Manhattan's first and only medical marijuana dispensary is like a fortress. To enter the building, located on 14th Street near the 3rd Avenue subway station, patients have to pass through two security systems before they even encounter another human. First, they flash their medical marijuana card in front of a camera. If everything looks in order, the first set of doors opens to a vestibule and then closes behind them. There, they hold their cards under an electronic scanner. If there's a problem, guards — many of them ex-cops — will escort them from the premises.
Once inside, the Columbia Care dispensary looks clean, sterile, and modern, like any upscale waiting room. But those familiar with legal pot shops in Washington, Colorado, and other states will notice that one thing is conspicuously absent: There are no pot brownies, and no jars of green buds labeled with names like Green Crack and White Widow. In fact, there's no smokeable or edible marijuana of any kind for sale.
New York state lawmakers voted to legalize marijuana for medical use in 2014, and Governor Andrew Cuomo signed the bill into law last June. The new law just took effect on January 6 — but it hasn't made it any easier for sick New Yorkers to get high. Among the 23 states that now allow some form of legal weed, New York's law is among the most restrictive. Only a handful of serious conditions qualify for a prescription, and so far there are only 71 patients in the entire state. The patients are only allowed to use tinctures and oils, which can be vaporized, inhaled, or consumed orally in capsules. Smoking or growing marijuana is still strictly forbidden.
Advocates for the palliative use of marijuana contend that New York's law is far too narrow. While medical marijuana has become increasingly mainstream over the past decade, Keith Stroup, a DC-based attorney and founder of the National Organization for the Reform of Marijuana Laws (NORML), said there's still a lingering suspicion by some lawmakers that patients just want to use the drug recreationally.
"State legislators tend to think that getting high is something to be avoided," he said. "And they're trying to avoid the appearance of someone enjoying themselves when they were meant to be taking their medicine… They don't want to see it turning into another California, where anyone can get a prescription."
New York wields considerable influence over national policy, and Stroup thinks the new law could be bad news for patients in states that have yet to legalize medical marijuana. Stroup noted that when New Jersey set a precedent by becoming the first state to prohibit patients from cultivating their own plants, Delaware, Illinois, and Washington, DC followed suit. Stroup said he expects states in the Midwest and South to follow New York's model by outlawing edibles and smoking when they eventually pass their own medical pot laws. Pennsylvania is currently finalizing a bill that includes those same tight restrictions.
New York's law only allows people with "severe debilitating or life threatening conditions" to obtain weed extracts. The qualifying conditions are cancer, HIV/AIDS, ALS (Lou Gehrig's disease), Parkinson's, multiple sclerosis, intractable spasticity from spinal cord damage, epilepsy, inflammatory bowel disease, nerve damage, and Huntington's disease. State officials are still deciding whether to add Alzheimer's, muscular dystrophy, dystonia, PTSD, and rheumatoid arthritis to the list.
The New York Department of Health, which oversees the state's medical marijuana program, did not provide responses to questions sent by VICE News.
Karen O'Keefe, director of state policies at the Marijuana Policy Project, pointed out that the majority of data on the palliative effects of marijuana comes from examining the effects of smoking dried buds, rather than consuming it in the forms allowed under New York's law. She also noted that pot legalization has been shown to correspond with a decline in the number of opiate overdoses, a claim supported by recent study by the RAND Corporation.
'They don't want to see it turning into another California, where anyone can get a prescription.'
"There are 6,000 rare diseases that exist in the world, and innumerable things that can cause serious pain," O'Keefe said. "Prescribing opiates to treat pain can be risky. There are 16,000 fatal overdoses from opiates every year."
In a letter sent to the New York state legislature, New York Physicians for Compassionate Care — a group that represents more than 650 doctors who support medical marijuana — stressed that numerous scientific studies have shown that smoking cannabis is generally safe and can be beneficial in some cases. The letter also voiced concern that tinctures or extracts — which have higher levels of THC, the psychoactive compound in weed — might prove too potent for patients accustomed to self-medicating by smoking.
There's also a price difference. Oils and tinctures require a great deal of marijuana to make just one gram, which in turn drives up the prices for patients, who will ultimately be paying out of their own pockets. Insurance companies don't cover medical marijuana, chiefly because federal law still classifies pot alongside heroin, LSD, and other hard drugs as a Schedule I controlled substance, meaning it has no accepted medical use and a high potential for abuse.
Even the few patients who do qualify and are willing to go through the hassle will have a hard time finding a doctor that can write them a prescription. Only licensed physicians whose expertise includes the conditions listed earlier can prescribe medical marijuana in New York. To do so, the doctors have to complete a special course that lasts up to four hours and costs $250.
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The tight restrictions are worrying for Daniel, a 27-year-old from New York's capital Albany who asked that his last name be withheld for medical privacy reasons. When he was 14, Daniel was diagnosed with ulcerative colitis, a type of irritable bowel syndrome. Ten years ago, he had his large intestine removed.
In high school, Daniel smoked weed recreationally "just like everyone else." He eventually noticed that the drug helped ease his symptoms, which range from constant diarrhea to stabbing pain in his abdomen. It made him feel "more comfortable," he said, and improved his appetite.
He hasn't used marijuana in over three years, but now wants to explore the possibilities offered by the new law — he's just worried that he doesn't look or seem sufficiently sick enough to warrant a prescription.
"I don't look like have a disease," Daniel said. "Some folks look like they're literally about to die any minute. What makes me worried is that even though I can fax all of my medical records to the physician, I still worry that they think I am only doing it just so I can get high."
New York's law also only allows for 20 dispensaries in the entire state — one every 2,700 square miles. Eight of the 20 permitted dispensaries opened across New York last Thursday, including Columbia Care in Manhattan. The company, founded in 2012, is preparing to open three other locations in New York State. (It also has grow facilities, processing plants and dispensaries in Washington, DC and Arizona.)
But while New York's law is restrictive, medical marijuana advocates still see it as a positive move.
"It does give [New York lawmakers] an opportunity to experience the reality that medical marijuana helps a lot of seriously ill patients," Stroup said. "Once they see that it's not a scam or a trick to legalize it for the rest of us, maybe they'll come back in a year or two and improve on it."
"As weak as the law is," he added, "it's still a significant step forward."
Follow Tess Owen on Twitter: @misstessowen