Published: Aug 4, 2021

Everything You Wanted to Know about Medical Marijuana in NY, but Were Afraid to Ask.

In our latest question and answer, the pharmacist discusses common questions about NY's medical marijuana program.

Answered by: Dr. Geoffrey Brown, PharmD

Medical marijuana New York Statee

Intro

There’s been a lot of hype around NY’s legalization of marijuana as of late, but although the MRTA has passed, it will still be quite a while before we see recreational cannabis products hit the shelves. With that being said, medical cannabis is already legal. In this CannaBuff deep dive, we take a look at everything you could possibly need to know about NY’s medical marijuana program.

Do I Qualify for Medical Cannabis?

In the great state of NY, the following are conditions for which a “registered practitioner” may choose to recommend treatment with medical cannabis:

  • Cancer
  • Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig’s Disease
  • Parkinson’s Disease
  • Multiple Sclerosis (MS)
  • Spinal Cord Injury with Spasticity
  • Epilepsy
  • Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)
  • Neuropathy
  • Huntington’s Disease
  • Post-Traumatic Stress Disorder (PTSD)
  • Chronic Pain
  • Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS)
  • Pain that degrades functional capability as an alternative to opioid use or substance use disorder

In addition to one of the above qualifying conditions, patients must also have one or more of the following complicating conditions:

  • Cachexia (Wasting Syndrome)
  • Severe or chronic pain
  • Severe nausea
  • Seizures
  • Severe or persistent muscle spasms
  • PTSD
  • Opioid use disorder

Common Questions about Qualifying

What if I don’t qualify?

If you don’t qualify, there’s still hope! The list of qualifying conditions will soon be changing. The MRTA not only legalized cannabis for adult use, it also significantly expanded the medical program. The MRTA allows practitioners to recommend medical cannabis for Alzheimer’s disease, muscular dystrophy, autism, rheumatoid arthritis, and any other condition they deem appropriate.

Are Insomnia or Anxiety Qualifying Conditions?

No, but you may try to treat your insomnia or anxiety with medical marijuana if you have one of the above qualifying conditions (and an associated complicating condition). You would need to get certified for one of the conditions listed above, but the focus of your treatment would be reducing your symptoms of anxiety and/or insomnia. This is a pretty common occurrence and is generally acceptable to do as long as your qualifying diagnosis is documented in your medical chart.

I think I qualify, but I’m not sure. Who can I ask or how do I verify that I’m eligible?

A registered practitioner will ultimately make the call as to whether or not you qualify for treatment with medical cannabis. Many practitioners are willing to determine your eligibility for medical marijuana, and if you don’t qualify, your appointment is free of charge. Our affiliate, NuggMD, furnishes medical cards online via secure telemedicine and there is no cost associated with the service unless you qualify.

General Questions

What does “Registered Practitioner” Mean?

A registered practitioner is a physician, physician’s assistant, or nurse practitioner that is registered with the State Department of Health to prescribe (or “recommend”) medical cannabis. In order to register, they must pass a state-approved 2-4 hour education course on medical cannabis. Registered practitioners can also work at dispensaries, but must pass a 4-hour course if doing so. Pharmacists that work at dispensaries are also considered registered practitioners, though they don’t have prescriptive authority, so they can’t certify patients. Most registered practitioners charge a substantial fee for their services. For more information about why these fees are so different between practitioners, read our dedicated blog post on the topic.

What’s the Easiest or the Cheapest Way to Get a Medical Card?

The easiest way to get a medical card in New York is online through secure telemedicine. While this method is the easiest, it may not be right for everyone. Particularly if you’re inexperienced with cannabis or require in-depth guidance. Most online medical card providers charge approximately $150 for the certification process.

The cheapest websites offering telemedicine certifications are HelloMD.com and MedCardNewYork.com which both charge approximately $129. This gets you your medical card and registers you as a medical cannabis patient with the state for one year, and that’s it. There is no follow-up, no guidance, or communication with the practitioner after you get your card. This is a much cheaper option than most doctors will charge for in-person visits, but again, may not be right for everyone.

What Products are Allowed?

