The vast majority of Americans — nearly 95% of us — support the use of medical cannabis. Thirty-three states plus the District of Columbia have legalized it, and that number is likely to rise.

But like all swiftly embraced changes in public health, there can be unintended consequences of legalizing cannabis for medical uses. My colleagues and I are seeing this one: the rise of a new health care disparity, because it is harder for poor people to access medical cannabis than it is for wealthier people.

Since 1996, I have worked as a primary care physician in the Bronx, N.Y., home to several of the county’s poorest congressional districts. Two years ago, we started a medical cannabis practice in one of our busiest primary care practices to better serve people with chronic pain — one of the qualifying conditions in New York state for the use of medical cannabis. Each year, our practice sees thousands of patients with chronic pain stemming from conditions such as degenerative joint disease, inflammatory arthritis, HIV, sickle cell anemia, fibromyalgia, and neuropathy.


Medical cannabis is a good option for them. In fact, data from the first two years of New York state’s Medical Marijuana Program show that more than 70% of registered patients seek medical cannabis to treat chronic or severe pain, often in an effort to avoid prescription opioid medications.

In addition to certifying patients for medical cannabis, I educate them on the potential harms of cannabis and on how to obtain legal, highly regulated, non-smokable medical cannabis from legal dispensaries. I always recommend that patients purchase particular tinctures or oils based on the relative quantities of the two common compounds in medical cannabis: cannabidiol (CBD) and tetrahydrocannabinol (THC).

Unfortunately, most patients do not follow through on my recommendation.

Of nearly 500 chronic pain patients certified to use medical cannabis in our practice to date, fewer than half reported purchasing it at a licensed dispensary — largely because they cannot afford it. Because the federal Drug Enforcement Administration still classifies medical cannabis as a Schedule I substance, insurance doesn’t cover it. For the same reason, it can’t be bought using a credit card. For my patients, monthly cash-only payments run from $200 to $300. While this is manageable for some people, the majority of my patients find this to be a very heavy burden.

On top of the high cost of medical cannabis, it is available only at licensed cannabis dispensaries. These are few and far between. My patients usually need to take a multi-leg bus, train, and subway ride, or a costly car service. While the distance to a dispensary might pose an irritating hurdle for people with solid finances, it’s an overwhelming barrier for those on limited budgets. One of my elderly patients spent $200 in one month just to travel to a dispensary.

As a result, some of my patients skip the licensed dispensaries and buy cheaper, more readily available street marijuana through unregulated sources. Purchasing street marijuana is not only illegal, but it also means that I do not know exactly what patients have purchased, how they are using it, or how it may affect their health.

Other patients with chronic pain continue to take opioids, as there are few barriers to buying prescription opioid medications. Most patients spend nothing, or a small copay, to fill a prescription for opioids, and they can pay with a credit card.

The experience of the patients in our clinic points to a new mandate: make it easier and more affordable for all qualified individuals to obtain medical cannabis. It’s time to advocate for a new federal classification for cannabis, so insurance companies can cover it, just as they cover the costs of drugs to treat cancer, diabetes, and other diseases. At the same time, we need to consider subsidies or discounts for low-income patients and expand the number of licensed dispensaries for medical cannabis.

Without a more equitable system, this new health care disparity will become entrenched alongside so many others, leaving many of those most in need of medical cannabis without access to it.

Julia Arnsten, M.D., is chief of the Division of General Internal Medicine at Albert Einstein College of Medicine and Montefiore Health System, and a registered practitioner with the New York State Medical Marijuana Program.

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  • fantastic put up, very informative. I ponder why the other specialists of this
    sector do not understand this. You must continue your
    writing. I am confident, you have a huge readers’ base already!

  • Why is it that CBD isn’t covered by insurance? This makes those of us on a fixed income chained to the opioids that we DO NOT WANT and plus even THOSE are eventually going to be taken from us if the propaganda can be believed. I would PREFER to be OFF the opioid monster but what is the answer when no pain means no mobility and no quality of life?

  • I Wish MJ Worked FOR Me, instead, it makes me more sensitive, (physically and emotionally). Also, I personally know people who have the card yet admit that it doesn’t help with certain kinds of intense pain. In NY I translated on Google Scholar from German To English, that The Reseacher Regrets The Process used which was supposed to attach to certain Opioid Centers in the Brain. Our Extremely Capitalistic and Corrupt Higher level officials Recently Admitted To the Creation Of The Opioid Crisis, (please read the 2 Part Story from CIAAG). A new but eye-opening Research Story via Pharmacist Steve Blog And Their Own Washington-Congressonal Investigation. Massive Lies, Untruths, and The incomprehensible Greed Created By Insurers, Along With Others, in anticipation of the Baby Boomers Retirement, and becoming in need of potential situations to where they may be in need of Adequate And Authentic Pain Relief. No one is speaking of the Uninformed, non consensual, LAB RAT Experiments being performed on All Americans with Chronic Illnesses. Everything From Sleep, Anxiety, ADHD, and Pain Medications. Mainly because They wrote themselves and their Families out from the secret and illegal Abuse 10 years of my life and health have been painfully ruined, wasted and resulting in profound Additional Disability. The Medications I Just Mentioned are Fraudulent and need to be tested. These Crimes Against the American People, (the ones who haven’t committed Suicide, will go down in history as Mass Genocide.

  • Indeed if the system fails like it now does : grow the plants, and use the mj. This is what one gets forced into if the product is not available legally or if it is otherwise not affordable. Until US health care systems wake up and peddle hard to catch up to other more cannabis advanced civilizations the do-it-yourself / help yourself world will thrive.

  • I Understand how this is a problem. I am on disability due to severe degenerative disc disease. Spinal Stenosis ruptured disease and facet disease plus the Arthritis In my spine. My primary care physician I was seeing only does urgent care now so I have to go to one 9f the only 2 pain doctors that dosent accept my insurance. So Every month I have to make arrangements on a couple of my Bill’s, usually electric and water to be able to pay for my office visit and medications. It’s a terrible thing when you have to make a choice of Do I suffer all month or Try to juggle the Bill’s. Thank You for speaking up on your patients behalf and God Bless

  • Hello,

    I am from the state of Illinois and suffer from Sickle Cell Anemia, which you know is very painful and debilitating. I was wondering if you can tell me why Sickle Cell is not on the list as a qualifying condition for the use of medical marijuana and if there is anything I can do to petition to have it added as such.


    • As soon as the Chicago gang can increase taxes on medical MJ — you won’t have an issue. Really. Not kidding.

      How laughable this “legal” MJ thing is. MJ is a green plant that rapidly grows — a 12-year-old can grow it. If the Daley gang thinks I’m going to pay $50 for 2 grams — they are dumber than they look. One plant can grow 30 grams.

  • How very odd, this is. My GP (U of Chic Med) will NOT ‘script med MJ. She would not explain, but I am guessing, it has to do with the shark-like trial lawyer crowd. That is, something goes wrong, it is LAWSUIT time.

    So much for that.

    • Your physician works for you, not the other way around. If your Doc refuses to issue a recommendation, fire her and find a new doc.

    • You must be joking, Bobo. She’s the best GP in town. Only a fool would “fire” the best.

      I must have some kind of immunity to pharms. I got ‘scripted Tramadol after a bike accident — no effect. So, I just used ice.

  • Well written article. Health disparity is wide spread. How can we combat this phenomenon? Please do comments!

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