COMPROMISE CAN'T QUELL NEW JERSEY MEDICAL MARIJUANA DEBATE

Diane Riportella is in the final stages of Lou Gehrig's Disease. She
expects to die soon.

The 54-year-old Egg Harbor Township woman says smoking pot "gives me
a reprieve from this living nightmare" by suppressing her pain
without relying solely on morphine, which leaves her "lifeless."

"When I smoke marijuana, I feel normal. I can express myself and be
the person I want," she said at a Senate committee hearing last month.

Poonam Alaigh, the state health commissioner and a doctor, also says
she has seen the value of medicinal marijuana. One patient suffering
from severe nerve pain recently confided to her he has been using pot
in addition to prescription painkillers and feels remarkably better.

"He told me how his life changed so much as a result of this," Alaigh
said. "It was an eye-opening experience for me."

But all year long the politics of medical marijuana in New Jersey has
trumped any shared belief in its benefits.

Fearing the new law will feed more recreational users than patients,
Gov. Chris Christie's administration proposed unprecedented
restrictions limiting the potency level of legal pot far below what
can easily be bought on the street, as well as the number of strains
sanctioned growers may cultivate.

Christie would also prohibit the sale of cannabis-laced brownies and
other edible products popular in other medical marijuana states as an
alternative to smoking.

Democratic lawmakers say they never intended such a restrictive
program and have advanced a resolution to kill the rules. Christie on
Friday sought to end the standoff by announcing a compromise on other
parts of his plan, saying he will remove tougher rules on where pot
will be distributed and requirements that doctors allow medical
marijuana as only a last resort.

But the announcement didn't quell the controversy over how New Jersey
will implement its new medical marijuana law.

In her first interview since the health department unveiled its rules
three months ago, Alaigh said New Jersey's approach to medical
marijuana is misunderstood. While concerned about keeping pot from
recreational users, she contends New Jersey's program is better than
other states with medical marijuana laws because it is more focused
on the patient's well-being.

"Where other states give patients a license to possess, our
physicians will be actively involved ... ensuring the right patients
are on the appropriate care plan," she said.

The state also plans to be the first to create a database tracking
patients' progress and side effects from pot, based on reports from
doctors and operators of "alternative treatment centers," that will
dispense the pot, Alaigh said.

"This is going to be a great observational study over time, and may
actually be the foundation for future studies," she said. "This is
really exciting."

While medical marijuana advocates strongly oppose many of the
administration's proposals, the debate is hindered because there
hasn't been much research in this country, where pot was declared
illegal by the federal government in 1937.

ProCon.org, a nonpartisan, nonprofit research site, identifies 69
studies worldwide: 32 said marijuana is a valid source of pain and
symptom relief, 14 concluded it had no medicinal benefit, and 23 had
mixed results.

The favorable studies credit marijuana with reducing pain and helping
people regain their appetite, including cancer patients undergoing
chemotherapy. It's been shown to reduce muscle spasms seen in
multiple sclerosis patients.

In crafting New Jersey's medical marijuana program, Alaigh said she
was most influenced by the recent studies from McGill University
Health Centre in Canada and state-funded research at the University
of California at San Diego. At both sites, researchers gave patients
marijuana with a potency level at or less than 10 percent THC
(tetrahydrocannabinol) and they felt a marked drop in pain, fewer
problems with sleep and reduced anxiety, according to the published findings.

Alaigh said this is why the Department of Health and Senior Services
would require growers to produce marijuana with a potency level of no
more than 10 percent. Patients will have the option to buy low,
medium and high doses of pot to see what works best for them, she added.

The department would also restrict the number of plant strains sold
in New Jersey to six from the thousands that exist. Known elsewhere
by colorful names such as Diesel, AK-47, White Widow, strains reflect
varying degrees of chemical compounds cultivators say (but science
hasn't proven) provide an energy boost or a sleeping aid, depending
on a patient's needs.

Alaigh also would prohibit the sale of pot-infused edibles like ice
cream and brownies. The alternative treatment centers would sell buds
for smoking and vaporizing, as well as lozenges, skin ointments and
edible oils. They may also provide patients with recipes for edible
goods, Alaigh said.

