Dana Kelley recalls the exact moment when her neurologist suggested she try medical marijuana.
The retired Army Intelligence linguist said it caused her emotional upheaval and led her to question her willingness to continue living in constant pain.
Kelley's neck and back were severely fractured in a car crash three years ago in her hometown of Pennsville, Salem County. She underwent five surgeries, including a fusion of a large part of her spinal cord, and was prescribed morphine and opiates.
Last September, Kelley, 53, met with Andrew Medvedovsky, a board-certified neurologist and pain specialist with RA Pain Services, at his Turnersville office, one of several in South Jersey. She didn't know then that he was one of the 360 doctors statewide who is registered with the New Jersey Medical Marijuana Program and who approve patients to use cannabis.
Patients and their advocates say a shortage of enrolled doctors is one of the big reasons that so few patients - only about 7,000 statewide - have been able to obtain cannabis. When the program started, the number of doctors was so small that many patients were traveling to a North Jersey gynecologist who had enrolled and who was willing to examine non-gynecological patients to give them cannabis recommendations.
In an interview last week at the Turnersville clinic, Kelley said she went to Medvedovsky to ask for an injection to relieve her continuing pain.
"He said because of my underlying condition and the phone book of things that have been tried on me, he didn't see the point of sticking another needle in me," she said. He also told her: "I don't mind if you walk out, I would understand," before he finally mentioned she should consider cannabis.
Kelley's mind raced: "You're talking to me about a piece of grass, like oregano, and I've taken many pharmaceutical drugs . . . and still have so much pain I want to bang my head against a wall? Are you serious?"
Medvedovsky is an easygoing doctor who's been practicing medicine for nearly eight years, including four years as a resident at Virginia Commonwealth University. He said the stigma surrounding marijuana - that it's a "drug used by hippies to get high" - is so pervasive that he finds himself getting nervous when he recommends it to a patient.
"It's not a miracle for everyone, but it sure helps some people," Medvedovsky said. Since he enrolled in the program last July, he has recommended cannabis for more than 300 patients. He said the results surprised him - 80 percent, including Kelley, have given him glowing reports about how it helped them.
But Medvedovsky said he wasn't on board four years ago when the state program began. "I didn't want to be seen as a weed doctor," he said, explaining why he didn't sign up right away.
Marijuana is an illegal substance under federal law, and the American Medical Association has said more studies are needed to determine if it is effective and safe. New Jersey is one of 22 states with a medical marijuana program; Pennsylvania is among several states considering creating one. There are five dispensaries in New Jersey.
Insurance does not cover a patient's doctor visits, and Medvedovsky and some other doctors in the program charge new patients about $400 for visits before they can be approved. Every 90 days, patients are required to have a follow-up visit that costs $100.
Medvedovsky, 33, who earned his medical degree from Ross University, opened his clinic in Turnersville just for medical marijuana patients. One reason he said he decided to join the program was some patients confided that they had used marijuana illegally and that it had helped stop their pain. He said he wanted to offer patients an alternative if they failed to get relief from conventional treatments. "It's an effective drug," he said.
In New Jersey, patients are eligible for cannabis only if they suffer from one of about a dozen ailments, including cancer, Crohn's Disease, multiple sclerosis, and epilepsy. But Medvedovsky said there are "gray zones" in which a physician has discretion to determine whether a patient's symptoms meet the requirements.
Medvedovsky said many patients come to him and complain of a vicious cycle in which their pain leads to a lack of sleep, irritability, loss of friends and employment, and then to a lack of exercise and to other ailments. Chronic pain is not on the list of ailments that qualify a patient for cannabis, but Medvedovsky said that if a patient has secondary ailments, such as severe muscle spasms, he or she may meet the requirement.
A report released last month by the Health Department found the majority of cannabis patients suffer from intractable skeletal muscular spasticity.
Kelley is among them. At first she worried about the stereotypes surrounding cannabis, saying many people believe it is used by "lawbreakers and those who want to get high." But after three weeks of weighing the decision and discussing it with her fiance, she decided to give cannabis a try.
First, Kelley had to be weaned from Fentanyl, a highly addictive opiate that she had been using. She feared that she would become vulnerable to another round of excruciating pain and that the marijuana wouldn't work. At one point she felt so low, she told her fiance she wished she had died in the car accident. "I felt I was trapped in my body and how could I go on?" she said.
Kelley wept at Medvedovsky's office when she recalled how she had revealed to her fiance her feelings of hopelessness. She was about to start using cannabis the next day but had serious doubts about it.
Then, 10 days after she started using it, she said she felt as if a cloud had lifted. "I won't say it's a miracle cure," Kelley said. "I will always have pain, but it's not unbearable anymore." For the first time in three years, she sees a future without constant agony. She can walk with a cane and has lost 50 pounds.
But with her joy came anger. "My government had kept me from having this relief," Kelley said. When she visited Medvedovsky, she thought marijuana still was illegal in New Jersey.
Audrey Rosania, who screens Medvedovsky's patients, says others also have reported success with cannabis. "I'm a big believer," she said. "It works."
Kelley said she purchases an ounce of cannabis a month at the Compassionate Sciences dispensary in Bellmawr. She bakes cannabis into cookies or smokes it when she needs quicker relief.
Reflecting on her four months of recovery, Kelley's words tumbled out. Suddenly she stopped, and looked over at Medvedovsky, who sat at his desk during the interview, listening and nodding.
"I never got to thank you, Doctor," she said, stopping suddenly. "I want to thank you," she said, smiling.