Tuesday, May 17, 2022

Testimony to the Senate Judiciary Committee Concerning the implementation of recreational cannabis in New Jersey

Testimony to the Senate Judiciary Committee
Concerning the implementation of recreational cannabis in New Jersey 
May 12, 2022

Chairman Senator Brian P. Stack, Vice Chair Senator Nellie Pou and members of the Senate Judiciary Committee, I want to thank you for the opportunity to address this committee concerning the implementation of recreational cannabis in New Jersey. My name is Ken Wolski, and I’m executive director of the Coalition for Medical Marijuana—New Jersey, Inc. (CMMNJ).

I would like to congratulate the Cannabis Regulatory Commission (CRC) for the mission that it has taken on, and the progress it has made, in creating this new cannabis industry with social justice at its core and dedicated to rebuilding individuals and communities that have been devastated by the decades-long War on Drugs. The CRC is doing all this while managing the Medicinal Cannabis Program (MCP).

I’ve worked in New Jersey state government for 25 years, so I am aware of some of the challenges that the CRC faces. I earned my Master of Public Administration (MPA) degree from Rutgers University in 1992, so I was not only working for the state, but I was studying it at the same time. I know the bureaucracy is not meant to be speedy. It has other priorities. It is a remarkable accomplishment for the CRC to begin adult use sales of cannabis just a little over one year since Governor Murphy signed the New Jersey Cannabis Regulatory, Enforcement Assistance, and Marketplace Modernization Act (CREAMMA) into law. It took nearly three full years before medical marijuana began to be distributed (December 2012) in the state after Governor Corzine signed the bill into law in January 2010.

Cannabis reform is continuing in this state at a safe and reasonable pace, and that means a great deal to me and to all the people in New Jersey. Of course, so many people are impatient to have this industry fully implemented, and to have additional reforms implemented. But, speaking as one who has been an advocate for cannabis reform for over 50 years, I know that these things take time. I am only glad that I lived to see legal sales of cannabis to adults in my home state in my lifetime.

Since adult use sales began, CMMNJ Board members have been meeting weekly with the New Jersey Cannabis Trade Association (NJCTA) to identify and remediate any problems concerning patient access to medical cannabis. The Friends of CMMNJ Facebook page has over 3000 members who act as a support group for cannabis patients. We are happy to report that there have only been minor issues with patient access since recreational sales began at the ATCs. Access for medical patients has improved so far what with newly instituted measures such as online ordering and curbside pickup, dedicated parking and points of service for medical patients, dedicated hours for medical patients and nearly half the ATCs still only serving patients, and the threat of fines for ATCs if medical access is adversely affected by adult use sales.

Some patients have complained that ATCs raised prices when adult use sales began. We were not able to determine if these were appropriate price increases. The ATCs are only permitted to raise prices one time a month, but the price list is not publicly available.

Other patients complained that specific strains of cannabis were not available. However, this is an issue that is not new since ATCs have been running out of specific strains and discontinuing strains that patients have found helpful almost since the program began.

Finally, there were issues with Home Delivery of medical cannabis. This service was approved by the “Jake Honig Compassionate Use Medical Cannabis Act" in 2019 and finally implemented by some of the ATCs on April 21, 2022. Some patients complained of delivery problems. In one case, a patient said that the ATC she called would not deliver to patients living in her zip code, even though she only lived about 20 minutes away from the ATC. Several dedicated cannabis home delivery services have expressed interest in working in New Jersey and perhaps the CRC should revisit their proposals to supplement the ATC delivery services.

CMMNJ and NJCTA plan to continue to monitor the situation. 

I agree with Senator Scutari that these oversight hearings are needed to “determine what can be done to reduce the costs of medical marijuana. Affordability and availability must be priorities for medical consumers who rely on cannabis for health reasons.”

Two of the most important measures to meet these goals are insurance coverage for medical cannabis and home cultivation for registered patients in the state’s MCP. These measures have nothing to do with the CRC but require actions by the Legislature and Governor.

Insurance coverage for medical cannabis will have profoundly positive effects. It will greatly increase the number of patients who can use this therapeutic modality, it will lower healthcare costs in the state, and it will produce a healthier New Jersey.

New Jersey has some of the most expensive medical cannabis in the country, with an ounce of premium buds costing over $400. This makes the medical benefits of cannabis unavailable to many residents who have been impoverished by their illnesses or injuries. With medical cannabis insurance coverage, the poverty stricken in New Jersey can also have access to the therapeutic benefits of cannabis.

Cannabis stabilizes multiple conditions in individuals. Greater access to cannabis therapy will result in fewer emergency room visits, fewer hospitalizations, and fewer surgical procedures. A study released in February 2020 showed a 6.7% decline in workers compensation claim activity where states have approved medical marijuana.

Fears of the federal government’s involvement in this issue are unfounded. Congress has forbidden the Department of Justice to interfere with state medical marijuana laws. I was pleased to see that S313 passed unanimously out of the Senate Health Committee on 3/10/2022 and was referred to the Senate Budget and Appropriations Committee. Hopefully, this bill will be soon signed into law so that more state residents here can enjoy the multiple benefits of cannabis therapy. 

