100,000 REASONS: MEDICAL MARIJUANA IN THE …

100,000 REASONS:

MEDICAL MARIJUANA IN THE BIG APPLE

New York City Comptroller John C. Liu

AUGUST 2013

100,000 Reasons: Medical Marijuana In The Big Apple

August 2013 Published by the New York City Comptroller's Office

John C. Liu

Comptroller First Deputy Comptroller Ricardo Morales Deputy Comptroller for Public Affairs Ari Hoffnung Chief Economist Frank Braconi Special Assistant for Public Affairs Jacqueline S. Gold Executive Director for Budget Jonathan Rosenberg Director of Policy Carolyn Karo Rachel Bardin Doug Giuliano Tomas Hunt Andrew McWilliam Susan Scheer

New York City Comptroller John C. Liu

Contents

1Medical Marijuana in New York City: An Urgent Need 2More Than 100,000 New Yorkers Could Benefit 3Medical Marijuana's History in New York 4Twenty States and Counting 5 Conflict with Federal Law 7 Scientific Evidence Supporting Medical Marijuana 7 Policy Recommendations 10 Conclusion 11 Appendix: Methodology

About the New York City Comptroller's Office

The New York City Comptroller, an independently elected official, is the Chief Financial Officer of the City of New York. The mission of the office is to ensure the financial health of New York City by advising the Mayor, the City Council, and the public of the City's financial condition. The Comptroller also makes recommendations on City programs and operations, fiscal policies, and financial transactions. In addition, the Comptroller manages the assets of the five New York City Pension Funds, performs budgetary analysis, keeps the City's accounts, audits City agencies, manages the City's debt issuance, and registers proposed contracts. His office employs a workforce of more than 700 professional staff members. These employees include accountants, attorneys, computer analysts, economists, engineers, budget, financial and investment analysts, claim specialists, and researchers, in addition to clerical and administrative support staff.

About Regulate Marijuana NYC

Regulate Marijuana NYC advocates for regulating and taxing the sale of marijuana for personal use for adults in New York City. It recognizes that marijuana has great medical potential and should be available to patients as well as researchers for further study. It also calls for the creation of an interagency task force comprising the Police Department, Administration for Children's Services, Department of Education, Department of Health and Mental Hygiene, District Attorneys, and Department of Consumer Affairs to study issues related to regulation and work collaboratively with the New York State Senate and Assembly in order to pass appropriate legislation.

Acknowledgments

The Comptroller's Office is grateful to Dr. Sunil Kumar Aggarwal, M.D.,

Ph.D., Senior Resident Physician at New York University Langone Medical

Center and Executive Science Director of the Center for the Study of Cannabis and Social Policy. His expertise,

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insight, and guidance contributed greatly to the research

in this report.

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100,000 REASONS: Medical Marijuana In The Big Apple

AUGUST 2013

MEDICAL MARIJUANA IN NEW YORK CITY: AN URGENT NEED

With the New York State Legislature poised to consider at least one bill that would legalize marijuana,1 and with Comptroller John C. Liu's proposal to legalize, regulate, and tax marijuana in New York City2 generating wide discussion, the Comptroller's office undertook a study of how New York City residents might benefit from the legalization of medical marijuana, an idea gaining currency in our State.

Public polling and the legislative history suggest that New York State may indeed legalize medical marijuana soon because New Yorkers overwhelmingly support the idea. According to a May 2013 poll conducted by the Siena College Research Institute and Drug Policy Alliance, 82 percent of State and 79 percent of City registered voters support medical marijuana. In 2012, the City Council overwhelmingly passed (44-3)3 a resolution calling on Albany to pass medical marijuana legislation being considered then (A.7347/S.2774).4

On June 3, 2013, the New York State Assembly voted 99 to 41 in favor of establishing a medical marijuana program.5 The bill died in the State Senate, but given the Assembly's strong support it seems likely to see reintroduction. The legislation would have allowed healthcare professionals to recommend medical marijuana for New Yorkers suffering from serious conditions such as cancer, HIV/AIDS, multiple sclerosis, Parkinson's disease, and more. Physicians could grant written certification to qualifying patients, and the Department of Health would be charged with monitoring marijuana use and promulgating rules and regulations for registry identification cards for patients and designated caregivers. Marijuana possession for patients would be restricted to two and a half ounces. New Yorkers under the age of 18 with a qualifying condition could receive medical marijuana, so long as the application for a registry ID card is completed by a person age 21 or older, and the minor has an appropriate adult designated caregiver.

