Gov. Murphy's Kinder, Gentler Medical Marijuana Program

Plan, endorsed by patient advocates and cannabis industry representatives, adds new conditions that can be treated, doubles THC levels — for starters.

Gov. Phil Murphy’s call to expand access to New Jersey’s beleaguered medical marijuana program will immediately let hundreds of thousands more state residents legally obtain the drug. It could also result in an easier, web-based patient registration system, far more dispensaries, and stronger medicine in greater quantities.

Murphy unveiled a report from the state Department of Health on Tuesday that outlined short-, mid-, and long-term changes the state can make to improve the eight-year-old program, often considered one of the most restrictive in the nation. His plan, one of several reforms under discussion — and separate from his more controversial push to legalize recreational use of the drug — was in large part endorsed by patient advocates and cannabis industry representatives.

Murphy announced he had already added five new conditions — including various kinds of pain and anxiety — that could be treated under the program and cut in half the patient fees for participating. The DOH is also revising the permitting process for production and distribution facilities and plans to eliminate the current 10 percent cap on THC, or tetrahydrocannabinol, the active ingredient in cannabis; potent strains generally contain double that level. Murphy is also willing to explore eliminating sales tax on the drug, currently around 6.6 percent.

No more jumping through hoops

The report, generated in response to an executive order Murphy signed his second week in office, recommends a mix of direct department actions, regulatory changes, and statutory reforms to create what he said would be a more compassionate, progressive program. The goal is “opening it up and making it work,” he said. “The days of making residents jump through hoops are coming to an end.”

Peter Rosenfield, with the Coalition for Medical Marijuana New Jersey, said he was “pleased and excited” about most of the changes involved, especially the immediate expansion of covered conditions. But he fears the existing alternative treatment centers won’t be able to supply enough to meet the demand, and he urged the state to consider home cultivation as a low-cost option for the many patients with limited means.

The changes were also good news to Myrna Taylor, a program participant who purchases medicine at an ATC in Bellmawr to counteract the effects of treatment she receives for breast cancer. “I was taking hundreds of pills for cancer that I no longer have to take,” she said, noting that it also allowed her to sleep and function daily. "People need this. This expansion is overdue,” she said, adding, “I have a better quality of life and everyone deserves that.”

Murphy’s plan is one of several policy proposals to improve the state’s medical cannabis program, which currently limits legal access to the drug to patients diagnosed with some two dozen conditions — some only after traditional treatments have been exhausted. There are now six licensed ATCs, five of which are operating, that cultivate, process, and sell medical marijuana. Patient fees are listed at $200 for two years, but nearly half of the nearly 18,600 participants pay a discounted charge of $20.

Assembly on pot

Democrats in the Assembly are also considering a bill that would overhaul the program, enabling any licensed physician to prescribe marijuana for whatever diagnosed diseases they see fit. The measure, which has yet to be addressed in the Senate, would also eliminate the program fees for patients, double the amount of marijuana they could receive monthly, and permit up to 40 additional dispensaries.

And regardless of what happens with legalization — which Murphy has championed, but has triggered concerns among a growing number of Senate Democrats — the medical marijuana program is likely to continue to play an important role providing access for children and monitoring medical cannabis use.

Signed into law in 2010 under Democratic former Gov. Jon S. Corzine, the rollout of New Jersey’s Compassionate Use Medical Marijuana Act was effectively stalled under former Gov. Chris Christie, a Republican, who feared that cannabis served as a “gateway drug” to harder substances. It took several years for the DOH under Christie to develop regulations to guide the program and, through this process and legislative changes, the program was tweaked to limit edible forms of the drug to minors, cap the THC limit, prohibit the development of satellite dispensaries, and block home delivery, among other things.

“New Jersey should have been at the front of the class in terms of allowing residents with debilitating or chronic medical conditions to access marijuana as part of their medical regime,” Murphy said Tuesday. “But the bureaucratic conditions put in place limited its availability, it stifled the law’s ability to help, and imparted — if that weren’t enough — a stigma both on those who sought to use medicinal marijuana and on the doctors willing to prescribe it.”

