New Jersey’s top doctor Tuesday encouraged physicians and medical students to embrace cannabis as another tool to help their patients, despite acknowledging that rigorous scientific research is lacking.
During an hour-long special grand rounds presentation that drew more than 100 attendees at the Rutgers Robert Wood Johnson Medical School in New Brunswick, State Health Commissioner Shereef Elnahal said his goal was to “demystify” medical marijuana because thousands of patients are using it and finding relief.
“We want to see more research, better research, but we are not,” Elnahal said.
As long as marijuana remains a “schedule 1 drug,” the U.S. Drug Enforcement Administration will view it as among the most dangerous substances with no medical benefit, he said. The limited studies that have occurred in the United States often rely on private funding, and the outcomes are based on a small sample size, he said.
But the research is promising, Elhanal said. Cannabis reduces pain, muscle spasms and the incidence of seizures, and promotes appetite and sleep, he said.
“I want this to be in physicians’ and other providers’ heads as a therapeutic option — not something separate, not sort of in a different category like alternative medicine. This really is reaching a level of relevance and importance to patients,” said Elnahal, a physician and former Veterans Administration official.
He urged doctors to recommend vaping or to consume non-smokable forms of cannabis, which anecdotally have shown great benefits.
Before 7-year-old Jake Honig’s death from cancer in January, the boy’s parents Mike and Janet from Howell said “medical marijuana oil was the only therapy that allowed for him to be comfortable in the last few months of his life,” Elnahal said.
“At the end of the day, this is about patients. The Department of Health is pushing this because…many times it is the best therapy you can give them.”
This presentation was the first in a series to promote New Jersey’s medical marijuana program, which has grown from 16,000 patients in December to 22,000 this month, with expansions and changes touted by Gov. Phil Murphy’s administration.
But in a state will 28,000 registered physicians, only 622 participate — a problem for patients seeking access to the program.
It was hard to tell whether Elnahal changed minds. The audience, many in scrubs and white coats, listened intently and applauded respectfully. But when it came time for questions, the doubt was obvious.
One child psychiatrist said she could understand how cannabis might be recommended for a terminal cancer patient, but not for her patients, who may be diagnosed with depression and post traumatic stress disorder.
“We don’t have the evidence, for me, to jump on board to do that,” the psychiatrist said.
Jill Williams, an addiction psychiatrist and medical school professor, said the state needs to be more cautious, especially when involving mental health diagnoses like anxiety.
Murphy added that condition to the list of qualifying illnesses in March.
“The leading research right on the biology of addiction says all people use substances to take away bad feelings, so they idea they would feel better when they use marijuana is not a surprise,” Williams said. “I don’t think you can totally interpret that as medicinal. People use alcohol to cope with trauma and depression and other problems.”
Williams said the state should “come clean” and legalize marijuana for everybody if it’s going to be used to treat “human conditions” like anxiety.
Gloria Bachman, a professor of Obstetrics and Gynecology, asked the health commissioner to include perinatal physicians in any discussions about women of child-bearing age using cannabis. Elnahal said that was a “totally reasonable” request.
Laura Methuin, an internal medicine resident, suggested the state drop the slang and street terms, such as “edibles” or even the word “marijuana,” itself, to help build acceptance from the medical community. Elnahal called that “a great idea,” one that has been suggested by the National Academy of Medicine.
Medical ethicists contacted by NJ Advance Media gave Elnahal credit for having the conversation, but urged caution because of the limited research.
“If you are not teaching this at medical school, you are not giving an adequate education. It’s out there enough and being used from an educational standpoint. It deserves to be talked about,” said Barron Lerner, a professor of Medicine at the NYU Langone Medical Center.
“It shouldn’t be used to replace other medications that are efficacious,” Lerner said, offering his opinion. “There should be good informed consent before prescribing it.”
Abraham M. Nussbaum, an associate professor at the University of Colorado’s Department of Psychiatry, said physicians should keep an open mind about cannabis, especially for their patients who want to try it.
“I don’t think physician are obligated ethically to recommend anything to anyone,” Nussbaum said. “But physicians are always obligated to be open to where their patients are, and talk in a neutral way. We should keep abreast of scientific knowledge – so patients know the risks and benefits, which are changing monthly.”
