Patient-centric concerns re: NJ’s Medicinal Marijuana Program

4 of the 8 Medicinal Marijuana Product Strains offered by my dispensary.

1-4 of the 8 Medicinal Marijuana Product Strains offered by my New Jersey dispensary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 3 of 4-part Series chronicling my current experience as a Crohn’s Disease patient participating in New Jersey’s Medicinal Marijuana Program (NJMMP)

Reasonable Need for NJMMP Patient-centric revisions have made this a 4-part Series

      I began this Series detailing the extensive, rather long, often even onerous and inherently expensive NJMMP registration process. In Part 2 I shared my very positive experience interacting with the NJMMP when a representative with the authority to solve my problem was kind enough to phone me in response to an email I had sent only the previous weekend to the general email address listed on the NJMMP website.  Following the suggestions of this very kind NJMMP representative, I resolved my registration problem and was then registered for the NJMMP at the much lower  biennial registration fee of $20.00 (instead of $200.00) in consideration of, and after I provided required proof of, my fixed and limited income from receiving Social Security Disability benefits. I received my NJMMP ID Card shortly thereafter and initially decided to conclude the NJMMP Series in Part 3 after visiting my Alternative Treatment Center (ATC) [a/k/a my dispensary], purchasing Product then medicating with it and sharing my assessment of how effectively it met my medical needs.

      For that purpose, I kept my medical needs simple and only sought the anti-inflammatory benefits from a product high in CBDs and very low in THC ingredients so that medicating did not include feelings of “euphoria” or “being stoned.” Then, after listening intently to my description of the various painful inflammatory problems I encounter as a result of 31 years battling the incurable, autoimmune Inflammatory Bowel Disease, namely, Crohn’s Disease, my dispensary adviser “explained” the 8 different available marijuana Product strains by attaching flavor, mood and medicinal characteristics to each, much the same way a Seascapes Painter might associate personality traits to specific colors.  I know, this is very esoteric and pretty strange but when it’s told to you in a professional manner through intermittent morsels of medical jargon and the dispensary advisor maintains a straight face throughout his sales pitch, well, you gotta go with the flow.

      But when he hands you a professionally-printed Menu of the 8 different marijuana Product strains and it also includes the aforementioned arcane descriptive attributes (please see a picture of the Menu below), then you realize you are no longer driving and it’s time to sit back, listen and learn.  Maybe.  But given my communicated medical needs, my very well-informed dispensary adviser sold me the only “High CBD” strain carried by the dispensary.  But no matter the dose or medicating mechanism, I got “stoned” each and every time I tried the “High CBD” Product and that made me wonder about the NJMMP and whether or not enough parts of it reflect the patient perspective in terms of reasonably foreseeable patient medical needs. So I did some research and consulted with some friends very knowledgeable in the business of medical marijuana and this necessitated me adding a Part-4 to conclude the Series.

4 of the 8 Medicinal Marijuana Product Strains offered by my dispensary.

5-8  of the remaining 8 Medicinal Marijuana Product Strains offered by my New Jersey dispensary.

The Allure of NOT Getting Stoned from Medical Marijuana

      Many years ago I had gotten “stoned” or “high” during my adolescent phase of recreational experimentation and I never enjoyed the associated paranoia and loss of control over my personality.  Sure, smoking pot enhanced all of my senses, or at least it made me feel that way, and I actually enjoyed this laser-focused superpower especially when playing full-court hoops, while listening to The Grateful Dead and Steely Dan and during a few other more private activities.  But smoking pot quickly bored me because it made me feel “stupid” even if I was laughing hysterically during the transformation from leader-to-follower and extrovert-to-White Castle-devotee. A few friends of mine never felt that way and marijuana remained in their lives to this day as they became, and continue to be, prolific, respected and wealthy members of society. Notwithstanding their continued marijuana usage and real life successes, my dull experiences “getting stoned” left such an indelible negative impression on me that I was never tempted to revisit the marijuana experience and I found other sources to which to turn for attaining that almost instantaneous relaxed state.

