Medical marijuana patients and advocates welcomed Governor Andrew Cuomo’s signing a bill last week that would expedite emergency access to medical marijuana for extremely sick people, most prominently children with severe seizure disorders. But the bill was necessary because there appears to be a slim chance that the state’s medical marijuana program will be ready to open by the January 7th deadline.

For it to open on schedule, four things need to occur. Patients will have to register with the state and show they’ve been approved by doctors. Doctors will have to be certified by the state before they can prescribe the cannabis extracts that are the only form of the drug permitted by the state’s medical-marijuana law. The 20 dispensaries allowed by the law will have to open, and they will need an adequate supply of medicine. (It would also help if patients knew where to find certified doctors.)

Out of these, the dispensaries are the closest to becoming a reality. The state Department of Health has authorized five production facilities and 20 dispensaries. “We actually had the first harvest today,” a spokesperson for Vireo Health, the company that will be running dispensaries in Queens, White Plains, and the suburbs of Albany and Binghamton, told us last week.

But the dispensaries do not yet know what products they will be able to sell. The state did not start the classes used to certify doctors until last month. And there is no way for patients to register yet, although the Department of Health says it “expects to launch the Patient Certification Program soon.”

“Patients don’t know where to sign up,” Reginald Brown of VOCAL-NY, a harm-reduction group primarily focused on low-income people with HIV/AIDS, said at a rally outside Cuomo’s Manhattan office a week ago. “There’s just thing after thing after thing, impediment after impediment.”

New York’s medical marijuana law, enacted in 2014, is the most restrictive in the nation, where 23 states and the District of Columbia have legalized it. It permits use only for 10 “severe, debilitating, or life-threatening conditions”: cancer, HIV infection or AIDS, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, spinal cord injury with spasticity, epilepsy, inflammatory bowel disease, neuropathy, and Huntington's disease.

Like only Minnesota, New York's law prohibits the use of actual marijuana, whether by smoking, vaporization, or eating. Instead, dispensaries are allowed to sell “up to five brands of medical marijuana product.” These must include one low in THC—the main intoxicating ingredient—and high in CBD, cannabidiol, which is believed to be effective against seizures, and one with approximately equal amounts of THC and CBD.

Of the 20 dispensaries, four will be in New York City: one in the Bronx, one in Elmhurst, Queens, and two in Manhattan, on East 14th Street and in Murray Hill. There will be three each in the Albany and Syracuse areas, two in Westchester County, the Buffalo area, and on Long Island (one in Nassau County, one in Suffolk), and one each in Kingston, the Rochester area, the Binghamton suburb of Johnson City, and Plattsburgh, near the Canadian border.

None are slated for Brooklyn or Staten Island, although Cuomo has directed the Department of Health to consider whether more dispensaries are needed.

New Mexico, which has roughly 200,000 fewer people than Queens, has 23 dispensaries serving 17,500 patients, and its health department announced in early October that it had approved 12 more “licensed nonprofit producers,” to bring the total to 35. It allows 21 “qualifying conditions.” Unlike New York, it permits cannabis use for severe chronic pain, glaucoma, post-traumatic stress disorder, severe anorexia or cachexia (“wasting syndrome”), and inflammatory autoimmune-mediated arthritis.

Governor Cuomo signs the Compassionate Care Act into law in July (Flickr)

“We plan to have product available at each of our four dispensaries in January 2016. Yes, we have started production,” says Teddy Scott, CEO of PharmaCann, the Illinois-based company that will be running dispensaries in Albany, Buffalo, Syracuse, and the Bronx.

“We’re ready. We’re on point,” says Dr. Stephen Dahmer, Vireo Health’s chief medical officer. But they are “still waiting to hear back” about what products they’ll be permitted to sell, whether oil for vaporization or tinctures and liquid capsules for oral use, he adds. In any case, they won’t be able to offer the “full spectrum” of cannabis medication that Vireo does in Minnesota.

However, “we prefer the stricter laws,” Dr. Dahmer says. With a drug where the appropriate dosages, side effects, and interactions with other drugs haven’t been thoroughly researched, he explains, “let’s err on the side of caution.” Like most doctors, he doesn’t approve of smoking; he hopes that new delivery methods such as vaporization can be found that bring the same immediate relief as smoking.

He’s already taken the state’s doctor-certification class. The four-hour online course costs $249 and covers the pharmacology of marijuana, contraindications, adverse reactions, drug interactions, dosing, routes of administration, risks and benefits, and abuse and dependence.

It was “relatively easy to pass” for a physician, Dr. Dahmer says; one way to do so is by completing a crossword puzzle with the answers to test questions.

The Department of Health didn’t respond to follow-up questions about how many doctors have been certified so far. “The medical-marijuana program is still on track to begin as planned in January,” its spokesperson says.

Patients are more skeptical.

“It’s November and I haven’t heard one thing about patient registration,” says Missy Miller of Atlantic Beach, on Long Island.

Her son, Oliver, is one of the patients who’d qualify for the emergency program. He suffers from Lennox-Gastaut syndrome, a severe form of epilepsy that usually afflicts young children. He has multiple seizures every day, Miller says, including the muscle jerks of myoclonic seizures, the stiffening of tonic seizures, and atonic seizures, which make him go limp and collapse. Though he’s 15, he weighs only 65 pounds, and is about the size of an eight-year-old. At the rally, Miller pushes Oliver around in a wheelchair that resembles a large stroller.

When relatives in California got some high-CBD medical marijuana for her son, Miller says, she saw a “reduction in seizures, right off the bat.” But she’d rather not break the law.

“I’m trying to be a law-abiding citizen and save my son,” she says.

Another question is how patients will find certified doctors. “Right now it is not clear how that will happen,” says Julie Netherland, the deputy state director of the Drug Policy Alliance.

“Ideally, patients will ask the physicians already treating them to get trained and register with the state,” but “clearly, not all doctors will do so.” The Compassionate Care NY coalition has asked the Department of Health to make a list of certified physicians publicly available, but it has not yet decided whether it will, she adds.

Dr. Dahmer doubts the department will create such a list. In Minnesota, Vireo has its own doctor finder on its website. “We certainly hope to offer that,” he says, but some physicians may be reluctant to have their names posted on it.

Another concern, Netherland adds, “is that not enough doctors know about and/or have taken the training. If too few doctors participate, patients will really be in a bind, and those doctors who do register could find themselves quite busy.”

Meanwhile, since the bill was enacted in July 2014, four children with seizure disorders known to the medical-marijuana movement have died.

“I deeply sympathize with New Yorkers suffering from severe illness and I appreciate that medical marijuana may alleviate their chronic pain and debilitating symptoms,” Cuomo wrote in his signing memorandum for the emergency-access bill. But he also insisted that the 2014 law be made much more restrictive than the version originally drafted by Assemblymember Richard Gottfried and State Senator Diane Savino.

“The governor has not met with a single patient or caregiver to discuss the importance of medical marijuana,” VOCAL-NY’s Reginald Brown said the rally. “It appears the governor is without a heart.”