Monthly Archives: September 2016

28Sep/16

The Insurance Denial Disaster

Frank Jones and I co-wrote this article between May and June of this year. We found that it was far too long for a newspaper op-ed and that treatment professional magazines did not want to print this. The insurance industry is powerful, as they buy a lot of advertising and contribute to thousands of politicians on both sides of the aisle on both the federal and state levels. I expect that this article will hurt my consulting business a little, but the moral and social imperatives demand that this issue be properly addressed. Mr. Jones’s biography can be found at the end of this piece.

____________________________________________________________________

For over a decade, both of us have seen many insurance companies deny payment for addiction treatment services (one of us is a licensed clinical social worker, while the other operates a boutique insurance agency) to hundreds of individuals. The denials by insurance companies to pay for opiate detoxification, in-patient addiction treatment or intensive outpatient counseling have increased in the last few years, even as more and more people are abusing opiates, overdosing and dying.

This isn’t a new problem, but it has been getting worse in recent years. In 1996, Congress passed the Mental Health Parity Act. It stipulated that insurance companies must pay for mental health treatment in the same way that they would pay for physical health treatment (Kevin Sabet states that it took Congress decades to take the radical position that the brain is part of the body). The law was rife with exceptions and carve outs and was ultimately quite toothless. Addiction treatment was not covered in the law, despite the desire of the bills’ sponsors to include it, because of the stigma associated with substance use disorders. In 2008, the Mental Health and Addiction Parity Act was passed and it attempted to fix a number of faults in the 1996 law, as well as provide equal coverage for addiction treatment (this linked article notes that the MHPAEA did not mandate mental health or substance use treatment, but if treatment for these conditions is included as a benefit, plans have to provide it under the same terms and conditions as other medical treatment). In 2010, the Affordable Care Act improved upon the 2008 law by directing that all insurance plans cover mental health and addiction treatment. Despite all of these laws and the vast amount of media attention that is now paid to the heroin epidemic and the rich and famous people that are dying, insurance companies are still often denying addiction treatment. This urges the key question: how are they able to do it? The answer is horrifying: many states do not have an enforcement mechanism to ensure compliance and wading through the federal bureaucracy requires more time and skill than the average person possesses. In the rare cases where insurance carriers have been found to be in violation, they have not been fined. They have just had to pay for the appropriate level of care. This is the epitome of a toothless law and weak enforcement.

Ed Brazell’s family has been struggling to help his son for several years. He has Anthem Blue Cross/Blue Shield, which is considered to be an excellent health care plan. When his son went to Seabrook House in NJ to deal with his severe substance misuse disorder, he had to pay an additional $5,000 on top of the insurance. It was tough and required the family to scramble, but the alternative was grave. His son stayed clean for a bit, but he relapsed and quickly was using 25 bags of heroin a day. When his son agreed to go to a detox, the insurance company told them that “should stay in bed and take Tylenol.” Ed was aghast, and asked to talk to the doctors and counselors that Anthem Blue Cross/Blue Shield utilizes to make those decisions. “I wanted to know about their decision making process and they refused to talk to me.” Ed’s son went to Florida where he received a form of inpatient care (level 3) that was billed to the insurance companies as intensive outpatient (level 2) – this is known as the Florida Model, and while it is sometimes rife with problems, it sprung up as a reaction to the fact that insurance companies are either paying for limited treatment or not paying at all.

The American Medical Association, American Psychiatric Association, and the World Health Organization have characterized addiction as a chronic medical problem. It seems that this assertion from those esteemed bodies has not made its way to the insurance carriers who apply coverage limitations to addiction and mental health treatment modalities, which are not applied to treatment modalities tied to physical or medical disease categories. Increasingly, carriers are lowering reimbursement and shortening the benefit periods for those afflicted with addiction and in need of recovery treatment.  This behavior seems to be contrary to the aforementioned Mental Health and Addiction Parity Act and the Affordable Care Act.