      Therefore, any medical use of marijuana which gets ME “stoned” is a non-starter as I believe MY “stoned” or “high” marijuana personality compromises and completely negates my ability to function as a responsible adult.  I truly believe that marijuana may work wonderfully for others, and I have seen it be a beneficial source of relaxation and/or creativity for some of my most beloved, normal, well-accomplished and respected friends, but FOR ME, “getting stoned” won’t work as a medical solution.  However, non-euphoric “High CBD” Product makes medical marijuana extremely appealing to me because soothing the systemic painful inflammation running ramped in my body via extra-intestinal manifestations of Crohn’s Disease would substantially increase the quality of my life and I would no longer be physically dependent on narcotic prescription painkillers.  Prescription painkillers and alternative pain management modalities such as acupuncture have always been my only effective defenses against severely painful inflammatory problems due to my inability to take ANY anti-inflammatory drugs because of their intestinal-obstructive harsh effects on my gastrointestinal tract.

Why scrutinize New Jersey’s well-established Medicinal Marijuana Program?

      After purchasing “High CBD” Product from my dispensary and sampling it in different amounts and via different medicating mechanisms, I “got stoned” each time.  While I am permanently disabled due to the damage done by 31 years of Severe Crohn’s Disease, I am still an active and effective Patient Advocate whenever I am physically well enough to do so and I’m also the Guardian of my 83-year-old Mom assuming responsibilities for which “being stoned” is an unacceptable state-of-mind and objectively it is demonstrative of a lack of “readiness” to help her whenever I am required to do so.  This “unintended consequence” of “getting stoned” after medicating with Product marketed and sold in my New Jersey dispensary as being a “High CBD” strain provided the impetus for my extensive CBD research which included consulting with friends and acquaintances from all over the country, each of whom is intimately familiar with medicinal marijuana. My consultations included in-depth personal conversations with a pharmacist friend who works at a dispensary in a different state.

       In the end, and in order to personally continue forward with seeking medical benefits from marijuana in New Jersey or to advocate that others do so, I had to understand the answer as to why I got “stoned” from “High CBD” New Jersey product when its ratio of CBD-to-THC ingredient percentages seemed to mimic those of successful non-euphoric “High CBD” strains dispensed in other states.  I concluded that I am either hypersensitive to THC, such that the otherwise small and inactive amount of THC present in the New Jersey “High CBD” Product was enough to affect ME when it would not have any euphoric effects on others, or the “High CBD” Product I had purchased in the NJMMP was improperly labeled, devoid of reliable ingredient consistency and/or indicative of other fundamental flaws in the NJMMP which could only be identified and remedied after a patient-centric analysis.  By no means do I intend to portray the NJMMP in a negative light but my “High CBD” “stoned” experience made me think about similar “unintended consequences” potentially happening to seniors or to children looking to medical marijuana for relief.  So I decided to take a more comprehensive look at the NJMMP to identify any problematic areas and highlight opportunities for it to more safely and effectively meet patient needs.

Former Democratic Governor Jon Corzine passed the NJ Medicinal Marijuana Act, but Republican Governor Chris Christie designed and implemented the NJMMP

      Accordingly, Parts 3 and 4 of this Series are intended to offer constructive “patient perspective” suggestions re: the NJMMP and to pose some provocative questions, the honest answers to which will undoubtedly require several patient-centric modifications to the NJMMP.  These patient-driven updates are necessary to more reasonably meet the patient needs identified by the 2010 marijuana de-criminalization Act, i.e., the New Jersey Compassionate Use Medical Marijuana Act (the “Act”), because these reasonably foreseeable patient needs were not truly considered when the NJMMP was designed and implemented in 2010 under the stewardship of anti-medical-marijuana Republican New Jersey Governor, Chris Christie.  More specifically, Governor Christie inherited this implementation task from his predecessor, former Democratic New Jersey Governor, Jon Corzine, who signed into law this politically-sensitive medicinal marijuana legislation literally on his last full-time day as Governor.  Governor Christie was then tasked with heading the design and implementation of the NJMMP even though he had been, and continues to be, an outspoken opponent of the legalization of medical marijuana viewing any such laws as pretexts for, or indirect paths toward, the legalization of recreational marijuana.

