Adi Talwar

Nelson Cuevas, general manager and head pharmacist of at a Bronx medical marijuana dispensary, says he's seen dramatic changes in his patients who suffer from illnesses including multiple sclerosis and cancer. Attorney General Jeff Sessions has a different view.

During President Trump’s first 100 days, the national conversation turned on big ideas: whether it was right to bar refugees, whether Obamacare was worth keeping, and more. Over the next several weeks, City Limits will explore less recognized ways in which the Trump administration and its supporters might affect life in New York.
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Attorney General Jeff Sessions has asked for Congress’ permission to use federal resources to crack down on medical marijuana providers in the 29 states like New York that allow it. Even if Congress lets him, it’s unlikely he’ll be sending Drug Enforcement Agents to bust doors in New York City. There are only three doors he could bust, in fact.

This state has one of the most restrictive medical marijuana programs in the nation and there are only three dispensaries in New York City. Advocates and stakeholders aren’t worried that he’ll shut down what we already have — but they are worried New York’s small and struggling program will suffer from the side effects of Sessions’s hardline stance on marijuana.

Businesses are worried if the feds start meddling in states that have legalized medical marijuana, it will scare away investors. And doctors. New York already has had a hard time getting doctors on board, so a federal administration hell-bent on cracking down on weed won’t help that problem.

Finally, advocates for legalization see this as a step in the wrong direction. They thought they already secured the right to medical marijuana and that full legalization was the next hurdle in New York. On June 12, advocates were rallying in the Capitol for state Sen. Liz Krueger’s “Marijuana Regulation And Taxation Act,” a bill that would legalize recreational marijuana in New York. But the next morning, they woke up to the news that Sessions wants Congress to remove the Rohrabacher-Farr Amendment from the next budget, thus allowing him to use federal resources to crack down on medical marijuana providers.

“It puts a damper on things,” says Nancy Udell, one of the directors of Empire State NORML. “We’re upset but we’re moving forward.”

Cannabis cash

If that amendment is removed from the budget due on Oct. 1, as Sessions wants, New York’s highly regulated program is likely low on his priority list.

“Jeff Sessions has a tremendous amount of low-hanging enforcement fruit that he needs to get to before he starts bothering those of us who operate in New York,” says Jeremy Unruh, general counsel for PharmaCannis, which owns four dispensaries statewide including one in the Bronx.

There are easier targets like Washington, Alaska or Oregon — states that have much looser regulations on who can prescribe and who qualifies for medical marijuana.

In New York, the problem posed by Sessions’s move is not legal, but financial.

“The biggest effect that all of this noise has is on investment. That’s where the rubber really meets the road in the marijuana space,” says Unruh.

“We can’t go to a bank and secure commercial loans or construction loans.”

Unruh says right now investment in manufacturing and dispensing medical marijuana comes largely from rich individuals — but recently there’s been more money from venture capital hedge funds and other institutional money.

“The institutional money is just beginning to creep into the cannabis space, slowly. So this noise at the federal level makes those investors question their strategy,” he says.

That’s not good for New York’s program, which is already struggling. There are not enough doctors, the product is expensive and firms say unnecessary regulations make it hard for them to grow their business. The regulations are so restrictive in New York that when it started, some companies walked the other way. And the five companies that are registered to operate four dispensaries each are currently suing the state because the state recently announced it would register five additional companies but not let the existing companies expand themselves.

Unruh says PharmaCannis, which is part of the lawsuit, is already spending more than it’s making in New York, so adding five companies without increasing demand could ruin an already “fragile” market.

No flowers, few doctors

Right now, just over 1,000 practitioners can prescribe marijuana to the 22,000 certified New Yorkers in the program — but the patients can’t smoke the product. For certified patients, New York allows you to purchase 30-day supply of liquid or oil for vaporization or cannabis capsules. The more common way to use cannabis — smoking the marijuana flower — is not permitted.

There are signs other aspects of the program are changing. The state Department of Health recently added chronic pain to its list of eligible conditions — and in order to get more patients in the program, the agency is now allowing nurse practitioners and physician assistants to certify patients. In a statement, a DOH spokesperson said they have “made great strides.”

A Bronx physician says the program helps people who are unwilling to go to the black market for marijuana.

Nelson Cuevas, general manager and head pharmacist of PharmaCannis’ Bronx location, says he’s seen dramatic changes in his patients who suffer from illnesses including multiple sclerosis and cancer. He also says it’s a great alternative to opioids for people who need pain medication. One recent study says access to marijuana reduces opioid misuse.

“Cannabis therapy helps heroin addiction,” Cuevas says. “It’s a great alternative to pain management than what most folks are prescribed which is leading to heroin addiction. It’s a great option. It’s an alternative option.”

Sessions doesn’t buy that.

“I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana – so people can trade one life-wrecking dependency for another that’s only slightly less awful. Our nation needs to say clearly once again that using drugs will destroy your life,” Sessions said in March.

And it’s that kind of rhetoric that may not help New York expand its roster of practitioners.

“We need to get more doctors knowledgeable and comfortable in prescribing marijuana,” Gov. Andrew Cuomo said in May, according to the Daily News.

Growing the certified patient base has been a struggle. The feds’ desire to crackdown on medical marijuana certainly won’t help New York solve that problem, either. Dr. Charles Rothberg, president of the Medical Society of the State of New York, says doctors who were already skeptical of marijuana’s medical use are going to be more hesitant to certified given Sessions’ rhetoric.

“It’s still a Schedule I drug, so according to the FDA there is no medical use for it,” says Dr. Rothberg. “And the previous administration said they wouldn’t prosecute people for this, so it enabled states to make the kind of laws like in New York. The new administration hasn’t made that promise.”

In order to get certified, practitioners must take a four-hour state-approved course.

“If I was looking at what course to take this year and I was thinking of taking that one and I now knew the federal government felt the way it does, I might take other courses,” says Dr. Rothberg.

In December, the Medical Society sent a letter to the state asking, among other things, for the state to shield any doctors who prescribe marijuana.

“Perhaps of greatest concern is the likely enhanced risk of federal prosecution,” reads a letter to the state from Malcolm D. Reid, then-president of the Medical Society of the State of New York.

“… [W]ith the upcoming change in the federal Administration which could result in a US Attorney General who is opposed to the use of medical marijuana, we are concerned that physicians or other prescribers who certify patients for medical use of marijuana may be exposed to criminal or civil sanction by the federal government.”

The state says it is keeping an eye on any change at the federal level.

“The Department is closely monitoring the federal government’s policies regarding medical marijuana. The Department remains committed to ensuring that patients who qualify for this therapy have access to it,” reads a statement from DOH spokesperson Jill Montag.