Expansion of Medical Marijuana Program Among Public Health Gains
DOH talks budget with Senate Budget Committee, explaining where funds go and what initiatives got lopped off New Jersey’s medical marijuana program has made major progress since Gov. Phil Murphy took the helm, adding more than 1,000 patients a month on average, many of whom would not have been able to qualify in the past.
And there will still be a need for medicinal cannabis — to treat children, in particular — even if the Garden State does legalize recreational use, according to New Jersey Department of Health Commissioner Dr. Shereef Elnahal, who testified Tuesday before the Senate Budget Committee. Legalizing adult use has been a priority for Murphy.
Elnahal said the medical marijuana program may also be able to play a greater role in addressing the state’s opioid epidemic, which contributed to nearly 2,000 deaths last year. And he confirmed after the hearing that he is considering expanding the cannabis program further to assist patients with certain substance-use disorders — something Murphy has also encouraged him to explore.
Marijuana and opioids
Research suggests greater access to marijuana may reduce the deadly impact of opioid addiction, Elnahal told the committee. “You see a reduction in opioid prescriptions. You also see a reduction in opioid mortality,” he said, recalling a recent American Medical Association report. Elnahal noted he has not yet seen data that suggest cannabis use reduces addiction rates, “but you’re seeing the causal chain in these studies.”
The medical marijuana program was one of several areas of focus for members of the Senate panel, which is reviewing each department’s spending plans as part of their consideration of Murphy’s $37.4 billion state budget proposal for fiscal year 2019, beginning July 1. The DOH’s $2.9 billion proposal — a mix of state and federal dollars — includes more than $1 billion for state psychiatric hospitals and community mental health programs, nearly $637 million in acute-care hospital funding, and $100 million for efforts to address opiate addiction.
As in past years, budget committee members asked questions about the state’s plans to distribute $252 million in hospital charity-care funding, which helps cover the cost of treating uninsured patients and traditionally pits urban hospitals, which generally receive more, against suburban and rural operations. (Expect more changes in the future, Elnahal said.)
Several senators also pushed Elnahal to defend his decision not to extend funding for legislative priorities that were included in the current budget — like a palliative-care pilot program in northern New Jersey that is a favorite of Sen. Paul Sarlo (D-Bergen), the committee chairman. (Tough choices had to be made, the commissioner noted.)
Medical marijuana a Murphy priority
But the conversation frequently turned to the state’s medical marijuana program, which critics said languished under former Gov. Chris Christie, a Republican who considered cannabis a gateway drug. Murphy has prioritized revitalizing and expanding the program and, under his direction, the DOH released a report two months ago with some 20 recommendations to make the program more compassionate.
More than 5,000 new patients have enrolled in the program since January, Elnahal said, including some 2,000 who were able to qualify under the five new eligibility conditions that were added as a result of the March report. In all, there are now more than 21,000 Garden State residents participating, with some 600 physicians signed up to prescribe the medicine, and 900 registered caregivers who can assist patients. Among the reforms were changes that made it more attractive to doctors, something critics said was needed.
In the past two months the DOH has also launched a mobile version of the online enrollment process, which advocates said was far from user-friendly, and has invested some $50,000 on a public relations campaign, with radio ads and social media features designed to reach both potential patients and additional prescribers. At one point in April, Elnahal said they were signing up nearly 100 patients daily.
Increasing cannabis supply
The DOH is also making progress to expand the program’s capacity, seeking to increase supply and also give patients more options in where to purchase their medicine. This was good news to Sen. Sandra Cunningham (D-Hudson), who said her office has been flooded with requests for more information, both from patients and prospective operators.
The state has six licensed (five operational) Alternative Treatment Centers — which grow, process, and sell the product. The department is drafting regulations that would allow greater flexibility in how this supply chain functions. Elnahal said the DOH also approved a request Monday by Garden State Dispensary, in Woodbridge, to open a satellite location — another option created under the March report. (Local approvals are still pending, so officials did not specify the new site.)
Cunningham also asked what impact legalizing recreational cannabis would have on the state’s medicinal marijuana program. Elnahal said that even with wider access there is a clear healthcare need for a clinically regulated program, which now includes guidelines for the maximum strength — something the DOH report urged easing — and strict growing and processing standards. In addition, he said the medicinal program is critical for children, who would not be eligible under the recreational initiatives envisioned.
“This program will need to continue. It will need to have the same regulation and tracking,” Elnahal said, noting that in Colorado — one of the first states to legalize recreational use — interest in the medicinal marijuana program remained “flat” after the new law took effect. “We will continue to need this program and support it,” he added.
The price of pot
Price remains a concern for many program participants, something Elnahal conceded was a problem. The DOH has cut the program fee in half, to $100, and many enrolled pay a discounted fee of $20. But patients must also obtain a prescription from a doctor, a visit that can cost well over $100 and is rarely covered by insurance, and purchasing the product can cost as much as $500 an ounce.
The high cost of the medicinal cannabis program also caught the attention of Sen. Troy Singleton (D-Burlington), who urged the DOH to explore using state dollars to help some patients afford this medicine. Singleton noted that Canada’s largest health insurance company added a medical marijuana benefit on March 1, which reports suggest will cover up to $6,000 of the drug.
Elnahal called these “really interesting ideas” and promised to follow up. Federal law currently prohibits the use of Medicaid dollars for cannabis treatment, since marijuana is considered to be in the same class of drug as cocaine and heroin — highly addictive and with no medicinal value. But the state is now pursuing rescheduling marijuana, which would reduce the penalties associated with illegal sales and transport and ease the logistics of medical treatment for some patients.
“I think re-scheduling will allow a lot more flexibility” when it comes to production and, eventually, price, Elnahal said.
The issue of product cost also prompted Sen. Sam Thompson (R-Middlesex) to question the administration’s decision to include an extra $20 million in medical marijuana tax revenue in the proposed budget. Medicinal cannabis is now taxed at close to 6.6 percent and, while the March report urged the state to reduce this levy, the DOH officials insisted — based on current and projected growth — this was a highly conservative figure.
In fact, Elnahal said Michigan, which has a program that includes similar conditions, has enrolled some 100,000 patients. “We anticipate New Jersey could also get that high,” he said.