THE ALTERNATE APPROACH TO MEDICAL MARIJUANA DISTRIBUTION

WE FEEL there is no question about it: The careful, legal distribution
of medicinal marijuana to those in need is a good thing. The New
Jersey Legislature agreed and passed legislation permitting
distribution last January. Then-Gov. Jon Corzine signed the measure
before leaving office.

But Governor Christie has requested a delay in its implementation, and
a proposal to modify the system of distribution is cause for concern.

More than a year ago, Seton Hall Law's Center for Health and
Pharmaceutical Law and Policy distributed a position paper to New
Jersey lawmakers urging passage of the marijuana measure, called the
"New Jersey Compassionate Use Medical Marijuana Act." The center did
so citing the inclusion of "multiple measures designed to reduce the
risk of abuse or diversion" and noting that "the medical literature
supports the conclusion that smoked marijuana can provide relief to
patients suffering from debilitating medical conditions for whom
conventional treatments have failed."

Implementation Delayed

The act was to have taken effect this month, but, in response to a
request from Christie, the Legislature pushed back the effective date
to October.

As passed, the act provides that medical marijuana be grown and
distributed by six not-for-profit "alternative treatment centers."

But now, the New Jersey Council of Teaching Hospitals has proposed
that the act be amended - before it is even implemented - to provide
that medical marijuana instead be grown by Rutgers University and
distributed by the state's teaching hospitals.

While hospitals are, as the Council of Teaching Hospitals points out,
experienced dispensers of medicine, the act should not be rewritten to
require them to dispense medical marijuana.

The passage of the act affects the rights and responsibilities of
patients and providers of medical marijuana under New Jersey law; it
does not change the fact that distribution and use of marijuana are
illegal under federal law.

Although Attorney General Eric Holder has pledged not to prosecute
patients and providers who comply with applicable state laws, and
hospitals could thus dispense medical marijuana without fear of
criminal prosecution, they would still be violating federal law.

Condition of Participation

This is a problem because compliance with federal law is a condition
of participation in the Medicaid and Medicare programs. Hospitals
depend heavily on Medicaid and Medicare funding; the Compassionate Use
Act's alternative treatment centers would not.

Hospitals would require assurances beyond Holder's pledge not to
prosecute before they could dispense medical marijuana. At a minimum,
they would need an assurance from the federal Centers for Medicare and
Medicaid Services that dispensing marijuana in accord with New Jersey
law would not affect their eligibility to participate in Medicaid and
Medicare.

Even assuming that such an assurance would be granted, obtaining it
would, in all likelihood, lead to further delay.

The New Jersey Council of Teaching Hospitals argues in support of its
proposal that, in addition to being experienced dispensers of
medicine, many hospitals have experience conducting medical research.
The council suggests that hospitals could direct some of the proceeds
from the sale of marijuana toward research into the drug's medicinal
effects.

The Necessary Expertise

More medical marijuana research is much needed and New Jersey's
teaching hospitals have the requisite expertise and experience to
conduct it. But if hospitals were to violate federal law by selling
marijuana, it is unlikely that they would be able to secure the
federal approvals necessary to embark on such research.

As the Compassionate Use Act provides, "Modern medical research has
discovered a beneficial use for marijuana in treating or alleviating
the pain or other symptoms associated with certain debilitating
medical conditions."

But there is still a lot we do not know about marijuana's full
potential as a medicine. For example, a clinical trial sponsored by
the Center for Medicinal Cannabis Research at the University of
California San Diego suggests that determining the correct dose could
be key to how well the drug works. While marijuana cigarettes
containing a low dose of the active ingredient THC provided no pain
relief to study participants, marijuana cigarettes containing a medium
dose of THC had a significant pain killing effect. Meanwhile,
marijuana cigarettes containing a high dose of THC actually increased
the study participants' pain.

New Jersey researchers seeking to study marijuana's medicinal effects
would first have to comply with numerous federal laws and regulations.
Before any unapproved "new" drug is tested in humans, an
investigational new drug application must be filed with the Food and
Drug Administration.

When the drug in question is marijuana, researchers must clear
additional bureaucratic hurdles. A Public Health Service committee has
to sign off on the merits of the research protocol and the competency
of the researchers, after which the Drug Enforcement Administration
must give its approval.

Research-Grade Product

The National Institute of Drug Abuse then provides the research team
with government-authorized "research-grade" marijuana. Only by
establishing working relationships with all of these federal
regulators was the University of California's Center for Medicinal
Cannabis Research able to conduct the first clinical trials of smoked
marijuana in the United States in over two decades.

It is hard to understand how New Jersey's hospitals could successfully
establish similar relationships while simultaneously selling marijuana
in contravention of federal law.

Beneficial Research

Our hospitals do not need to go into the medical marijuana business in
order for beneficial research to proceed. Sen. Nicholas Scutari,
D-Union, one of the sponsors of the Compassionate Use Act, has
proposed that the government tax sales of medical marijuana. Some or
all of the proceeds of such a tax could be directed to a dedicated
research fund.

A rigorous, competitive process, akin to that developed by the Center
for Medicinal Cannabis Research, could then be employed to determine
which research proposals would be supported.

If the Legislature requires New Jersey's teaching hospitals to
distribute medical marijuana, it will put them at legal risk and make
it near impossible for them to pursue clinical research into the
drug's safety and efficacy.

The Compassionate Use Act should be implemented as written, with
marijuana plant growth and distribution conducted through alternate
treatment centers, as quickly as possible.