      With the advantage of 20/20 hindsight, it is clear Governor Christie prioritized the NJMMP with more concern about staving off what he publicly perceived to be a backdoor to legalizing recreational marijuana when he should have also focused on creating a NJMMP which reasonably addressed the foreseeable needs of patients diagnosed and suffering from the Act’s specifically enumerated debilitating medical conditions.  While it is somewhat understandable for the initial design and implementation of the NJMMP to focus on the establishment of firm governmental controls and well-managed state registration and dispensary processes given the controversial, politically-charged subject matter encompassed by the NJMMP, the corresponding rules and regulations are rigid, restrictive and lack any patient-friendly overtures.

At least 25 States currently permit Medicinal Marijuana.

It’s time for a New Jersey Medicinal Marijuana Program (NJMMP) to better serve its Patients

      It is now 6 years later, and based on subsequent medical findings and a plethora of magnificent medical marijuana success stories, including children battling epileptic seizures and patients of all ages finding relief from incurable Inflammatory Bowel Diseases,  more and more states are legalizing medical marijuana initiatives and an increasing number of these state efforts reflect a genuine attempt to dutifully service the legitimate patient needs which underlie the medicinal need for marijuana despite marijuana being illegal under federal law. All things considered, it is now therefore timely for the NJMMP to be re-analyzed from a patient perspective with the intent of modifying the NJMMP so that it is robust and capable of meeting reasonably foreseeable and practical patient needs and so that it can be compared favorably with similar efforts of other states, just like legislative programs covering other cutting-edge issues of our times such as privacy, drones, the heroin epidemic, the minimum wage and cyber-protection.

Specific Product Strains and their CBD/THC ingredient concentrations

      By looking at the aforementioned and posted “Menu,” the Cannatonic “High CBD” strain I purchased seems to have a total of approximately 7% CBD and 0.314% THC, which would appear to be a ratio similar to other successful CBD strains which produce no euphoric or “stoned” effect.  I was told at the dispensary that the 5.955% of THCA, or tetrahydrocannabinol acid, is a cannabis compound that unlike THC, is a non-psychoactive cannabinoid.  However, I have subsequently read conflicting information about the possible conversion of THCA to THC when it is heated and decarboxylation occurs or possibly even when it is heated during vaporization (or heated while smoking the marijuana) thus increasing the Product strain’s amount of THC thereby enhancing its psychoactive effects.  This inconsistency of ingredient concentrations might explain why I got “stoned” from the “High CBD” Cannatonic strain no matter the dose or medicating delivery mechanism.  The THC ingredients should have been INACTIVE or MUTED in a strain promoted and sold as “High CBD” Product.  Additionally, there also appears to be several different laboratory methods for measuring THC potency in strains of medicinal marijuana as the THCA conversion process and the resulting increased amounts of THC are interpreted and calculated differently by different laboratories.

      During my first and currently only visit to a NJ dispensary, I also purchased small amounts of 2 other Product strains with ingredient percentage ratios higher in THC than the aforementioned “High CBD” strain (i.e., “Cannatonic”) despite my aversion to “getting high” or “being stoned”  (this calculation does not count the amount of THCA which my post-dispensary research indicates might be extremely relevant). These strains are listed on the aforementioned “Menu” as “Blueberry #32” and “AK-47.”  “Blueberry 32” seems to have only 0.031% CBDA but no CBDs and 0.238% THC and 13.83% THCA.  However, I have also read about a similar decarboxylation effect on CBDA which converts it to CBD which would in effect render “BlueBerry 32” slightly less potent in THC than as advertised.  The “AK-47” strain is significantly more THC-potent because it has 1.269% THC, 17.73% THCA and approximately 0.096 % CBD (talking into account the CBDA decarboxylation conversion factor).

