of these qualified patients are unable to obtain the drug. There are currently 1,399 patients registered with the State of NY and only a handful of them are able to get cannabis. The reason is because it is too expensive, insurance companies will not cover it, there are not enough dispensaries and there are not enough doctors registered with the state to prescribe the drug. Many of the qualified patients cannot get medical cannabis because they cannot afford it. Due to medical cannabis being federally illegal and because of the fear of federal prosecution, Health Insurances will not cover medical cannabis and patients can’t afford the $300 a month to cover the cost. Many patients seeking medical marijuana are on disability or are unable to work due to their disease and therefore have no way of paying for the high cost of the drug. The high cost of medical marijuana is due the strict restrictions placed on the distributers and the dispensaries by the state of New York. To obtain a license in New York, applicants had to pay a $200,000 refundable registration fee and a $10,000 non-refundable fee. The high application fee will eventually translate to the price of the product. Out of the forty-three applicants, New York chose five to be registered organizations to manufacture and dispense medical marijuana. Additionally, each of these five organizations can only open a maximum of four dispensaries which means that only twenty dispensaries are allowed statewide. The organizations have to pay a 7% sales tax and the counties where the dispensaries are located receive 22.5% of the revenue. These restrictions are causing a monopoly market and it is affecting the patients. A competitive market results in a push to lower prices and constant improvement of the product. The limit on the forms of medical cannabis allowed to be sold is also limiting the market and raising the price. New York only allows the medical marijuana to be sold as liquid, oil or capsules. The registered organizations have to invest in expensive equipment to extract the oils and liquids from the plant. Minnesota is the only other state that bans smoking. To reduce production cost, and therefore reduce consumer price, New York needs to allow dispensaries to supply the whole cannabis plant and not just parts of it.New York needs to lower the restrictions to allow for ways for dispensaries to bring down costs. Policy Option 3: Expanding the conditions of patient eligibility The Compassionate Care Act limits patient qualifications to ten diseases and then further restricts the qualifications by identifying the specific conditions that qualify. These restrictions are excluding many patients who could greatly benefit from medical marijuana. Many studies have been done on the effectiveness of medical marijuana and it is believed that medical marijuana can help people with glaucoma, anxiety, arthritis, Alzheimer’s, and many other diseases and syndromes. Medical marijuana has also been proven to help with Post Traumatic Stress Disorder (PTSD), and in New Mexico, PTSD is the number one cause for prescribing medical marijuana.New York needs to adopt a similar prescribing protocol as Massachusetts. Massachusetts does not specify diseases and conditions that would qualify a patient to receive medical marijuana. MA leaves it up to the certified doctors to determine whether the patient is a candidate. Widening the qualifications for patients to be eligible to receive medical marijuana will increase the market and will allow for a competitive market which will eventually reduce the cost of the drug ................
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