Testimony to the New Jersey Cannabis Regulatory
Commission
By: Ken Wolski, RN, MPA, Executive Director
Coalition
for Medical Marijuana--New Jersey, Inc. (CMMNJ)
June 17, 2024
I appreciate the opportunity to make
public comments on these issues:
·
Qualifying medical conditions for
the Medicinal Cannabis Program
·
Research
·
Healthcare provider access
Qualifying medical conditions:
I urge
the Cannabis Regulatory Commission (CRC) to allow anyone with prescriptive
privileges 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.
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 state’s Department of Health (DOH) refused to act on CMMNJ’s petition for rulemaking. That condition was post-traumatic stress disorder (PTSD). PTSD was added after a vigorous, multi-year campaign by CMMNJ, local veterans, and others who suffer from this condition.
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.
In 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 30 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.
A while 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 New Jersey'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 since then there has
not been a single instance of this happening 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 in these institutions are 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.
Research:
There are
approximately 80,000 patients and caregivers in New Jersey's Medicinal Cannabis Program currently. These patients buy and consume medicinal
cannabis regularly and some have been doing so for over a decade. It is a
wasted opportunity to be providing medicinal cannabis to tens of thousands of
patients every month and never once ask how they are doing on this medicine.
A simple questionnaire needs to be developed and sent to every patient as part of this program. The questionnaire would be voluntary, of course, and anonymity would be assured, but it can develop useful indications of how effective medicinal cannabis can be for various conditions.
The questionnaire should be simple to complete but with areas where patients can divulge greater information if they care to do so.
- What dosages and methods of administration do
they use?
- Are patients experiencing side effects?
- Have they reduced their use of opiates or
other medications?
- Have they experienced drug interactions?
These questionnaires, and follow-up questionnaires, can provide valuable information and be the basis for further research.
If the CRC does not have the resources to conduct this research, it can be farmed out to a local university in the state. Rowan University and Stockton University, among others, now have some exciting cannabis research projects that this could be a part of.
Researchers have complained for decades that the federal government obstructs research into the benefits of medicinal cannabis. The federal government's position that "marijuana has no currently accepted medical use in treatment in the United States" is effectively kept in place by the obstruction of privately funded medical cannabis research. As a result of its monopoly on the supply of cannabis that can be legally used in federally approved research, The National Institute on Drug Abuse (NIDA), a subdivision of the National Institutes of Health (NIH), oversees all cannabis research in the U.S. and funds most approved studies involving cannabis. While a nominal number of studies in the U.S. are aimed at investigating the medical efficacy of cannabis NIDA focuses exclusively on the supposed harmful effects of the plant.
Even if the DEA eventually reschedules marijuana from a Schedule I to a Schedule III drug, it will be years before any federally approved clinical research studies are completed. It does no good to call for more study of cannabis and then fail to conduct what research is possible.
Healthcare provider access:
There is
a great deal of ignorance and lack of interest in the physician community about
medicinal cannabis. The American Medical Association (AMA) has refused to endorse
any of the more than three dozen state medical marijuana programs. The AMA insists
that medicines pass the gold standard of research--large scale, double-blind
placebo-controlled clinical trials--which so far have been impossible to
conduct in the United States.
Indeed, only about 1500 physicians in New Jersey have signed up to allow patients into the medicinal cannabis program, out of approximately 28,000 physicians in the state (under 6%). Even the physicians who recommend cannabis in New Jersey typically make no specific recommendations about dosages, particular strains to use, or methods of administration. This information is more reliably obtained from bud tenders in the state’s Alternative Treatment Centers than from physicians.
The best way to ensure the appropriate
education and counseling of medical cannabis patients in New Jersey is to
ensure that the educators and counselors are themselves appropriately educated
and trained.
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 ECS educational programs are readily available. Some
of the best resources on the ECS include:
- Patients Out of Time: https://patientsoutoftime.com/
- Americans for Safe Access: http://www.safeaccessnow.org/
- Society of Cannabis Clinicians: http://cannabisclinicians.org/
- American Cannabis Nurses Association: https://www.cannabisnurses.org/
- Project CBD https://www.projectcbd.org/
- The Answer Page: https://www.theanswerpage.com/
- National Organization for the Reform of Marijuana Laws: https://norml.org/
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. Even the
DEA appears to be on the verge of finally admitting that marijuana is medicine,
by reclassifying it to a Schedule III drug, as the U.S. Department of Health
and Human Services (HHS) recommends. Medical cannabis use in New Jersey
is expanding rapidly as the adult use industry exposes 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 ECS for all
health care professionals in the state of New Jersey as a condition for continued
licensure in the state.
It is truly remarkable that an entirely new system in the human body was discovered a mere 30 years ago. The purpose of the ECS is to produce homeostasis or balance in the body. In doing so, the ECS interacts with all the other systems in the human body--the musculoskeletal system, the digestive system, the nervous system, etc. Healthcare professionals who specialize in limited areas of the body cannot claim that cannabinoids play no role in their practice. The ECS may well play a role in all disease processes affecting humans and animals.
Thank you for the opportunity to address the
CRC.
Ken
Wolski, RN, MPA
Executive Director, Coalition for Medical Marijuana--New Jersey, Inc.
219 Woodside Ave., Trenton, NJ 08618
609.394.2137 (home/office)
609.721.1658 (cell/text)
June 17, 2024
