More than twenty years after I first attempted to quell a migraine headache with a bong hit, I have become a card-carrying medical-marijuana user.
Well, not exactly. This is New York State. You can’t get actual marijuana, only extracts. This makes it impossible to access what could be my best medical option, and significantly increases my costs — but at least it’s legal.
I’ve suffered frequent, sometimes near-daily, migraines for almost forty years — virtually all of my adult life. I’ve learned to manage them fairly well with a combination of triptan migraine-abortion drugs, marijuana, prescription-opioid painkillers, and rest when I can get it. I’m pretty stoic about my migraines, and I can function when I have one, as long as people give me a little leeway for being spacey. But about once a month I get an incapacitating attack that sends me to bed with an ice pack and hydrocodone.
Like the migraineur protagonist of the Nineties film π, I’ve tried myriad would-be remedies, with more side effects than success. So when the state added chronic pain to the list of qualifying conditions for medical marijuana at the end of last year, my doctor was quick to give me a recommendation.
Once my doctor files her paperwork — under federal law, she can’t write a formal prescription — and I sign up on the New York State Department of Health website, a purple-striped ID card arrives in the mail. The dispensary I go to, one of four in the city, is on what was once a fairly notorious drug block, the “dubious business enterprise touches Skid Row” place where William Burroughs copped heroin in the late 1940s, and a flea market for Valium, Placidyl, and other repurposed psych meds in the Seventies and Eighties.
It’s gentrified now. When I ring the bell at the dispensary, a security guard lets me into the small vestibule, then makes sure the outside door is locked behind me before opening the one that leads inside.
The handful of patients are middle-aged to younger elderly, with a couple using canes or walkers. The dominant decorations are house-ad posters with slogans about “excellence” and “leadership,” giving the space a corporate New Age atmosphere. The cannabis culture has always been prone to self-aggrandizing mysticism, and now that marijuana is semi-legal and potentially quite profitable, this tendency has cross-fertilized with corporate mysticism, in which businesses do not merely purvey goods or sell services, they’re about “passion” and “empowerment.” On the other hand, the background music on a recent visit is Mazzy Star’s So Tonight That I Might See, one of my main migraine-soothing albums since the Nineties.
As state law currently limits the permitted cannabis products to vaporizable extracts, tinctures, and capsules, there are only nine medications available, and they’re seriously expensive. A bottle of tincture with a 20:1 ratio of THC (the intoxicating ingredient in marijuana) to CBD (cannabidiol, nonintoxicating but widely believed to help with chronic pain and anxiety) costs $53 for about fifteen five-milligram doses. A bottle of high-CBD tincture costs the same. That’s a worse deal, because I’d use CBD more as a preventative than an acute pain reliever — taken once a day, it would cost $106 a month. A steel vaporizer pen for cannabis-oil extract is $110 — $10 for the device, $100 for each oil cartridge — or about $2 a toke.
No health insurance policy in the state will pay for this. (The most that insurance companies are legally allowed to reimburse for is doctor’s visits that aren’t solely for a medical-marijuana recommendation.) It’s cash or debit card only, to avoid running afoul of federal money-laundering laws.
In contrast, my $216 would get me close to twenty grams of high-quality U.S.-grown pot on the black market, and California’s largest dispensary advertises vaporizer cartridges for $25 to $50. California’s and Michigan’s medical-marijuana programs each offer patients many more options for medication, from myriad strains of cannabis to ganja-infused “edibles” to oil extracts advertised as containing more than 60 percent THC.
Still, being on the program seems to have helped me. The frequency of my migraines has come down to one or two a week, and my painkiller consumption has declined proportionately, although there could be other reasons for that. The vaporized oil is potent and instantaneous. The THC tincture doesn’t feel as benevolently psychoactive as a home-baked pot cookie, but it’s not as harsh as Marinol, the synthetic THC that was for decades the only legal cannabinoid medication in the U.S. And it’s good to be legal, after having to be furtive about my marijuana use ever since I copped my first nickel bag on MacDougal Street as a teenager. I could even openly show my vaporizer pen to a fellow nascent geezer on the subway in Queens.
The reason the New York program allows only extracts is that Governor Andrew Cuomo feared the optics of having the state authorize selling pot. But marijuana is not a pharmaceutical drug where doses can be measured in milligrams; it’s an herb, by nature more nebulous, and there are some theories that the constellation of different chemicals in it — cannabinoids, terpenes, and more — enhances its therapeutic effect.
Cuomo, then, opted for a pseudo-scientific approach in which doses can be quantified, but the medicine may be less efficacious. He feared blurring the lines between medical and recreational use, so New York, like Minnesota and Pennsylvania, prohibits actual marijuana.
California is the example those states are trying not to emulate. Its law, the first in the nation to allow the distribution of medical marijuana, treated the herb like a standard medicine, letting doctors recommend it for any condition they thought it would help treat. The problem was that a lot of dispensaries stretched that to “If you’ve got anything wrong with you, we’ll sell you weed,” marketing themselves with ads like “Home of the Five-Gram Eighth.”
To be fair, until Barack Obama’s second term, the federal government treated any state or local efforts at regulation as a prospective conspiracy to traffic in a controlled substance. And while California is generally viewed as having the laxest law in the country, its ban on letting nonresidents get medical herb meant that when I got a screaming migraine in Oakland in 2010, I got tossed out of a dispensary the minute they saw my New York driver’s license.
For what other medication are you not allowed to cross state lines? When I popped a nasty migraine on a previous trip to the Bay Area, I went to the emergency room and left with a prescription for codeine.
The line between medical and recreational use can blur, however. If I have a migraine and, after my painkillers and herbs kick in, feel good enough to play bass along with slow, pain-exorcising 1960s soul tunes, is that because playing music is therapeutic, or because I’m just another weedhead/dopefiend musician? Some pot evangelists argue that “all marijuana use is medical.” As someone who’s both a medical and recreational user, I find that to be self-serving nonsense. There is a difference. If I’m not sick, I don’t want to have to put crutches under my ass to have the pleasure of getting high.
The best way to handle marijuana as a genuine herbal medicine would be to do serious research on how to use it. Plenty of scientific and historical evidence has shown that it’s medically useful, but very little research has been done into which varieties and cultivars, what cannabinoid profiles, work best for specific ailments. What’s best for seizures? What’s best for pain?
There has been a bit of research in Spain, Germany, and Israel, but next to none in the United States, where anecdotal feedback from patients is usually buried under marketing and folklore, and the commodity fetishism about strains of pot. There are also major legal and economic obstacles: Federal law says marijuana has “no valid medical use,” and the government maintains a near-total lock on the supply available for research. The Food and Drug Administration’s drug-approval process is expensive, its three-phase testing protocols costing millions of dollars. No pharmaceutical company is going to put that kind of money into research on a plant they can’t patent.
The result: When I asked the pharmacist at the dispensary which formulation would be best for migraines, he said, “I really don’t know.”
It would be nice to live in a society that treated medical marijuana like an actual medicine instead of as a grudgingly tolerated toxic taboo.