NEW YORK STATE & CITY RESIDENTS OF ALL TYPES OVERWHELMINGLY SUPPORT LEGALIZING MEDICAL MARIJUANA.

New York State

New York City

82% 79%

Liberal

Moderate

Conserva7ve

92% 80% 77%

18--34

35--54

55+

85% 82% 83%

White

La7no

Black

85% 67%

77%

Male

Female

84% 81%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: Siena College Research Institute and Drug Policy Alliance, May 2013

1 Liz Krueger New York State Senator, "Top News," Posted May 29, 2013, , accessed on August 22, 2013.

2 New York City Comptroller's Office, "Regulating and Taxing Marijuana: The Fiscal Impact on NYC," August 14, 2013,

tent/uploads/documents/NYC_RegulateMarijReport.pdf.

3 The Fix, "NYC Inches Towards Medical Marijuana," March 2, 2012, , accessed on August 20,

2013.

4 "Resolution 0094-2010,"

100727BB7E10&Options=&Search=, accessed on August 20, 2013. 5 New York State Assembly, "Bill No. A06357",

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=Y&Votes=Y, accessed on August 20, 2013.

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100,000 REASONS: Medical Marijuana In The Big Apple

AUGUST 2013

The bill attempted to shield practitioners and patients from federal prosecution, stating: "State or local law enforcement agencies shall not cooperate with or provide assistance to the government of the United States or any agency thereof in enforcing the Controlled Substances Act...solely for actions and conduct consistent with this title, except as pursuant to a valid court order."6 It also protected medical marijuana patients and designated caregivers from discrimination by schools, employers, or landlords, stipulating that they may not refuse to enroll, employ, or lease to them, unless there is a conflict with federal law or one of the above actions could result in a lost federal contract or lost funds.

Beverly McClain, a New York stage 4 cancer patient, describes how medical marijuana helps alleviate her pain and suffering from chemotherapy treatments.

Notably, the bill did not require insurers or health plans to cover medical marijuana.

Source: Compassionate Care NY

Prominent members of the medical community

strongly supported the bill. New York Physicians for

Compassionate Care, a group of more than 750 physicians in New York State, advocated for the Albany legislation.

The bill was also endorsed by New York health organizations such as the Hospice and Palliative Care Association

of New York State, New York State AIDS Advisory Council, New York State Nurses Association, New York State

Psychological Association, the Public Health Association of New York City, and others.7

Despite majority support in the State Assembly, significant challenges remain in Albany. Thus far, Governor Cuomo has not backed legislation to establish a medical marijuana program, although in April 2013, he said of medical marijuana that "the situation is an evolving one," indicating that he might be flexible if the Senate could also pass a bill.8

MORE THAN 100,000 NEW YORKERS COULD BENEFIT

If New Yorkers widely support medical marijuana, it is because they know many people who could benefit from it. The Comptroller's office decided to quantify that figure. We estimate that more than 100,000 New York City residents suffering from serious conditions such as cancer and chronic pain could benefit if an effective and implementable medical marijuana program were established today,9 deriving our estimate from most recently reported or estimated registered medical marijuana patients in states where the drug is legal. Moreover, we believe this is a conservative estimate because registration for medical marijuana programs in the various states falls short of the potential. Patients experience social stigma and related social sanctions for using medical marijuana, and many doctors are not familiar with its benefits. Moreover, the federal government has created unnecessary obstacles for academic and research institutions to study marijuana, thereby impeding research that could lead to a broader use of medical marijuana.10

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6 Ibid. 7 C ompassionate Care NY, "Healthcare Practitioners across New York Support a Carefully Regulated Medical Marijuana Program,"

, accessed on August 20, 2013. 8 P aybarah, Azi, "As Cuomo evolves on medical marijuana, Savino urges him to hurry up," April 23, 2013,

article/politics/2013/04/8529346/cuomo-evolves-medical-marijuana-savino-urges-him-hurry, accessed on August 20, 2013. 9 S ee the Appendix for a detailed methodology. 10 Marijuana Policy Project, "Federal Obstruction of Medical Marijuana Research,"

Obstruction-of-MMJ-Research-1.pdf, accessed on August 20, 2013.