 “Medical Measurables” such as milligrams (mg) are needed to measure Product ingredient Concentration Consistencies

     Notwithstanding the foregoing Product ingredient specifics, how reliable are these relative percentages in terms of consistent measurements of ingredient concentrations such as that of THC and THCA? I have read conflicting theories on the most medically measurable labeling techniques and the absence of measurable units such as milligrams (mg), for example, prevents New Jersey dispensaries from devising dosing guidelines for the specific debilitating medical conditions the NJMMP treats and for the different degrees of severity within each specific disease.  After discussing this aspect of the NJMMP with a pharmacist friend working at a dispensary in a different state, I was impressed by his state’s medical marijuana initiative when I learned that in his state he is able to, for example, consult with a Crohn’s Disease patient and then based upon the severity of the case recommend “4 mgs of Product Strain, 2 times a day,” based on the dose protocols established in his state or in his dispensary.  The medical marijuana is then labeled much like direction labels on prescription drugs.  He is only able to do that because the Product in his state is measured by a medically measurable unit, i.e., a milligrams (mg).  Due to the existence of the above-referenced different laboratory ingredient measurement techniques and different application philosophies, it seems crucial for the NJMMP to utilize Product measurement units which can be reasonably relied upon to create and measure consistent Product ingredient concentrations which then can be used to create disease-specific dosing guidelines.

After Getting Stoned” from “vaping” Trace Amounts of “High CBD” Product, did my Scientific Experiment run askew?

        Due to my need and preference to remain clear-headed on a 24/7 basis, I knew I would rarely use these 2 other product strains other than late-at-night and only in instances of severe pain.  But more realistically, I purchased them to create comparison reference points for the non-euphoric “High CBD” strain which the dispensary adviser strongly recommended as the strain which most accurately meets my clearly articulated medical needs. Looking back a few weeks to the time I visited the dispensary, it is possible the dispensary adviser mentioned the possibility of minor “euphoric effects” resulting from the “High CBD” strain, and thus if I am hypersensitive to THC that could also explain my “stoner” experiences, but I do recall him specifically stating that I “would not get stoned.” However, the degree to which marijuana affects each person is most assuredly personalized, varying and dependent on numerous factors so any scientific expectations are unrealistic whether they are made as sales representations or depended upon by buyers like me UNLESS the marijuana is consumed via medically measurable edible products which are not readily available in the NJMMP although they recently were added to the Program and are in the process of being manufactured.

      In any event, however, I figured I could at least learn about the accuracy of the NJMMP’s product labeling and gain a practical understanding of the different strains’ varying effects on me by sampling strains which were CERTAIN to get me “stoned” and comparing those experiences with sampling the “High CBD” strain which was REASONABLY CERTAIN NOT to get me “stoned.”  But my “research” plans ran askew after I got “stoned” from the “High CBD” strain the very first time, and every time thereafter, no matter the dose.  But now I know this could be explained by the strain containing significantly more THC due to the THCA conversion factor or the “High CBD” Product is properly labeled and I am getting “stoned” from this strain due to my THC-hypersensitivity.

      As I mentioned at the beginning of this Post, my experience thus far with the NJMMP has raised many questions which I believe must be addressed from the perspective of whether or not the NJMMP meets patient needs.  In light of the possible “High CBD” improper Product labeling regarding THC concentration, I think it is fair to say that all bets are off as to the NJMMP meeting that standard. That said, does the inexact THC concentration in the “High CBD” Product and/or me consistently getting “stoned” from it mean my experiment is futile?  Since Edibles are innately more consistent in terms of dose and potency, is there knowledge to be gained from making edible products from the “High CBD” strain? Is my scientific experiment OVER or can I still learn a great deal about the NJMMP by sampling the different Product strains and creating Edible Product?  In this regard, to quote the sage philosopher John “Bluto” Blutarsky from the humorous precedent-setting significant movie, “Animal House:”

“What? Over? Did you say ‘over’? Nothing is over until we decide it is! Was it over when the Germans bombed Pearl Harbor? Hell no!”  

Final Part 4 of this Series details the many benefits of adding Edible Products to the NJMMP. Part 4 also includes discussion of a Web mechanism for patients to be able to access NJ’s 33+ Product strains and converse with one another in a secure manner to share experiences regarding their usage of the different Product Strains and to discuss specific dosing, etc.  The current stigma associated with the medical legitimacy of the NJMMP is also addressed and suggestions are offered to attract more mainstream physicians to the NJMMP. Part 4 is expected to be posted on Monday, July 18, 2016.

Please leave your comment here, good or bad. I only ask that it be constructive. Thank you.

Please leave your comment here, good or bad. I only ask that it be constructive. Thank you.

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