CRC Testimony March 24, 2022

Testimony to the New Jersey Cannabis Regulatory Commission

By: Ken Wolski, RN, MPA

Executive Director, Coalition for Medical Marijuana--New Jersey, Inc.

March 24, 2022

I appreciate the opportunity to make public comments on: 

1. Medical conditions that should be considered for the Medicinal Cannabis Program

2. Patient education/counseling needs

3. Medicinal product expiration dates

Medical conditions that should be considered for the Medicinal Cannabis Program

I urge the Cannabis Regulatory Commission (CRC) to allow anyone with prescriptive privileges in New Jersey, and an office in New Jersey, to recommend cannabis therapy for ANY condition that the prescriber feels may be helped by medical cannabis.

Leave this issue up to the physician, the Advanced Practice Nurse, or the Physician’s Assistant to act in the best interest of the patient.

The state of New Jersey has already approved numerous medical conditions as qualifying for cannabis therapy. Therefore, cannabis should be allowed to be recommended “off label” for any other condition, as is the case with prescription pharmaceuticals. Once a drug is approved for use by the FDA, that drug may be used “off label” for other conditions by prescribers.

Adding individual conditions to the Medicinal Cannabis Program is time-consuming and inefficient. The Compassionate Use Medical Marijuana Act (CUMMA) passed into law in January 2010 with very limited conditions that qualified for marijuana therapy. It wasn't until September 2016—over six years later--that the first additional condition was added. This was done by the New Jersey Legislature, after the DOH refused to act on CMMNJ’s request. That condition was post-traumatic stress disorder (PTSD). PTSD was added after a vigorous campaign by the Coalition for Medical Marijuana--New Jersey and local veterans. 

It wasn't until October of 2017--nearly eight full years after CUMMA passed into law--that 43 additional petitions were approved for cannabis therapy.

Also, consider the case of Rare and Orphan diseases. A Rare disease is one that affects fewer than 200,000 Americans. An Orphan disease is one whose treatment is not considered profitable by the pharmaceutical industry to develop. There are over 7,000 Rare and Orphan diseases that affect between 25 million and 30 million Americans. In New Jersey, somewhere between 500,000 and 900,000 residents suffer from Rare and Orphan diseases. These diseases often cause great difficulty in proper diagnosis and treatment. Over 95% of Rare disease patients lack FDA approved treatment. Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s Disease) and Tourette Syndrome are two of these diseases, and they both qualify for marijuana therapy in New Jersey, but the latter took nearly eight years to qualify.

Around 2009, a woman called me and told me her son suffered from one of these Rare diseases called Friedreich's ataxia, a neurological condition that, among other things, affected his ability to walk. The woman told me her son was helped tremendously by medical marijuana, but at the time she risked arrest and imprisonment for giving her son this treatment. Friedreich's ataxia is still not a qualifying condition for marijuana therapy in New Jersey. 

The discovery of the Endocannabinoid System (ECS) about 25 years ago provides the scientific basis for how cannabis can help with so many diseases, symptoms, and medical conditions. The ECS consists partly of a series of receptors throughout the entire human body for the components of marijuana--the cannabinoids. Our own body produces substances—endocannabinoids--that are identical to phytocannabinoids, or the cannabinoids found in the cannabis plant. The purpose of the ECS is to restore homeostasis, or balance, to the mind and body. Medical cannabis can help where there is a deficiency in the production of the natural endocannabinoids. ECS researchers say that this system may play a role in all disease processes.

New Jersey needs to stop taking baby steps with cannabis therapy. It must begin taking robust measures. Allowing for any condition that a prescriber recommends is the appropriate way to proceed with additional qualifying conditions.

However, it really doesn't matter what condition qualifies for cannabis therapy if a patient cannot get it because of their living situation.

Three days ago I received a phone call from a woman who told me about her 90-year-old father who is living in an assisted living facility in central New Jersey. 

This woman’s father suffers from chronic pain, and he is on opiates and cortisone injections. Her father's doctor recommended medical marijuana for him. So, the daughter got a caregiver card from the state’s Medicinal Cannabis Program and went to an Alternative Treatment Center. She spent $400 to purchase medical cannabis oil for her father. But the assisted living facility staff told her that she could not even bring the medical cannabis into the facility, let alone give it to her father. The director of the facility said their lawyers told him they could not have medical marijuana in their facility because they receive federal funds, and this would place those funds in jeopardy. 

This patient, and many patients like him, continue to suffer needlessly by being deprived of the appropriate physician-recommended medicine due to fears that the federal government will interfere with this state's medical marijuana program.

However, Congress has forbidden the Department of Justice to spend any money interfering with medical marijuana programs in any of the over three dozen such programs in the United States. The US Attorney General affirmed that they will not do so, and there has not been a single instance of this happening in recent years in any of the states with medical marijuana programs.

The CRC needs to reassure all facilities that house medical marijuana patients, and that receive federal funds, that they are not at risk of federal interference with New Jersey’s medical marijuana program.

The 2019 “Jake Honig Compassionate Use Medical Cannabis Act" called for immediate implementation of “Institutional caregivers” in the state. These caregivers are employees of a health care facility who are authorized to assist registered qualifying patients, who are patients or residents of the facility, with the medical use of cannabis, including obtaining medical cannabis and assisting these patients with the administration of medical cannabis. 

Currently, most health care facilities forbid the use of medical cannabis in the facility. This is a dangerous and potentially fatal situation. A patient who suffers from seizures may be admitted to a health care facility for a condition that is unrelated to the seizure condition. Then, when the patient is denied access to the only medicine that controls their seizures--medical cannabis—the result can be fatal.