Unrealistic demands are made on the treatment centers, such as the requirement that progress must be demonstrated within three days of admission, or further coverage will be denied. A person so afflicted for years, prior to finally seeking treatment, is highly unlikely to progress in just three days.  This coverage model has not yielded successful, sustained treatment outcomes (one treatment center executive we spoke with said, “It is almost as if they are trying to create a system that is denied to fail”). As an example, some carriers will allow for 12 days of outpatient coverage with no coverage for in-patient treatment. It is quite clear that people with opiate addictions have better outcomes with a full continuity of care: a week of detoxification services, a week to a month of inpatient treatment and then a few months (at least) of outpatient treatment.  Several years ago, 30 days was allowed for in-patient addiction recovery treatment and five days per week for intensive outpatient treatment.

Like oncologists who are far more equipped to diagnose and treat cancer than insurance carriers, diagnosing and treatment for those in addiction should be more influenced by the treating clinicians. Instead, the physicians and therapists that are employed by insurance carriers have a much stronger role in determining what level of care (or if any) a patient gets (this is almost always done sight unseen; the professional employed by the insurance company reviews a file and only occasionally talks on the phone with a patient). Some argue that the insurance professionals’ primary goal is managing costs instead paying for the proper services – if they are recommending a lower level of care or denying coverage than is medically indicated, then that is a true conflict of interest as the physician potentially benefits directly from turning down treatment. This raises a second question: what criteria are they using to limit or deny treatment?

These claims we are leveling against insurance carriers are not new. Nor is it the first article that details the insurance denial disaster. On their website, Aetna writes that they use the American Society of Addiction Medicine’s (ASAM – full disclosure: Mr. Greenagel is an associate member) criteria, which states that the proper level of care is “the least intensive, but safe, level of care.” This ambiguous wording is open to interpretation and is used as a shield to defend insurance companies against claims that they are denying proper coverage. Unfortunately, this vague wording and loose criteria are taken from a medical professional organization and is legal for the insurance companies to use in this way.

Patricia Rogers’s experience was similar to Ed Brazzell’s, but with a far more devastating outcome. She had Horizon Blue Cross/Blue Shield of NJ and experienced denials for her son at least three times in 2010. She paid out of pocket costs and unpaid claims of over $60,000. She wrote about her experience:

We found out about my son’s addiction over the holidays in 2009. He was using alcohol, marijuana and heroin. We tried to get him to willingly go to treatment. He refused and eventually ended up in Union County Jail. He agreed to go to a treatment facility, but insurance at the time would only approve IOP but through some grace of God he was able to live at a facility in Florida (and it was only considered IOP through insurance – the Florida Model). That was the first of many rehabs my son attended, along with many detoxes and halfway houses. He was considered to be dually diagnosed with mental illness as well. Over the course of his fight with this chronic medical illness and he was denied treatment too many times for me to remember. There were also times where his treatment was cut short and I gladly paid out of pocket for his care. His fight ended on May 27, 2011, when he died from this chronic medical illness.

Many treatment programs are not getting paid by the insurance companies that had previously agreed to pay for the treatment. Post payment and prepayment claim reviews are conducted by Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs) and the Zone Program Integrity Contractors (ZPICs) who work for the insurance carriers and the Center for Medicare and Medicaid Services (CMS) respectively.  The purpose of the audits is to uncover fraud, waste and abuse, the audits aim to ensure that payments are made correctly the first time and to identify, investigate, and recoup payments made in error. Ostensibly, it is a program which will save millions, and potentially, billions of dollars. In reality, it is a program heavily dependent on the use of intimidation and strong-arm tactics to achieve much of that savings. Treatment approved in advance by the insurance carriers, for which payments are received by the treatment centers, are too often identified as an overpayment by RAC reviewers with a demand for repayment, under the guise of “medical necessity”. The auditors are rewarded (9-12% of the recoupment) for their efforts based on the amount, which gets returned to the carrier or CMS. Much like the physician employed by the insurance company, the auditors have a financial misalignment of interests, as they benefit from denying coverage and/or withholding payments. It is a bad policy and terrible ethical position.

