Doc, how about some marijuana?

I have an admission to make. When I was in college not only did I not inhale, but when it came to pot, I never imbibed.  Yes, I am one of the few who stumbled out of the 70s without anything more intoxicating than a cute coed or a beer (drinking age then was 18).  So, it is with some trepidation and shock that years later, the State of New Jersey has placed in my hands the power to order marijuana.

Now truthfully, it is not so amazing, cannabis is just another drug I have not used.   I have never taken chemotherapy, narcotic pain medications, diabetic drugs or hundreds of other chemicals that I have professionally ordered for decades. Still, even though medical practitioners have prescribed marijuana for several thousand years, it is somewhat bizarre that someone who retreated at the sweet scent of smoking weed to the musty smell of library shelves, is now responsible for ordering quarter ounce bags. Based on my experience I am not the only one surprised and a little confused.

In recent days, I have seen several patients befuddled about the approved uses of prescription pot. Mary has lung cancer under the care of another oncologist. She saw me not to change docs, but rather to obtain medical marijuana. While not an unreasonable request, especially in light of her disease, this 82-year-old’s reason was;  “The Internet says that cannabis can cure cancer.” Another patient wanted it to treat his chronic back pain.  The next day, Edwin inquired about a script for marijuana to prevent claustrophobia during air travel. As I explained to the three, in order, “not true”, “perhaps partially affective, but not legal” and “The TSA strongly advises; ‘traveling while stoned, not a good idea’.”

So, in order to prevent future odd conversations, let us review the legal uses of medical marijuana in New Jersey and the steps necessary to get a prescription.  This is not like most other drugs, where it is the doctor’s decision whether to prescribe a treatment based on the his judgment.  The State has a specific process and has approved only certain medical indications.  Both doctors and patients who stray from this path, do so only at significant legal risk.  Whatever your beliefs are regarding recreational reefer; we are talking healthcare here, and not entertainment.

The approved debilitating medical conditions approved by the New Jersey Medical Marijuana Program are:

◦                                  Amyotrophic lateral sclerosis (ALS)

◦                                  Multiple sclerosis (MS)

◦                                  Terminal cancer

◦                                  Muscular dystrophy

◦                                  Inflammatory bowel disease, including Crohn’s disease

◦                                  Terminal illness, if the physician has determined a prognosis of less than 12 months of life. 

The following conditions apply, if resistant to, or if the patient is intolerant to, conventional therapy:

◦                                  Seizure disorder, including epilepsy

◦                                  Intractable skeletal muscular spasticity

◦                                  Glaucoma 

The following conditions apply, if severe or chronic pain, severe nausea or vomiting, wasting syndrome results from the condition or treatment thereof:

◦                                  Positive status for human immunodeficiency virus

            Acquired immune deficiency syndrome


If a patient has one of these conditions, then the next step is to see a physician who has registered with the State of New Jersey to prescribe these medicines. A list can be found on the Medical Marijuana Program’s website.  In order for that doctor to prescribe the drug, they must have a “bona fide” relationship with the patient.  In NJ bona fide means that a relationship has existed for at least one year, the patient has seen the doctor at least four times or the doctor does a complete medical exam and assumes responsibility for treating the debilitating condition.

After seeing the patient, the doctor certifies the patient on the State Website.  After that, the patient must register.  This is done online and requires documentation, including photo identification and proof of NJ residency.  A patient must pay $200 to register and if they wish to send someone else to pick up the drug, as it cannot be mailed, that caregiver must also register and pay $200.  Patients under 18 must register with a legal guardian.

The patient must pay for the drug, which is not covered by private or government health plans. Marijuana is supplied only at recognized ATCs (Alternative Treatment Centers), of which there is so far only one, Greenleaf Compassion Center in Montclair, although five more may soon open.

Marijuana in New Jersey is packaged in eighth and one-quarter ounce bags.  The most that can be supplied is two ounces per month (the equivalent of 50 to 110 joints).  This is parallel to any prescription pain medication for which the usual maximum amount is 120 doses per month. The physician can certify each patient for up to 90 days and then the patient must see the doctor and be recertified.  Like any intoxicating substance, a patient using medical marijuana can not drive or operate dangerous machinery, nor can it be used in any car in motion, smoked on public transit, in school, in a park, on the beach or in jail.  I find the last restriction redundant.

