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Putting the pieces together to improve your health

The New Jersey Department of Health (DOH) accepted 45 petitions from the general public to add qualifying conditions to the state’s Medicinal Marijuana Program (MMP) in August 2016. Most of these petitions were for conditions that are characterized by chronic pain, the most common reason medical marijuana is used in the United States.

Members of the Coalition for Medical Marijuana – New Jersey (CMMNJ), a non-profit educational organization, submitted the following petitions: Neuropathic Pain, Migraine Headaches, Osteoarthritis, Anxiety, Autism, and Opioid Use Disorder.

The DOH appointed a panel of eight healthcare professionals to evaluate the petitions. The panel, consisting of five physicians, two pharmacists, and one registered nurse, is expected to conduct a public hearing on the petitions in early 2017. This panel will make recommendations to the Commissioner of the DOH who will have the final say on adding conditions that qualify for marijuana therapy in the state.

The actual petitions under consideration, with some information redacted and which are only identified by numbers on the DOH website, can be found at http://www.nj.gov/health/medicalmarijuana/review-panel/petitions2016.shtml
A complete list of the conditions under consideration, with the identifying DOH numbers, can be found on the CMMNJ website at http://cmmnj.blogspot.com/2017/01/petitions-to-NJ-doh-panel.html
CMMNJ was instrumental in getting a medical marijuana bill introduced into the state legislature in January 2005. In January 2010, New Jersey became the 14th state to pass a medical marijuana law when the Compassionate Use Medical Marijuana Act (CUMMA) was signed by Governor Jon Corzine. Governor Chris Christie, who took office shortly after the law was signed, complained that he would not have signed this bill into law. Marijuana advocates and state legislators have said that Governor Christie delayed and obstructed the full implementation of the CUMMA. For example, the CUMMA empowered the DOH to add qualifying conditions at any time, but this is the first action taken by the DOH to do so, seven years later.

Currently, in New Jersey, only five conditions allow unqualified access to marijuana therapy: amyotrophic lateral sclerosis; multiple sclerosis; muscular dystrophy; terminal cancer; inflammatory bowel disease; and any terminal illness. Four conditions qualify for marijuana if conventional treatment has failed: seizure disorders; intractable skeletal, muscular spasticity; glaucoma; and post-traumatic stress disorder (PTSD). Patients with HIV/AIDS and cancer may qualify if the condition or its treatment causes chronic pain, nausea or vomiting, or the wasting syndrome.

The original version of the CUMMA, passed by the New Jersey Senate in 2009, included Chronic Pain (from any cause) as a qualifying condition for marijuana therapy. However, when the bill later went to the New Jersey Assembly, Chronic Pain was removed as a qualifying condition except in the cases of cancer or HIV/AIDS.

Sources at the statehouse said that this was a political expedient to move the bill along. The decision was not based on scientific or medical research.In fact, there is no valid scientific or medical reason to limit marijuana therapy for pain management to only two diseases — cancer and HIV/AIDS, as is currently the case in the state’s MMP. Marijuana is effective pain management for any disease, injury or medical condition that causes chronic pain. Marijuana therapy is significantly safer than narcotics. There is a 25 percent reduction in opiate overdose deaths in states that have robust medical marijuana programs.

PTSD was added as a qualifying condition by an act of the legislature that was signed by the Governor in September 2016. CMMNJ waged a multi-year effort to add this condition because 22 U.S. Veterans were committing suicide every day, largely because PTSD is so poorly managed by traditional pharmaceuticals. CMMNJ submitted a formal Request for Rulemaking through the DOH regulatory process in 2014 to add PTSD as a qualifying condition, but the DOH rejected this request. CMMNJ continued its educational efforts about marijuana therapy for PTSD with New Jersey Legislators, and a bill was introduced in September 2014. CMMNJ identified Veterans who were willing to testify to legislative committees about marijuana’s usefulness in managing the symptoms of PTSD. Two years later, the bill became law. PTSD, the first condition added to the state’s MMP, was also the first mental or emotional condition that qualified for marijuana therapy in the state.

The petitions accepted for review by the DOH in August 2016 display extensive research, persuasive scholarship and passionate testimony. For example, CMMNJ Board member Vanessa Waltz, submitted the petition to include Opioid Use Disorder
(MMP – 063) And this petition alone is 80 pages long. Waltz’s petition identifies:

• The problem (DSM – V “Opioid Use Disorder” and ICD-10 “ Opiate Related Disorders”);
• The scope of the problem (16,651 deaths due to overdose on prescription opioids and 3,036 deaths due to overdose on heroin in the U.S. in 2010 according to the World Health Organization, with over 5,000 opiate overdose deaths in New Jersey in the last decade);
• The ineffective attempts to manage the problem (an in-patient rehabilitation center in New Jersey estimates that 33% of addicts in the state are denied access to treatment resources and that 45,000 state residents were turned away from treatment facilities due to high costs); and,
• The hope that marijuana brings to the issue.

Marijuana brings more than hope. Waltz’s petition documents scientific studies published in peer-reviewed journals, the compelling testimony of patients who have struggled with opiate addiction, and testimony from healthcare experts that attest to the effectiveness of marijuana in mitigating Opiate Use Disorder.

New Jersey, a state in the midst of a worsening opiate epidemic, can ill afford to ignore this evidence. Even when mortality is not the outcome, the morbidity associated with intravenous drug use is an important concern among New Jersey’s 128,000 heroin addicts. Hepatitis C infections may occur in up to 90% of people who inject drugs, and HIV infections can be as high as 60% among heroin users who do not have access to Needle Exchange Programs.