We have hundreds of stories about insurance denials just in NJ (though there has not been much data collection on a statewide or national basis on insurance denial disaster). Another harrowing tale is by a woman who asked to remain anonymous. Her insurance was Anthem Blue Cross/Blue Shield, and she has detailed their three denials:

I learned of Z’s drug use sometime in March 2014.  The insurance company website was of little to no use in trying to find treatment.  I learned of an addiction doctor in Merchantville, NJ (Dr. Lance Gooberman) who provided an opiate inhibitor.  In addition I tried to find counseling for my son.  This was all new to me and my husband and we quickly learned how naïve we were in fighting this on our own.  In June, Z attended IOP at Rehab After Work.  The counselor told us he needed inpatient care or he would die.  Our first try to get Z into a rehab was in July 2014.  He was denied but given approval for outpatient treatment.  We tried again in August at Seabrook House in Bridgeton, NJ.  Z was told verbally that the insurance was denying.  I do not know if he ever received written confirmation of this.  In September, he hit bottom and once again tried to enter an inpatient facility.

On September 20, 2014, we took Z to Livengrin in Bensalem, PA.  Since it was a Saturday, the facility could not get in touch with our insurance.  Z remained.  By Monday, he was denied, and Livengrin went through the appeal process 3 times.  All were denied and Z returned home on September 24.  He returned to Dr. Gooberman for Vivitrol injections.  He remained clean for 3 months.  On December 27, 2014, I found him dead at home in his music studio.  The detective told me he found 2 bags from heroin.

Legislation to address these issues is imperative, as it would have a profound effect on the outcome of recovery for millions of Americans (1) battling this chronic medical illness(6).  We urge you to consider advocating for and supporting legislation to respond to these national needs. We are currently working with members of Congress to introduce such legislation, and we hope to attract the attention of the White House. The legislation would:

Address the adverse determinations by insurers. The systematic coverage denial position the hired carrier physicians take result in prohibiting necessary care to the patients. A bill to address and correct this practice should permit decisions of continued or extended care be deferred to the judgment of the treating physician.  This would almost certainly have a positive effect on treatment, as long-term addiction treatment provides overwhelmingly better outcomes for this chronic medical illness. Similar legislation has passed in Massachusetts and Pennsylvania, but it is greatly needed nationwide.

Address the wanton payment audit practices of the carriers, and of the Recovery Audit (RAC), Medicare Audit (MAC) and Zone Program Integrity (ZPIC) Contractors. There must be limitations and mutually beneficial regulation of the billing audit process, of the strong-arm practices of the contractors and the at-will financial hostage situations created by the carriers and audit contractors.

Last week in New York, Governor Cuomo and the NY legislature announced bi-partisan legislation that begins to address some of these problems. Three of the seven major bills/programs address the failings of the insurance companies and provide very clear directions:

1) It ends prior authorization by insurance companies for inpatient or outpatient treatment. The first review by the insurance companies can only take place after 14 days of treatment (as we have already discussed, reviews currently happen after 2 or 3 days)

2) It addresses insurance coverage and how insurance companies are not paying for treatment, despite the legal requirement to do so as dictated by the 2008 Mental Health and Addiction Parity Act and the 2010 Affordable Care Act.

3) It mandates that insurance plans pay for Naloxone (the anti-overdose drug)

Our final story involves Valerie and her family. She has been a NJ public school teacher for many years. Her youngest son has been in and out of treatment programs for most of the last decade. Her insurance company is Blue Cross/Blue Shield and they used Magellan for Behavioral Health Services. Her son’s treatment was often denied or cut short, despite having a reputed Cadillac insurance plan. She and her husband have paid out over $100,000. She explained her family’s story in a lengthy letter to us:

We have spent the past five years working through the labyrinthine process of receiving denials and writing appeals; of requesting and wading through medical records; of phone calls and emails; of preparing and presenting our sons’ cases for hearings or External Review. All while responding to both sons’ treatment needs and legal issues, as well as one son’s multiple relapses. And yes, going to work every day.

