NJ medical marijuana: A beginner's guide to the process

Mike Deak | Courier News and Home News Tribune

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BRIDGEWATER - You have chronic lower back pain that just doesn't go away. Or you have inflammatory bowel disease, glaucoma or suffer from anxiety or migraines.

Nothing seems to work and you're afraid on relying on opioids that could lead to destructive addiction. What can you do?

Mary, a Somerset County resident, was diagnosed with Crohn's disease, an inflammation of the bowel, when she was 18. She is now 50 and the pain never went away.

"That's a long time to be in pain," said Mary, who asked that her name not be used.

After a while, she said, "you stop paying attention to it. You get used to being in pain all the time," she said.

Then she started using medical marijuana in June and by mid-August, "I feel a large improvement."

Since 2012, medical marijuana has been legal in New Jersey. Cannabis may not cure your disease, but in some cases it can relieve the symptoms.

But marijuana may not be a miracle drug.

"It’s important to not get ahead of the science with regards to medical marijuana," said Dr. David Boguslavsky, a Bridgewater family physician who is registered with the state to perform medical marijuana evaluations. "The evidence that we have so far suggests that medical marijuana can be an effective modality to treat a number of conditions, such as chronic pain, anxiety, etc. but that it is unlikely to be a panacea cure-all that many wish it to be."

The doctor emphasized that medical marijuana is just another option for physicians.

"Medical marijuana, like many other tools in a clinician’s toolbox may help many, but not all, patients feel better and lead more active productive lives," he continued.

The state

In New Jersey, with the debate raging about whether to legalize recreational marijuana, and some local towns the number of residents using medical marijuana is small compared to other states where medical marijuana is permitted.

According to the New Jersey Department of Health, only 26,806 residents have participated in the state's medical marijuana program since it started in 2012. In 2017, the total number of patients in the program was 11,349. That's less than .2 percent of the state's population.

Two states on the opposite ends of the country, California and Maine, have the highest percentage of residents in medical marijuana programs at 3.15 percent, according to the Marijuana Policy Project, which estimates there are 2.2 million patients nationwide.

Of the 30 states where medical marijuana is legal, New Jersey ranks near the bottom in resident participation.

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The most common medical condition for which medical marijuana is recommended in New Jersey, according to state statistics, is intractable skeletal spasticity where muscles stiffen and undergo involuntary spasms. That accounts for 40 percent of all patients in the program since 2012.

The second most common diagnosis is severe or chronic pain (21 percent) followed by post-traumatic stress disorder (9 percent), inflammatory bowel disease (8 percent) and terminal cancer (6 percent.)

Adding to the complexity of the situation, about half of medical marijuana patients are seniors, who need help learning how to select and use their medication properly.

There are six medical marijuana dispensaries, or what the state calls alternative care centers, in New Jersey, and only two in Central Jersey — Woodbridge and Cranbury. The other dispensaries are in Egg Harbor Township, Montclair, Secaucus and Bellmawr.

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As the use of medical marijuana becomes more acceptable, Boguslavsky said, the state will need to authorize more dispensaries, which are strictly regulated by the state. That may also lead to an eventual reduction in prices as supply and competition increase, he said.

The process

Obtaining medical marijuana is not easy in New Jersey. And, because the marijuana itself is not covered by insurance or Medicare, it's not cheap.



The process starts with a visit to a physician who is registered with the state Department of Health to perform marijuana evaluations and write marijuana recommendations. They're not called prescriptions because that would be a violation of federal law, Boguslavsky said, which still prohibits the use of marijuana.

Boguslavsky sees prospective patients for an hour-long intake visit where a detailed medical history is taken, medical records are reviewed, a physical exam is performed and a discussion whether the patient qualifies for medical marijuana under state law.

An urine test is also requested for a drug screen to see if there would be any "co-mingling" with any other drug use, Boguslavsky said.

Patients should bring their complete medical records, their driver's license and a proof of residency because the state is strict in establishing the identity of residents admitted into the program. In a spirit of full transparency, Boguslavsky posts on his website that he charges $270 for the initial consultation.

At a second visit about a week later, Boguslavsky reviews test results with the patient and establishes the monthly proper dose of medical marijuana. That monthly dose typically ranges from a half ounce to two ounces, the maximum legal dose.

He also talks with the patient about what previous experience, if any, they had with marijuana. For many senior citizens, they may not have used marijuana for decades since their college days and others may not have used it at all.

Then the patient has to register with the state by going on-line and uploading the necessary documentation. Two to three weeks later, the patient will receive in the mail an identity card that will allow them to go to a dispensary and purchase marijuana.

After they start using, the patients follow up with an office visit so the doctor can monitor their progress or change the dosage like any other legal drug.

Sometimes the impact of the medical marijuana will not be felt immediately, especially if a patient has experienced years of pain, the doctor said. Unlike common opioids, the incidence of marijuana dependence is minimal, only 1 to 2 percent, he said.

