The Coalition for Medical Marijuana New Jersey (CMMNJ) Report: New Jersey Medicinal Marijuana Program Physician/Patient

Registry
September 10, 2012 Subject: A non-scientific survey of physicians registered with the New Jersey Department of Health (DOH) to recommend medicinal marijuana to patients. Background: New Jersey residents with a serious illness must register with the Department of Health to obtain their marijuana and enjoy legal protections as patients. The New Jersey Department of Health regulations for the Medicinal Marijuana Program (MMP) created the first mandate that physicians also register with the state. The regulations went further in requiring all patients go through a registered doctor in order to get their ID card for the MMP. On April 16 2012, the NJ DOH published a list of the registered physicians online. 148 of the 30,000 doctors in NJ are participating. Patients without a doctor already on the list would be forced to find one willing to take them into a bona fide patient relationship so they can participate in the MMP. Survey Process: Vanessa Waltz, a cancer patient and Board member at The Coalition for Medical Marijuana New Jersey telephoned all of the 148 offices listed on the NJDOH website and reached 99. The calls were made between August 9 and August 17. Waltz identified herself and asked, Would you mind answering questions about the physician participating in the Medicinal Marijuana Program? Waltz also asked if the doctors were accepting new patients interested specifically in the MMP and gaining access. Waltz found that some of the offices were interested in talking at depth about their participation or lack of participation in the program; other offices either declined to offer insight into their participation or did not return calls. INITIAL INFORMATION: - 46 offices reported that they were actively accepting new patients interested in the program - 30 offices reported that they were not currently accepting new patients but may in the future - 23 offices reported that they were registered but were not currently participating in the MMP PARTICIPATING DOCTORS Many of the offices reached reported that although they were actively accepting new patients; they were unclear about how the program worked. These points were made numerous times: Offices reported that there has been no communication initiated by the state in terms of: How the program works; how the patient registration process works; that the physician registry would be published online;

that the patient registry was opening; alerts to any changes in guidelines on the DOH informational website. The following responses were also common: Offices are overwhelmed with phone calls from patients; Offices are receiving phone calls from patients who do not have a condition related to their specialty and/or do not have a condition which qualifies under the current regulations; doctors do not understand the legal definition of bona fide relationship. Wording on DOH website is very ambiguous related to the patient/physician relationship required for the MMP. From the Patients: Do I Qualify page of DOH website: The physician-patient relationship has existed for at least one year; The physician has seen and/or assessed the patient for the debilitating medical condition on at least four visits; or The physician assumes responsibility for providing management and care of the patients debilitating medical condition after conducting a comprehensive medical history and physical examination, including a personal review of the patients medical record maintained by other treating physicians reflecting the patients reaction and response to conventional medical therapies. There is some confusion over whether the patient must meet 1, 2, or 3 of the qualifying criteria. Many practices were unclear whether the patient a) must meet all the criteria b) must meet either both of the first two criteria or the third. Some of the confusion by the participating doctors in the New Jersey Medicinal Marijuana program is because of a lack of communication from the NJ Department of Health. Some physicians offices are getting information directly from the contracted Alternative Treatment Centers (ATCs) rather than Medicinal Marijuana Program. The practices tend to identify ATCs as the state Some participating doctors offices are not getting their information from anyone associated with the NJ MMP at all. Representatives from marijuanadoctors.com have contacted a number of offices directly by phone claiming to be able to assist in implementing the program. These participating NJ MMP doctors offices that are listed on the marijuanadoctors.com website believe it is official and contains official information from the State of New Jersey. NOT PARTICIPATING YET The majority of the offices who are interested in the program but are not actively accepting new patients reported that confusion about how the program worked was preventing them from beginning to register patients. The same issues of confusion described above were cited numerous times. Other reasons for delayed participation are as follows: - Doctors want to see how the program is running before participating: Reasons cited include fear of legal repercussions, lack of operational ATCs, and lack of educational information about cannabis provided by the DOH.

