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Fanfare, let down, and then confusion dominated discussions around New York’s recreational market over the past year, but access to medical marijuana – available in-state since 2016 – is still an ongoing concern for regulators and health care professionals.
Minority communities, which suffered the brunt of criminalization during the War on Drugs, were also the least likely to have access to medical marijuana or even a doctor authorized to prescribe cannabis, according to a recent study.
Black and brown neighborhoods in New York have historically suffered from substandard access to health care and lower life expectancy rates. In the South Bronx, dubbed ‘asthma alley,’ residents of Mott Haven were hospitalized for respiratory issues 21 times more than in other neighborhoods, due to high levels of traffic pollution. The neighborhood is one of many across the city, highlighted in the study, that does not have access to a medical marijuana dispensary.
General regulations, expected to be released this fall, will open the door to new medical marijuana providers, expanding a pool where there are currently only 10 in operation.
Dr. Torian Easterling, former Chief Equity Officer at New York City’s Department of Health and Mental Hygiene, talked to NY Cannabis Insider about his concerns regarding access to medical cannabis and ways companies can work with communities to meet needs.
The following has been lightly edited for style and clarity.
Many of the communities disproportionately impacted by the War on Drugs were minority communities and now these communities also have the least access to medical marijuana. Where does the conversation start around access to medical marijuana in these neighborhoods?
The best way to provide some context on that is that currently in New York City, your ZIP code dictates your health outcomes. So you can live in Brownsville, Central Brooklyn, you can live in Harlem, Northern Manhattan, the South Bronx, and what we see in our data is that these are communities that are predominantly Black, brown, foreign born, and English is not their first language.
But also, when you look at health outcomes – diabetes, cancer, whether it’s lung, colon or breast – you see some of the highest rates of these health outcomes in these communities. By design, these neighborhoods have had long-standing inequities and do not have the best health care systems. You can also layer on top of that social outcomes such as poverty, housing inequality – these are the same neighborhoods that light up in jail incarceration. And so all these things are true and we haven’t even touched on the conversation on cannabis.
So what does health care disparity look like when it comes to cannabis?
There have already been existing health care inequities within these neighborhoods. What we see in some of the data is that the majority of communities that are Black and brown do not have certifying health care providers (to issue medical marijuana cards).
When it comes to medical marijuana, this is a new program that is rolling out, and typically, when you have a new program, there are always kinks in the road. Then you put the economic inequalities on top of that. These are the same neighborhoods where you have many of your essential workers during the COVID pandemic, whether they are shop owners, home care, daycare, school, teachers, etc. There are investments that need to happen, infrastructure put in place, funding, there needs to be physicians who are going to be providing access to the medicine.
Is their awareness right now around this? Conversations with OCM or the state?
I think the most recent legislation around marijuana is really trying to close the gap. But I think with communities that have been over criminalized for marijuana in the past, there has to be an intentional approach, a bold approach, to make sure that communities know that the resources are for them.
I think the Office of Cannabis Management has been taking steps to increase awareness and ensure that patients who are eligible to use medical cannabis to treat their health condition know that they can register as a patient and receive a medical cannabis card, and I would say that that the process is feasible. The OCM has tried to minimize as much as possible any barriers that patients may have. So that’s one.
And also, we need to be really trying to expand the number of providers that are allowed to certify patients to receive medical cannabis, increase awareness, and make sure that patients are educated. I think that that will help to expand access. But that’s more of a universal approach.
What about concrete steps?
I think the steps going forward are getting to the existing barriers. One, we need to increase physical locations where individuals do not have to travel more than a mile, two miles, to be able to use your medical cannabis card or access a medical cannabis program. Specifically, my background as a public health professional, we knew that if we were going to provide vaccines to address COVID, we needed to make sure those vaccines were readily available. If I knew a patient had to travel two or five miles just to get to the resource, there was already going to be a barrier and most likely that person was not going to make the extra effort.
If you have pharmacies, if you have other dispensary locations within that community, there’s a better chance of the individual accessing resources. And so that’s really important.
