Patients with severe pain, nausea and vomiting often accompanying chronic or terminal illness now have one more viable treatment alternative on their side. NJ Gov. Jon Corzine's Jan. 18 signing of the New Jersey Compassionate Use Medical Marijuana Act will allow patients in the Garden State to have legal access to marijuana with a physician's prescription.
"It never made sense for many of New Jersey's residents to suffer when there was a viable way to ease their pain, and medical marijuana will now soon alleviate a lot of suffering," said bill co-sponsor, NJ Assemblyman Reed Gusciora (D-Princeton, Lawrenceville, Ewing), in a news release.
What the Law Allows
The law states only patients with proven "debilitating conditions" will qualify to use medical marijuana. It specifically mentions patients with HIV-positive status, AIDS, cancer and glaucoma. The law also encompasses "a chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome, severe or chronic pain, severe nausea, seizures, including, but not limited to, those characteristic of epilepsy; severe and persistent muscle spasms, including, but not limited to, those characteristic of multiple sclerosis or Crohn's disease; or any other medical condition or its treatment that is approved by the department by regulation."
In addition, the law mandates a patient with a prescription and a state-issued identification card will be allowed to receive medical marijuana with a limit on the amount that can be accessed in 1 month.
Defining Exact Amount
While parameters have not been determined yet, other states with mandated medical marijuana use usually prescribe it in doses of 3-5 g per day or 3-5 marijuana cigarettes, with effects that can last 2-4 hours, according to Eva Russell, BS, RN, CWS, FACCWS, CHPN, CLNC, director of nursing at Samaritan Hospice, Marlton, NJ.
Under the new law, patients would be prohibited from smoking marijuana in public, growing it in their own homes and driving under its influence. In fact, marijuana has to be purchased at one of six state-authorized nonprofit alternative treatment centers (locations to be determined).
While the law takes effect in 6 months, it could be close to a year until it's fully in place in the patient care setting.
Impact on Patients & Nurses
Regardless of how long it will take to be fully implemented, many nurses see the law as exciting news for patients.
"In our work, we're acutely aware of the toll chronic and severe pain takes on the quality of life," said Joanne Scillia, BSN, RN, vice president and chief clinical officer at the Visiting Nurse Association of Northern New Jersey, headquartered in Morristown. "As a result, it's our belief patients should have access to all medically and legally approved treatment alternatives. As soon as this drug becomes available, we're ready to support patients and work collaboratively with physicians to identify cases where it might prove beneficial for pain/symptom management."
Medical marijuana can be an adjunct for patients with neurological pain, nausea and/or vomiting who don't want to take numerous narcotics, said Russell. "Marijuana is proposed to create a sense of well being, especially helpful for our terminal patients."
Nurses could be involved in acquiring medical marijuana for patients unable to physically get to an alternative treatment center by receiving the physician's order and filling the prescription.
Concerns & Issues
While the benefits of medical marijuana are touted in current literature and anecdotally, the movement has its critics. Opponents say medical marijuana could be a gateway drug to the use of stronger controlled substances, could lead to the legalization of marijuana as a whole or could get into the wrong hands.
Russell disagreed, "If someone is going to use a drug, they're going to get it whether it's legal or not. I don't think that's a real issue."
Still, a potential medical disadvantage could be the smoke as an irritant to the patient, said Russell. "If patients can't tolerate the smoke, patients [can do as they've done] in California [where the law has been in effect longer] and ingest it in food or tea."
Another drawback could be patients may not be able to afford it since the law doesn't require it be covered by insurance or government medical assistance programs.
"Access may prove to be the biggest challenge," said Scillia. "We're also awaiting details about how the drug will be dispersed since the law calls for establishment of six licensed facilities throughout the state."
It's not for everyone, asserted Russell. "I don't think everyone will be smoking medical marijuana," she said. "But I do think it has its place for the right patients. Medical marijuana will be another tool for symptom management."
Christine McLaughlin is a frequent contributor to ADVANCE.