New York allows a variety of medical cannabis product types and dosage forms. To the dismay of many patients and passionate consumers, NY does not allow whole smokable flower. Instead, the Department of Health has decided to allow metered-dose flower preparations as long as the flower is ground up to a particle size less than or equal to 5mm. While we don’t know for sure why this requirement on particle size was placed, we believe that it’s related to consumer safety and preventing the development of mold which is a common problem with cannabis flower. If cannabis flower is not properly harvested, dried, and stored, mold may develop and could be inhaled, potentially causing an infection in the lungs or airway. This is of particular concern in immunocompromised patients.

Now back to the flower situation. Flower allowed in NY’s medical marijuana program must be ground up to a particle size < 5mm and can only be used for vaporization. While the Department of Health has virtually no way of enforcing that flower only be used in vaporizers, they require that dispensaries selling ground flower also sell compatible vaporizers and counsel patients that the flower is for vaporization use only.

The following section discusses all other products dosage forms that are available in NY’s medical program.

Oral Dosage Forms

Capsules, tablets, and gummies to be taken by mouth.

Chewable Tablets

  • Cannabis extract is dehydrated into a powder and formulated with a mix of fillers, binders, disintegrants, lubricants, coloring agents, and preservatives to maintain the shape, consistency, and appearance of a tablet.
  • Common inactive ingredients (excipients): Compressible sucrose, colloidal silicon dioxide, caprylic/capric triglycerides, lemon/orange oil, citric acid, sodium stearyl fumarate
  • Product Features: Can be chewed, crushed, or broken in half which makes them more flexible in terms of dosing and administration. Vegan.
  • Example: Matter Chewable Tablets

Liquid “Gel” Capsules

  • Cannabis oil that’s dissolved in medium-chain-triglyceride (MCT) oil and filled into a capsule.
  • Common inactive ingredients (excipients): MCT Oil, gelatin capsule
  • Product Features: May take effect quicker than other oral dosage forms because the active ingredients are already dissolved in oil, which makes them more bioavailable. Powder-based products have to dissolve in the stomach before they are absorbed in the small intestine.
  • Example: LuxLyte Gel Caps

Capsules (Self-Emulsifying Drug Delivery System)

  • Common inactive ingredients (excipients): Lauroyl polyoxyl-32 glycerides, Caprylic/Capric Triglyceride, Vitamin E TPGS, Alpha-tocopherol acetate, Ascorbyl palmitate
  • Product Features: Self-emulsifying drug delivery systems are mixtures of oils, surfactants, and hydrophilic solvents. The aim of these systems is to increase the rate and extent of drug absorption. This would result in a faster onset and greater effects for the user.
  • Example: Matter Capsules

Chewable Gels

  • Chewable gels are a fancy way of saying gummies. These are similar to recreational edibles that readers may be familiar with (similar in form not necessarily dose). They cannot actually be called gummies due to state regulations and concerns over incidental exposures with children.
  • Please keep these products away from children as they may look appetizing to kids and are usually fruit-flavored.
  • Common inactive ingredients (excipients): Gelatin, sucrose, glucose syrup, citric acid, water, artificial flavors and colors, carnauba wax, sorbitol, pectin, and MCT oil.
  • Product Features: Numerous flavors and formulations are available.
  • Example: Columbia Care Gummies

Oromucosal Dosage Forms

Oils, Tinctures, Sprays, Lozenges & Orally Disintegrating Tablets to be placed under the tongue.

Sublingual tinctures and oils

  • Product features: These provide a lot of flexibility for dosing since the dropper enables you to measure exactly how much liquid to administer each time you dose.
  • Common inactive ingredients: alcohol (ethanol) or MCT oil
  • Example: LuxLyte Drops

Orally disintegrating tablets

  • Product features:  A convenient way to dose sublingually which provides more rapid effects than taking a capsule or tablet by mouth.
  • Common inactive ingredients: Sorbitol titanium dioxide, PVP, natural flavoring, menthol, vitamin E, magnesium stearate
  • Example: Curaleaf micro tablets

Oromucosal Sprays

  • Product Features: This might be considered the most evidence-based dosage form. Sativex, a cannabis-based spray containing ~1:1 ratio of THC:CBD, is an approved treatment for spasticity in patients with MS in Europe.
  • Common inactive ingredients:
  • Example: Etain spray

Lozenges

  • Product features: Lozenges are made with real honey, providing natural benefits. Lozenges can be used temporarily and then wrapped up and saved for later to make them last longer.
  • Common inactive ingredients:
  • Example: Etain lozenges

Topical Dosage Forms

Products intended to have effects at the site of application.