- Registered specifically for existing patients and are not currently interested in accepting new patients interested in medical marijuana - Doctor does not have an office location in New Jersey - Area of practice (i.e. Rheumatology) does not cover patient qualification conditions - Overwhelmed by volume of phone calls and taking a waiting list due to administrative need - Concern about not being able to follow up with patients after recommending to the program* *This concern was voiced prior to the DOH website update which included 30-60-90 day review by physicians in order to write further recommendation. NOT PARTICIPATING AT ALL Offices who immediately stated that they were not participating in the program generally did not make further comments. Those who were willing to answer further questions cited the following reasons: -Didnt know their name and contact information was going to be publically available on the DOH website -Overwhelmed by call volume -Overwhelmed by paperwork necessary to participate -Only joined the registry for existing patients and not interested in accepting new patients ADDITIONAL CONCERNS FOR PHYSICIANS -While some of the offices reported that DOH, MMP, or ATC representatives have returned phone calls or emails, others reported that these offices have not responded to emails or phone messages at all or only sporadically -Some of the physician contact information on the DOH website is either out of date or incorrect GENERAL CONCLUSIONS: There are still significant barriers that must be overcome before this program is working effectively for physicians or patients. The NJ DOH and the MMP official are not communicating with physicians. Participating doctors did not receive notice when patient registry was opened, and only found out when their phones started ringing or saw it on the news. The DOH has failed in providing doctors with information including clear educational materials, guidelines, and updates. Phone calls and emails from offices are not being returned. Shouldnt the state provide new information or changes in information to the list of registered doctors via email? They do not. THE DOH WEBSITE ADDS TO CONFUSION ABOUT THE PROGRAM. The information available to physicians and patients on the DOH website has been updated and changed numerous times.

Some doctors believe that earlier guidelines on the DOH website are still in effect, including those mentioning requirements struck before the registry was open but published as recently as June 2012. How often should doctors have to look at website to see changes? PROGRAM GUIDELINES ARE UNCLEAR. The information that has been available on the website is still worded ambiguously. The issue mentioned most was the ambiguous definition of bona fide relationship. DOCTORS ARE UNWILLING TO PARTICIPATE. Reasons include the lack of information provided by the DOH/MMP, the online publication of the physician registry, and the influx of calls from perspective patients. DUE TO LACK OF INFORMATION FROM THE DOH/MMP, DOCTORS ARE RELYING ON 3RD PARTIES, SUCH AS MARIJUANADOCTORS.COM AND ATCs. Doctors using marijuanadoctors.com have been told that 3 visits establish a bona fide relationship and patients must be over 18. Also, the downloadable patient screening form provided by marijuanadoctors.com includes questions about criminal record. DOCTORS ARE ONLY LISTED BY COUNTY AND NOT BY SPECIALTY. This places an undue administrative burden on both doctors and patients. FINAL CONCLUSIONS Ultimately, these obstacles are not only frustrating for doctors; they are preventing patients from becoming registered. Although 99 offices were reached, all of the offices on the registry were contacted meaning that 49 offices did not return phone calls or did not have working numbers. It is logical to assume that patients are encountering the same difficulty in contacting doctors. It is also important to note that even when patients are certified, there is still not an operational ATC that provides cannabis in New Jersey. Clearly, the physician registry is not working effectively for doctors or patients. Many doctors expressed disdain for the program, and asked why they should have to register to recommend patients marijuana while they have free reign to prescribe narcotic pharmaceuticals. Doctors also complained that there are many conditions left uncovered which would respond well to marijuana. There is also significant confusion over whether practices can accept health insurance for appointments related to medical marijuana. In essence, the physician registry model has already failed. The number of doctors registered less than .05% of licensed physicians in New Jersey - is an issue in and of itself. At least 30 doctors who did register to participate in the program had dropped out within 2 weeks of the opening of the patient registry. The most vulnerable patients have undoubtedly become discouraged in trying to find a doctor, and it is logical to assume that many have given up. The logical solution to this problem for patients is to amend the MMP regulations immediately to remove all provisions related to the physician registry.

The Coalition for Medical Marijuana New Jersey can be contacted though Executive Director Ken Wolski: 609 394 2137 or ohamkrw@aol.com