Why N.J. patients with chronic pain still can't get medical marijuana

Five months ago, a New Jersey health panel voted in favor of dramatically expanding the list of conditions that may be treated with cannabis. Chronic pain, Alzheimer's, autism, anxiety, migraines, and other maladies should be added to the list of 13 ailments, said the panel of doctors and other health professionals.

Before the panel reached this decision, it reviewed petitions submitted by 68 patients a year ago, and then held three hearings. At these hearings, patients pleaded for the right to use cannabis to alleviate various ailments. Many confided that they had tried cannabis and wanted to be able to use it legally because it had helped.

But it doesn't appear a new list will be adopted soon.

The state Department of Health now says the panel must hold another meeting — to take a vote that would finalize its first vote. That's scheduled for Oct. 25, according to Alex Bekker, chairman of the Medicinal Marijuana Review Panel. "We just have to go through the voting," he said. "The majority of the panel believes it's the right treatment."

Then, the health commissioner has up to six months to decide whether to approve the panel's recommendation.

Gov. Christie, who appointed Commissioner Cathleen D. Bennett, has long been opposed to adding to the list of ailments covered by medical marijuana. Last year, he reluctantly signed a bill that allowed post-traumatic stress disorder to be added.

New Jersey's marijuana program is considered one of the most stringent of the 29 states with such programs. Other states allow cannabis to be used for chronic pain and autism, as will Pennsylvania when it rolls out its medical marijuana program next year.

Here are some questions and answers about the New Jersey program.

About 14,600 patients are enrolled in the state's nearly eight-year-old program. An estimated 200,000 more could qualify for cannabis if the new ailments are added.

Multiple sclerosis; terminal cancer; muscular dystrophy; inflammatory bowel disease, including Crohn's disease; terminal illness; amyotrophic lateral sclerosis; seizure disorder, including epilepsy; intractable skeletal muscular spasticity; glaucoma; post-traumatic stress disorder (PTSD); positive status for human immunodeficiency virus; acquired immune deficiency syndrome; cancer, if the treatment causes pain or other complications.

In some cases, a doctor must certify that conventional treatments failed, before he or she can recommend cannabis.

The panel voted, 5-1, in favor of opening the door to patients with 43 new conditions.  For starters, the panel says cannabis should be available to treat chronic pain arising from surgeries, injuries, back and neck problems, and other medical problems. Chronic pain is defined by the Cleveland Clinic as pain that lasts longer than six months.

Other ailments the panel is recommending for inclusion are migraines, anxiety, opiate-use disorder, arthritis, Alzheimer's disease, autism, Tourette syndrome, sciatica, diabetes, neuropathy, Lyme disease, lupus, fibromyalgia, irritable bowel syndrome, and pancreatitis.

The law is nearly eight years old, and one year after the marijuana program was implemented, patients should have had the opportunity to submit petitions to a health panel to request that conditions be added.  But the Department of Health delayed creating the health panel until March 2016, effectively preventing any petitions before then. The Coalition for Medical Marijuana New Jersey submitted one anyway, in 2014, saying the commissioner has discretion to add conditions to the list anytime.  The petition — suggesting PTSD be included  — was rejected.

Petitioners were required to provide reasons, answer questions, attach scientific research papers, and submit letters of recommendation from physicians before submitting their requests, which were due at the end of August 2016.  The petitions then were posted online, and the health department invited public comment. The panel then had to hold two hearings to take more comment. After the panel took a vote on the petitions at a May hearing, it was told by the health department that it had to hold yet another hearing in September and take a final vote in October.

When patient advocates complained at the September hearing about the lengthy process, Bekker said: "I want to emphasize that this panel has nothing to do with the timing of this legislative process." Bekker, who is head of anesthesiology at Rutgers New Jersey Medical School in Newark, said later: "It's not up to me. … It's the policy and procedures of the health department."

Stewart A. Berkowitz, a radiation oncologist who served on the New Jersey State Board of Medical Examiners; Jessica Anne Scerbo, a pediatric hematology/oncology attending physician; Petros Levounis, chair of the department of psychiatry at Rutgers New Jersey Medical School and a former director of the Addiction Institute of New York at Columbia University; Stephanie Zarus, a pharmacist who is a consultant for health-care companies; Mary L. Johansen, a registered nurse and clinical associate professor at Rutgers-Newark; and Mary M. Bridgeman, a pharmacist who teaches at Rutgers University in New Brunswick.

Bennett has not responded to requests for an interview, but a health department spokesperson said in an email: "The commissioner has to review the recommendations and rule on them, so the department has no comment at this time."

There are several bills that outline how marijuana could be legalized, but it is unclear which, if any, would win approval of the legislature and the signature of  the next governor after Christie leaves office next year.  Christie has vowed to veto any such legislation.

Recent polls say a majority of New Jersey residents favor legalization, and lawmakers are working to get a bill on the desk of the next governor as soon as next year. Some lawmakers say the medical marijuana program would continue and would offer patients a bigger tax break on marijuana purchases than consumers who buy it for recreation.