New York State Governor Andrew M. Cuomo, seated, assisted by...

New York State Governor Andrew M. Cuomo, seated, assisted by 10-year-old Amanda Houser, ceremonially signs New York States medical marijuana bill in Manhattan on Monday, July 07, 2014. New York has become the 23rd state in the U.S. to authorize medical marijuana. Credit: Charles Eckert

Once an opponent of medical marijuana, Gov. Andrew M. Cuomo ceremonially signed a new law Monday that makes New York the 23rd state to approve the drug for medicinal purposes.

Cuomo actually signed the law Saturday and held a news conference Monday to highlight the program.

"There is no doubt medical marijuana can help people," said the Democrat, who is facing Republican Rob Astorino in the gubernatorial race this fall. "If there is a medical advancement, we want to make sure we're bringing it to New Yorkers."

Assembly Speaker Sheldon Silver (D-Manhattan) said at the ceremony that if someone told him, as young man, the state would legalize medical marijuana: "I would not have believed it."

"Times change. Public opinion changes," Silver said, adding "knowledge expands."

The governor was opposed to medical marijuana his first three years in office. But Cuomo agreed in June to a proposal driven by state legislators after he negotiated concessions that will make New York's medical-marijuana law among the most restrictive.

"I believe some of the other states, frankly, not to name names, they were too loose," Cuomo said. "They were too flexible. Their list of diseases was too long, where it almost became a joke that if you have common, relatively common conditions, you could get medical marijuana . . . I am against legalizing marijuana, and that's not what this is."

The New York program won't open for business for at least 18 months. Patients with the following conditions would qualify: cancer, HIV/AIDS, ALS (Lou Gehrig's disease), Parkinson's disease, multiple sclerosis, damage to the nervous tissue of the spinal cord with objective neurological indication on intractable spasticity, epilepsy, inflammatory bowel disease, neuropathies and Huntington's disease. The state Health Department could expand the list in the future.

Five manufacturers would be licensed. Each could run up to four dispensaries -- meaning there would be 20 dispensaries around the state. Geographic balance would be a consideration in the location of dispensaries. The state would apply a 7 percent excise tax on manufacturers. All product would have to be grown within state borders to not run afoul of federal anti-marijuana laws. That's part of the reason for the long lead time, the governor said.

"It takes about nine months just to grow the marijuana in state," Cuomo said. "Plus, there's some time to set up the protections, because again we want to make sure we have the right protections in place."

Smoking medical marijuana would be prohibited, as Cuomo and some Republican lawmakers preferred. Instead, patients would have to intake the drug through edible or oil forms, or through a vaporizer.

The law also gives the governor power to shutter the program at any time if he believes problems are developing.

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