There also has to be additional steps working with organizations. Showing up at faith-based institutions, working with local communities. That means working with individuals within the communities who know how to do outreach, how to market, and how to do engagement strategies.
I think what also needs to happen, and I haven’t seen much around this, is how do you really begin to engage more with health systems and providers to make sure that in communities of color, the physicians feel most comfortable with being able to provide resources? We know that there is a preference to have cultural concordance with your providers, someone that looks like you, that speaks like you. We’re not making efforts to train and certify those providers.
Why medical over recreational? What are the benefits for having more patients enrolled in medical marijuana?
Until we can really lift the restrictions and move cannabis off of the classification as a Schedule 1 controlled substance, what that limits is research on the benefits and risk of cannabis. It limits us from fully understanding the data, fully funding research studies to see the benefits of how cannabis is used to not only fight pain, like chemotherapy-induced nausea, but what are the other benefits and what are the risks?
With the medical program, there’s better control of the dosage for the type of issues or health conditions that someone may have. As opposed to adult-use recreation, where you’re not getting that type of education. You certainly want to make sure that you’re working with a provider, also with a dispensary, who is actually going to walk you through and talk to you about the dosage, the benefits, the health effects of the cannabis that you’re using for your health condition.
Does having more patients enrolled in the medical cannabis program help further the research around cannabis?
Individuals can be helpful in the type of research studies that are happening and we see this outside of cannabis. We know that there are clinical trials that are happening in the cancer space, we know that there are clinical trials in HIV. We’ve seen the type of effects when you have individuals enrolled in vaccine trials, antiretroviral medications, and with that type of diversity it allows us to better understand the benefits of a dose or a specific strain towards a health condition.
If many people are not enrolled, and identify that they have these health conditions, they’re not going to be engaged or recruited for those clinical trials. And this is what we have to better understand. Without this type of knowledge, providers are restricted and may not feel as equipped to be able to manage a patient’s health conditions.
What are the biggest obstacles right now to opening more stores and increasing health care providers in marginalized communities: Is there lack of demand in these neighborhoods, or is it stigma and selective zoning from current medical providers?
I think the demand is there. We’ve seen, certainly in New York State, that there has been a huge push to make available more regulated cannabis for both recreational use and also for our medical cannabis programs. The supply of dispensaries is the limitation. And so, how do we ensure that we’re providing a consistent supply of dispensaries for both medical patients as well as for the adult use market?
I think that we also see stigma and stereotypes. I think there is a narrative that Black and brown communities do not always use preventative medicine or are likely to show up in the emergency room and wait until their pain is so severe that they have no other choice, and so it’s less likely that they’re going to access any resource within a dispensary.
And so if that is the narrative, then I’m not going to make the investment in that community because I’m not going to see the distribution or the sales that would offset some of those costs.
There is a sort of a narrative shift that needs to happen. Because the investment isn’t about ‘building it and they will come.’ We have to do it in partnership with the community. And then they will see it as a resource.
It seems like the connecting piece here is bridging the gap between communities that have been historically marginalized and service providers that could benefit them. What’s the missing link between those two?
When you’re talking about increasing access, what are those innovative ways? Are you talking about our mobile van that’s going to be on the corner of a street or are you talking about a brick and mortar? But certainly we know that part of it is engagement. We need to better understand what they’re trying to access. And that’s not about just showing up, it’s talking to legacy market dealers, it’s engaging with your faith-based institutions, it’s talking to your existing health systems to understand what works best in your community.
What about existing ROs? Do you think they will shift their focus away from medical and toward the recreational market come general licensing?
Really the concern is that they’re going to continue to expand medical access but not in communities of color. I think that’s the major issue. And so, even though you can partner with a social equity firm, or find some way to make that possible, who are you servicing? How are you increasing access in communities that clearly do not have the type of access to what they need – access to medical cannabis. And so those are the questions. Hopefully the state, the Office of Cannabis Management, will be looking intentionally at that particular point.