Petitioning the panel

In recent years patients have petitioned the state’s Medicinal Marijuana Review Panel, which serves in an advisory capacity to the DOH, to expand the program, particularly the number of conditions eligible for treatment. But, despite recommendations last spring from the panel to add five conditions — migraine, anxiety, Tourette’s syndrome, and pain caused by muscular-skeletal problems or visceral issues — coverage has remained largely static. (Christie signed a law in 2016 to include PTSD, the only addition in years.)

Dr. Shereef Elnahal, the acting DOH commissioner — who was unable to attend Tuesday’s event because he was with his wife in the hospital as she gave birth to their second child — said in a prepared statement he has seen the therapeutic benefits of marijuana in his own practice and noted the recommendations in the report reflect input from patients, families, clinical experts, dispensary owners, and others. “We are reducing the barriers for all of these stakeholders in order to allow many more patients to benefit from this effective treatment option,” he said.

Not all physicians were entirely on board, however. Dr. Lewis Nelson, chair of the emergency medicine department at Rutgers New Jersey Medical School, said the reforms might enable some pain patients now using opiates to find less potentially lethal options, but more study is needed on the pros and cons of marijuana use. "There are very limited data to support this measure’s effectiveness, and we do not know if the risks associated with marijuana use outweigh the benefits of treating these conditions," he said.

The DOH report issued Tuesday notes that the Murphy administration approved the panel’s recommendation to add those five conditions in late February and urges the Legislature to consider additional changes that would allow medical marijuana to be prescribed as a “first-line” treatment for all covered conditions, not just as a last resort in certain cases. And regulations will be changed to allow for other conditions to be added through a more expedited process. (Murphy urged the DOH to next consider treatment for opioid addiction, but noted he was not a medical expert.)

“As we have learned, sometimes medicinal marijuana is the best and most effective treatment up front,” explained assistant DOH commissioner Jackie Cornell, who joined the governor on Tuesday. The department will also “elevate and better support” the program, she said, raising it to a division level with a director who reports to her directly. “This is the beginning of the conversation, not the end,” she added.

Other changes planned

Other changes in the works include a more patient-friendly online application system, with a mobile app that allows individuals to easily upload information and pay the reduced $100 fee online. These reforms will also enable homebound patients to register additional caregivers who can fetch their medicine, and eliminate the current requirement that minors receive permission from a psychiatrist, in addition to their prescribing physician, in order to participate.

The report also outlines legislative changes to benefit patients, including reforms to allow participants to obtain up to four ounces of medical cannabis a month — twice the current limit — and unlimited supplies for those in hospice. Statutory revisions are also needed to allow all patients to obtain edibles and allow them to register at multiple dispensaries, to make it easier to obtain their medicine.

Murphy’s plan also seeks to ease restrictions on doctors to encourage greater participation; more than 500 are now enrolled, but patients have long complained about the difficulty of finding a provider. The DOH will also change the regulations that now require prescribing doctors to be listed publicly on its website, making this feature optional; some said the list stigmatized the program and discouraged physicians who did not want to become the target of “doctor shoppers.” The state would also like to use the Medicinal Marijuana Review Panel in a more proactive way to develop dosing guidelines and provider education tools.

Dr. Bonni Goldstein, the medical advisor to weedmaps, a dispensary search tool, said the voluntary list will encourage more physician participation and “go a long way toward creating a healthier New Jersey.”

The DOH report also recommends significant changes to the way ATCs, or dispensaries, are licensed by the state. It calls for regulatory changes to allow existing facilities to open satellite locations and, going forward, to enable future licensees to focus on one or more aspect of the business, which is generally broken down into cultivation, processing, and sales. Under the current system, each ATC is responsible for the entire process, from planting the seed to dispensing the final product.

Regardless of the specific recommendations, Murphy stressed that the report was just the first step in an ongoing process. “This isn’t the end of history,” he said. “Color us open minded as to what else we may want to tweak.”

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