NJ’s Compassionate Use Medical Marijuana Act

The second alternative treatment center recently became operational in New Jersey under the state’s Compassionate Use Medical Marijuana Act. We review some of the legal requirements that impact participating physicians.

About Compassionate Use Medical Marijuana Act

The New Jersey Compassionate Use Medical Marijuana Act (Act) authorizes the use of marijuana to treat or alleviate pain or other symptoms associated with certain debilitating medical conditions, which are specifically defined by law. Under the Act, a patient’s physician must issue a certification authorizing the patient to be registered with the Department of Health and Senior Services for purposes of obtaining and using marijuana for the patient’s medical condition. The physician must also issue written instructions to an alternative treatment center for qualifying patients that seek marijuana for medical use.

Physicians

In order for a physician to provide the required patient certification to the state, the physician must hold an active license in New Jersey and be in good standing. The physician must also have an active controlled dangerous substance (CDS) registration issued by NJ Division of Consumer Affairs that is not subject to limitations.

Physicians and Patients

Prior to issuing a patient certification for the medical use of marijuana, the rules require that a physician have a bona fide relationship with the patient.

The rules define a “bona fide physician-patient relationship” as a relationship in which the physician has ongoing responsibility for the assessment, care and treatment of a patient’s debilitating medical condition. “Ongoing responsibility” is further defines as follows: 1) The physician-patient relationship has existed for at least one year; 2) the physician has seen and/or assessed the patient for the debilitating medical condition on at least four visits; or 3) the physician assumes responsibility for providing management and care of the patient’s debilitating medical condition after conducting a comprehensive medical history and physical examination, including a personal review of the patient’s medical record maintained by other treating physicians reflecting the patient’s reaction and response to conventional medical therapies.

Of the approximately 20 states that currently have compassionate laws, New Jersey’s law is considered to be one of the strictest partly because of the law’s narrow definition of what constitutes a “debilitating condition,” which is defined as:

1. If resistant to, or if the patient is intolerant to, conventional medical therapy: seizure disorder, including epilepsy; intractable skeletal muscular spasticity; or glaucoma;
2. If severe or chronic pain, severe nausea or vomiting, cachexia or wasting syndrome results from the condition or its treatment: positive status for human immunodeficiency virus, acquired immune deficiency syndrome or cancer;
3. Amyotrophic lateral sclerosis, multiple sclerosis, terminal cancer, muscular dystrophy or inflammatory bowel disease, including Crohn’s disease;
4. Terminal illness, if the physician has determined a prognosis of less than 12 months of life.

The rules allow for future expansion of the “debilitating condition”  list for which medical marijuana may be authorized but since the Act was enacted three years ago the Department of Health has not expanded the list.

The rules also require that, among other things, a physician authorizing the medical use of marijuana is to review, at a minimum of every three months, the course of treatment for the patient’s debilitating medical condition as well as the patient’s progress toward treatment objectives as a result of the use of medical marijuana. Physicians are instructed to pay attention to whether the patient is achieving the therapeutic results intended, has developed significant untoward side effects, or is experiencing any physical or psychological problems associated with marijuana use.

If the physician determines that the patient is achieving treatment objectives, and is not experiencing untoward side effects or physical or psychological problems associated with marijuana use, the physician may continue the patient’s treatment with medical marijuana without alteration.

Prior to obtaining medical marijuana patients must register with the State and pay a fee, valid for two years, of $200. Patients who qualify for certain state and federal assistance programs may be permitted to pay a reduced fee of $20 for the registration period. Neither Medicaid nor Medicare, however, consider medical marijuana as a covered service.

Record Keeping

A physician must conduct a comprehensive medical history and physical examination of the patient to determine whether the patient suffers from a debilitating medical condition that qualifies the patient to receive medical marijuana. The rules require accurate and detailed medical record keeping of such exams, which must include, at a minimum, the following:

1. The medical history and physical examination of the patient;
2. The diagnosis of the debilitating medical condition, including the patient’s symptoms and their severity and the patient’s reaction and response to conventional medical therapies, which qualify the patient for the medical use of marijuana;
3. Other evaluations and consultations;
4. Treatment plan objectives;
5. Evidence of informed consent. In obtaining informed consent, the physician shall advise the patient about the lack of scientific consensus for the medical use of marijuana, its sedative properties and the risks for addiction;
6. Treatments and other drugs prescribed or provided;
7. Any agreements with the patient; and
8. Periodic reviews conducted.

Additional rules apply to minor patients.

Did you know that New York currently has pending legislation to legalize marijuana for medical use?

If you are a healthcare provider and have questions about New Jersey’s Compassionate Use Act, you may contact us here.