We learned that our insurance company uses the American Society of Addiction Medicine (ASAM) criteria and dimensions to determine medical necessity. As we went through the letters of denial we wondered whether they were actually referring to our sons or their history at all. Both boys were adolescents at the time – by ASAM’s own definition – which meant they needed to fulfill 2 of the 6 ASAM dimensions to meet medical necessity for approval for treatment. Yet, our insurance determined them to be adults which meant they had to meet all 6 dimensions.  Despite the fact that our sons’ medical records revealed that they did in fact meet all 6 dimensions, our insurance company ignored those facts and misapplied and misrepresented the ASAM criteria to deny life-saving treatment.

Valerie has organized a large number of these families into a group and they are hoping to effect an investigation on the state level. They are also advocating for insurance reform through legislation. Valerie’s grandmother was a suffragist and worked very hard to get women the right to vote. Now, Valerie has taken up the mantle in an equally important fight in our time.

We have a health crisis in the United States which is not being adequately addressed, despite the soundbites uttered by politicians and the constant media attention.  We need addiction to be recognized and regarded by the carriers as the chronic medical illness that it is. We need mental health and substance disorder clinicians to have the same role in defining treatment for their patients as medical doctors have in defining treatment for their patients with physical illness. Most significantly, substantive penalties need to be put in place in order to ensure compliance with the existing laws that mandate coverage. The costs associated with inactivity on this critical point are both high and disastrous. Advocates, professionals, politicians and even private citizens have both a vested interest and an obligation to push for insurance reform. And if you don’t have insurance, the results are even worse.

 ________________________________________________________________________________

 

 

https://mintsagency.files.wordpress.com/2010/03/frank-jones.jpg

Frank Jones, Partner, Mints Insurance – a 20 year insurance leader who advocates for the medical industry and a government affairs professional. He operates a national boutique insurance agency with a focus on medical risks, and a special niche in mental and behavioral health operations and medical malpractice. He can be reached at Frank@mintsinsurance.com.

 

https://pbs.twimg.com/profile_images/638725899609706497/ocZuxIpb.jpg

Frank Greenagel, MPAP, LCSW, LCADC, ICADC, ACSW, CJC, CCS, is a clinical social worker who specializes in addiction & recovery treatment.

Frank is an adjunct professor at the Rutgers School of Social Work and an instructor at the Center of Alcohol Studies. He writes a blog at greenagel.com. He conducts trainings and delivers keynote speeches around the country. He completed a Master in Public Affairs and Politics in 2015.

He has served on the NJ Governor’s Council on Alcohol & Drug Abuse (GCADA) since 2011 and was also the Chairman of the NJ Heroin & Other Opiates Task Force. In 2014, 10 years after he was granted an honorable discharge, Frank was directly commissioned into the Pennsylvania Army National Guard as a First Lieutenant. He helps soldiers that have experienced PTSD, substance abuse issues and tries to point them all in a positive direction. He can be reached at flg2@aol.com.

25Sep/16

People Attack Me About Marijuana

I recently wrote an article about how NJ recently approved the use of marijuana to treat people with PTSD. To be clear, I am against it. A number of people responded negatively on either Facebook, Linked In or via email. Several messages attacked me on a personal level, and more than one person accused me of taking money from Big Pharma. Last April, I wrote about the different kind of statements that people make when they disagree with me. I have found that most people are set in their ways and views on the topic of marijuana, and usually do not want to have a discussion with someone with a different view (they usually just engage in shouting, insults, and a number of other fallacies). As an educator, I strive to help people understand and sometimes change the process of how they arrive at their conclusions. I adore discussions where people have different backgrounds, beliefs and philosophies, but I expect the discussion to be free from fallacies. I’m going to highlight three fallacies: agrumentum ad ignorantiam (argument from ignorance), red herring (bringing up a different topic than has been addressed) and arugmentum ad hominem (you engage in personal attacks).