Suppositories

  • Product features:  These are the only products available that are intended for rectal or vaginal use. This unique feature may make suppositories helpful in certain situations.
  • Common inactive ingredients:  Polyethylene glycol
  • Example: Theraceed Suppositories

Topical Balms

  • Product features: Provides topical relief for pain or other conditions localized to a specific area. For external use only.
  • Common inactive ingredients:  Medium Chain Triglycerides (MCT), Coconut Oil, Shea Butter, Beeswax.
  • Example: Vireo Green Balm

Inhaled Dosage Forms

Products Intended for vaporization.

This is the tried and true method of consumption for many consumers. Because most people are very familiar with the pros and cons associated with these methods, we won’t devote a ton of time to this section. Highlighted below are some of the slight differences between the types of vapes, oil, and quantities of flower available.

Vape Pens

Single unit devices with a single-use battery built-in. The entire device can be disposed of when finished. If you’d like to be more eco-friendly you can dispose of used pens at a battery recycling receptacle. Typically, vapor pens contain less oil (~0.3 grams) compared to cartridges (~0.5 grams).

Vape Cartridges

Cartridges come in a variety of types and sizes. Standard sizes are a half to a full gram of oil. Countless strains are available. Different oil types include live resin vs regular extract. Live resin extracts contain higher concentrations of terpenes and are supposed to closely resemble the feel and taste of smoking flower. Cartridges require an external battery that is usually purchased separately.

Metered-Dose Flower

These have largely been phased out. These were ground flower “pods” similar to a k-cup that would pop into a compatible vaporizer. Consumers quickly figured out you could break the pods open to access the ground flower. Now that “refills” are allowed, the pre-filled pods have become obsolete.

Ground-Flower “Refills”

Simply put, these are jars of flower that’s ground up to a 5 mm particle size. Jars come in different sizes/quantities. Standard sizes are 3.5 grams to 7 grams.

How do I Pick a Strain?

Cannabis is available in a seemingly limitless number of strain varieties. Depending on the strain of cannabis, the chemotype, or what chemicals are naturally produced by the plant, may vary. This variation can result in small to large differences in the final concentration of different cannabinoids as well as the THC:CBD ratio. This is important in regards to medicinal effects because different THC:CBD ratios, cannabinoid, and terpene profiles can contribute to different effects.

However, due to the extraction and formulation processes that are used to manufacture medical cannabis products, the strain is a lot less likely to make a difference. In NYS, and in most medical markets, dispensaries must offer medical cannabis at standardized THC:CBD ratios. The THC:CBD ratio has been found to play a large role in determining clinical effects. In nature, this ratio naturally varies across cannabis strains and varieties along with the presence of other secondary cannabinoids such as CBC, CBG, CBDV, and terpenes. A lot of misinformation about these lesser-known cannabinoids and terpenes gets circulated online (what’s said is usually overstated). A lot of what we know about these compounds are still working hypotheses. The truth is that evidence on secondary cannabinoids and terpenes is still very limited.

Due to the State’s regulations on product potency, each lot or batch of products produced must pass laboratory testing that confirms the potency of the product, its designated THC and CBD content, and ensures the product is free from contaminants.

Registered organizations (RO’s) that produce medical cannabis products are forced to extract cannabis oil from the plant, isolate THC and CBD, and then reformulate the products with THC and CBD to create the desired THC:CBD ratios. At the final stages, products may receive additional terpenes. These added terpenes may be cannabis-derived from the initial extraction, or terpenes can be purchased in bulk from external sources.

This gives rise to the question, will different strains of cannabis at the same THC:CBD ratio produce different effects? Maybe. We just don’t know enough yet. Our understanding of the interaction between THC and CBD is still very limited. We used to think CBD could counteract the effects of THC, but more recent evidence suggests it is MUCH more complicated than this and that CBD is actually more likely to enhance THC’s effects at doses that are common.

