Monday, March 2, 2015

Oral Testimony to the New Jersey Assembly Regulatory Oversight Committee, March 2, 2015, by Kenneth R. Wolski, RN

Chairman Gusciora and members of the Assembly Regulatory Oversight Committee, thank you for the opportunity to again address this committee.

My name is Ken Wolski.  I am Executive Director of the Coalition for Medical Marijuana—New Jersey, Inc.  (CMMNJ)   I am a registered nurse with 39 years experience in New Jersey & Pennsylvania.

In 2003, I co-founded CMMNJ.  We are the only statewide organization in NJ that is solely dedicated to bringing about safe and legal access to medical marijuana.  We incorporated in 2006 and became a 501(c)(3) in 2007.  Our mission is to educate the public about the benefits of medical marijuana.
Last year I presented to this committee my resume, some Op Eds I had published on the importance of home cultivation, some testimony from patients who are having a great deal of difficulty with the medical marijuana program, and a Compact Disc (CD) containing the revisions to the Regulations that enact the Compassionate Use Medical Marijuana Act (CUMMA) that we feel are necessary in order to make this a successful program.

In looking at where we were a year ago and where we are today, not much has changed.

3 ATCs were open then; 3 ATCs are open now (it's like having three pharmacies in the entire state);
About 250 doctors were in the program then; about 350 doctors are in it now--out of over 30,000 licensed physicians in the state;
About 1700 patients were registered a year ago; about 3700 patients are registered now, in a state with almost 9 million people.

When the CUMMA passed into law in Jan., 2010, The Legislature found and declared that:
there was “beneficial use for marijuana in treating or alleviating the pain or other symptoms associated with certain debilitating medical conditions” and,
this “law will have the practical effect of protecting from arrest the vast majority of seriously ill people who have a medical need to use marijuana.”

That has simply not happened in the 5 years since this bill became law.

Marijuana has enormous therapeutic potential, but,
Most people who could benefit from marijuana therapy do not have one of the severely limited qualifying conditions;
Those who do have a qualifying condition find the application process too difficult, or too time-consuming to manage; and,
Even those who manage to get an ID card find the program too expensive to afford.

Limited qualifying conditions:
There is no valid medical or scientific reason to limit marijuana therapy for pain management to only two diseases, cancer and HIV/AIDS.

Marijuana is effective for pain management for any disease, injury or medical condition that causes chronic pain, and, for conditions that cause neuropathic pain, marijuana works better than any other drug on the market.  Last year there was some question about what constitutes chronic pain and I want to offer a definition so that we are clear on this. Chronic pain is unrelieved pain in a major disabling condition that continues for six months or more. Marijuana therapy is appropriate for any chronic condition that a doctor might prescribe a narcotic for
and, in fact, marijuana is significantly safer than narcotics.  There is a 25% reduction in opiate overdose deaths in states that have robust medical marijuana programs.  See that article from “Science Daily” that I provided to members of this committee.

There is no reason to limit marijuana therapy for only three neurological conditions.  Marijuana is neuroprotective according to the Expert Opinion Paper of the National MS Society published in 2008. That means that marijuana can delay or even stop the progression of these incurable neurological conditions, but it continues to be nearly impossible for patients to legally access.

Twenty-two veterans commit suicide every day in the U.S. because Post Traumatic Stress Disorder (PTSD) is so poorly managed by traditional pharmaceuticals. We give parades and platitudes to veterans for their
service, but we deny them access to appropriate health care—marijuana therapy—which shows great promise in the management of PTSD in the states and foreign countries where it is allowed.

The DOH is empowered to add qualifying conditions at any time.  But the DOH has created an overly burdensome process that we believe is designed to fail.  The process has not even started yet due to self-imposed restrictions by the DOH.

Application process too difficult:
Finding a doctor who participates in the MMP is difficult when only about 1% of NJ physicians are signed up to take part. The Regulations created the very thing the statute wanted to avoid—patients going to a small list of doctors specifically for marijuana recommendations.  The statute wanted to ensure that there was a bona fide doctor/patient relationship but instead, patients have to abandon their family doctors and specialists and find a doctor on the DOH’s list.

The application process is too lengthy for nearly all hospice patients who die before they ever get access, and for many cancer patients who get a cancer diagnosis and have to endure chemotherapy before they can ever get an ID card.

Medical marijuana too expensive:
The marijuana from New Jersey’s ATCs is the most expensive in the nation.  It is just not an option for the many patients who have been impoverished by their illness.

The DOH justified this high price by saying in its Biennial Report that NJ is an expensive state to live in.  There was no sympathy at all from the DOH, no attempt at accommodating the poor—the DOH just seemed to say, “If you want cheaper medical marijuana, go find yourself another state to live in.”