Alaigh said the edible pot-product market booming in California and
Colorado lacks the "integrity" she wants the program to convey, and
any benefits of eating pot would be harder to measure. "I don't want
an ATC to become a bakery, This is serious business."

The two studies cited by Alaigh showed less-potent pot relieved pain,
but its leaders say more research is needed to determine the effects
of higher levels.

Igor Grant, director of the Center for Cannabis Research at the
University of California-San Diego, said in seven clinical trials,
his team relied on marijuana with a maximum potency of 8 percent
because that's what is produced at the only legal place the center
could obtain it, a federally sanctioned lab.

Grant said patients felt the most pain relief at the 4 percent to 6
percent potency, with fewer benefits and more side effects at the
higher range. "I don't think anyone has done enough research yet but
our data show for neuropathic pain, THC doses of 4 percent were fine
and did ameliorate the pain, and the side effects were very
tolerable," he said.

Grant noted his studies were short-term, and did not take into
account how the body grows accustomed to the drug and its side
effects if the patient is a frequent user.

The clinical director of McGill's Pain Clinic, Mark Ware, gave
patients with severe nerve pain marijuana with potencies of 2.5
percent, 6 percent and 9.4 percent. Patients who received the highest
dose felt the least pain and slept better, according to a McGill
statement on the research released in August.

Although Ware did not use pot with a THC level in excess of 10
percent, he said future studies should examine the impact on patients
who consume higher potency levels.

"So would we get better results if we had slightly higher THC levels,
would we get better results if the patients could use it for longer
periods, or if they could use it more frequently during the day?"
Ware said. "I think these are questions that we can't answer."

The San Diego and McGill studies did not look at pot in edible forms.
Grant said in general, inhaling the drug is faster and more reliable
than any edible product.

Those who support medical marijuana, however, say patients, not the
government, should decide what form of the plant is best for them,
whether it's in a pipe or baked into a cookie.

"This is very important to chronic pain sufferers, plus it offers an
alternative for throat and lung cancer patients, who have difficulty
smoking the medicine," said Cindy Kleiner, 47, of Wantage. She takes
Marinol, an FDA-approved synthetic form of THC that doesn't do enough
to control the chronic pain she suffers from two car accidents. She
said she researched medical marijuana in anticipation of the law passing.

"When cannabis is smoked, it only lasts for approximately two hours
and you are not even getting close to the 10 percent THC. When it is
eaten, the dosage can be measured and it can last up to 12 hours,"
Kleiner said.

Kleiner and other patients also object to limiting strains and
potency because some who already use pot illegally are exposed to THC
levels at 15 percent or 20 percent.

"Patients are not going to buy from legal dispensaries. They are
going to be forced to purchase this medicine on the streets because
of the better quality there," said Kleiner.

Patients and medical marijuana advocacy groups say they are
frustrated by the administration's reluctance to give more credence
to the experience in other countries.

"Many of the new restrictions created by the Department of Health and
Senior Services are based in politics, not in science," said Chris
Goldstein, a board member for the Coalition for Medical Marijuana New Jersey.

Philippe Lucas from the Vancouver Island Compassion Society, a
nonprofit marijuana club operating outside Canada's sanctioned
program, said government-supplied marijuana is typically 12 percent
THC potency, compared with the 15 percent to 25 percent he sells.

"The main thing to remind regulators is that if the product legally
available to patients is not as good (or as potent) as that available
on the black market, patients will keep having to risk arrest to get
effective medicine, and that benefits no one," Lucas said in an
e-mail. "That's exactly the situation we currently face in Canada."

Dale Gieringer, state coordinator for the California National
Organization for the Reform of Marijuana, noted that cannabis
products sold in the Netherlands have potency levels ranging from 6
percent to 18 percent, and are "rigorously tested according to
established pharmaceutical standards" in that country.

Alaigh said she has reviewed European studies and practices, and does
not give them as much weight.

"There is no drug that gets approved here based on studies outside
the U.S.," Alaigh said, "This is not an FDA-approved drug, but I
cannot relax our standards."