What do doctors, nurses need to know about N.J.’s medical marijuana program, legalization?

Despite being signed into law in July 2019, many of the improvements touted by Jake Honig’s Law, which expanded the state’s medical marijuana program, have yet to be implemented, frustrating physicians, healthcare professionals and attorneys operating in the healthcare space.

With more than 86,000 patients signed up for the medical marijuana program in New Jersey, and a ballot question asking voters to decide whether or not to legalize recreational cannabis, health care experts say many in their industry remain under informed about the medicinal value of cannabis and when or how to prescribe it.

Dr. David Nathan, founder and president of Doctors for Cannabis Regulation, said there were numerous issues the medical cannabis program still needed to address in order streamline the program including the sign-up process for patients and physicians, increasing the number of dispensaries, delivery, home cultivation and allowing nurse practitioners and physician assistants to recommend cannabis.

“My feeling is that anybody who is eligible to prescribe medication in the state of New Jersey should be eligible to recommend cannabis,” Nathan said.

Sheila Mints, a healthcare attorney with Capehart Scathard, said Jake Honig’s Law authorized nurse practitioners and physician’s assistants to register patients for the medical marijuana program but, in practice, that change has yet to take effect.

“Even though legally they can still do it, the website hasn’t been changed to allow them to register,” Mints said. “It’s like a simple, stupid thing that you would think would not be that difficult to do. If you go on the MMP website, the only way that you can register is if you’re a licensed physician, but if you’re a nurse practitioner, you can’t do that.”

Moreover, while the patient population continues to rise, physicians participation in the program has remained relatively static, she said, potentially setting up a crunch for patients and physicians down the road.

Not enough physician input or education

Among the reasons for physicians' reticence to join the program, Mints said, are the lack of physician involvement in treatment and the lack of continuing medical education (CME).

“They register the patient, but they’re not actively involved in what the patient gets, how much they take, and they don’t understand enough to be able to say, ‘Okay, this is a good you know,’” she said. “They don’t understand the drug interactions. They don’t have clinical information provided in a way physicians are used to getting that information.”

That lack of education, she noted, was an issue intended to be addressed through Jake Honig’s Law but CMEs about medical cannabis have yet to materialize.

For Dr. Jordan Tishler, a Massachusetts-based physician who regularly recommends medical cannabis, the largest problem he faces as a cannabis specialist is the inability to write a true prescription — he can recommend cannabis to a patient but he’s not able mandate the strain type, amount or frequency of use.

“This laves patients subject to the massive hype from the media and up-selling at the dispensary,” Tishler said. “Prior to COVID, I routinely saw patients buy hundreds of dollars of products that I had not recommended who then did not get the expected result, or worse, got sick.”

Tishler will be part of a panel of experts to discuss what medical professionals need to know about cannabis at NJ Cannabis Insider’s Sept. 29 webinar.

“Since COVID, with online ordering, I’ve seen an improvement in outcomes, which just shows how harmful all the advice from non-medical sources was,” he said. “A prescription would remove this interference and return the process of choosing and adjusting the medication to the patient and their knowledgeable and caring cannabis specialist.”

Stigma still a factor

Stigma, Mints said, also impacts physician participation in the program.

“When I talk to my clients, they’re concerned because there’s a number of sort of high-profile practices that are kind of loosey goosey when it comes to abiding by some of the regulations related to doctors and the prescription of medical marijuana by registering people,” she said.

Even still, she said, “there are certainly a lot of doctors who have medical marijuana registration, as part of their practice, but they don’t advertise it at all.”

“They don’t try to encourage new patients to be involved,” Mints said. “If one of their existing patients comes to them and says, ‘I want to do this,’ then they’ll do it, but they want to keep it private.”

A version of this story first appeared in NJ Cannabis Insider.