In the packet of material I have provided to Committee members, there is:
Testimony from two patients, Maryanne Boniello and Vanessa Waltz who could not be here today.  Their testimony explains in detail some of the problems they have had with the medical marijuana program;
A Petition for Rulemaking that CMMNJ submitted to DOH in Oct., 2014.  CMMNJ made a formal application through the Regulatory process to the DOH for modifications to some of the more egregious regulations. Namely:
1. Eliminate the $200 fee for all volunteer caregivers and eliminate the illegal sales tax on medical marijuana.
2. Delete the registration requirement for doctors as well as the unwarranted course requirement in pain management in order for licensed physicians to recommend medical marijuana.
3. Eliminate the regulatory requirement for physicians to violate patient confidentiality and that section which interferes with the physician’s professional judgment.
4. Eliminate the regulatory requirement that requires physicians to provide warnings to patients that directly contradicts the law.
5. Add as an additional qualifying debilitating condition Post Traumatic Stress Disorder (PTSD) to accommodate the influx of recent military service veterans inasmuch as the DOH failed to establish the panel as required by N.J.A.C 8:64-5.1 to add new conditions.
6. Eliminate the requirement for parents to seek the approval of three licensed physicians in order to obtain medical marijuana for their child.
The packet of material also contains a summary of the changes A3525/S2312 will bring to the NJ Medicinal Marijuana Program. This is a much more comprehensive legislative fix of the MMP, that:
1. Eliminates the physician registry;
2. Expands qualifying conditions—includes PTSD, Alzheimer’s, Lyme or Parkinson’s Disease, hepatitis, nail patella & any condition causing severe or chronic pain, severe nausea or cachexia;
3. Restores limited home cultivation (five plants plus one or more mother plants) for patients--patients may grow themselves, use a registered grower, or use an Alternative Treatment Center;
4. Protects organ transplant patients from disqualification simply for the use of medical marijuana;
5. Eliminates the tax on the sale, use, cultivation and possession of marijuana;
6. Includes explicit employee protection—makes it unlawful to take adverse employment action simply for medical marijuana use;
7. Eliminates background check and fee for caregiver ID card;
8. Reduces ID card fee to $50 with no automatic expiration;
9. Eliminates requirement for psychiatric clearance for minors—keeps pediatrician requirement;
10. Requires initial and ongoing training for all state, county and local Law Enforcement Officers (LEOs) on the rights of patients, growers and caregivers and trains LEOs in Field Sobriety Tests who may not simply rely on blood or urine tests for DUIs;
11. Includes explicit immunity from civil liability and criminal prosecution for the authorized use of medical marijuana;
12. Requires physicians to determine the form, strain and amount of marijuana for their patients and eliminates the two ounce/month limit, as the amount required is determined by patient need;
13. Allows patients to obtain medical marijuana from out-of-state if necessary and out-of–state ID cards are honored in New Jersey;
14. Cuts permit fees for Alternative Treatment Centers (ATCs) from $20,000 to $5000 and imposes no upper limit on the number of ATCs permitted;
15. Removes strain or potency limits imposed on marijuana cultivated;
16. Allows ATCs to dispense a 60-day supply of marijuana instead of current 30-day limit;
17. Permits any edible form of marijuana for any age;
18. Establishes dosage units for all forms in conjunction with Department of Health (DOH);
19. Requires testing in licensed laboratories on each batch of marijuana (and on request) for chemical composition, biologic contaminants, pesticides, solvents and foreign material with results of testing available on request;
20. Forbids the DOH to issue overly restrictive or unduly burdensome regulations for this law.

In summary, the MMP fails the vast majority of patients in NJ who:
Who know they can benefit from marijuana therapy;
Who see patients in other states obtaining relief with marijuana therapy for the same debilitating medical conditions that they have;
Thought they would be protected by having safe and legal access to marijuana therapy; and,
Who continue to suffer needlessly—and even die--in NJ, or who break the law and risk serious civil and criminal penalties for their use of an unauthorized medicine.

CMMNJ believes that the MMP is a case of Failure to Thrive.  This Failure to Thrive is not the result of a lack of ability on the part of the Health Department, but a lack of political will to create a meaningful program, and this is directly a result of Governor Chris Christie.

This governor has said that he is “done” expanding the medical marijuana program, apparently regardless of whatever evidence is presented to him. He has questioned the legitimacy of this program, and all 23 state programs like it, by saying these programs are just a “front” for legalization.

I worked in state government here in NJ for 25 years, all, or part of, five decades, actually. I know how the system works.  The governor appoints the commissioner of the Department of Health and that commissioner serves at the pleasure of the governor.  If the commissioner does not carry out the wishes of the governor, that commissioner is replaced.

I believe that public health is too important to be run this way.  The Commissioner of the Department of Health needs independence from the political whims of governors (especially those with presidential ambitions whose decisions may well not be based on the best interests of the people of the State of New Jersey).  A Health Commissioner in New Jersey could perhaps be independently elected, or else be given lifetime tenure after vetting.  Some solution must exist to ensure that public health decisions in NJ are based on sound science and not political whims or worse yet, delusions.

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