As a pharmacist, it’s hard for me to endorse choosing products based on a strain name without reliable information on the content of secondary cannabinoids (CBC, CBG, etc.) or terpenes present in that strain. Ideally, this information would be reported on the product label and verified by a lab test.

The Status Quo

Currently, the majority of strain information is obtained from leafly.com’s strain database which uses crowd-sourced feedback on effects to tell you what users think of the strain’s specific effects. If you’d like some advice on picking a strain please talk to your local dispensary associate, but also know that the information they’re providing you about the strain is based solely on that crowdsourced feedback. This means users simply logged how they felt after they used a specific strain. It’s completely subjective, but I guess it’s better than nothing. Leafly surely did not test the same flower or product you’re thinking about purchasing at the dispensary, so I don’t think the information provided is that useful or meaningful when making a decision.

The distinction between Indica, Hybrid, and Sativa is taxonomically meaningless. This has been proven time and time again in agricultural and genomics research. So why is it such a large focus of product selection at dispensaries? Well, unfortunately strains get overhyped and overplayed because it’s good marketing and allows dispensaries to increase their sales. Dispensaries can sell you an Indica for bedtime, a Sativa for during the day, and a hybrid for a more balanced effect. In reality, the effects between these different strains aren’t likely to be that distinct. If you think you can tell the difference between Indica, Sativa, and Hybrid I’m not surprised because there are likely some differences between what you’re using. But those subtle differences aren’t what they’re marketed to be and are often undetectable under a blinded “taste test”.

To be crystal clear, we don’t think strains are entirely meaningless. There is a lot of promise in researching strains with the presence of unique cannabinoid and terpene profiles. But there is a disconnect between what the research says and what the public is being told to believe. For more about where Indica and Sativa labels come from and how they are so often misused, view our dedicated article on this topic (written by Professor of Cannabis Horticulture, Melissa Moore).

Why Are Products So Expensive?

Probably one of the biggest criticisms of the medical marijuana program in NY is the cost of the products. The cost of the products used to be astronomically higher than they are now. A number of dispensaries cut their prices back in 2019.

The high cost of medical cannabis products in NY can be attributed to numerous factors (and greed). We’ll cover two key factors that we think play the biggest role in contributing to the high cost.

Strict Regulations

NYS has created one of the most stringent medical cannabis programs in the country. Political views aside, they did this in order to protect consumer safety. These regulations certainly create more work for registered organizations (at the manufacturing, distribution, & dispensary levels). The more work registered organizations are required to do, the more money it costs them, and those costs are eventually passed on to consumers.

Limited Competition and price-fixing

NYS has only granted ten licenses (to ROs) to operate medical dispensaries. Each RO may open four dispensaries in the state and some of them have yet to open all four dispensaries they’re allowed. Since there are less than 40 dispensaries, and the majority of them are clustered around the most populous metropolitan regions of the state, there is somewhat limited competition. Dispensaries can easily see what their competitors are charging for products and price their products similarly. If and when there are more medical dispensaries allowed to enter the marketplace, competition may drive prices down (hopefully).

Price transparency may also help drive prices down. This is something CannaBuff is on the cutting edge of and we’re very excited to bring our readers. Visit our Pricing Dashboards to learn more.

Is Medical Marijuana Covered by Insurance?

Currently, medical marijuana products are not covered by health insurance. Doctor visits related to medical cannabis may be covered by insurance as long as medical cannabis is not the sole purpose of the office visit. For more on this topic read the state’s guidance. Some individuals may want to try writing off the cost of their medical cannabis on their state taxes because it could be considered a medical expense. When will we see medical cannabis covered by insurance? It will likely take years for the major health insurers (payers) to be compelled to consider medical cannabis’ value as a treatment option. In Canada, some payers have had some success getting medical cannabis covered by insurance.

Do Dispensaries Accept Credit Cards?

To our knowledge, there is only one chain of dispensaries in NY that accepts credit cards, and they created their own credit card in order to do so. The company is called Columbia Care and they’re one of the largest “Multi-State Operators” in the cannabis industry.

What are the Dispensaries Like?