Home Cultivation is needed for three reasons:

1) Cost - the cost of medical marijuana exceeds half the income of 50% of disability patients; 

2) Consistent supply - many patients need specific strains for their conditions, but the dispensaries often drop production of the most effective strains; and,

3) Empowerment - allowing patients to grow their own medicine lets them take control of their disease or medical condition. 

Home cultivation puts patients at the center of healthcare—not the pharmaceutical industry or the health insurance industry.

With home cultivation limits of 6 plants per patient and 12 plants per household (the standard for many legalized states) there is no real room for diversion, and it would have no significant effect on the legal market. Of the 18 states (and Washington, D.C.) to legalize marijuana, New Jersey is the only one that still prohibits its medical cannabis patients from growing cannabis at home. This must, and will change.

CMMNJ Board Member Peter Rosenfeld has even drawn up sample regulations to enact a home cultivation law for patients that is available at the CMMNJ blogsite here.

Additional measures that the CRC can do, and should do, involve fully implementing the “Jake Honig” law, which was signed by Governor Murphy almost three years ago, in July 2019, and went into effect immediately. These measures include adopting educational programs on the Endocannabinoid System and Dosing and Administration guidelines.

Adopting and promulgating these guidelines to the cannabis consuming community and to the healthcare community will increase the safety and appropriate use of cannabis products. The Jake Honig law says: 

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

     (1)   The curriculum…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.”

The New Jersey Department of Health’s Executive Order 6 Report on 3/23/2018 agrees and outlines how these programs and guidelines should be developed: 

DEVELOPMENT OF PROVIDER EDUCATION PROGRAM AND DOSING GUIDELINES With the expansion of authorized debilitating conditions, 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. In addition to the provider education component above, the Department will charge the Medicinal Marijuana Review Panel, in an advisory role, to oversee the study of the efficacy of medicinal marijuana in treating New Jersey Medicinal Marijuana Program patients. This research will inform dosing and administration protocols to create best practices and improve health outcomes for qualifying patients. The Department believes that this refocusing of the Medicinal Marijuana Review Panel will make the best use of the expertise that the Panel provides to create best practices to inform health care providers and improve health outcomes for qualifying patients. https://www.state.nj.us/health/medicalmarijuana/documents/EO6Report_Final.pdf

These educational programs and dosing guidelines will make health care providers more likely to recommend medical cannabis for their patients. Moreover, they 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 in the training have been developed by physicians who kept track of every patient’s profile and reaction to cannabis.

Marijuana is mainstream medicine. The Medical Cannabis program in New Jersey is expanding rapidly, and the adult use industry is now exposing ever 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 Endocannabinoid System for all health care professionals in the state of New Jersey as a condition for continued licensure in the state.

The Jake Honig Act also called for “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 and then denied access to the only medicine that controls their seizures--medical cannabis. I was part of a team that tried unsuccessfully to save a patient in Status Epilepticus, an unrelenting seizure condition, at Trenton Psychiatric Hospital when I worked there in the early 1970’s. It was a tragic experience that I have never forgotten. It should never happen again. But sadly, simply being admitted to a hospital is currently one of the leading causes of death in America. “Research estimates up to 440,000 Americans are dying annually from preventable hospital errors. This puts medical errors as the third leading cause of death in the United States, underscoring the need for patients to protect themselves and their families from harm.” Denial of essential medicinal cannabis in hospitals may well be a contributing factor to this dreadful statistic.

In addition to the expanding medical cannabis program and the anticipated increase in cannabis users through the adult use program, 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 the state prison system and at a state psychiatric hospital. I know that many patients in these institutions qualify for medical cannabis and could benefit greatly from it. The staff there is already 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 are entitled to “community standards” of healthcare. Edible medical cannabis products will improve health care in state institutions, group homes, hospices, etc., and will reduce the costs of running these programs.

In March 2022, I urged the CRC to greatly expand the conditions that qualify for medicinal cannabis. I said the CRC should 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.

The CRC should 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.

Finally, my sister-in-law’s dentist just asked her how he could recommend cannabis for his patients who are undergoing dental surgery. I told her she had to tell him that dentists are not yet permitted to recommend medical cannabis in New Jersey, even though they can order opioids for their patients.

Obviously, a great deal of work still needs to be done.

Thank you.

Ken Wolski, RN, MPA

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

219 Woodside Ave., Trenton, NJ 08618

609.394.2137 ohamkrw@aol.com

Attachments (3): 

Resume of Ken Wolski, RN
“Medical marijuana should be covered by health insurance.” K. Wolski, 2021.
“Study links lower comp frequency to medical marijuana laws,” Louise Esola, Feb. 10, 2020
Hospital Errors: 
“It’s time for N.J. to fully embrace medical marijuana.” K. Wolski, 2016

The Coalition for Medical Marijuana—New Jersey, Inc. is a 501(c)(3) non-profit educational organization whose mission is to educate the public about medical marijuana.