New Jersey Health Department officials are taking the state's medical-marijuana program on the road, showing it off to physicians during grand rounds at hospitals and offering lectures for health-care professionals enrolled in continuing-education classes.
Medical weed, approved for use in the state eight years ago, is being polished, repackaged, and sold as a mainstream frontline treatment for patients as the Murphy administration relaxes the tough regulations put into place by the governor's predecessor, Chris Christie.
But it was a bit of a tough sell in late October for Jeff Brown, the assistant commissioner of New Jersey's medicinal-marijuana program, when he described the new rules and the health benefits of the program to 70 health professionals gathered at the Samaritan Healthcare and Hospice Center in Voorhees Township.
The questions were rapid-fire after he ended his lively pitch to convince doctors, nurses, and others that medical marijuana is real and it's easier than ever to provide authorization to allow their patients to use cannabis.
What about the lack of research?
How is smoking weed better than federally approved synthetic cannabis?
Why do dispensary workers – not doctors – determine the dose?
"We're trying to get the word out to health-care providers that cannabis is a legitimate medication and its use is growing by the day," Brown said in an interview. Patients are reporting that cannabis has helped them, he said.
Over the last five months, more than 1,500 physicians have attended seven grand-round lectures at hospitals throughout the state. More are planned.
Health Commissioner Shereef Elnahal said in an email that he is holding the rounds because he wants to reduce the stigma surrounding cannabis and "to help educate physicians about the benefits of medicinal marijuana and the changes … made to make it easier for patients and physicians to participate."
Medical marijuana is enjoying a rebirth in New Jersey, after years of stagnation under Christie, who viewed it as an alternative to conventional medicine to be used only as a last resort and only for a limited number of patients. In 2010, when New Jersey was one of the first states to approve medical marijuana, his administration began creating the strictest rules in the nation.
Under Murphy, who was sworn into office in January, the marijuana program was overhauled and some rules were eliminated or modified.
Besides holding the grand rounds, health officials have traveled around the state, delivering the message to patient groups, hospital administrators, lawyers, cannabis-industry representatives, retiree associations, county health departments, and EMS squads.
A few weeks ago, Susan Carson, director of the medicinal-marijuana program, gave a presentation to residents in an assisted-living facility at the request of a resident who is a satisfied medical-marijuana patient.
"There's a lot of interest," Brown said. "A lot of people want to learn what we're doing to expand the program and the requirements to sign up."
For the event at Samaritan – which provided educational credits for doctors and nurses – there had been a waiting list. The presentation was open to anyone.
Under an executive order, Murphy has softened eligibility rules, allowing many more patients, including those with chronic pain and anxiety, to use cannabis. Enrollment doubled this year to 34,000. There are six dispensaries and the Health Department expects to award licenses this year for six more.
Physician participation grew from 500 to 800, but the vast majority of the state's estimated 28,000 physicians still have not signed on, even though they no longer are required to appear on a public list of cannabis doctors.
The biggest problem, Brown said, is that cannabis is still illegal on the federal level, and doctors worry about potential legal risks to their practices and their licenses. Most hospitals and hospice centers do not permit patients to use cannabis in-house because they are concerned that could jeopardize their Medicare and Medicaid eligibility.
In September, the Medical Society of New Jersey released a statement reinforcing a long-standing policy
– it does not support medical marijuana. "At present there are open questions about the effectiveness of marijuana as a medication," the policy statement said. The society called for "more robust research."
But the federal prohibition is the reason there are so few studies in the United States on whether cannabis is beneficial. Marijuana is listed as a Schedule I drug, the most dangerous category, along with heroin and LSD, and research generally is not permitted.
Studies in Israel and other countries offer promising findings, Brown said, and patients also are reporting good results with cannabis for an array of symptoms and ailments, especially for seizures, muscular spasticity, multiple sclerosis, and post-traumatic stress disorder.
"Obviously there are still some skeptics, but the opinion in the public and in the medical community is starting to shift," Brown said. "I do think we're seeing cultural change."
There was a mixed response at the Samaritan event. Lynne Eiding, a nurse practitioner, wondered why patients couldn't get the same results from Marinol, or synthetic cannabis, which is legal. Brown said that some health experts report marijuana provides more relief than Marinol for several ailments.
Responding to another question about how qualified dispensary workers are since they advise patients on strains and dosing, Brown said federal law prohibits doctors from prescribing marijuana. He said the Health Department works closely with dispensaries on how to educate patients.
Janet Kammerer, a licensed practical nurse, said she used to work in drug rehab and found marijuana was the "gateway drug" for a majority of the patients. "I feel terrible about all this marijuana," she said.
But Sandy Dilullo, a research nurse involved with clinical trials, said she has witnessed improvements in cancer patients who use cannabis. She found the educational session informative. "I didn't realize they are not conducting many studies in the U.S., and the reasons," she said.
In April, a Quinnipiac University poll found medical marijuana enjoys 93 percent support across New Jersey. Last month, a Gallup poll reported 66 percent of Americans support legalization of recreational marijuana for adults, a record.
Murphy also backs recreational cannabis, but bills that would legalize it in New Jersey have repeatedly stalled. It is uncertain whether legalization will happen before the end of the year.
The state's medical-marijuana law and program also had a rocky start. It took years for the law to be passed and then implemented.
Stephen Goldfine, chief medical officer at the Samaritan Center in Voorhees, was among the first group of doctors to register for the program. At the Samaritan event, he discussed the lack of research and the reluctance of doctors to sign up for the program.
"Cannabis has existed for more than 3,000 years, but we don't have the data because it's a Schedule I drug," he said.
Goldfine said he sees the benefits firsthand as a palliative-care doctor who recommends marijuana to hospice patients who are in pain. "Medical marijuana is used to gain relief from pain and symptoms, vs. getting high," he said. "I think, generally, it is safe to use and satisfaction has been very high."
Goldfine said some doctors are watching and waiting because they don't know enough about cannabis. The grand rounds and lectures are helping, he said. "There is a lot of curiosity, and at the end of the day, doctors want their patients to do well," he said.