The layout and shopping experience at dispensaries varies. Some dispensaries have the “trap shop” set up, similar to how medical dispensaries were first rolled out in California. This means there is a doorway that you must wait in upon entering before presenting identification and being buzzed in by the dispensary staff. Other dispensaries are much more modern. A popular theme amongst dispensaries seems to be wood accents and the use of green or plant-based decor. The art of merchandising is definitely a big theme in a lot of dispensaries. Check out the botanist’s store here. Check out MedMen, sometimes called “The Apple store of weed”, here. Columbia Care (closest location in Rochester) allows you to shop their store virtually!

Do Dispensaries Deliver?

Yes, the following dispensaries offer delivery.

How do I renew my Certification?

To renew your certification, talk to your registered practitioner that issued your initial certification. They will issue an updated certification and dosing recommendation.

Common Problems with Re-certifying

 

I Re-certified, but My Medical Card is Still Inactive

This likely means you will need to repeat the registration process online at my.ny.gov. To do so, login in with your username and password and then go to health applications => medical marijuana data management system=> my registrations. Ensure you have an active registration and then click the blue hyperlinked PC-1 number that is listed as active. Scroll down to the bottom of the page and click submit. After clicking submit, wait a few seconds and a temporary card will appear. Print or save this card and bring it with you to the dispensary.

Forgot Login Information

If you have forgotten your login information you have two options for resetting your password. You can answer security questions or reset using the email address used to set up your account. If you fail to answer your security questions enough times, you’ll be locked out and will need to reset using email. If you do not have an email address or you don’t know the email address you used to set up your account, call the Department of Health medical marijuana program at 844-863-9312 and ask them to reset your account info via phone.

Wrong Username

If you entered the wrong username, you can get your correct username by calling the state at 844-863-9312, giving them your PC-1 number, and verifying your identity.

Two Accounts Set up

One of the most frustrating and common problems experienced by medical patients is when they have multiple accounts on my.ny.gov. This creates a problem for the user because they do not know which account their MMJ certification is linked to. Oftentimes, patients may already have an existing account with my.ny.gov and not know it. The website is used for a variety of state-administered programs, including unemployment and healthcare benefits, teaching certificates, and commercial driver’s licenses. The simplest way to resolve this issue is to call or email the Department of Health MMJ program and request your username that is in the state’s Medical Marijuana Data Management System (MMDMS). Once you have your username you can log in if you know your password, or reset your password using your email address or predetermined security questions you chose when you set up your account.

Medical Marijuana Data Management System and COVID-19

Like any high-traffic website, the Medical Marijuana Data Management System can experience periodic downtime for various reasons. During the COVID-19 pandemic, this downtime was exacerbated by the statewide immunization effort, which was coordinated and tracked using the State Department of Health’s online resources (connected to MMDMS). There is frankly nothing you can do when the site is down besides call the NYS MMJ program (844-863-9312) and be patient. The website usually isn’t down for long and the representatives from the Department of Health are typically very responsive to any issues you may have as a result of any downtime.

Why is the Medical Program in NY So Complicated?

NY’s medical marijuana program is one of the most stringent programs in the United States. Despite the headaches these laws may cause, the program was built this way to maximize consumer safety and ensure consistent product quality, potency, and reporting standards are met. While there are definitely some hoops one needs to jump through in order to become a medical cannabis patient in NYS, it is possible with a little willpower and comes with the benefit of reliable products that are safer than what’s available on the black market.

If we missed something, or you have any other questions about New York’s medical marijuana program, please, do not hesitate to reach out to us or ask us a question!

References

New York State Medical Marijuana Program Regulations (Link)

Genetic tools weed out misconceptions of strain reliability in Cannabis sativa: implications for a budding industry (Link)

CBD and THC: Do They Complement Each Other Like Yin and Yang?CBD and THC: Do They Complement Each Other Like Yin and Yang? (Link)

Dr. Geoffrey Brown, PharmD

Dr. Geoffrey Brown is a registered medical cannabis pharmacist in New York State and the founder of CannaBuff. He graduated from the University at Buffalo with a Doctor of Pharmacy degree in 2018. His research on cannabis has prompted coverage from national advocacy organization NORML and local news outlets. Please feel free to reach out to him if you want to connect!