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Medical Cannabis: Have You Checked the NJPMP?

There is no question that our current administration is aggressively pushing to expand the Medical Marijuana Program (MMP) in New Jersey, separate and apart from pursuing legalization of adult use.  The number of patients registered in the MMP has doubled during the Murphy administration.  When Gov. Murphy took office earlier this year, approximately 17,000 patients were registered; now, less than a year later, 34,000 patients are registered.  That is a drastic increase, considering that the MMP has been in effect since 2011.

One of the reasons for the drastic increase in patient numbers is the addition of five qualifying debilitating conditions: chronic pain related to musculoskeletal disorders, migraines, anxiety, chronic pain of visceral origin, and Tourette’s Syndrome.  Chronic pain related to musculoskeletal disorder is the leading debilitating diagnosis for the patients who have registered since the expansion of qualifying conditions; anxiety is second.

Additionally, medical marijuana is being viewed as a means to combat the opioid epidemic and physicians are encouraged to recommend the use of medical marijuana to patients suffering from an opioid use disorder related to chronic pain.  A physician recommending the use of medical marijuana as an alternative to opioids or to aid in weaning off opioids should make use of the NJ Prescription Monitoring Program (NJPMP) and maintain proof of checking the NJPMP in the patient’s chart.  If the patient is obtaining medical cannabis, then presumably his/her use of opioids would begin to taper, hopefully significantly reduce, and optimally result in complete discontinuation of opioids.  The current law requires that a physician review the course of treatment and effectiveness of medical cannabis every three months.  Periodically checking the NJPMP is one of the best tools physicians can employ in monitoring opioid use by their patients.  Accordingly, I would encourage all physicians who recommend medical cannabis to review the NJPMP for signs of abuse or diversion on a quarterly basis and document their findings in the patient records.  If the physician is working with the patient to reduce their opioid consumption, then the number of prescriptions and quantity of pills should decrease as medical cannabis is introduced. If the quantity of opioids remains the same, even after medical cannabis is introduced, then the physician should take great care to document the clinical reasons for not tapering the opioids, as this will be highly scrutinized if the physician comes under investigation.  The law also requires that the Department of Health be notified if the patient is misusing or diverting medical cannabis.

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