Since New York Mayor Andrew Cuomo first signed the bill that would allow the first ever medical cannabis program in the state 18 months ago, and this month was when the doors officially opened. While the bill had been talked about greatly by lawmakers over that period, the interest in people taking part in it has turned out very low.

The numbers provided by the New York State Department of Health show that a mere 166 patients have signed up with the program that will allow them to obtain medical cannabis. Out of the 79,000 active doctors in the entire state, only 226 have gone through the proper procedure to become eligible to prescribe cannabis to their patients.

New York deputy state director for the Drug Policy Alliance, Julie Netherland, says that “It’s hard for me to celebrate this as a success. I don’t think, for those of us who fought so hard to pass this bill, this is what we were fighting for.”

Technically, doctors can’t “prescribe” medical cannabis since it is still banned by the FDA, but they can recommend it only if they are certified. They must complete a $249, four-hour online course before they can then register with the state. This course covers such topics as dosing, effects, safety, and the science of medical cannabis and how it is applied to treat ten life-threatening or debilitating conditions. One in forty patients across the state, or around 500,000, are qualified to receive medical cannabis.

One reason why so few have signed up is because the list of qualified physicians hasn’t even been released to the public, instead the list will only be available to doctors. “That creates another barrier for patients. They don’t have a way to find the physicians who are enrolled, and not enough physicians are enrolled in the first place,” said Netherland.

Another concern is the affordability of cannabis for medical use which is often daily. The laws specify that insurance will not cover medical cannabis, so patients have to pay for it out of their own pocket. Advocates have been promoting the idea of the Department of Health creating a charity pool from the tax revenue collected from selling cannabis, and using that to help lower income people. “Now we’re left with the goodwill of the five producers. Whether they voluntarily choose to provide a discount or system for low-income patients remains to be seen,” Netherland said.

This theme is similar here in Canada, where local dispensaries are providing the majority of medical cannabis to people instead of the licensed producer system in place. People are voting with their dollars, and the results show that so far people prefer what the dispensaries have to offer when compared with the LPs. The New York situation obviously has a long ways to go and with a ton of room for improvement.