Tuesday, April 3, 2018

Assembly Health Committee Testimony Re: Substitute A3437

March 25, 2018 (Revised testimony)

Assembly Health and Senior Services Committee
State House Annex, Trenton, New Jersey
March 22, 2018

Re:  Substitute A3437:  Revisions to the “Compassionate Use Medical Marijuana Act,” P.L.2009, c.307 44 (C.24:6I-1 et al.)

My name is Ken Wolski. I have practiced as an RN in NJ and PA for over 40 years. I am executive director of the Coalition for Medical Marijuana –New Jersey (CMMNJ), a nonprofit organization I co-founded 15 years ago.

The testimony I originally submitted to this committee was in opposition to A3437. However, after reviewing Substitute A3437, available on the day of the committee meeting, I want to change my testimony to support this bill, though with some concerns and recommendations.

The overarching concerns of our educational organization are:
access to the program;
availability of strains;
cost of the product; and,
artificially low limits/month.

Substitute A3437 substitute has a number of good recommendations. It would:
allow physicians to determine the need for medical marijuana;
make the physician registry voluntary, not mandatory for physicians to recommend medical marijuana;
eliminate the psychiatrist requirement for minors to access the Medicinal Marijuana Program (MMP), but keep the pediatrician requirement;
authorize edibles in various forms and instruct the New Jersey Department of Health  (DOH) commissioner to set limits on edibles;
do away with the previous administration’s requirement that edibles are only for minors;
mandate that 15% of new dispensaries would go to businesses that are run by minorities, women, veterans and/or disabled veterans;
increase the allowable amount of marijuana dispensed from two to four ounces; and,
reduce fees for ID cards from $200, with a $20 discount rate, to $50 with a $10 discount rate for patients on government assistance.

A main thrust of Substitute A3437 is to change the nature of future Alternative Treatment Centers (ATCs) into cultivation/processor centers and dispensary centers.

Substitute A3437 would allow six (6) additional cultivation/processors added to the five existing ATCs (soon to be six) in each region of the state (Northern, Central and Southern regions), for a total of 12. These 12 cultivation/processors would furnish marijuana products to 40 dispensaries in the three regions of the state.

This represents a reasonable and conservative approach to expand the MMP. Doubling the number of cultivation/processors should help MMP patients who regularly complain that the existing ATCs run out of particular strains of marijuana that are most effective in controlling the symptoms of their serious medical conditions.

The primary purpose of the MMP is to meet the needs of patients. Currently, patients in New Jersey pay the highest prices in the nation for their medicinal marijuana. Simply expanding the outlets where they can pay these prices is not doing any service to the patients. Vigorous competition that allows for market forces to influence pricing should bring the out-of-pocket expenses of the MMP patients down to more reasonable levels. Hopefully, Substitute A3437 will stimulate price reductions for MMP patients.

A home cultivation provision for MMP patients is the ideal solution to both availability and affordability of therapeutic strains of marijuana, but this provision is lacking from Substitute A3437.

Substitute A3437 creates a new “total amount of usable marijuana that a patient may be dispensed, in weight, in a 30-day period, which amount shall not exceed four ounces.” The addition of two ounces per month to the current amount allowed is appreciated, but it will also be inadequate for some patients. Marijuana therapy is highly individualized. The actual amount allowed each month should be what the recommending physician deems necessary to control the symptoms of the patient.

Substitute A3437 still requires patients to be seen every 30/60/90 days by a physician simply for renewal of their marijuana recommendation.  Some patients’ underlying condition(s) will never go away. They should not have to be seen so frequently. Yearly visits should be adequate, unless the patient is a minor.

Some of these recommendations in Substitute A3437 are not necessary to be included in legislation. The DOH plans to release its report improving access to the MMP very soon and it will presumably make significant changes by regulation.  A new administration that looks favorably upon the MMP is more likely to expand the program as needed without revisiting legislation. The DOH may well:
add to the MMP the 43 petitions that were recommended be approved by the DOH Review Panel, and may allow individual physicians to determine future conditions that qualify for marijuana therapy;
allow any New Jersey licensed physician with prescription privileges to recommend medical marijuana, and make the Physician Registry voluntary;
reduce the fees for MMP ID cards; and,
evaluate whether there are sufficient numbers of alternative treatment centers to meet the needs of registered qualifying patients throughout the State and make its own recommendations for expanding the MMP since, according to the New Jersey Compassionate Use Medical Marijuana Act, the Commissioner of the DOH is empowered to do this:
“The (DOH) shall seek to ensure the availability of a sufficient number of alternative treatment centers throughout the State, pursuant to need…and centers subsequently issued permits may be nonprofit or for-profit entities.”

While we have some concerns about the proposed bill, and would like to see a number of other provisions added to the bill (see below), the Coalition for Medical Marijuana—New Jersey, Inc. supports Substitute A3437.

CMMNJ’s recommended additions to the Substitute A3437:

Allow any licensed healthcare professional with prescription privileges, including Advanced Practice Nurses, Dentists, and Veterinarians, to recommend medical marijuana;
Mandate education on the Endocannabinoid System for all healthcare professionals in NJ who have prescription privileges;
Recognize out-of-state ID cards now that 30 states have medical marijuana programs including NY, PA, DE, etc.;
Adopt “Patient Focused Certification” in order to bring national standards to every aspect of the MMP (testing, etc.) through Quality Assurance audits using the industry’s best technical experts, (currently used in DE & MD): https://safeaccess2.org/patientfocusedcertification//
Require ongoing, documented training for all state, county and local Law Enforcement Officers on the MMP (OAG Guidelines posted on the DOH website is not adequate training);
Have the DOH develop complete dosing and administration guidelines for standardized medical marijuana products (including information on expected effects, side effects, adverse effects, etc.); See: “Medicinal cannabis: Rational guidelines for dosing:”  https://pdfs.semanticscholar.org/582a/efb5bfa326fdba0affc23e343151e02aa903.pdf
Allow edible medical marijuana products for qualified patients in all state institutions to improve care and reduce healthcare costs (including lawsuit avoidance)—allow institutional physicians to recommend, and nurses to administer, medical marijuana after appropriate training, and then conduct case studies on patients receiving this treatment;
Deschedule marijuana in New Jersey;
Include explicit employee workplace protections for MMP patients:
Evaluate the effectiveness of state mandated policies and procedures for the administration of medical marijuana at schools and facilities for the developmentally disabled throughout NJ, amend these policies as needed, and extend these policies to include colleges and universities in NJ; and,
Restore home cultivation of 6 (six) plants for qualified patients with an MMP ID card (this provision was originally approved by the NJ Senate on 2/23/09).

Respectfully submitted,

Ken Wolski, RN, MPA
Executive Director
Coalition for Medical Marijuana--New Jersey, Inc.
219 Woodside Ave.
Trenton, NJ 08618
609.394.2137 www.cmmnj.org

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