David Holland, Executive and Legal Director
Empire State NORML


Addressed to:

Katherine Ceroalo, Bureau of House Counsel, Regulatory Affairs Unit
New York State Department of Health
By email: regsqna[at]health[dot]ny[dot]gov


Medical Use of Marijuana, Chronic Pain; I.D. No. HLT-51-16-00006-P


Empire State NORML, the State affiliate of the National Organization for the Reform of Cannabis Laws (NORML), submits the following letter in support of the proposed amendment of sections 1004.1 and 1004.2 of Title 10, the Official Compilation of Codes, Rules and Regulations of the State of New York (NYCRR), as related to the medical use of cannabis for chronic pain.

    Our organization supports amendment of sections 1004.1 and 1004.2 of Title 10 NYCRR, to add any debilitating or life-threatening condition causing severe or chronic pain as a qualifying condition for recommendation of cannabis to patients. We also support a wider amendment, allowing recommendation of cannabis in the first instance, and without a patient having had to suffer for at least three months.

    The currently proposed regulatory amendment only authorizes a practitioner to recommend cannabis after one or more therapeutic options had failed, and where the patient has experienced severe debilitating pain for at least three months:  

Severe debilitating pain that the practitioner determines degrades health and functional capability; where the patient has contraindications, has experienced intolerable side effects, or has experienced failure of one or more previously tried therapeutic options; and where there is documented medical evidence of such pain having lasted three months or more beyond onset, or the practitioner reasonably anticipates such pain to last three months or more beyond onset.

    Today, twenty-eight states and the District of Columbia have legalized medical cannabis use. Chronic pain is a qualifying condition in eighteen (62%) of these jurisdictions[1]. In nearly all of these states, cannabis can be recommended in the first instance, and there are no added requirements of patients suffering contraindications, intolerable side effects or failure of other therapeutic options, causing a significant diminution in their quality of life for at least three months. Just last month, in January 2017, the National Academies of Sciences issued a detailed report, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, concluding that “there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.”[2]

    We respectfully submit that it is not fair to require that patients must suffer severe pain for months, and experience contraindications, intolerable side effects, or failure on opioid or other therapy, before a practitioner can recommend cannabis. Patients should be allowed access to cannabis before they are given opioids, not after, and practitioners should be allowed to recommend cannabis based upon the individual patient.

    Cannabis-based pain treatment provides a safer, less addictive, alternative to narcotic pain relief prescription. This is of particular importance given the opioid addiction, diversion and overdose crisis that is currently afflicting New York.[3] The proposed amendment would have the effect of relieving long-term, debilitating pain and suffering of individuals with serious medical conditions while also reasonably protecting public health and safety. It would provide access to medical cannabis by patients who suffer from severe, debilitating, and life threatening conditions, as set forth in Section 3360(7) of the Public Health Law.  

    We believe that the likely impact of the proposed change would be to stimulate a significant number of severe pain patients to participate in the state medical cannabis use program, oftentimes in lieu of opioid-based pain therapy. This would result in an increased amount of taxes and fees collected by the State, a reduction in the harm caused by opioid addiction and diversion, and an increase in medical cannabis-related jobs and employment opportunities for New York residents. Given the likely positive effects of the proposed inclusion of chronic, debilitating pain as a qualifying condition under the New York Compassionate Care Act, we endorse it, subject to the proposed amendment.

    Please feel free to contact Empire State NORML, should you have any further questions.  

Respectfully submitted,
David C. Holland, Esq.
Executive and Legal Director
Empire State NORML

Comments prepared by: Joseph B., Douglas G. & David H.