Marijuana officially was recognized as a medication in the state of New Jersey on Jan. 18, 2010, when former Gov. Jon Corzine signed the New Jersey Compassionate Use Medical Marijuana Act into law. Two days later, a request to delay implementing it was established by newly inaugurated Gov. Chris Christie.
The law didnt go into effect until Oct. 1, and soon after, the New Jersey Department of Health and Senior Services published 97 pages of regulations or rules to enact the law. Patients, advocates and legislators found the DHSS regulations to be overly restrictive and in some cases, actual amendments to the law, said Ken Wolski, RN, MPA, executive director of the Coalition for Medical Marijuana New Jersey.
Both houses of the legislature passed resolutions that gave the DHSS 30 days to rewrite the rules for the medicinal marijuana program in New Jersey.
Whats Next?Carolyn Torre, RN
Legislative champions and co-sponsors, CMM-NJ members and patients are expecting the DHSS rewrites by mid-January, and if the DHSS does not produce acceptable rules by then, there will be further legislative action, Wolski said.
Jim Miller, president of CMM-NJ, Wolski and members of the coalition have prepared a CMM-NJ toolkit, which are 2011 recommendations that include a general medical necessity defense, home cultivation, rescheduling of medical marijuana and explicit workplace protection for patients.
One outspoken opponent of medical marijuana legislation is New Jersey Assemblywoman Mary Pat Angelini, R-Monmouth, a substance abuse prevention professional. Legalizing marijuana use for medicinal purposes by adults sends a confusing message to teens about the severity of drug abuse, Angelini said. On the one hand, we tell them that drugs, such as marijuana, are harmful and dangerous and then we legalize marijuana claiming that its effects can be soothing and used to relieve pain.
Another opponent of the legislation is Terrence Farley, former director of the Ocean County Narcotics Strike Force and first assistant to the prosecutor in Ocean County. After studying thousands of peer-reviewed scientific research studies on marijuana, we have found none that provide data on marijuana and its medicinal effectiveness, risks, benefits, safe dosage, interactions and impact on other pre-existing conditions, Farley said.
Nursing SupportMary Pat Angelini
Wolski brought the medical marijuana resolution to the New Jersey State Nurses Association in 2000, and after some changes, the NJSNA endorsed the resolution at its annual 2002 convention. The ANA supported it in 2003, and in May 2008 the New Jersey National League for Nursing testified in support of medical marijuana at the New Jersey Assembly Health Committees informational hearing on the medical marijuana act.
In response to the recent proposed regulations, the NJSNA wrote a letter to the DHSS on Dec. 14, in which the NJSNA raised concern about some specific provisions. Among other concerns, we questioned whether the recommended THC content was adequate to meet the pain/symptom-reduction needs of patients using medical marijuana and the whether the four [alternative treatment centers] could make the program sufficiently accessible to residents who wish to participate, said Carolyn Torre, RN, MA, APN, director of regulatory affairs.
Nurses should know that many national organizations, like the National Association for Glaucoma, the National Association of Multiple Sclerosis, the American Cancer Society, the American Academy of Opthalmology and the National Institute for Neurological Disorders and Stroke, just to name a few, do not support the use of medical marijuana, Farley said. We are talking about an unsafe drug with many harmful and carcinogenic chemicals and numerous side effects.
Now New Jersey nurses find themselves on awkward ethical ground, Wolski said. With the bill in limbo, nurses cant legally recommend or advise patients on the use of medical marijuana, something that has been on the legislative table for about six years. What is a nurse to say to a patient when a physician has already advised that patient, usually off the record, to use marijuana? Wolski said. Nurses who counsel patients on the use of medical marijuana should be aware of the potentially severe criminal and civil consequences that use of this drug entails.
Other IssuesTerrence Farley
The Compassionate Use Medical Marijuana Act, as originally written, allowed for home cultivation, which the 14 other states and Washington, D.C., that have legalized the use of medical marijuana, allow for patients. Although the original bill was finalized, the clause was changed, resulting in the necessity for alternative treatment centers, or ATCs, that will make and distribute marijuana.
The DHSS stipulated that only two centers could produce the marijuana and four could distribute the medicine. The rules further limited the tetrahydrocannibinol content, which could result in subtherapeutic doses in some cases, Wolski said. The DHSS calls for a physician registry, besides the existing patient registry, and for ATCs entrepreneurial nonprofit organizations to function like state government agencies, Wolski said.
Theres the concern that marijuana is growing in popularity in the U.S. The White House drug czar has blamed the rise in marijuana use on the publicity surrounding the marijuana legalization, Angelini said. Legalization makes our youth believe that marijuana is comparable to medicine, and therefore, is safe to use. No wonder many teens are dismissing our warnings to avoid marijuana and other illicit substances.
A large number of patients who are in chronic pain do not qualify under the present N.J. law; only those who suffer from cancer or AIDS qualify at this time. As written in the department rules, the DHSS will not review and change the qualifying conditions for two years.
Although the DHSS says that it does not want to fuel illegal underground activity, the burdensome and overly restrictive rules will actually encourage what it is hoping to avoid, Wolski said.