Boguslavsky, who also performs acupuncture, said he believes that skepticism about the effectiveness of medical marijuana will fade as more and more medical practitioners become aware of the benefits of medical marijuana.

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Acupuncture, when he started practicing, met with skepticism among other doctors who followed what Boguslavsky calls "traditional Western medicine," but over time, more and more doctors began referring their patients to him for treatment.

So far, Boguslavsky said, his patients have been "very positive" about medical marijuana.

Mary called the doctor "phenomenal" and said he is very approachable and cares about his patients.

For another of Boguslavsky's patients, medical marijuana was a godsend.

" I've tried various medications for pain and chronic insomnia, all of which were mostly unsuccessful because of nasty side and after effects, along with potential issues of dependence. Nothing gave me relief without the downside. Ultimately I just suffered endlessly without relief," said Nancy, a Somerset County resident who asked that her name not be used..

That frustration led her to explore the benefits of marijuana.

"I finally decided to look into cannabis, as recommended by so many others, who have experienced success," she said. "This turned out to be a long awaited solution. Relief has been provided with no side effects! I can function again."

Her life, she added, has turned to the better.

"All of my doctors are pleased with the change in me and have encouraged me to continue," she said. "They all feel that this course has upside only with no downside"

She has also seen the positive impact of medical marijuana on others.

"My mother is 87 and lives in a retirement facility," she said. "They too are all using medical marijuana and can't stop talking about how much it has helped them. It's pretty funny!"

The store

You've cleared the first hurdle by obtaining an identity card from the state. Now you face the second hurdle - buying the marijuana. And that's not easy for someone whose last connection was 40 years ago or your 80-year-old aunt who has never touched marijuana in her life.

That's where Robert Young can help.

The 68-year-old Bridgewater resident started smoking marijuana when he was 16 years old and the Beatles were still together. And while he continued to use it surreptitiously, he now uses it legally to help relieve anxiety and insomnia.

Young learned a lot from his cousin who operated a 40-acre farm that produced both chestnuts and illegal marijuana in Humboldt County, Ca., about 300 miles north of San Francisco. For decades Humbodlt County was the epicenter of California's black market marijuana industry and the farm, after many years, dropped its chestnut harvest became a legitimate raw marijuana business.

Young is a certified medical cannabis consultant who helps patients walk through the process once they leave the doctor's office, obtain a state identity card and is ready to go to a dispensary.

For many patients, that can be the most daunting part of the process.

Since so many of his patients are seniors, he said, he can identify with their concerns not only buying the marijuana, but learning how to use it.

"They tell me'I don't know what to do'," he said. "They're lost."

Young, who completed on-line courses from the Cannabis Training University based in Denver, will first go through the process "step by step" and explain how marijuana works through the combination of THC, the chemical that produces the high, and cannabinoids, which affects neurotransmitters.

"We need the THC and cannabinoids to work together," he said.

Like a parent going with their child on the first day of school, Young offers to accompany the novice medical marijuana patient on their first visit to a dispensary.

"I'm like a caregiver," he said.

Once they arrive at the dispensary, the patient has a 20-minute orientation session with a counselor and when that is finished, the patient goes into the dispensary itself which, Young said, looks "like a jewelry store."

The person behind the counter, called a "bud tender," can help you pick the marijuana that's right for their condition with the proper mix of THC and cannabinoids. Young said he takes the Blue Dream brand for his insomnia.

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Some of the available brands include East Coast Sour Diesel, Nigerian Haze, Death Star and Platinum Girl Scout Cookie.

"I will help put you on a strain that will help you," he said.

Most of the bud tenders are millennials, Young said, so they have trouble identifying with the seniors and their concerns and questions. "The 25-year-olds can't relate to seniors," he said

An ounce of marijuana is not cheap, Young said, ranging from $200 to $650 an ounce. Dispensaries do not accept credit cards and insurance does not cover the cost. For senior citizens living onn a fixed income, having to come up with that much cash per month is a burden, Young said.

"How can you afford it?" Young said.

"It's unfair," Boguslavsky agreed. "It's unfortunate."

Business at the dispensary is not finished. The patient now has to select the paraphernalia to use the marijuana.

Because aging fingers may not have the dexterity to roll a joint like they once did in college while listening to Grateful Dead albums, Young recommends a pipe or a vape pen. That can be an added expense of $30 to $125 unless you want to make marijuana-laced brownies.

Young then goes home with the patient and stays with them as they take their first puffs to make sure they're doing it right.

"Some of the stuff will hit you hard," he said.

Young cautions his clients that it may take days or weeks for the marijuana to take full effect depending on the dose and the medical condition. And for some people, it may not have an impact at all.

But Bob promises his clients that "I'll be there for you" if they encounter any problems.

"I believe in this stuff," he said.

For more information, visit Boguslavsky's website at MyPremierMD.com.

Young can be reached at rtyoung021@yahoo.com.

For a list of doctors registered with the state, visit https://www.nj.gov/health/medicalmarijuana/patients/find-doctor/

Staff Writer Mike Deak: 908-243-6607; mdeak@mycentraljersey.com