The Insider NJ Interview: NJ Health Commissioner Shereef Elnahal On NJ’s Medical Marijuana Program

JAY LASSITER: I’m a bud man, for the record. I’m old school.

NJ Health Commissioner SHEREEF ELNAHAL: If  that’s what you prefer and it works for you, great. 

(Trenton)–

I’ve smoked cannabis to manage my HIV symptoms for over 25 years. Mostly as a criminal. That’s why I’m full of ideas how to improve NJ’s medical cannabis program, long viewed as the worst in the nation.

New Jersey’s Health Commissioner Dr. Shereef Elnahal has a few ideas of his own. So does his deputy, Jeff Brown who’s charged with defibrillating NJ’s medical marijuana program which languished under Chris Christie, a notoriously retrograde voice on cannabis reform.

InsiderNJ met with Dr Elnahal and deputy commissioner Brown last week for a progress report on the changes made by Governor Phil Murphy’s administration. After 8 years of Chris Christie, it’s nice to have a governor who’s on our side on cannabis reform.

Dr. Elnahal and his team are on the right track. There are more qualifying conditions than before. Enrollment has doubled from 17,ooo to 34,000. It’s cheaper and easier to get your state-issued ID card. But if you ask anyone in NJ’s program – especially someone who’s not rich – you’ll find that patience is wearing thin.

Medical cannabis is still expensive and hard to get in NJ, where there are no provision for patients to grow their own.

I planned to ask Dr. Elnahal if he appreciates our sense of urgency but he brought it up before I could even pose question.

“It’s justified impatience,” Commissioner Elnahal told InsiderNJ. “It holds us accountable, makes sure we’re not losing perspective on how patients are feeling. That, to me, is very valuable. I think this program, as it had been managed over the last eight years (under Gov Christie) it was very unnecessarily restrictive. While it may hurt my feelings a bit to be trolled on Twitter sometimes it actually, it leads to action.”

Did you hear that everyone?

“We’re concerned about prices,” Dr. Elnahal added. “Prices are higher in New Jersey than in other states with medical marijuana programs, mostly because the program here hasn’t been allowed to expand appropriately.”

And most onerously, the program requires all patents to rectify with a special doctor every 30-, 60-, or 90 days.  Even terminally or chronically ill patients like myself, HIV+ for 26 years. Annual certification from my primary doc should suffice as it would in other states.

Many of these pot doctors are exploiting NJ’s stupid rules to get rich. There’s a certain pot doc in south Jersey, let’s call him “Dr. Bop”,  whose caseload is well over 3,300 patients. Do that math: 3300 patients pay $100 cash an average of 6 times per years and you’ve got a very rich doctor netting $1,980,000 annually.

Meanwhile, you’ve got disabled folks and cancer patients rolling change for their medicine and these extra doctor visits.

I visited “Dr. Bop” once around this time last year. He’s close by and I wanted to streamline since this is a recurring thing. And while his office looked the part, it just didn’t feel …. medical. They didn’t weigh me or take my temperature or pulse. No flu shot. No talk of my appetite or other symptoms. Just some very brief smalltalk, a quick good bye, pay the lady at the desk — cash only —  and we’re back in compliance for another 30-, 60-, or 90 days.

‘We’ve been in cooperation, close cooperation with the legislature on a medical marijuana bill,” Dr. Elnahal told InsiderNJ. “To remove some of the rules that don’t make sense. Why do you have to, for example, as a patient, continue to verify that you have the same chronic condition every 90 days?”

(Of course, the legislature could have fixed these issues already. But Senate President Steve Sweeney chose to tie medical cannabis to the larger, more complicated recreational cannabis debate. So the extra hurdles remain.)

“This really should be a relationship between doctors and patients,” Elnahal told InsiderNJ.

You mean like, our primary doctors?

“Yeah, absolutely,” Elnahal added. “And, the doctor will see you based on when they think they need to see you to treat you.”

Having to prove I’m still HIV 6 times a year?

“That makes no sense,” he said.

