NJ health commissioner pitches medical marijuana to doctors

Medical marijuana use is increasing quickly in New Jersey and recreational use may become legal soon, but many doctors remain skeptical about recommending it to their patients.  

On Wednesday, hundreds of health professionals heard from the state health commissioner, Shereef Elnahal, as he sought to "demystify" the use of medical marijuana and explain recent policy changes made by the Murphy administration to increase access to it.  

For North Jersey doctors, two big impediments induce wariness: The federal government puts marijuana in the same category as heroin, a Schedule 1 drug having "no medical value and high potential for abuse," and little clinical research exists on its effects.  

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Currently, only 700 of the state's 28,000 licensed doctors have registered with the state to recommend its use for patients. (Doctors recommend, rather than prescribe, medical marijuana, because it is not approved by the federal Food and Drug Administration.)   

"Like most, I am intrigued but not convinced," a primary-care doctor at Hackensack University Medical Center told the commissioner.  

"Anecdotes are worth nothing," said a neurologist who treats patients with epilepsy. "We have to be somewhat cautious. ... The lack of research is really bothersome."  

"I remain conflicted," said a palliative care specialist. "I don't think the debate is going to be resolved until we do something on a federal level."  

Elnahal encouraged doctors at Hackensack University Medical Center and at St. Joseph's University Medical Center in Paterson to consider marijuana as a "legitimate therapeutic option" — another tool in their repertoire to treat an expanding list of medical conditions. While it should not be the first course of treatment, he said, it should be considered when other treatments fail.

In New Jersey, the Murphy administration recently added chronic pain, migraines, anxiety and Tourette's syndrome to a list of approved conditions for which medical marijuana can be used. The list already included multiple sclerosis, seizure disorders, glaucoma, post-traumatic stress disorder, muscular dystrophy, inflammatory bowel disease and the pain and nausea associated with cancer and HIV/AIDS. 

The number of patients registered to buy medical marijuana has increased by 10,000 — to 25,000 — since Gov. Phil Murphy took office in January, and is on track to double, Elnahal said. Half of the patients are over age 50. 

Marijuana can also be recommended if patients suffer severe withdrawal pains when they stop using opioids, Elnahal said, but an advisory panel is still considering whether it can be used as a first-line treatment for patients addicted to opioids.  

Doctors expressed concern about whether allowing patients to use marijuana in hospitals would jeopardize the hospitals' federal funding or subject them to federal law enforcement action. Most hospitals receive more than half their revenues from Medicare and Medicaid, the government insurance programs.  

For example, a patient who used legally obtained marijuana at home to control seizures was barred from using it when admitted to Hackensack, one doctor said.  

Elnahal said the risk of federal enforcement action "is very, very low."  

"My view," he said, is "hospitals should allow patients to self-administer marijuana in the hospital — to bring it in and self-administer." While acknowledging that smoking is prohibited, he said patients could bring in marijuana in a lozenge or edible form. "I really encourage hospital administrators to allow patients to do it," he said.  

Federal restrictions on marijuana's use mean that little research exists on its effects, he noted. But he cited small studies that showed benefits for patients with HIV/AIDS, rheumatoid arthritis, epilepsy, inflammatory bowel syndrome and multiple sclerosis.  

Two public health studies this year have shown that in states where medical marijuana is permitted, there are 6 percent fewer prescriptions for opioid painkillers and 24 percent fewer deaths from opioid overdoses.   

Elnahal is visiting hospitals around the state in a series of "grand rounds" to educate health professionals and to try to remove the stigma from medical marijuana. His next stops will be at Cooper Medical School of Rowan University in Camden, Jersey City Medical Center, Virtua Health in South Jersey and the New Jersey Medical School in Newark. 

Email: washburn@northjersey.com