After months of regulatory review and public comment, New York last week officially added chronic pain as a qualifying condition for its medical cannabis program.
The change was long overdue in the eyes of many patients, coming more than a year after New York’s medical cannabis program began in January 2016. The rollout has happened slowly: While initial estimates pegged the number of potential patients at somewhere between 200,000 and 400,000, so far only 15,000 patients and 911 registered practitioners are part of the program. Many hope the inclusion of chronic pain as a qualifying condition will open the doors to patients who so far have felt shut out.
Chronic Pain: How to Qualify
The first step to getting a medical cannabis card in New York is establishing a doctor-patient relationship with a state-certified practitioner.
“We have over a hundred patients who’ve been contacting us since at least December,” said Manhattan-based Dr. Ken Weinberg, who had a full slate of appointments starting at 9:30 a.m. on the day the program launched. New patients to Weinberg’s practice, Cannabis Doctors of New York, are required to provide extensive medical paperwork, but unlike many other clinics, the practice doesn’t require a referral from a primary doctor.
What qualifies as chronic pain? According to the state Department of Health, it’s “any severe debilitating pain that the practitioner determines degrades health and functional capability.” To qualify for medical cannabis treatment, the department requires that a patient “has experienced intolerable side effects, or has experienced failure of one or more previously tried therapeutic options” and that pain has lasted longer (or is likely to last longer) than three months.
Chronic pain is a symptom of a variety of illnesses, from endometriosis to arthritis to traumatic injuries. Many who suffer from it rely heavily on opioids.
Rachel Schepart is a pharmacist who oversees PharmaCann’s four dispensaries. Part of her job involves working directly with doctors to integrate cannabis into existing treatment regimens and help wean patients off other drugs.
“We all know opiates are overprescribed, but what a lot of people don’t realize is that there are a certain percentage of patients that are taking opiates but are still not under pain control” she said. “They’re living in a chronic pain scenario even on traditional medication. This is where the opportunity for medical marijuana is … so that they can get off their opiates or maybe even get off of pain.”
Some patients who begin taking opioids looking for pain relief end up abusing the drug, developing addictions and fueling the country’s deadly overdose epidemic. Medical cannabis helps mitigate that. It’s not chemically addictive, nor has it caused a single recorded overdose death. Moreover, states that have implemented medical marijuana programs have seen opioid overdose deaths decrease by 25%.
But patients interested in trying medical cannabis needn’t be recovering opioid addicts. While New York mandates that a patient has to have tried other therapeutic options before seeking cannabis, those treatments include a range of holistic and low-intervention treatments, such as occupational therapy, massage therapy, acupuncture … acetaminophen, [and] topical creams or ointments,” among others.
“There’s an incredible amount of discretion tacitly imbued in the physician, saying we trust the physician to find the best way to treat this,” said David C. Holland, the legal director for Empire State NORML. “Doctors who are in compliance with the New York state statute can feel comfortable believing that they will not be the target of a federal investigation because of the well-regulated state-level framework.”
‘The Biggest Issue Is Acceptance’
Despite the reassurance from advocates, some doctors still are hesitant to embrace cannabis due of its federal status as a Schedule I controlled substance. A majority of New York’s medical marijuana-certified doctors still don’t advertise their services.
At Compassionate Care NY, a patient advocacy group that fought to pass the state’s medical marijuana law,more than 50% of outside inquiries are from patients with chronic pain looking to qualify for medical cannabis. “As a patient advocacy group, we try to give patients the tools they need to navigate the system on their own,” said Kate Hintz, an advocate for the group. “This may mean helping them start a conversation with a doctor they feel might not be open to cannabis therapy, or steps they can take to communicate issues or problems to the Department of Health.”
Dent Neurologic Institute in Buffalo requires a doctor’s referral in order to be seen. As a comprehensive neurological research center, the Dent Cannabis Clinic is one of the rare cannabis clinics that accepts insurance for consultations. Amanda McFayden, the clinic manager, estimates that it has a waiting list of more than 600 patients referred for chronic pain.
The clinic’s 16 certified practitioners now serve 527 patients—or roughly 3.5% of the state’s entire medical cannabis population. The demand has led Dent to open the clinic on Saturdays, and on a recent Saturday morning it had more than 40 consultations scheduled. Patients who are approved for medical cannabis are asked to return to the clinic for an initial follow-up visit after starting treatment, returning every two to three months afterward.
Patients without a referral are often forced to scour the internet looking for doctors willing to publicize their cannabis certification. New York has an online database that doctors may use to refer patients, but the information isn’t accessible to the general public. “The biggest issue is acceptance within the the physician community and enrollment,” said Hillary Peckham, the spokesperson and chief operations officer for Etain, a chain of woman-owned medical cannabis dispensaries. “We need to focus on getting the physician community—including nurse practitioners and PAs—on board, taking the course and getting enrolled.”
Chris Reid, 44, found a cannabis-certified doctor online. He was at the doctor’s office first thing on a recent Wednesday morning, and later that afternoon he registered at the Etain dispensary in Yonkers. He expects to get his card in the mail within a few days. A former corrections officer, Reid retired early due to constant pain from injuries sustained on the job.
“I’ve had three spinal cord surgeries and am on a pain management system I really don’t care for,” he said, adding that “the opioid medications, they make you drowsy and nauseous.”
“So I decided to go in another direction,” Reid said. “I think if more people knew it was attainable, they would try.”