For nearly three decades, Elise Segal has worried that police might arrest her for using marijuana.
The 58-year-old Deptford nurse started smoking the drug in her 20s to relieve pain and muscle spasms brought on by her multiple sclerosis.
"I was blessed enough to find something to give me quality of life but the flip side of it . . . if I got caught or not I was breaking the law," Segal said. "That made me a criminal every day and that was very hard for me."
Finally, she said, she doesn't have to carry that stigma anymore.
After a five-year legislative battle, New Jersey last week became the 14th state to legalize marijuana for treating certain medical conditions. Gov. Jon S. Corzine is expected to sign the bill before leaving office Tuesday.
Medical marijuana advocates say the law isn't ideal because several provisions were stripped from the Senate version that passed almost a year ago. But they're optimistic that it could still help thousands of patients, and perhaps even more if regulations are loosened in the future.
"We're thrilled that there's a good start to providing safe and effective medicine to the patients who need it," said Ken Wolski, a nurse and director of the Coalition for Medical Marijuana in New Jersey.
That said, the lobbying isn't over yet. The health department now has six months before the law takes effect to set regulations for the centers that will grow and distribute the drug.
Opponents promise to push for the strictest possible oversight, while advocates say they'll fight to ensure that patients can access and afford the medication they need.
California was the first state to pass a medical marijuana act in 1996. In New Jersey, Sen. Nicholas Scutari, D-Union, introduced the "Compassionate Use Medical Marijuana Act" in January 2005.
During Senate hearings, doctors and patients argued that the drug has been shown to reduce pain and nausea for patients suffering from a variety of medical conditions. In some cases, they said, marijuana was the only effective alternative to other medications that caused debilitating side effects.
Critics countered that there wasn't enough proof that marijuana worked any better than existing federally-approved medications.
The advocates won out. Senators passed the bill last February with bi-partisan support. But sponsors tightened regulations after continued outcry from critics who claimed that the bill made marijuana too accessible and could open the door to legalizing it altogether.
In the last week before the two-year legislative session ended, the Assembly approved the bill 48-14. The Senate voted 25-13 in favor, gaining three votes from February. Under the final bill, patients with HIV/AIDS, cancer, multiple sclerosis, muscular dystrophy, Crohn's disease and terminal illness can submit a doctor's recommendation to petition the state for medical marijuana treatment.
If approved, patients or designated caregivers living in New Jersey would be able to receive up to two ounces of marijuana every 30 days from a licensed treatment center. The Department of Health and Senior Services would issue ID cards to protect them from criminal prosecution. Caregivers must also register and pay for their own state and federal background checks.
The marijuana will only be available at "alternative treatment centers" regulated and monitored by the DHSS and the Department of Law and Public Safety. To start, there will be six nonprofit centers - - two each in north, central and south New Jersey. Additional non-profit or for-profit centers will be added based on demand.
The law makes it clear that health insurance companies are not required to reimburse costs for medical marijuana, nor are employers required to accommodate it at work. Patients are also banned from driving under the influence or using the drug in public areas such as parks, school grounds, beaches and recreation centers.
Strictest in the Nation
Lawmakers pointed out that their act is stricter than any other in the nation when comparing the amount of marijuana that patients are allowed to get or the conditions that qualify for treatment. The law also prohibits doctors from becoming marijuana specialists.
But supporters wondered if so many controls were added that those who legitimately need the drug won't be able to get it, or get enough.
Among their biggest gripes was the removal of a provision that allowed patients to grow six marijuana plants at home. Of all the other states with medical marijuana policies, New Jersey is the only one to prohibit home cultivation.
"It was not a problem and you don't hear about it as a problem in any of the other states," Wolski said.
This prohibition takes the focus away from patients' health and back to the business of medicine, Wolski said. Instead of being able to produce the drug themselves "for pennies," he said, patients will have to travel to centers that might be far away or cost-prohibitive.