A lot about NJ’s medical marijuana program makes no sense until you remember that Chris Christie was its chief architect and, well, pretty much every thing he touched turned to (redacted.)

For example: during the Christie administration, dispensaries would pay to transport and incinerate whatever leftover plant material doesn’t get sold, even though stems and leaves and seeds don’t get you high. Now they can compost the stuff which is cheaper, easier, and infinitely more sustainable.

Or take the regulation that prohibits dispensaries from advertising. You might think that means no TV ads or posters on the walls advertising a popular strain and you’re right. But Chris Christie took that to the nth degree and actually prevented the dispensaries from posting their daily menus online!

Imagine the inefficiencies, both for patients who don’t know what’s on offer before they leave the house, but especially for dispensaries who spent hours on the phone with patients asking what’s on the menu.

That’s now changed. I got an email blast from Curaleaf, a dispensary in Bellmawr and was shocked to see their whole menu included. On the one hand OMG this shouldn’t feel like a revolutionary reform! But, the truth is patients couldn’t even look at menus until last week.

“This is, by the way, where traditional medicine has also failed, in transparently communicating the cost of therapies to patients,” Commissioner Elnahal told InsiderNJ. “This is across the board in medicine, across the board with pharmaceutical agents, that people have to pay so much out of pocket for. I think we’re making some good progress. And, just being transparent with patients on how much they’re gonna have to pay out of pocket when they show up.”

And that’s especially important in NJ where an ounce of medical cannabis might set you back $450. Cash. Plus tax.

Sales tax was never a part of the original legislation. Chris Christie, man of irony, added that himself after promising to get big government out of our lives.

According to Deputy Commissioner Brown who oversees NJ’s program, legislative help may ramp down sales tax on medical cannabis purchases.

“Nothing’s been introduced yet,” Brown told InsiderNJ. “But the drafts I’ve seen do phase out the sales tax which is good. That was our recommendation in an Executive Order that the sales tax go away. That’s the department’s position.”

Sales tax in NJ is currently 6.25%.

“It is a real cost to patients. If you look at the cost per ounce, it’s $25 to $30 per ounce, and that’s real money for somebody who’s on government assistance,” Brown added.

The best way to lower costs is to open more dispensaries. The department is set award six new licenses probably by the end of the year. After that, opportunities open up for smaller scale operations and entrepreneurs.

“We have proposed regulations right now,” Brown told InsiderNJ. “We’re in the process of responding to public comments. What they’ll allow us to do, once they’re finalized, is to essentially segment the market, so we can release an RFA (request for applications) for just cultivators. And then, we can release an RFA for just manufacturers who specialize in different products.”

Like edibles.

“You know there was an ALS patient who wanted a transdermal patch and none of the (dispensaries) in New Jersey create those,” Brown added.

“This is basic micro-economics,” Commissioner Elnahal added. “So, not to get wonky-”

At this point, we urged him to go ahead and get wonky.

“When you allow for specialization in key parts of the value chain, like extraction, you’re gonna get people who know how to do that, scientists and engineers, and folks who have done this in other industries coming into the market and doing it efficiently, and offering extracted products at a lower price. And you don’t have to just offer the bud. You can offer ointments. You can offer topical, other topicals,” Commissioner Elnahal said.

Physicians in NJ, and presumably elsewhere, are hungry for scientifically-grounded info about medical cannabis.

“As health care providers, doctors, nurses, you have to continue learning because the evidence is always moving faster than you on what works for your patients,” Elnahal told InsiderNJ “And so, there are these events called grand rounds. They are when experts come in and, basically, teach their peers, residents, medical students, people on the totem pole to become physicians, but also nurse practitioners, PAs, other medical professionals that see patients.

Are doctors in NJ curious about medical cannabis?

“They are very curious,” Commissioner Elnahal said.

Good. They should be.

 

Jay Lassiter is fighting hard to keep the government out of your bong. And your womb. And our bedroom. He’s on Twitter @Jay_Lass.

 

 

 

 

 

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