Efficacy, Adherence, and the Barriers to Care: A Survey of our Patients’ Experience with the New York State Medical Marijuana Program

Purpose
Although marijuana remains a Schedule I drug at the federal
level, a growing body of evidence suggests that it has
potential as a medical agent. A 2017 report by US National
Academies of Science, Engineering, and Medicine, which
analyzed more than 10,000 studies, found “strong evidence”
that marijuana is useful in treating chronic pain and the
complications of cancer and multiple sclerosis and “moderate evidence” that it can alleviate sleep problems associated
with disease. Increasingly, state governments have recognized the medical potential of marijuana and authorized its
use for select groups of patients. With the signing of the
Compassionate Care Act on July 7th, 2014, New York
became the 23rd state to make such exceptions for the
24 ABSTRACTS medical use of marijuana.
The first patients began obtaining
treatment 18 months later. New York’s Medical Marijuana
Program has since grown rapidly. As of July 17, 2017, the
Medical Marijuana Data Management System (MMDMS) has
registered 1,123 practitioners and 24,555 patients.
Despite the growth of the program, patients continue to
face significant barriers to access, particularly if they are of
lower socioeconomic status. Health insurance does not cover
marijuana prescriptions, which means patients must pay
entirely out-of-pocket. Moreover, stringent regulations limit
the number of dispensaries and make accessibility a challenge.
For example, the Borough of Brooklyn (the location of our
clinic) has 2.6 million residents but not a single marijuana
dispensary. Barriers to access remain significantly greater for
medical marijuana than for opioids.
Although there has been extensive research on the discrete
health benefits and risks of marijuana, there is a dearth of
studies looking at the overall experience of patients in states
that have legalized medical marijuana. The aim of this study is
to examine the efficacy of medical marijuana among patients
in New York State’s program and the way barriers to access
have impacted adherence. We believe that our neurology
clinic in Brooklyn, which serves a culturally and economically
diverse group of patients, represents a useful microcosm for
the benefits and challenges of medical marijuana in New York
State and around the country.

Methods
Our clinic was approved to prescribe medical marijuana beginning on January 1, 2016. As of July 2017, we have enrolled 72
patients in the program. After reaching out to all enrolled
patients, 49 responded to our calls and agreed to an interview.
The subjects had all taken medical marijuana for between
three months and a year. We found that 38 of 49 (78%) were
still adherent to their treatment regimen. The sample was
59.2% male. The average age was 50. The most common
primary diagnosis was neuropathy (89.8%). In our interviews,
we aimed to assess the efficacy and tolerability of the treatments and their effect on our patients’ quality of life. We also
sought to investigate the reason for patient non-adherence.
To our knowledge, this is the first study of its kind.

Results
Our survey of patients found remarkable efficacy, tolerability
and satisfaction. One hundred percent of patients reported an
improvement in symptoms. Among the neuropathy patients,
the average pain rating went from 8.1 to 4.5, an approximately
56% decrease. Fifty seven percent reported a significant
improvement in mood. One third reported significant
improvements in sleep quality. Twelve percent said they had
improvements in appetite. Patients also reported a diverse
range of improvements in symptoms and outlook.
Remarkably, there were no significant side effects reported.
All participants were satisfied and expressed the desire to
continue treatment.
Despite general satisfaction, eleven patients (22%) were
non-adherent. We asked these patients about the reasons for
their non-adherence, and all eleven stated that they stopped
taking their medication primarily because of cost. Many also
cited the difficulty of traveling to fill their prescription as an
additional factor. These problems were reported in the sample
generally. The average cost was 215.5 dollars for a month’s
supply of marijuana. Nearly a quarter of patients said that
travelling to the dispensary to fill their prescription was
“Hard” or “Not Easy.” Many had to travel more than hour
each way to access a dispensary, a difficult prospect for
those who are seriously ill. These findings suggest that the
precarious legal status of medical marijuana - with its impact
on cost and availability - may be seriously hindering the ability
of patients who will benefit from these treatments to access
them.

Conclusions
This study substantiates a growing body of literature that
suggests marijuana can have significant benefits in relieving
pain and improving sleep, appetite, and quality of life.
However, it also underscores the challenges of accessing medical marijuana under today’s limited, state-based system.
Without insurance coverage and a better system for distribution, the high out-of-pocket costs and logistical inconvenience
associated with medical marijuana will continue to limit
access, disproportionately affecting low-income patients. We
recommend the creation the creation of larger, multi-center
trial to examine the benefits experienced by patients taking
medical marijuana as well as the way cost and accessibility
impact adherence.