Medical marijuana advocates worried that center operators would also charge inflated prices in order to absorb the cost of following all the requirements in the law.
"As with any other product, with more regulation the higher the cost is going to be," said Roseanne Scotti, director of Drug Policy Alliance New Jersey. "If you're paying for various security apparatus and background checks and reporting to the state, that's expensive and gets passed on to the patients."
Wolski noted that some places in California sell marijuana for as much as $440 an ounce.
Wolski and Scotti said they were also frustrated that thousands of people who could benefit from the medication won't be able to get it because "chronic pain" was removed from the definition of qualifying ailments. That term encompasses some of the most painful conditions such as degenerative disk disease, fibromyalgia and burns, Wolski said. He estimated that up to 50,000 New Jersey residents could benefit from prescription marijuana, but maybe only 10,000 will actually qualify.
Lawmakers "were more worried that someone, somewhere might abuse this for some level of pain that wasn't serious enough and they left out a lot of people who have very serious pain conditions," Scotti said
Wolski also guessed that the two-ounce monthly allotment would only be enough for about half the patients.
Looking for Answers
Despite the added restrictions, opponents said they believed the new law would still wreak havoc on local communities.
"It is definitely going to be an issue," said Mitchell Sklar, executive director of the New Jersey State Association of Chiefs of Police.
Sklar said police chiefs in California warned him that medical marijuana could lead to increases in criminal activity, particualrly in the areas where it is sold. On top of that, he said, police officers will have the added burden of distinguishing whether someone is using marijuana legally or not.
Since state lawmakers saw fit to pass the law, Sklar said, he'll wait for the state to provide training and direction on how to enforce it. There are many questions that need answering, he said, like what the penalty will be for registered users found with more than their share of marijuana, or those caught with fraudulent medical identification cards. Police will also need to know what constitutes probable cause to ask someone if they're using marijuana, he said.
"It's just another layer of bureaucracy," said Naomi Hubbard, executive director of the Camden County Council on Alcoholism & Drug Abuse.
Hubbard said she was planning to pay close attention to crime reports and hospital records to track any negative impacts. Beyond that, she said, she would focus on educating parents to be aware that their children might have easier access to marijuana in the near future.
Maybe the new law will at least convince lawmakers to funnel more funding into prevention programs, said Diane Litterer, executive director of the NJ Prevention Network.
Litterer said she's sympathetic to patients in pain but didn't think that legalizing marijuana was worth the message it sent to youth.
"They're hearing on the news that it's medicine and it's okay to take it," Litterer said. "We have a tough enough job trying to educate our youth that it's not a good choice to use drugs and alcohol and this just adds to those difficulties. It's like, 'Oh, it's not so bad.'"
Scotti discounted arguments that the law will encourage illegal drug use.
"Allowing seriously ill people access to marijuana doesn't send any different message about recreational use of marijuana then allowing medical access to morphine," she said.
Quelling fears and educating doctors about appropriately prescribing the drug will take time, Scotti said.
Even after the law takes effect in June, Wolski said patients may have to wait another three months for the dispensaries to open and another three to four months after that for the plants to grow - though centers might be able to import plants in the interim.
On a positive note, he said, that gives New Jersey the chance to be a model for other states that have been uncomfortable with home-grown plants or other "lax" components of existing laws.
Until that happens, Wolski said, even state-certified patients will still face hurdles when it comes to traveling. Four states with medical marijuana acts have reciprocal agreements: Montana, Michigan, New Mexico and Rhode Island, according to the National Organization for the Reform of Marijuana Laws, or NORML. But otherwise, states don't have to honor the policies of another state - which means South Jersey patients who work in Philadelphia will have to leave their marijuana at home.
Segal said it's still hard to absorb that this is really happening even though she witnessed the final vote at the statehouse.
"We didn't know whether to clap or not to clap," Segal said. "We walked out like deer in headlights."
January 17, 2010
New marijuana law hailed, but concerns still remain