1) Do you have PTSD?

I’m not sure how this is relevant. If I answer no, then I assume I’ll be accused of not personally understanding the issue. If I say yes, I figure I’ll be told that I am too close to the topic and while marijuana may not have been a treatment answer for me, it works for others. Or perhaps I’ll be told that my mind is addled.

I have treated people with PTSD for over a dozen years though. I care so much about soldiers (and other service members) and veterans that I rejoined the Army as a medical officer in 2014 after having been out of the service for over 10 years.

To answer the PTSD question: no, I do not have, nor have ever had, PTSD. I have had an easy life.

 

2) Are you satisfied instead with big pharma pushing life destroying, highly addictive, narcotic analgesics? (I added the commas).

 

I have been an extremely vocal critic of Big Pharma in my professional talks, in my college classrooms, in my writing, and in my service on the NJ Governor’s Council. I recently wrote an article about the problems with big pharma here. If someone accuses me of taking money from the pharmaceutical industry, it shows that they are guilty of conducting little to no research or background checks.

That said, the discussion of prescription opiates is a red herring when talking about marijuana for PTSD. I am assuming that you are arguing for marijuana to treat pain instead of prescription painkillers. That is a different argument. As I just wrote, I am critical of Big Pharma and the overprescription of painkillers (I suggest you read the NJ Heroin and Other Opiate Task Force Report from 2014). If you have clinical, controlled studies on how marijuana helps people with pain without causing psychological side effects, I would be thrilled to see them.

 

3) Have you not done even the smallest modicum of research? The overwhelming evidence of numerous studies has already definitively PROVEN the many many positive effects and benefits of medicinal marijuana for ptsd!

Sadly sir, you are mistaken. The studies that some people cite (you mentioned none, just that there are numerous ones) do not pass scientific muster. Most people have a hard time differentiating good from bad studies. Additionally, many pro Marijuana for medicine reports are funded by the for-profit Marijuana industry.

Here are some of my other opinions on marijuana:

  • I would like to see it decriminalized in every state. I don’t want to see people get arrested for using it in private spaces. I have no problem with a person who is 21 or older using marijuana in their home.
  • I caution people who use it on the amount and frequency though. With full legalization, American marketing power would be brought to bear, which would encourage people to large amounts of it, in order to maximize profits.
  • I am against full legalization, which allows for advertisements on the internet, TV, radio, and billboards. I am against marijuana candy being sold in convenience stores. I am against lawsuit shield protections for marijuana producers.
  • Marijuana is currently a schedule I drug (highly addictive, no medical value). I support rescheduling to level II. This would federally allow it to be given to people with late stage cancer, HIV/AIDS, and glaucoma. It would also allow for federal funding of studies on the effectiveness of marijuana as a medical treatment for other conditions.
  • I am deeply concerned about the use of marijuana by people who drive or operate any kind of machinery. Studies have shown that coordination and reaction are affected over 24 hours after using marijuana.
24Sep/16

Dr. Herb Conaway, the 2nd Worst Person in NJ Politics

Image result for terrible person

In a state rife with some awful people on both sides of the political aisle, Dr. Herb Conaway ranks as the second worst person on my list (if you don’t know who the first is, than you haven’t been paying attention). Dr. Conaway is a Democratic Assemblyman out of Burlington. He is well educated: undergrad at Princeton, law degree from Rutgers, and a medical degree from Thomas Jefferson. He served as a Captain in the Air Force medical corps for four years. He is clearly smart, hardworking, and has had some valuable experiences. This is what makes his opposition to bills that combat the opiate epidemic and his support of medical marijuana so concerning.

