Medical marijuana pitch raises concerns, questions

COURTESY PHOTO | Governor Andrew Cuomo delivers the State of the State Jan. 8, where he formally announced plans to launch a medical marijuana research program.

Gov. Andrew Cuomo’s announcement of plans to launch a pilot medical marijuana research program came as encouraging news to some but worried others, with both sides seeing it as New York State inching closer to the possible legalization of marijuana.

The announcement, made last Wednesday during the governor’s State of the State address, described the pilot program as a way to evaluate the effectiveness of a statewide medical marijuana system by allowing eligible participants to legally seek relief from pain and discomfort.

“Research suggests that medical marijuana can help manage the pain and treatment of cancer and other serious illnesses,” Mr. Cuomo said in his speech. “Twenty states have already started to use it.”

Mr. Cuomo said he will use an executive order to revive the Antonio G. Olivieri controlled substances therapeutic research program, which was established by law in 1980 and discontinued soon after, and allow up to 20 hospitals to dispense marijuana to approved patients suffering from cancer and other serious illnesses.

It is unclear whether any local hospitals, including state-run Stony Brook University Hospital, would be among those in the program.

While praising Mr. Cuomo’s decision to come out in support of medical marijuana, advocates have concerns about the feasibility of such a program — many stemming from the limitations of the outdated 1980s law as well as federal law, under which marijuana remains illegal.

“Back then we didn’t have the experience we have now within the other 20 states” that have legalized medical marijuana programs, said Evan Nison, co-founder and director of the New York Cannabis Alliance, which works along with Compassionate Care NY and the Drug Policy Alliance toward the legalization of medical marijuana.

“We’re sort of starting from ground zero, from the bottom floor when there are states around us that have skyscrapers, if you will, that we can learn from,” he said.

Mr. Nison said Cuomo’s program relies on the ability of participating hospitals to dispense the medical marijuana, however “there are very large concerns that the hospitals cannot participate in these studies because of the federal regulations.”

Most hospitals rely on federal funding, he noted, adding that there could be issues with insurance as well.

“We’ve seen in other states that have tried to involve hospitals in medical marijuana programs that they are just unwilling — and rightfully so, because they would have a lot to lose under the federal law,” Mr. Nison said.

Advocates feel the governor’s proposal is simply a first step rather than a solution to providing a suitable program and has yet to specify which patients would be eligible, which hospitals would participate and where those hospitals would get the marijuana.

According to the 1980 legislation, found in Section 3397 of the state’s public health law, the program must be limited to cancer patients with cancer, glaucoma and other diseases approved by the health commissioner. But the legislation also says it “shall be limited to such patients who are involved in a life-threatening or sense-threatening situation.”

The law suggests that marijuana could be obtained through the federal government — which is not a possibility since the drug is outlawed — or from local law enforcement agencies. But Mr. Nilson said using marijuana confiscated from street crimes “isn’t a suitable, or safe solution for patients, or anyone” — and health experts agree.

Mr. Nison added that under Mr. Cuomo’s plan, the drug could not be obtained from states where it is legally grown.

Since there is an obvious dearth of available, safe marijuana in New York, plant growers and cultivators are already looking at production possibilities in the state.

“The New York market is one of the premier markets that we are looking at,” said Derek Peterson, chief operating officer of Terra Tech Corp., an all-natural hydroponic food producer that cultivates marijuana for both medicinal and recreational purposes.

“Our hope would be that we can make a capital investment in New York, open a new facility in there and get it up and operating to provide medical cannabis, whether it is through this program or hopefully a more broadened-out law in the future,” Mr. Peterson said.

Terra Tech Corp. uses greenhouses with supplemental lighting to grow everything from herbs and lettuces to medical-grade marijuana and employs all-natural processes — even using lady-bugs for pest management as a substitute for synthetic pesticides.

“The bottom line is you’re consuming it and putting it in to your body,” Mr. Peterson said. “So I think consumers are really going to start paying attention to where their medicine is actually grown. If you’re going to have a program in place, let’s make sure it’s one that is not only economically friendly but environmentally friendly as well.”

Mr. Peterson said he believes politicians are beginning to understand the economic impact marijuana production can have, in terms of not only job creation but tax capture as well.

As an example, Mr. Peterson said, the company paid about a $1.5 million in taxes last year for sales in Oakland, Calif., alone — with about $500,000 going directly to the city’s general fund thanks to a 5 percent special purpose tax that was added to sales of medical cannabis on top of the state’s 10 percent sales tax.

As to interest in a Long Island production facility, Mr. Peterson said it would be a “no-brainer.”

Dr. Brian Durkin, director of the Center for Pain Management at Stony Brook University Medical Center, said that — if administered in the right dose using the right varieties — marijuana may be an effective treatment for patients in some select cases.

