Patients fear medical program is failing without intervention from state officials, cannabis agency

New Jersey is among five states that have legalized recreational marijuana but have not banned police officers from consuming cannabis while they're off duty. (Photo by Daniella Heminghaus for the New Jersey Monitor)

Recreational marijuana continues to boom in the Garden State as new dispensaries open every week two years after the industry’s launch.

But on the medical side, patient numbers have steadily dropped since the legalization of recreational cannabis, leaving patients concerned the program is floundering while the state fails to do enough to maintain a robust program for people who depend on marijuana as medicine.

“It’s like they’re not even faking an effort anymore, like feigning interest in saving the program. It just seems like there’s so much more they can do, and I don’t understand why they stopped caring about the medical program,” said Michael Wiehl, a medical marijuana patient and local advocate. “They just did.”

As of April 15, around 80,000 medical patients remain in the state’s medical cannabis program, which began in January 2010. Enrollment peaked in May 2022 at more than 129,000 people, before steadily dropping amid the opening of recreational cannabis stores, according to state data. Sales of medical marijuana have also plummeted, with about $226 million in sales in 2022, compared to $124 million in 2023. And recreational sales brought in over $675 million last year — almost five times as much revenue as medicinal, state data shows.

It was expected medical enrollment would drop once recreational cannabis became more accessible. The rate it’s falling at, though, has medical patients and activists worried. They say doctor’s visits are too expensive and there’s not enough incentive to stay in the program.

But there are some perks to staying in the medical program, like extended hours, reserved parking at dispensaries, better deals, priority sales, tax exemptions, and greater purchase amounts.

Still, patients are voting with their feet by leaving the program behind, and state officials need to find ways to make medical cannabis a “very real part of health care in New Jersey,” said Ken Wolski, director of the Coalition for Medical Marijuana New Jersey.

Officials from the state Cannabis Regulatory Commission say they’re still looking for ways to support the medical market. In an effort to get more patients registered, the agency cut medical card fees to $10 — it cost $200 in 2018 — or patients can get a digital card for free.

Jeff Brown, the CRC’s executive director, said the state’s enrollment drop is on par with what other states have seen, and emphasized the agency’s mission includes “an unwavering commitment to patient access.” The CRC, which oversees the state’s recreational and medical cannabis markets, also pointed to the high out-of-pocket costs for doctor’s visits as a factor for the dropping enrollment.

“Despite what the NJ-CRC has done so far — eliminating registration fee and requiring Alternative Treatment Center to preserve priority access for patients — patients are seemingly leaving the program because they cannot afford the fees they are being charged by some doctors,” Brown said in a statement.

Under the medical marijuana law, known as the Jake Honig Law, doctors must register with the state in order to certify a patient as qualified for medical marijuana under medical conditions that include anxiety, chronic pain, cancer, and migraines. Roughly 1,500 doctors are registered with the state program, and many on the agency’s list are labeled as not taking new patients.

CRC officials say they have no control over the rates doctors set. Brown highlighted legislation passed during the pandemic that made telehealth renewal available to medical marijuana patients. Those services advertise for around $100 to $150. Out-of-pocket payments can be between $150 and $200 a visit, Wolski said, and doctors can ask patients to renew every 90 days or annually.

“We hear from (patients) that the significant obstacles they are facing are centered around costs that are outside the purview of the NJ-CRC: cost associated with the fees charged by doctors to provide authorization forms, and the cost of cannabis and cannabis products,” Brown said.

A 2022 report from Americans for Safe Access, a national cannabis patient advocacy organization, found that it’s a national trend for state medical programs to slow down as a result of recreational laws, but graded New Jersey a C+ on its medical infrastructure, largely based on its lack of a home cultivation program. The report recommended New Jersey lawmakers shift their focus from recreational legalization to “cover the existing gaps in their legal protections for patients in the medical cannabis program.”

Several bills introduced in the Legislature aim to expand insurance coverage to include covering medical marijuana, but none have made it out of committee. One bill would require the CRC to start a program to subsidize 20% of medical cannabis purchased by qualifying patients enrolled in the state Medicaid or NJ FamilyCare programs.

Wiehl also suggested lawmakers introduce a similar program that covers the cost of the doctor’s visits, or changing legislation to allow more doctors to certify marijuana patients. He also would like to see a greater push to cover the cost of medical marijuana, adding that he spends more than $15,000 a year on medical cannabis.

“$1,200 a month and that’s on the cheap side. This is a lot to ask someone to pay for their medicine. If it could get covered by insurance, that’d be great, but if the medical program goes away, that’s never going to happen,” said Wiehl.

And patients have long advocated for a home grow program, which would allow patients to cultivate cannabis plants at home. Both Wolski and Wiehl agreed this would spur more interest in the program. New Jersey is the only state with legalized recreational cannabis where it’s still a felony to grow marijuana plants at home.

Wiehl also suggested other sweeteners such as making high dose edibles and THC drinks limited to medical patients, like the markets in Connecticut and Massachusetts. He stressed that without offering exclusive items, there’s no “reason to be on the medical side.”

Because of benefits like employment protections and states that let out-of-staters with medical cards purchase cannabis, Wolski said he plans to maintain his enrollment and continue advocating for improvements to the medical marijuana program.

But while Wiehl commends the CRC for the work they’ve done to improve medical marijuana space over the last decade, he fears the state’s medical program could “wither away and die.” With 52 of the state’s 125 dispensaries serving medical patients, patients may have no option but to become recreational customers, he said.

The agency “let everyone come in and open up all these rec shops without forcing them into the medical side. You let all this happen, you didn’t do anything to stop it, and now we’re here,” he said. “At this point, let’s just wrap it up and move everything over to the recreational side. It’s backwards, and it leaves a bad taste in my mouth.”

Brown vowed that the agency is not considering shutting down the medical side. Most patients feel satisfied with support from patient services and priorities at medical dispensaries, he said.

“We are reviewing the medicinal cannabis rules and looking for ways we can better serve patients within the purview of Jake Honig Law. We believe in the capacity of cannabis in medical treatment — and Jake Honig’s Law guarantees access for patients in New Jersey,” Brown said.

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