Also, Waltz’s petition documents the suffering caused by the three FDA-approved drugs used to treat Opioid Use Disorder—methadone, naltrexone, and buprenorphine (Suboxone). These drugs can cause serious side effects, drug interactions, and even death.

The peer-reviewed articles published in scientific journals that are noted in Waltz’s Petition show remarkable evidence for marijuana’s efficacy in alleviating the suffering caused by Opiate Use Disorder:

• In patients with chronic pain, cannabis use was associated with 64%lower opioid use, a better quality of life, and fewer medication side effects and fewer medications used;
• States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws;
• When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects);
• There is a statistical association between recent cannabis use and lower frequency of non-medical opioid use among people who inject drugs;
• Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription, and illicit drugs;
• Cannabis is a safer alternative (than opioids) with broad applicability for palliative care; and,
• National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013. Add to this the compelling testimony from eight patients in New Jersey’s MMP, and two other members of the community, along with a physician who recommends marijuana in the MMP, an RN expert in the field, and a Director of one of the state’s Alternative Treatment Centers, and it is difficult to imagine how the DOH could do anything but approve this petition.

However, it may not be so simple. It is the Commissioner of the DOH who will make the final determination in this matter after the panel of healthcare professionals makes their recommendations. In New Jersey, the commissioners of all the executive branch departments, like the DOH, are appointed and may be removed from office at any time by the Governor. Governor Christie still insists that marijuana is a dangerous gateway drug, despite scientific and even common sense evidence to the contrary. Governor Christie also insists, through his Office of the Attorney General (OAG), that marijuana remain a Schedule I drug on a statewide level.

This means that the NJ OAG believes that marijuana has no accepted medical uses in the U.S., even while the NJ DOH debates exactly what additional medical uses marijuana should have in New Jersey (!)

In 2014, the Board of Directors of CMMNJ endorsed legalization of marijuana. There are hundreds of thousands of people in New Jersey who would benefit from marijuana therapy. After all, if you live in the Garden State, you have a one in three chance of having a cancer diagnosis at some point in your life.

You have a one in three chance of having chronic pain–pain that lasts six months or more. We all die, and marijuana helps with some of the common problem associated with terminal illnesses like no other drug.

This is why CMMNJ joined with New Jersey United for Marijuana Reform (njumr.org) and endorsed legalization of marijuana in New Jersey. Along with undoing the harms to society that are caused by prohibition, legalization is the most efficient and effective way to get the therapeutic benefits of marijuana to the vast number of patients who can benefit from it. Legalization is the best way to get the right medicine to the most people.

References:

The entire Opiate Use Disorder (MMP – 063) petition can be found at:
http://www.nj.gov/health/medicalmarijuana/documents/petitions/MMP-063.pdf Selected references from this petition include:

1. Medical Cannabis Use Is Associated With Decreased Opiate Medication

Use in a retrospective Cross-Sectional Survey of Patients With Chronic Pain. Boehnke, Kevin F. et al. The Journal of Pain, Volume 17, Issue 6, 739 – 744. Source:
Abstract – http://www.jpain.org/article/S1526-5900(16)00567-8/abstract Full Text – http://www.jpain.org/article/S1526-5900(16)00567-8/fulltext References – http://www.jpain.org/article/S1526-5900(16)00567-8/references

2. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States:
1999-2010 Bachhuber MA, Saloner B, Cunningham CO, Barry CL. JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005.
Source: http://archinte.jamanetwork.com/article.aspx?articleid=1898878#Abstract
3. Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain: Lucas, Philippe. Journal of Psychoactive Drugs 08 Jun 2012; 44(2):125-133. Source: https://www.researchgate.net/
publication/230652616_Cannabis_as_an_Adjunct_to_or_Substitute_for_Opiates_in_the _T reatment_of_Chronic_Pain
4. Is Cannabis use associated with less opioid use among people who inject drugs?Kral AH, Wenger L, Novak SP, Chu D, Corsi KF, Coffa D, Shapiro B, Blumenthal RN. Drug Alcohol Depend. 2015 Aug 1;153:236-41. doi: 10.1016/j.drugalcdep.2015.05.014. Epub 2015 May 22.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509857/
5. Cannabis as a substitute for alcohol and other drugs. Reiman A. Harm Reduction Journal: 2009;6:35. doi:10.1186/1477-7517-6-35.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795734/
6. Cannabis in palliative medicine: Improving care and reducing opioid-related morbidity: Carter GT, Flanagan AM, Earleywine M, Abrams DI, Aggarwal SK, Grinspoon L. American Journal of Hospice and Palliative Medicine. 2011
Aug;28(5):297-303. doi: 10.1177/1049909111402318. Epub 2011 Mar 28.
Source: https://www.researchgate.net/
publication/50891411_Cannabis_in_Palliative_Medicine_Improving_Care_
and_Reducing _Opioid-Related_Morbidity
7. Medical Marijuana Laws Reduce Prescription Medication Use in
Medicare Part D.

Bradford AC, Bradford WD. Health Affairs 35, no.7 (2016):1230-1236 10.1377/doi:hlthaff.2015.1661
Source: http://www.ouramazingworld.org/uploads/4/3/8/6/43860587/bradford2016.pdf

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