Patients suffering from nausea and anxiety benefit from the tetrahydrocannabinol (THC) found in marijuana, while those suffering from pain benefit from the cannabinoid in the plant, Dr. Durkin said, adding that “not all marijuana is the same.”

“The way it’s grown depends on how much cannabinoid effect it has verses THC effect,” he said. Usually the amounts of each are inversely proportional, meaning the lower the THC the higher the cannabinoid level in the plant.

“They have shown that mild doses of marijuana with a strong cannabinoid effect can be effective for mild to moderate pain, but higher doses tend to make pain worse,” Dr. Durkin said, referring to a research study completed by University of California’s Center for Medicinal Cannabis Research.

Dr. Durkin said he believes more work needs to be done in the interest of supplying patients with a safe, quality-controlled form of marijuana.

“There’s a place for this, I’m sure, in medicine and I think the proper way to do that is just like all other medications that are available for use — they should go through clinical trials and be tested in a controlled environment to see if it is effective or not. If it is effective it should be marketed just like all other medications in the United States,” he said.

Currently, cancer patients must rely on opioids for pain relief, which Dr. Durkin says bring with them significant side effects.

“The problem with opioids is that we get tolerant of them, making them less effective over time,” he said, adding that opioids also have cognitive effects and that overuse can cause patients to stop breathing.

According to Dr. Durkin, 50 percent of U.S. patients who die of cancer do so with moderate to severe pain.

“The stuff we have available now, it is not optimal,” he said.

Cancer patients suffering from nausea and loss of appetite can benefit from one of two U.S. Food and Drug Administration approved medications that use synthetic equivalents to mirror the medicinal benefits of marijuana, according to the manufacturers’ websites.

Physicians caring for cancer patients suffering from nausea and vomiting associated with chemotherapy treatment can prescribe Cesamet (nabilone), which offers a man-made substitute for THC.

AIDS patients suffering from poor appetite and weight loss can be prescribed Marinol (dronabinol), which also contains a man-made THC substitute.

No approved marijuana-related options are currently available for patients seeking pain relief, Dr. Durbin said, though he noted that one may be on its way.

The oral spray Sativex, which is derived from extracts of the marijuana plant itself (rather than a synthetic version), is currently in Phase 3 of clinical trials, testing its effectiveness in treating pain in cancer patients. It is also marketed to treat spasticity in multiple sclerosis patients, according to its developer, GW Pharma. Sativex would be the first FDA-approved drug using extracts taken from the plant itself.

The Republican-controlled state Senate has thus far blocked legislation authorizing a state medical marijuana program in New York. And the North Fork’s two elected state leaders have concerns about Mr. Cuomo’s proposed program, saying it needed to be thoughtfully planned out before taking effect.

“I want to see the language and I want to see how restrictive it will be,” said Senator Kenneth LaValle (R-Port Jefferson). “These things begin to create a slippery slope, and there are already people out there, to use a Christmas analogy, that have sugar plums dancing in their heads, as to where this could go.”

Mr. LaValle said he had visited California, where medicinal marijuana is legal, and took time to see a marijuana industry in high-gear.

When asked whether New York should model its laws on California’s, he said, “Don’t count me in on that. No, no, no. I would say that the vast majority of people are OK with compassionate care in a very restrictive environment, in a very restrictive way, but beyond that it is not something that I would support.”

Assemblyman Anthony Palumbo (R-New Suffolk) said, “If there is a medical benefit I think it needs to be very particularly and specifically described, prescribed and proven before we even consider such a measure in New York State.”

A former prosecutor, Mr. Palumbo also spoke of the effects drug abuse and drug use can have on a society and said more research needed to be done.

Riverhead Police Chief David Hegermiller said he had some questions about Mr. Cuomo’s proposed research program.

“If there is a legitimate reason to use marijuana medically, who is overseeing usage to see that it’s used appropriately and not abused? All those [kinds of] questions needs to be answered,” he said.

But Chief Hegermiller said he didn’t see any such program affecting police work at the street level. As far as policing the use of medical marijuana, the chief said he imagined it would be enforced the same way other prescription medications are.

North Fork residents voiced varied opinions on the possibility that New York State could join Colorado and Washington in the marijuana movement. Several who were interviewed by a reporter — most of whom did not give a name — offered comments ranging from “those states are disgraceful” to “it is a naturally occurring plant that comes from the earth that is a healthy if not a healthier alternative to pain management options.”

Mr. Nison, the medical marijuana advocate, said, “If the governor or the state Legislature makes [Mr. Cuomo’s proposal] out to be the solution, or treats this as the solution, we will not have a suitable program in New York.

“Patients will not have access to anywhere near the quality of medicine that they need,” Mr. Nison said, “and patients will probably continue to move out of state, to places like Colorado.”

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