State May Expand Medical Marijuana to Cover PTSD, Other Conditions

Andrew Kitchenman | April 1, 2015 | Health Care
Doctors and patients emerge in sharper focus thanks to second annual report on program

medical marijuana
As New Jersey’s medical marijuana program moves into its third year, state health officials said they will consider expanding it beyond the 10 conditions it currently covers. A panel of doctors and other medical experts will meet in the next few months, for example, to discuss adding post-traumatic stress disorder (PTSD) and other problems to the list.

And while legislative leaders have expressed frustration with the slow pace of the program’s growth ,state Health Commissioner Mary E. O’Dowd said the three marijuana dispensaries open in the state are meeting needs, and there is capacity to handle an influx of new patients.

A clearer picture of the patients and doctors who participate in the program emerged yesterday with the release of the second annual report.

There are 3,569 active patients in the program, which was launched in December 2012. Seventy-three registered patients are inactive; 85 have died; and 203 had their applications disapproved.

Of the 371 doctors registered to prescribe the drug, 325 are active, 42 requested to change their status to inactive, and four were disapproved. Of the active doctors, 70 percent are currently authorizing patients for the program.

The report also updated progress of the six organizations that have applied to dispense and grow medical marijuana: three are open, while a fourth is scheduled to open this summer and another has built its cultivation facility. The state has just started its review of the sixth organization.

Of the three centers that are up and running, the newest — Garden State Dispensary in Woodbridge — is by far the largest, serving 1,682 patients and dispensing 493 pounds of marijuana in 2014. Compassionate Care Foundation in Egg Harbor served 583 patients with 185 pounds of pot, while Greenleaf Compassion Center in Montclair dispensed 55 pounds of the substance to 361 patients.

Breakwater ATC in Cranbury has started growing the plant and expects to be operational this summer, while Compassionate Science ATC has secured a host community in Bellmawr. The state expects to complete examining its principals, corporate structure, and funding source between April and June. Foundation Harmony will be located in Secaucus, and the state started examining the organization in December.

O’Dowd said she hopes the remaining centers will make significant progress soon. But she said that the centers that are already open have the capacity to handle a “significant influx of new patients” if needed.

“To me, that is the measure that I am most interested in,” she said, adding: “If we had patients that were not being served that would be a very difficult situation and right now, all of the patients that are looking to being served” are being served.

But critics of the program have said that potential patients are not signing up due to the relatively low number of doctors registered.

O’Dowd said this hasn’t been borne out by the department’s experience, since the state has received relatively few calls complaining about a shortage of doctors. Instead, the state receives an occasional call about a shortage of doctors in a particular area.

Medical marijuana advocates also allege that doctors aren’t registering because they don’t want their name listed in the public online registry.

O’Dowd said the department wanted the registry to be public to make it easier for consumers to find doctors. She said she’s heard from doctors who don’t want to be registered because they’re opposed to the program, or because they’re concerned that marijuana continues to be illegal at the federal level. She added that hospitals and some doctors are concerned that their eligibility to participate in Medicare could potentially be threatened in the future due to their involvement with the marijuana program.

[related]O’Dowd also said state officials have discussed how they plan to fill the new panel with the State Board of Medical Examiners and the Medical Society of New Jersey, the state’s largest doctors group. The majority of the panel will be doctors, but other positions can be filled by healthcare professionals who are knowledgeable about conditions that may be considered for inclusion in the program.

“I’m looking to put together a group of individuals that are well balanced in their approach,” O’Dowd said, adding that she would like to have experts in illnesses like PTSD that the panel is likely to evaluate.

The report also noted that the number of strains of marijuana grown in the state has increased to 49, after a law enacted in 2013 removed a provision limiting the variants to three per facility. Five of the 33 strains currently available are high in cannabidiol (CBD) and low in tetrahydrocannabinol (THC), the component of the marijuana plant that gets users high. Parents of children with debilitating seizure disorders seek this combination.

“That’s a significant benefit to patients, as well as providers,” O’Dowd said of the increase in strains.

She noted that the state is conducting research on the strains and posting results, which can be used by patients and providers to determine which chemical components are providing relief. She added that the state is maintaining an archive on medical and scientific research on the drug.

The state program regulations have come in for criticism from both medical marijuana advocates and legislators. They argue that the state hasn’t followed the intent of the January 2010 law, which has led to delays in its implementation, as well as in the number of centers open and patients and doctors registered. The Assembly recently passed a resolution, ACR-224, that could lead to the state changing or withdrawing regulations.

O’Dowd defended the Department of Health’s approach to the regulations.

“I feel the regulations put together some clear processes and protocols on how to run a program” that was new to the state, she said.

O’Dowd added that some regulations have already changed and will continue to change as a result of amendments to the law and comments from stakeholders.

The number of patients with each condition are, in order: intractable skeletal spasticity, 1,287; severe or chronic pain from HIV/AIDS or cancer, 970; inflammatory bowel disease, 561; multiple sclerosis, 549; terminal cancer, 260; seizure disorder, 258; glaucoma, 113; terminal illness, 73; muscular dystrophy, 68; and lateral sclerosis, 31. The total adds up to more than the total number of patients, since some patients have more than one condition.

Most patients pay a $200 registration every two years to stay registered. However, 48 percent qualify for a $20 fee, due to having low incomes or disabilities.

The medical specialties with the most active registered doctors are internal medicine, family practice, and neurology.

The report also notes that the state’s budget for supervising the program, including inspecting the facilities and testing the marijuana, is $1.86 million this year, offset by $206,000 in fees from patients and caregivers for registering and from the alternative treatment centers for permits.

Ken Wolski, a registered nurse and executive director of the Coalition for Medical Marijuana – New Jersey, said the state isn’t making satisfactory progress in building the program. He said that the law that created the program allowed state officials wider latitude to add conditions to the program. The panel is being formed due to state regulations, which say that the Department of Health will consider applications to add conditions after two annual reports on the medical marijuana program. The second annual report was released yesterday.

“They took it upon themselves that they would wait for these reports were out before they even started the process of adding the conditions,” Wolski said. “It’s been so frustrating,” especially for patients who’ve waited five years to become eligible.

Wolski said an example of the arbitrary rules is the fact that chronic pain from HIV/AIDS and cancer is a qualifying condition, but not chronic pain from other causes.

“It makes no sense from a medical or scientific point of view,” Wolski said, adding that his organization hopes that the department launches the panel quickly “to really start meeting the needs of so many patients in the state of New Jersey whose needs quite frankly are just not being met right now.”

Wolsk said he supports the legislative resolution to redo the regulations, saying that advocates have questioned the workability of the regulations since they were first proposed five years ago. In particular, he questioned the use of the physician registry, saying patients should be able to go to their own family doctors as they do for other prescriptions.

Wolski added that the state requires patients to make multiple visits to a new doctor if their current doctor isn’t registered, which adds needless expense to the process. And he questioned the state imposing a stricter requirement for participating doctors to receive ongoing education in pain management than it does for doctors who prescribe more dangerous, controlled drugs. He’d rather see a requirement that doctors be educated in the latest science on the system in the human body that processes the effects of marijuana.