TRENTON — After predictions that New Jersey's medical marijuana program could serve tens of thousands of patients with severe and painful illnesses, only 2,342 have signed up — a participation rate so small some worry the very future of the program could be at stake.

Lawmakers, some dispensary operators and patients blame the sluggish enrollment on the program’s rigid rules, exorbitant costs for patients and growers, and Gov. Chris Christie’s contention that he does not need to do anything more to enhance participation.

And they say one major roadblock is that so few New Jersey doctors are willing to recommend patients for medical marijuana.

"We have a dysfunctional program, and I think it’s going to take some sort of ‘pot summit’ bringing together patients, doctors and legislators to really make this a success," said Assemblyman Reed Gusciora (D-Mercer), one of the lead sponsors of the law.

"We are hearing more and more anecdotal evidence that dispensaries are not sustaining themselves, the quality (of the marijuana) is not always there, and it’s difficult for doctors and patients to get into the program," Gusciora said.

The lawmaker said while he has "every faith" in state Health Commissioner Mary O’Dowd, "there is so much reticence on the administration’s part, I don’t know how you break that logjam. All they have to do is open their eyes."

Enrollment in the program has more than doubled in the last year as two of the state’s three medical marijuana dispensaries opened their doors. But it’s nowhere near the 5,000 to 30,000 medical marijuana patients advocates anticipated when the law was passed. Dispensary owners looked at disease statistics in New Jersey and expected at least 50,000 patients. The state’s first dispensary opened in December 2012.

"We thought we would have 10,000 patients by now," said Yale Galanter, attorney and spokesman for Garden State Dispensary in Woodbridge, which has served 1,700 since opening six months ago.

The Compassionate Care Foundation center in Egg Harbor Township, which opened with great fanfare in October after securing a state-backed loan, says it needs 2,000 patients to break even and has served 600. The owners report bagfuls of cannabis are going to waste, and expansion plans are on hold.

Chief operating officer Bill Thomas quit last week, saying he could no longer work without getting paid.

"It’s failing," Thomas said in an interview days before he resigned Monday. "From a business standpoint and from a patient standpoint, it’s not successful. The governor says why change anything if (patients) haven’t shown up. Is there really no demand, or is it so hard to get access that it is easier to buy it from the high school kid down the street? It’s not like the people don’t get it another way."

Woodbridge’s Galanter said the problem can be fixed, based on owner Michael Weisser’s experience operating dispensaries in Colorado.

DOCTORS ARE 'KEY'

"We know the key to this program being viable is getting doctors involved," he said.

Patients must be referred by a doctor in order to participate. Just 296 of New Jersey’s 21,000 licensed physicians have signed up.

Many doctors don’t want their name on the state’s website, according to Gusciora, and dispensary officials from Woodbridge and Egg Harbor Township. They said doctors who are in the program report that they get calls from people diagnosed with illnesses they don’t treat, as well as others who don’t qualify for the program. As that word spreads, other doctors are wary about joining the program, the officials say.

And given the stigma surrounding marijuana, which is still illegal under federal law, some doctors fear they will lose patients or alienate their practice partners.

"They are not saying (their names) should be a secret," said David Knowlton, a founder and board member of Compassionate Care Foundation. "But having it on the website implies to patients they can walk in and be seen."

In New Mexico, a state Christie officials studied when modeling the program’s rules, doctors’ names are not publicly disclosed "due to confidentiality and legal issues," according to the state program’s website. Physician names are accessible by consulting the many commercial websites that have sprung up promoting the program.

O’Dowd’s spokeswoman Donna Leusner defended the state’s cautious approach to the program, noting New Jersey was the first state to enact the law that adopted "a medical model" rather than the business blueprint forged in states like Colorado and California.

"Physicians’ names were posted on the department’s website to assist patients in finding doctors, just as health insurers list physicians participating in their networks," Leusner said.

"The model of a medically based program was well-known and established by the Legislature and former Governor (Jon) Corzine when the law was passed," she said. "Advocates may have overstated the demand based on the experience of other states that do not have a medical model. But that’s a question best directed to (the dispensaries), their boards and investors."

'CONVENIENT EXCUSE'

Larry Downs, executive director for the Medical Society of New Jersey, said he found the lack of doctor involvement a "convenient excuse" for the program’s struggles.

"If dispensary owners have overestimated the market, then that is not the concern of the medical field," Downs said.

"If doctors believe it is a legitimate therapy, being published on a website is not going to stop them," he added. "A lot of doctors do not believe it is a good therapy and that it does not meet standards of efficacy and safety."

The slow enrollment rate and struggling dispensaries have had a ripple effect on some patients.

Betty Rand, an 89-year-old homebound stroke patient from Millburn, says medical marijuana eases her pain and muscle spasms, but it would be far easier if she could get it in the form of a lozenge. Smoking makes her cough and adds to her suffering from the host of other illnesses she’s battling.

Dispensaries, however, don’t offer lozenges or any edible product yet. The health department is reviewing manufacturing plans from the Woodbridge dispensary. With lagging enrollment, Egg Harbor officials have said they can’t afford the expense of developing a new product.

Rand describes the program as "a job they’ve half-done and are not finishing right, They are not making an effort, and as long as Christie is there, he is not going to do it."

Knowlton, a former deputy health commissioner, says he’s far from giving up on the program. He is talking with O’Dowd and program director John O’Brien about changes that could make it more accessible, such as allowing hospice centers and nursing homes to act as couriers for registered patients in their care. People who cannot obtain their own marijuana may identify a caregiver to retrieve it for them, but a caregiver can only serve one patient.

"I recognize that with a program that has this much scrutiny, the state has to move slowly," Knowlton said. "I think the department is trying to be helpful but cautious. They have to think ‘How could this go bad?’ I am confident this is going to work out. This is just a trying time."

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