Marijuana has benefit in certain patients with the conditions noted above.  Usually other prescription medications and treatments will be more effective.  On the other hand, cannabis is safe, with no confirmed overdose deaths in the world literature. In most people it causes positive changes in mood and perception, although in some it can increase panic, paranoia, cause rare hallucinations and while not classically addictive, highly dependent patients can have significant social malfunction and impairment. Like cigarettes it may, if used heavily for years, increase the risk of chronic lung disease and cancer.  However, compared to many prescription medications and alcohol, marijuana has few side effects.  Nonetheless, a frank conversation between the physician and patient regarding risks, benefits and alternatives, is vital in deciding whether to use this drug.

As an oncologist, I am happy to see another drug in the armamentarium to help our patients, especially as they battle complications of the dread disease.  While I do not see marijuana as a major breakthrough, it does offer another choice and will help some patients.  As a closeted nerd, I scratch my head.  I guarantee no one in my dorm, thirty years ago, would have believed that I would become a cannabis connection.



  • Kind of interesting how the world and our roles involved. I was offered medical marijuana to deal with some of the immediate post-transplant discomfort but declined - was lucky enough to have relatively minor symptoms and didn't want my then teenage kids to see me smoking weed! But I had tried it 30 years ago ...
    • James Salwitz, MD
      Often when I write narcotic presciptions, patient's do not take the meds for similar reasons ... don't want their kids to see them "taking dope." Weird world. jcs
  • The year was 1970. I was rounding on a young man about to receive chemotherapy for acute leukemia. He excused himself for a moment and retired to his bathroom. He emerged shortly thereafter wreathed in a cloud of acrid smoke. He was giddy and silly. He'd premedicated himself, of course. I have followed the scientific information of THC ever since. My personal experience with patients over 35 years has been that the drug is neither a very good anti-emetic nor an analgesic of note. However, the incredible pressures brought to bear by testimonials and demands made by young devotees of the drug have successfully coaxed its use into mainstream medicine, into legislative debates and to tacit support by the President himself. My point is that perhaps there is no need to spend billions every year in the private and governmental sectors to introduce new drugs into the cancer treatment armamentarium. It may be easier, and cheaper, to lace new compounds with a "feel good" component that makes advocates out of patients. After all, feeling good is what it's all about, eh?
    • James Salwitz, MD
      Interesting idea. Change the whole "War Against Cancer" campaign to a "hey man, it's all cool," sort of approach. An NCI meets Cheech&Chung concept. I wonder if there is grant funding? jcs
  • D Someya Reed
    Well, so you won't feel alone, I'll admit that I too exited the 1970's without inhaling, ingesting, or injecting anything. Can't even admit to that beer...Dad being an alcoholic and all. The cute coed? Now that was intoxicating but most of my time was spent, same as you, in the library. Since I'm baring my soul here, I'll admit too that some of my reading material (outside of the library) was of the comic book variety. Still is...can you ever tire of a man who can fly? For all its uses...real, imagined and wishful...cannabis is a drug just like any other. Some places it's legal, some places illegal. In my town it's the latter yet a flyer appeared on my door handle stating: "Will your doctor not certify you for medical cannabis? We have one who will!" Now that's disturbing.
    • James Salwitz, MD
      My son's response to this blog, was; : "Got the point across, you're as square as they come." Yeah, I do remember comics and punching hundreds of cards just to get those first computers to multiply two numbers. We got "high" adding up columns. My thoughts about a "doctor" who is advertizing cannabis prescriptions as a primary service? Make sure you have a great lawyer. jcs
      • D Someya Reed
        I like being square and, for us, what you say about adding up numbers is true. My favorite (and idol) was the "old man" (at least to me at the time) in the grocery store who could add up the items faster than the clerk could ring them up. This was before scanners...when dinosaurs and I ruled the earth. Anytime they wanted to hit subtotal he could tell them what the amount would be. I never saw him miss. Truly amazing!
        • James Salwitz, MD