Earlier this week, a devastating article about Dr. Conaway was written by Ken Serrano for the Gannett papers (it was pushed off the front page by the bombings in Seaside and Chelsea). Some highlights:

1) Limiting the amount of opioids a physician can prescribe to seven-day supplies is seen as a way to cut into the heroin and painkiller epidemic. The Centers for Disease Control and Prevention encourages limitations. But a proposed law that won approval in the state Senate hasn’t advanced in the Assembly, where Conaway, the chairman of the Health and Senior Services Committee, stands in the way. A proposed law eventually dies if it isn’t posted by the chairman of a committee for a vote. Conaway told the Asbury Park Press Friday he will not post the seven-day supply bill because it will hurt some patients.

2) From 2006 through 2013, Conaway’s reelection committees were the second biggest beneficiary of contributions to state candidates in New Jersey from the pharmaceutical industry, out of 127 candidates. His campaigned received a total of $41,750.

3) Another anti-abuse bill would require doctors and others prescribing opioids to minors to warn parents about the dangers of addiction and counsel them about alternatives to opioids, amid mounting evidence that those under 25 who have taken prescription opioids are more susceptible to addiction. Last year a different version of the bill that required that all patients being prescribed opioids be advised of their risks. The Senate version, S2366, passed 36 to 1, but the bill died when Conaway refused to post the Assembly version, A3712, in the Assembly health committee.

Back in 2014, the NJ Heroin and Opiate Task Force recommended that the Prescription Drug Monitoring Program (PMP or PDMP) become mandatory – that is that all doctors must enter opiate prescriptions in a central data base and that both doctors and pharmacists should check patients’ histories before writing and dispensing those opiate painkillers. A voluntary PMP is only used by medical professionals who are responsible and aware of the problem. About 20% of the states have mandated PMPs, and they have shown that doctors prescribe 30% less opiates when they are being monitored. Dr. Conaway has opposed expansion and mandating the PMP every step of the way – he often states that government should not get tell doctors how to do their job.

Dr. Conaway has also blocked parental notification laws about the dangers of opiates. He says that this would “open the door to further legislators governing doctors how to behave.” But there are many instances where doctors are required to inform patients about the risks of medication, surgery or other procedures. Dr. Andrew Kolodny, the Chief Executive Medical Officer Phoenix House, explained Conaway’s behavior thus:

Any efforts that would really be effective at addressing the opioid crisis will generally result in reduced prescribing. The manufacturers of opioid painkillers don’t want to see their prescriptions go down, so they are blocking efforts to promote more cautious use.

I’m just one of many people who are critical of Dr. Conaway, but the general public is unaware because they spend two out of every four years worrying about who is going to be President and little to no time monitoring their state governments. The entire interview with Dr. Kolodny is a good read.

Dr. Conaway is bright and well educated. It’s not that he can’t read scientific studies, look at reports or understand data. He can. His actions to block bills that hurt the bottom line of Big Pharma have brought many people to question his motivations, and they usually arrive at the same conclusion – that he takes money from Big Pharma and it has influenced him in their favor.

I have to take a number of ethics trainings every year at Rutgers, for the Army, at the Governor’s Council and to maintain all of my professional licenses. Over and over, conflicts of interest are explained and how that not only impropriety is bad, but the appearance of impropriety is also a huge concern. I can not say for sure that Dr. Conaway has killed bills that would help curb the opiate epidemic because he has taken thousands and thousands of dollars from Big Pharma, but it sure looks that way.

18Sep/16

Stoned Wrong in NJ: Marijuana and PTSD

 

Last week, a Democratic bill was signed into law by NJ Governor Chris Christie that will allow people with PTSD to get medical marijuana. This expands upon the original NJ medical marijuana law, which was passed by the legislature and signed by Gov. Corzine in January of 2010. Previously, only diagnoses of cancer, glaucoma, HIV/AIDS, multiple sclerosis, seizures, and crohn’s disease had been approved for medical marijuana in NJ. I have no comment on the aforementioned conditions – I am not a medical doctor and the treatment of those problems fall far outside of my scope of practice.

