Saturday, June 6, 2009

Analysis of Assembly Committee Changes to NJ Medical Marijuana Bill

The New Jersey Assembly Health and Senior Services Committee finally voted to release the A804/S119 bill to the general Assembly for a vote, but with significant modifications.

These modifications include:

1)Removing any allowance for home growing, instead requiring patients to purchase their cannabis from at least 6 non-profit "Alternative Health Centers" to be set up around the state;

2)Removing "severe or chronic pain" as a qualifying condition except when associated with cancer;

3)Requiring that patient recommendations come ONLY from the doctor who is directly treating the qualifying condition.

The first modification will put NJ at much greater risk of federal crack downs as well as cost many patients more money for medicine than they can afford. The second modification eliminates the largest group who could benefit from the act and for whom some of the best medical science exists supporting the use of cannabis. But the final change worries me the most. It will make it almost impossible for anybody to receive a cannabis recommendation. So this last change will make it unlikely that the program will ever get off the ground after it is signed into law.

Why? Because most doctors simply will not write recommendations for cannabis use. Their reason is two-fold:

First, doctors fear repercussions from their own certification professional societies and also fear losing their DEA scheduled-drug prescription license. Even though the act explicitly forbids professional societies from taking negative actions against doctors who recommend marfijuana, and a Supreme Court decision protects doctors' free speech rights to make a recommendation, most doctors are not going to realize the existence of these protections. Even if they are educated to be aware of them, they will not or trust these protections, fearing controversy with negative impact on their practice if they do make a cannabis recommendation.

Secondly, most doctors, quite rightly in my opinion, will not write prescriptions for drugs with which they do not have training and experience. Zero doctors in our state currently have experience with cannabis.

Even though California has had a medical marijuana law since 1996, only a few doctors there will make recommendations for the above reasons. Obviously, by this point most doctors in California should know the law and its protections. Many, perhaps the majority of doctors in California say they believe there are benefits to medical marijuana. So the reason is fear of reprisal and unwillingness to prescribe drugs with which they are unfamiliar.

So almost no New Jersey doctors treating patients with AIDS, MS, etc. will be writing marijuana recommendations. And the bill apparently also has a provision to prevent a patient from switching to one of these few doctors who might make a recommendation as it will require a long term doctor/patient relationship before the doctor can write a recommendation.

In general, doctors prefer to refer patients to specialists for treatment with scheduled drugs, especially if a patient needs long-term or strong pain relief. For example, a doctor will refer a patient with severe or chronic pain to a pain specialist. The pain specialist has superior knowledge of treatment with pain drugs and also knows how to go through the regulatory hoops to best protect himself and keep his patients within the law.

I had expected a similar situation to develop in New Jersey for cannabis recommendations. I know that a number of doctors with cannabis experience were considering setting up clinics here for exactly that purpose.

I realize that the Assembly committee was worried about abuses of the law. They put in the amendment regarding who can recommend because they feared that "pot clinics" would be set up where people can walk in with a hang-nail and walk out with a recommendation.

But the original bill already had strict definitions of qualifying conditions. And I'm sure a more subtle change could have been made to achieve the same level of protection from abuse that the Health and Senior Service committee desired. One method could be to require a note from the primary care doctor documenting the medical condition of their patient. There would be no need for the primary care doctor to make an actual recommendation The patient could then take this note to a cannabis doctor clinic to get a recommendation.

I believe that the Health and Senior Service committee does want to get this act in place and that they do want to help patients. But I fear that they have unknowingly gutted this act.

It will probably take at least a year to set up the regulation committees and get the Alternative Treatment Centers going. Hopefully in that time we can talk to committee members and get them to loosen some of these overly-restrictive provisions.

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