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As a neurologist specializing in medical marijuana treatment, a public health advocate,
a founder of a nonprofit dedicated to providing educational information about medical
marijuana and a parent with young children, I am deeply concerned about the potential
legalization of medical marijuana in New York.

Why? Firstly, I believe it may cause irreparable harm to the public health. Secondly,
legalizing recreational marijuana, especially the sale of it, will undermine the medical
marijuana program which legitimately provides help to thousands of New York patients
who need it. Sure, there may be political pressure to legalize it and NY State will benefit
financially – but at what cost?

If FDA approved as a medicine, medical marijuana would be a schedule II or III controlled substance – like Oxycodone and Morphine. Why should a controlled substance be approved like an over-the-counter agent? Keep in mind that the FDA can recall a drug after post-marketing data is reported. This ISN’T a luxury we’ll have with
recreational marijuana. Once it is legalized it will be essentially impossible to reverse. The standard for safety and approval must be higher.

The recent news about the planned NYS DOH report cites “new data” that supports the
decision of the NYS Health Department to recommend legalization of recreational
marijuana. I am not certain what data was reviewed, but I am aware of data that does
not support recreational marijuana legalization. States like Washington and Colorado
show increased rates of crime, deadly accidents, adolescent drug abuse and
hospitalizations following legislation. Data also shows dependence is 4-7 times greater
in youth. Why would we open New York up to that increase of violence, crime, injury
and fatality?

Our children need protection. Individuals who begin using the substance as teenagers
face a 17% risk of dependence. Marijuana use disorders have increased by 18% from
1992 to 2002 – particularly in young African American men, women and Hispanic men.
In other words, some populations that may benefit from decreased incarceration rates
through legalization are also more likely to experience the unintended consequences of
this legislation. Additionally, research shows that marijuana use in adolescents may
cause permanent brain damage.

Legalization is particularly harmful because it leads to increased access to children at
an age when dependence is higher and their brains continued development makes
them more susceptible to permanent injury. Therefore, cannabinoids cause permanent
brain damage in youth and lead to lower levels of achievement, higher levels of
depression, suicide and other morbidity.

As a physician, I am incredibly concerned that legalization will undermine the NYS DOH
Medical Marijuana Program, which legitimately provides help to thousands of patients in
New York.

Here are a few examples of what currently happens, and why the program could be
compromised if it is legal to sell marijuana in dispensaries for recreational use:

1) The program currently allows physicians to restrict the type of marijuana their
patients receive. If I see a person with paroxysmal A-fib, then I will not start them on a
formulation that may trigger a-fib like a vaporized high THC form. This is precisely the
products that patients are most likely to purchase at a recreational dispensary.

2) I can limit a patient to a one month or three-month supply of medical marijuana,
ensuring that adequate follow up is provided, if need be. Since they need a doctor to
extend their certification they are obliged to follow to receive more product. However, if
recreational marijuana is legalized and available at a dispensary for recreational use,
they will be unlikely to follow up, as recommended. This is analogous to prescriptions
for controlled substances, or any medication for that matter. Patients benefit and need
to be monitored, however, if they have unlimited refills many patients won’t show up for
a follow up visit. Which, as you know, often guides how many refills are written for by

3) Quality control. When I recommend a product to someone, I am confident that what
they get is what was recommended and that it isn’t contaminated with pesticides,
bacteria, solvents, or other drugs. Why? Because NYS regulates dispensaries and
requires that they test every batch of product. Since getting a license as a medical
marijuana dispensary is expensive in New York, it doesn’t pay to cheat and try to cut
corners by avoiding testing for contaminants or using solvents to yield more product.
One reason the regulations currently work in New York is because they can be
effectively enforced. The number of dispensaries is limited. Enforcement by sending
inspectors to 5-10 approved dispensaries is feasible.

But what happens when there are 500 dispensaries, like in California? Data shows that
products randomly tested from dispensaries in states like California are often
contaminated. Why? Because regulations without enforcement are meaningless.
Business owners are more willing to take risks in states with more dispensaries and the
quality of the products decrease there. The same thing is bound to happen if it becomes
legal to sell marijuana for recreational use in New York. The number of dispensaries will
increase, regulation enforcement will become more difficult, competition will become
stiffer for many dispensaries creating economic pressures that reward those who take
risks. Should this happen, doctors would be less likely to recommend medical marijuana
and patients who benefit most from medical marijuana will be less likely to receive
quality controlled formulations that can help them.

Please take the time to consider how significantly the cons outweigh the pros on this
important matter.