It is my sincere hope that the state will recognize its responsibility to the institutionalized patients in New Jersey. For 25 years, I have worked as a registered nurse (RN) in state institutions. I know that many patients in these institutions qualify for medical cannabis and could benefit greatly from it. The staff there is trained to administer, account for, and evaluate the effect of controlled substances. There is no reason to withhold this important medical therapy from these patients. 

In fact, courts have determined that inmates in New Jersey’s prison system are entitled to “community standards” of healthcare. Edible and topical medical cannabis products will improve health care in state institutions, group homes, hospices, etc., and will reduce the costs of running these programs.

Patient education/counseling needs

The best way to ensure the appropriate education and counseling of medical cannabis patient in New Jersey is to ensure that the educators and counselors are themselves appropriately educated and trained. 

As I testified at a previous CRC meeting: 

The CRC should quickly adopt cannabis Dosing and Administration guidelines and educational programs on the Endocannabinoid System. The CRC must promulgate these guidelines and programs to the cannabis consuming community and to the healthcare community to increase the safety and appropriate use of cannabis products. 

In fact, the Jake Honig Act required these guidelines, but they have yet to be adopted in New Jersey: 

     “g.    The commission shall establish, by regulation, curricula for health care practitioners…:

     (1)   The curriculum for health care practitioners shall be designed to assist practitioners in counseling patients with regard to the quantity, dosing, and administration of medical cannabis as shall be appropriate to treat the patient’s qualifying medical condition.  Health care practitioners shall complete the curriculum as a condition of authorizing patients for the medical use of cannabis.”

Educational programs on the Endocannabinoid System for medical providers in New Jersey, now including physicians, Advanced Practice Nurses, and Physician Assistants, are required. Dosing and Administration guidelines and Endocannabinoid educational programs are readily available. 

For example, a company called “Cannabis Expertise” offers 2-hour and 4-hour Medical Cannabis educational courses with nationally accredited AMA credits. These modules were the basis for healthcare professionals to be certified as recommenders in the states of Ohio and Pennsylvania. The organization trained healthcare professionals from 38 states and 9 countries. The dosing recommendations have been developed by physicians who kept track of every patient’s profile and reaction to cannabis.

The New Jersey Department of Health’s Executive Order 6 Report on 3/23/2018: 

The Department recognizes the need to provide education and guidance to providers. To that end, the Department is exploring the creation of an education program for all physicians, with focus on the endocannabinoid system. The Department plans to leverage the expertise of the Medicinal Marijuana Review Panel to oversee the curriculum development for this program. This education program will serve to create best practices for the safe and effective administration of medicinal marijuana to the expanded universe of qualifying patients. In conjunction with the provider education program, there is also a need to develop standardized dosing and administrative protocols for medicinal marijuana products, including information on expected effects, side effects, and adverse effects. 

Marijuana is mainstream medicine. The Medical Cannabis program in New Jersey is expanding rapidly, and the adult use industry will soon expose even more residents to the therapeutic benefits of cannabis. As more and more people experience these benefits, health care professionals in the state must become comfortable incorporating cannabis use into the therapeutic regimens of their patients. This can be done most efficiently by requiring education on the ECS for all health care professionals in the state of New Jersey as a condition for continued licensure in the state.

Medicinal product expiration dates

I previously testified to the CRC on information that consumers and patients should be aware of when purchasing edible cannabis items, including: 

⦁ Warning that the package contains cannabis; 

⦁ Total dosage of THC per package; 

⦁ Strength of THC per unit dosage; 

⦁ Expiration date and storage recommendations; and,

⦁ Special dietary contents if included (e.g., sugar-free, vegan, hypoallergenic).

Regarding expiration dates, proper processing and proper storage of cannabis products appear to be the most important thing in prolonging shelf life. This will ensure potency of medical cannabis products for a year or more.

Proper processing and drying of the product in the first place is essential in prolonging shelf life. 

Marijuana in the form of dried flower does not expire. Unlike food or prescription medication, there is no date in which this form of marijuana will be hazardous to consume. However, the potency and effects can change over time.

Here are some tips for proper cannabis storage:

Do’s:

⦁ Store marijuana flower in an airtight container

⦁ Keep marijuana in a cool location

⦁ Protect your marijuana from any exposure to light

⦁ Use your edibles by their use-by date

Dont's:

⦁ Store marijuana in a freezer or refrigerator

⦁ Leave marijuana outside of a storage container

⦁ Leave in an open container

⦁ Store marijuana in a hot location

Proper processing and storage of cannabis products appears to be more important than an arbitrary expiration date. Perhaps the “Best If Used By” date is more appropriate.

Edibles, on the other hand, can go bad the same way that food does. Because edibles are food products that are infused with cannabis, it is best to pay attention to the expiration date and consume accordingly. 

As for products such as vape pens, cartridges, or tinctures, it is recommended that you use them within one year of purchase. 

While FDA standards for other botanicals exist, the FDA is silent on the issue of expiration dates for medical cannabis.

Thank you again for the opportunity to address the CRC. And again, I want to thank the CRC for the mission that it has taken on, to create this new cannabis industry with social justice at its core and dedicated to repairing the damage that has been done to individuals and communities by the War on Drugs. I want to acknowledge the progress you have made in fulfilling this mission and note that you are doing all this while managing the Medical Cannabis Program. Well done, CRC!

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 

http://cmmnj.blogspot.com/

March 24, 2022

E.O. #6: https://www.state.nj.us/health/medicalmarijuana/documents/EO6Report_Final.pdf

Ohio Exp. Dates: https://www.ohiomarijuanacard.com/post/can-marijuana-go-bad-proper-storage-tips-for-medical-marijuana

DFCR THC symbol: https://www.dfcr.org/universal-cannabis-symbol

Cannabis Expertise: https://cannabisexpertise.com/