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100,000 REASONS: Medical Marijuana In The Big Apple

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MEDICAL MARIJUANA'S HISTORY IN NEW YORK

Medicinal uses for marijuana were officially recognized in the 1850 edition of the United States Pharmacopeia.11 However, in the beginning of the 20th century, a cohesive movement organized to outlaw the use of marijuana, along with alcohol, morphine, and opium. This culminated in the enactment of the Marihuana Tax Act in 1937, which the American Medical Association opposed because it instituted marijuana registration processes, compliance requirements, and taxes that significantly deterred physicians from prescribing it.12 In 1944, New York City Mayor Fiorello LaGuardia commissioned The New York Academy of Medicine to study marijuana. Its findings debunked many claims that inspired the Marihuana Tax Act: marijuana did not lead to significant addiction in the medical sense of the word, nor did it lead to morphine, heroin, or cocaine addiction.13

An advertisement for Cannabis Americana in New York, 1917 Source:

In 1970, the federal Controlled Substances Act classified marijuana as a Schedule I drug, banning it from medicinal use. However, by 1982, more than 30 states passed laws recognizing the medical value of marijuana. In 1980, New York State passed the Controlled Substances Therapeutic Act. Though largely unknown, it remains in the state's public health laws today in Article 33-A. It states, "...recent research has shown that the use of marijuana may alleviate the nausea and ill-effects of cancer chemotherapy, may alleviate the ill-effects of glaucoma and may have other therapeutic uses...there is a need for further research and experimentation with regard to the use of marijuana for therapeutic purposes under strictly controlled circumstances."14

Photo of Mayor Fiorello LaGuardia's 1944 report on marijuana. Source: New York City Municipal Archives

The law created a Patient Qualification Review Board to approve patients for research. Several hospitals participated in research to determine the effectiveness of inhaling marijuana, which was supplied by the only federal farm, in preventing the nausea and vomiting caused by chemotherapy in patients that did not respond to other treatments.15 By 1985, 208 patients had received marijuana therapy, 199 of whom were evaluated. North Shore Hospital reported that marijuana effectively reduced vomiting 92.9 percent of the time, compared to 89.7 percent at Columbia Memorial Hospital, and 100 percent at Upstate Medical Center, St. Joseph's Hospital, and Jamestown General Hospital.16 Nevertheless, the Department of Health abandoned the program by the late 1980's.17

11 HOPES Huntington's Outreach Project for Education at Stanford, "Medical Marijuana Policies in the United States," May 15, 2012, .

edu/group/hopes/cgi-bin/wordpress/2012/05/medical-marijuana-policy-in-the-united-states/, accessed on August 20, 2013.

12 American Medical Association Bureau of Legal Medicine and Legislation, "American Medical Association Opposes the Marijuana Tax Act of 1937," July

10, 1937, , accessed on August 20, 2013.

13 New York Academy of Medicine, the Mayor's Committee on Marijuana, The LaGuardia Committee Report, New York, USA, 1944,

wp-content/uploads/2012/12/laguardia.pdf, accessed on August 20, 2013.

14 Public Health Laws of New York, Article 33-A, available at

&QUERYDATA=$$PBH3397-A$$@TXPBH03397-A+&LIST=LAW+&BROWSER=BROWSER+&TOKEN=12248217+&TARGET=VI

EW, accessed on August 20, 2013.

15 Zeese, Kevin, "Research Findings on Medicinal Properties of Marijuana," January 1997, , accessed on

August 20, 2013. 16 Ibid. 17 Karlin, Rick, "Bureaucracy Stalls Medical Marijuana," Times Union, June 18, 2012,

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Bureaucracy-stalls-medical-marijuana-3639647.php#page-1, accessed on August 20, 2013.

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