Physicians could prescribe medical marijuana to any patient, for any diagnosed health issue, without registering their practice with the state. Patients could obtain twice as much medicine monthly as currently allowed and get it in edible and other forms. And there would be twice as many growers, and 40 new drug dispensaries across the state.
Those are among the changes to New Jersey’s medical marijuana program envisioned under a new hybrid bill that was crafted by several Democratic lawmakers yesterday and voted out of the Assembly Health and Senior Services Committee, over limited objections. One of more than two dozen nationwide, the Garden State’s program is considered among the most restrictive.
“We are putting patients and physicians in control,” said committee chairman Herb Conaway Jr., a sponsor of the measure, and a physician himself. “I’m also hopeful that the increased access to medical marijuana will allow people to de-escalate from opioids and reduce their risk of unintended addiction and death related to their use of narcotics,” he said.
The legislation is just one option to update the state’s eight-year-old program under consideration, as advocates seek to expand access to the cannabis program and find ways to reduce the impact of the opioid epidemic, which killed nearly 2,000 people last year. Gov. Phil Murphy, who is eager to legalize recreational marijuana, has also prioritized improvements to the medical program; a task force he appointed to review the system is due to report its findings in the coming days.
Not enough to meet demand?
But while most of the patients, policy experts, and other medical marijuana advocates who testified yesterday supported the final proposal — details of which were not immediately available — many warned it would still not create enough capacity to meet demand. Patients now struggle to find a doctor who can prescribe the drug, they said, and many travel long distances to reach one of the state’s five existing dispensaries and must wait weeks or more to receive their first dose.
“It’s a good jumping off point, but we need to do a lot more,” Leo Bridgewater, an Army veteran and Trenton resident, said of the hybrid bill. Bridgewater helped found the New Jersey Cannabis Commission and leads the New Jersey Chapter of Minorities for Medical Marijuana; these groups are now working with the New Jersey CannaBusiness Association to advocate for legalization as well.
New Jersey’s medical cannabis program, operated under the Department of Health, had more than 12,500 patients at the end of 2016, according to the latest state report; stakeholders said participation is now more than 15,000. While more than 500 physicians have registered to participate, some 426 were active in 2016 and only three-quarters were accepting new patients into the marijuana program.
One of the biggest concerns for patients, who begged the administration of former Gov. Chris Christie to expand the program, has been its limited scope; it currently covers just over a dozen specific “debilitating medical conditions,” half of these only after other treatment options have been exhausted. While the program’s medical advisory team called on state officials to expand the list last year, health officials have yet to act.
To address these issues, the legislation, (A-3740-3437), merges a proposal by Assemblyman Reed Gusciora (D-Mercer), a longtime champion for expanded access, and Assemblyman Tim Eustace (D-Bergen), with concepts crafted by Conaway.
More treatment centers
“We currently have limited diseases and ailments that qualify patients for medicinal marijuana,” Gusciora explained. “What we’re doing is lifting the restrictions and putting it in the doctors’ and the patients’ hands. If medical marijuana proves useful in treating (any) ailments, then the patients will indeed have access.”
Among other changes, the bill would allow the DOH to license up to a dozen “cultivator/processors;” these would include the six Alternative Treatment Centers that are already permitted under the law, five of which are operational. (These existing facilities would be allowed to continue to handle the entire process from growing through sale, while going forward the licensing would be split in two parts.)
That separate license process would be used to allow up to 40 dispensaries, or retail shops, carefully distributed throughout the northern, central, and southern parts of the state, to market the product grown by the 12 licensed cultivators.
“There are just not enough centers. You will hear that repeatedly from patients,” said attorney Anne Davis, who uses marijuana to treat her multiple sclerosis. (Medical marijuana is a “far better option” than the $3,000 pharmaceutical program she was previously on, she said.)
As it is, the existing five facilities “can’t consistently produce the same strains (of the drugs) and have enough supply to meet demands,” Davis added, although she raised concerns about the split licensing proposal and how it might impact the existing facilities.
Drive down costs
Gusciora said this additional competition would help drive down the cost to patients, which — at up to $400 an ounce — is among the highest in the nation, advocates said. “With 40 dispensaries, the price will come down,” he said.
But Peter Rosenfeld, with the Coalition for Medical Marijuana–New Jersey, said the underlying problem is the need for a bigger crop; without that, access will remain strained and price will stay high. “My concern is other aspects of this are going to rapidly increase the patient population,” he said, “and I just don’t think 12 (cultivators) is going to keep up. It’s the cultivators that are going to set the base price.”
The bill would also allow patients who visit these dispensaries to purchase up to 4 ounces of marijuana “flower” each month; currently, they are limited to 2 ounces each 30 days. Edibles, or marijuana-infused food items, and other substances containing the medicine would also be available, in doses to be determined by state officials; currently edibles are only provided for children.
In addition, the proposal would eliminate the fees patients now must pay the state to participate; the program currently costs $200, although nearly half those involved have been given hardship considerations allowing them to pay only $20.
Another major change is the legislation’s call to eliminate restrictions on which physicians could write prescriptions for medical marijuana, thus ending the program’s narrow focus on a specific group of conditions.
Addressing doctors’ concerns
Instead of requiring doctors to sign up with the state, they could make independent, patient-based decisions on what to offer. If a longtime patient had cancer and would benefit from cannabis, the doctor could write that one scrip, without “turning a general medicine practice into a pain practice,” Conaway said. “This has been a concern for physicians and has kept them from involving themselves in the program.”
Ken Wolski, who heads the medical marijuana coalition, said many of these changes were clearly positive. “Making any physician able to recommend marijuana is a great step forward. Doing away with the physician registry is going to open it up to much more access for patients,” he said. “This represents a reasonable and conservative approach right now.”
But Wolski was also among those with concerns. He, Rosenfeld, and others made repeated pitches to include a provision to allow home cultivation, an option that would expand access to different strains and help control prices. Another bill sponsored by Gusciora would, among other things, allow adults to grow up to six plants in their home and sell small amounts of the crop.
But Conaway wasn’t ready to bite on that suggestion. “You realize that’s a bridge too far,” he said. “Don’t look for that anytime soon.”