Thursday, October 8, 2009

A804 Substuitutions, Continued

My side of an ongoing email discussion with a NJ legislator - I am very concerned about the A804 "substitution" which allows only a person's primary treatment doctor to make medical marijuana recommendations. This has not worked out in other states that allow medical marijuana, for reasons I describe below.

I hope you have seen the above Star Ledger article where three potential New Jersey Medical Marijuana patients are interviewed: Chuck Kwiatkowski and Nancy Fedder, both with MS, and Mike Oliveri who has muscular dystrophy.

I recently spoke to all three about whether their primary treatment doctor would write a recommendation for medical marijuana when it becomes legal in New Jersey. All three felt it would be extremely unlikely.

Mike, living in "exile" in California while waiting for the New Jersey legislation to pass so he can return, says even in California it is still difficult to get a recommendation from one's primary treatment doctor, nearly 13 years after their legislation was enacted.

Even though these people can benefit more than most from medical marijuana, and even though their doctors understand this, the doctors are still reluctant to recommend for the reasons I outlined.

I seriously feel that the NJ legislation will be "dead on arrival" unless we get the restrictive physician recommendation clause removed.

I would appreciate any suggestions as to whom best to speak to in the legislature about this matter.

Thanks for any help,

Original Letter

I want to thank you for allowing us to discuss the A804 bill with you on

While Chris Goldstein and Ken Wolski may be more experienced with the NJ
political process, this is my first time supporting a bill. I'm an
engineer by trade and know little about politics. So allowing me to sit
in on this discussion was educational for me. I also appreciated your
positive attitude towards the bill.

So I now understand that the bill will probably be in flux when it
reaches the floor and the substitutions are discussed, and it is very
difficult to know at this time how similar A804 will end up to S119.

I'd like to offer a suggestion for a compromise on one of the
substitutions if it becomes necessary to do so. In the Assembly
committee substitutions, recommendations can be made only by a physician
"who is the physician responsible for the ongoing primary treatment of a
patient's debilitating medical condition."

I think that this provision will end up being one of the most
restrictive of the substitutions and could cause the bill to be
essentially useless to the vast majority of patients in New Jersey who
need access to medical cannabis.

From my experience with physicians, most primary treatment doctors will
not recommend a drug they don't have personal experience and training
on, especially if it will be needed long term and especially if the
treatment involves controlled drugs that require knowledge of the
State's paperwork requirements and procedures for that drug.

In my case, for instance, my neurologist focuses on the primary
treatments for my disorder. I see a pain specialist for pain treatment
with scheduled drugs. I see yet another doctor for spasticity control.
Each is a specialist in the class of drugs with which I am being

So it is VERY unlikely that most doctors who are providing the primary
treatment for disorders like MS will want to make recommendations for
cannabis. They simply will not have had experience with the drug, will
not know how much to recommend and they will also be unsure of the
State's rules and regulations for that drug.

Your average doctor will also be leery of dealing with a drug that is
illegal at the Federal level, unsure if recommendations could negatively
impact him or his practice in spite of the protections offered by the NJ

And because cannabis will not be sold by for-profit companies, there is
no wealthy organization that will be offering free training to doctors
on the use of cannabis and how to comply with state laws.

So almost no patients will get access to cannabis, no matter how likely
the drug is to help them.

I can guess the thought process behind this substitution. It was
probably to avoid the setting up of medical marijuana doctor mills such
as appeared in California, who issue recommendations for "hangnails".
Although this, of course, could not happen under the original Senate
version due to the restriction on the conditions for which
recommendations can be made.

Perhaps a compromise procedure could be offered, where the primary
treatment physician provides written verification of the patient's
qualifying condition. This written verification is then taken to a
specialist who then writes the recommendation for cannabis. Both the
verification and the recommendation would be needed for a patient to
receive the a registry ID from the Dept of H&SS.

This prevents the type of abuse I think was the goal of the substitution
and still allows patients to find doctors with the experience and
willingness to make recommendations.
Thank you again for receiving us this week and I hope you will consider
this compromise if the situation comes up where you can offer it.


1 comment:

  1. i got a PCP who guarteed me she will sign off for me. i have 2ndary prog MS i'm 58 M
    my ? is, wld i be a candidate?