          One does wonder what skills and what parts of creativity are being lost with the flood of IT. I have a partner who has what we once called a photographic memory. He can remember thousands of articles dating back many decades by author, date and page. A useless skill in the new world. jcs
  • Stacy Snyder
    My mother received extensive chemotherapy to treat Stage 4 colon cancer. Each prescribed anti nausea medication was only marginally effective and produced unpleasant effects such as severe ankle swelling, headache, CNS depression etc. As my mother's weight loss and malnutrition became alarming I requested Marinol (the pharmaceutical medication that is the anti nausea alkaloid in cannibis) and was told "it wasn't in the formulary in Pennsylvania". Desperate , I decided to offer her marijuana in ingestible form. The difficulty here was that I didn't possess any and did not know how to acquire it. Fortunately a friend of hers provided some and I baked with it. The effects were astonishing as my mother became able to leave her recliner for the first time in six months and stand like a human being. Nothing else (we tried every possible med) worked. I am glad that other cancer patients will have medical marijuana available as needed.
    • James Salwitz, MD
      Quite an endorsement. It is great to learn how much marijuana helped her. Thank you very much for the comment. jcs
  • Stephanie
    I am a 60-ish straight-laced, upper middle income, "regular" cancer patient. I tried marijuana in the 70's, but it never became part of my routine. Didn't like the "stoned" feeling, but I don't like alcohol either for that reason. However, while undergoing weekly carboplatin/taxol I had a very very difficult time with nausea and vomiting. Zofran and compazine provided minimal results and it took at least 30 minutes for these drugs to kick in. My adult daughter's friend talked me into trying marijuana. As I couldn't keep anything down, I smoked it. All I needed was 3-4 small puffs and the nausea would almost always go away completely within 1-2 minutes. Seriously. I know it sounds hard to believe, but this has consistently been my experience when used for chemo side effects. The amount I took in was so little, I just felt relaxed - not stoned. Perhaps I would smoke it 1-2 times per day, maybe 2-3 days per week. It got me through and I have no desire for it now. I recognize this is a tough issue and is loaded with medical, social and political perspectives. I can only tell you how it really helped me and I would do it again if necessary - that's how effective it was. I do worry about people abusing it and it getting into the hands of minors. Keep an open mind, Doc, and report back to us.
    • James Salwitz, MD
      Thanks for your very important comment. It is really important that patients speak up and share their experiences. It is people such as you who drive change. jcs
      • Angela
        What about fibromyalgia patients? Are we entitled to this?
        • James Salwitz, MD
          At present the NJ Marijuana program does not recognize non cancer, non HIV or non terminal pain as indication for marijuana. It is too bad as it likely would help some patients with fibromyalgia.
  • IBS
    I am so happy you cooked the pot instead of letting her puff, and she felt so much better. I tried ONE puff in 1966 with a friend. I got so sick and my voice changed into my brother's voice. I'm an artist, looked like an artist, but no drinking and no pot. LUNG cancer patients are looking for Cannibus OIL. They describe it as black sludge, and they're swearing by it. It's hard for them to get it though. Did you ever hear of this? They are mixing it with something and just a little at a time until they get to a certain amount. Well, it could get people to visit :) The word black sludge doesn't sound very appetizing, and my luck , I would probably bark like my dog. If it helps someone ....please give them a prescription. It will give them an appetite and takes the stress away. If it's not good for chemo and radiation patients, that decision is up to one's doctor. If a person is Palliative, they should be able to have it. Stephanie is doing great with it. For that, I 'm so happy for her!
  • IBS
    True but funny! One day my Mom showed me all these lovely plants that just grew in our backyard. She would make sure she watered them everyday, and they grew and grew. One day she couldn't find them. Someone pulled them out! Why would they take our plants? Truthfully, I didn't know.. Well, when one of my brother's came home, my mother started yelling about these dumb plants. She loved those plants. They were growing like bean stalks. She actually loved those plants. He didn't tell us until a year later who was the culprit! :) (Tell Mom thanks for watering them!) He had to buy more books. My Mom was still pissed, but I couldn't stop laughing. ( think my Mom took too much care and got too close to them!)

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