However, I have been treating a large number of both veterans and civilians with PTSD for over a decade, and as I have noted many times before, I have grave concerns about giving marijuana to those with PTSD.

1) The only evidence that marijuana helps people with PTSD has been anecdotal stories by people who claim it helps them. The unscientific, non-clinical studies that have been conducted with multiple individuals usually ask people after they’ve smoked if they feel better. The studies aren’t looking at how marijuana affects them 12 hours later, 24 hours later, multiple days, or weeks later.

2) The Veterans Administration (VA), which I am sometimes critical of, has the greatest experience and expertise treating veterans for PTSD. So many of the people that work in the VA care deeply for veterans and are willing to try anything in order to help them. The VA’s official position on marijuana for PTSD is this:

Marijuana use for medical conditions is an issue of growing concern. Some Veterans use marijuana to relieve symptoms of PTSD and several states specifically approve the use of medical marijuana for PTSD. However, controlled studies have not been conducted to evaluate the safety or effectiveness of medical marijuana for PTSD. Thus, there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD.

3) My experience treating people with PTSD  has shown that marijuana sometimes momentarily alleviates acute symptoms, but when the psychotropic effects wear off the symptoms return and often get worse.

4) Studies have shown that smoking marijuana causes decreased lung function, chronic respiratory track problems (wheezing, shortness of breath), a strong link to obstructive lung disease, increased bronchitis episodes, possible acute cardiovascular issues and a higher likelihood for cancer (but we need more studies on that specific item).

5) Studies have also shown that marijuana use may cause an earlier onset of psychotic illnesses. Long term heavy users (defined as 3x a week or more for a period of over 6 months) show impairment in memory and attention. Marijuana use causes withdrawal symptoms such as irritability and insomnia, and often makes symptoms of depression and anxiety worse.

6) There are currently four states where recreational use of marijuana is legalized:  Colorado (2012), Washington (2012), Alaska (2014), Oregon (2014), and Washington DC (2014). All five legalized marijuana much earlier: Alaska, Washington and Oregon passed medical marijuana laws in 1998; Colorado in 2000 and DC in 2011. The establishment and expansion of medical marijuana laws are a gateway to legalized recreational marijuana. Once recreational marijuana becomes legal in a state, for-profit marijuana corporations get a true foothold and start lobbying politicians and donating to their campaigns

7) If, IF, there are medical benefits from marijuana use (reduction of nausea, stimulation of appetite), they are caused by the CBD chemical in marijuana. The THC chemicals do not have medical benefits, but are popular because they lead to the psychoactive high. THC content in marijuana was between 2 and 5% from the 60s thru the 80s. A few years ago, the strongest marijuana was 19%. Two years ago, the winner of a competition was 29%. The strongest THC content available in Colorado now is 41%. (THC wax is over 90% and THC Vaping can be over 99%). NJ could have pushed for medical marijuana to be CBD concentrated with a maximum amount of THC content at 5%, but they chose not to do this.

8) NJ politicians from both political parties said that they had passed this law because veterans were in such dire need. We are seeing an ever-increasing use of veterans and 9/11 to justify legislation (and sell products). I wrote about this in the spring. There is an organization in Oregon called Grow for Vets. It is non profit whose sponsors are all, surprise, for profit marijuana companies. They use their supposed support of veterans to curry public favor.

This NJ law was introduced and sponsored by Senator Joe Vitale (D-Woodbridge). I have worked with him on a number of issues and I have often applauded him for the work he has done in the areas of addiction and recovery. For several years, he has been my favorite NJ politician. He still remains so, but on this we disagree. It is my hope that NJ will collect data on everyone with PTSD that is prescribed marijuana so we can monitor their condition. If the evidence shows that marijuana helps those with PTSD, I’ll publish a retraction. If however, the evidence shows that marijuana does not help those with PTSD, I hope that this law gets reversed.