STATEN ISLAND, N.Y. -- While the state's highly-regulated medical marijuana program is expanding, now with delivery options, more dispensary locations coming, more practitioners to certify patients, and more ailments approved for treatment, patients are still saddled with a high-priced product, payable only with cash, leading some to get the illegal version of the drug the old-fashioned way.

The Compassionate Care Act passed the state Legislature in 2014 to provide relief for people suffering from debilitating ailments like cancer, HIV/AIDS, ALS, Parkinson's, multiple sclerosis, epilepsy and more, including the recently-added chronic or severe pain.

That last one is a game-changer for many New Yorkers suffering from anything from back pain, migraines, or sciatica to fibromyalgia, arthritis or endometriosis.

CASH PAYMENT ONLY

Mike, who asked not to have his last name used, worked as vice president of a bank until he slipped and fell at his house two years ago, severely injuring his back.

The Port Richmond resident had surgery, leaving severe pain in his back and left leg.

Unable to work, he has been collecting disability.

Receiving only a partial salary and still having to support his family and pay his mortgage, the out-of-pocket costs of the drug may be too high to sustain.

Mike gets his drug at Columbia Care's dispensary in Manhattan, needing someone to drive him, unable to make the drive himself with the chronic pain.

He has only been in the state's medical marijuana program for two months and has already tried an oil, whose effects lasted about 90 minutes to ease the pain, he said.

The following month, he tried a capsule, whose effect lasted about two hours.

He takes the pills twice a day, and the rest of the day, he's in pain.

"Depending on what I do, the more active I am, the more pain I'm in," he said. "The last two years I've led a very sedentary life."

The cost? Between $400 and $500 per month.

Insurance does not cover medical marijuana, and only cash or debit cards can be used for payment. Credit cards are not acceptable.

Before he enrolled in the medical marijuana program -- finding a doctor to evaluate him, certifying him for the drug, paying the fee to get an ID card -- Mike was using prescription opiates to moderate the pain.

"Unfortunately, none of them had a big effect on me," he said.

Thankfully, he also did not develop dependence on the Vicodin, Oxycontin or other drugs that doctors sent his way.

"I never abused the prescription," he said.

But he expressed frustration that insurance covers those highly-addictive drugs, but not the non-addictive medical marijuana, which also only dull the pain, not eliminate it.

The capsules "don't make the pain go away. Instead of it being the only thing I can think about, it takes it down a little bit so it's not the first thing I think about," he explained.

BUYING ON THE BLACK MARKET

There are many others like Mike, who dole out hundreds of dollars for the drug, but some opt for the more well-known smokeable version of the illegal drug that people can buy on the street.

The marijuana derivatives approved by the state don't get a patient high, and there is no legal smokable form in the program, leaving capsules, oil and vapor as the options.

The state's Health Department "determined the reasonableness of the proposed prices and approved them as the maximum price per dose [for] each registered organization" and prices vary among the five registered companies that provide the drug.

While the Health Department said some organizations offer discounts for people who can't afford to pay the high price for the meds, they couldn't provide details about who is eligible or what the discounts are.

While low-income people can qualify for Medicaid or get subsidies for health insurance under the Affordable Care Act, none of that matters when it comes to medical marijuana, because insurance doesn't cover it.

The U.S. Food and Drug Administration hasn't approved the use of the drug, and marijuana is still on the Drug Enforcement Administration's Schedule 1 of Controlled Substances. While medical marijuana is legal in 29 states and Washington D.C., and recreational marijuana is legal in eight, it's still a crime at the federal level.

Doug Greene of Empire State NORML, which lobbies for medical marijuana consumers, said the organization hears feedback from patients, and it's mostly negative, both in the red tape surrounding access to the drug, but "also there's complaints about the price and the quality," he said.

"There are vape pens you can get for $30 or $40 in a state like Colorado that you can get for $100 here for an inferior product."

Do people toss up their hands in frustration and buy it on the street? Yes, he said.

"Most people seem to think they're better off staying in the unlicensed market and getting a cheaper product that way than getting it in the program, and that's unfortunate."

Landon Dais, political director of the Marijuana Policy Project of New York, said he has heard about people having similar experiences.

"Most people that go to a dispensary go once or twice and never go back," he said. "It's just too expensive. They like that the products are screened and safe ... but it's about the bottom line for people's pockets."

To make matters worse, until the state Department of Financial Services issued a letter clarifying that insurance does cover doctor's visits during which patients are certified for the drug, doctors were charging patients out of pocket.

"I know doctors were certainly charging for certification visits," Greene said.

State Sen. Diane Savino, the Senate sponsor of the bill that created the program, said, "it's because there's been a lot of misinformation."

The New York State Medical Society doesn't support the program, and since doctors usually look to them "to act as a clearinghouse for information," without guidance, doctors are left to figure it out on their own.

"Because they sat on the sidelines, doctors are left out, they're in limbo," Savino said.

A Health Department spokesperson cautioned people against using "street drugs ... an extremely dangerous choice, as the ingredients are completely unknown and untested."

The medical marijuana products are tested and approved by the Health Department's Wadsworth Center, looking for contaminants, pesticides and testing THC/CBD ratios.

"The New York State Department of Health is committed to growing the state's medical marijuana program responsibly and is continually working to enhance the program for patients and practitioners," a spokesperson said. "The addition of five new registered organizations will help to increase patient access, improve geographic distribution across the state, make medical marijuana products more affordable for patients through the introduction of new competition, and increase the variety of medical marijuana products available to patients."

As the spokesperson noted, issues with the program are slowly being sorted out, like the number of providers and dispensaries in the state soon doubling, with one coming to Staten Island in the near future.

Some companies are now offering delivery, a convenience for sick patients to avoid traveling to a dispensary.

A bill passed this year to add PTSD to the list of ailments approved for use and will be delivered to the governor for his signature.

But beyond the price, people are still having trouble finding doctors.

The Health Department lists 16 practitioners on Staten Island that will certify people eligible for the medical marijuana program -- but the department says the list is incomplete because some don't want to be listed.

"People definitely are still having problems finding doctors," Greene said. "There's a lot of doctors who don't want to talk about it."

As of September 26, there are 1,241 registered practitioners and 31,166 certified patients, according to the state Health Department.

That doctors don't want to prescribe medical marijuana but have no qualms about writing scripts for highly-addictive opiates baffles some.

"This is a possible partial answer to this horrendous health crisis we're having," Dais said.