State officials estimate as many as 100 marijuana cultivation sites would be needed to supply the adult-use recreational industry if it is legalized by New Jersey lawmakers. That would be on top of another three dozen that may be needed to handle expected growth in the medical marijuana program.

The hint about the scope of the economic impact of legalization are included in budget documents provided by the Department of Health to the Legislature as part of annual hearings about the proposed state budget. There is no estimate given about how many recreational marijuana dispensaries might be needed.

Gov. Phil Murphy met Thursday with Senate President Steve Sweeney and Assembly Speaker Craig Coughlin to discuss what to do next with marijuana legislation that stalled in the Senate in late March. The new goal is to have it passed by May 30.

Sen. Paul Sarlo, D-Bergen, remains opposed to the idea. He said the state should aggressively expand medical marijuana and “let the recreational piece evolve over time.”

“I am not evolved yet on the recreational piece,” Sarlo said. “I am a big supporter of medical marijuana. I think we should be expanding that, create the infrastructure to make it the most expansive and successful medical marijuana industry in the entire country.”

Even if no additional changes are made to the medical marijuana program, the Department of Health projects enrollment will increase by 35,000 to 50,000 by June 2020, on top of the 44,300 in the program now.

A report issued last week projected the need for 25 to 50 cultivation sites to meet patient demand, providing 500,000 to 1 million square feet of growing capacity. There are six now, with another six in the process of seeking licenses.

Using a similar model, the Department of Health estimates adult-use marijuana could require over 2 million of capacity initially – or more than 50 to 100 cultivation sites, on top of those needed for medical marijuana.

Currently, the state’s alternative treatment centers have a combined 105,000 square feet of cultivation.

State Sen. Sam Thompson, R-Middlesex, said he supports medical marijuana but worries that eliminating the sales tax on the drug, as proposed in conjunction with the legalization package, would encourage people to enroll as medical marijuana patients even if they don’t really qualify, to avoid the proposed $42 an ounce tax on adult-use marijuana.

“Consequently, there will be even a greater incentive for those who want it for recreational purposes to say, ‘Oh my head is killing me,’” said Thompson, who said “assessment of pain is subjective.”

Health Commissioner Shereef Elnahal said pain it’s purely subjective and that there are objective measures by which doctors assess it, such as alterations in vital signs, increased heart rate and blood pressure.

“Do what we can to address our patients’ needs. Do no harm to patients, but also listen and give all of our patients the benefit of the doubt, including when they come in and say they have pain,” he said. “I do believe that it is the fastest-growing condition we have, that pain is unfortunately difficult to treat.”

Elnahal said marijuana is an effective alternative for doctors to consider prescribing, stronger than over-the-counter options such as Tylenol and Advil but without the risks of opioids, particularly for people with chronic pain.

“Medical marijuana is an effective middle ground, safe therapy for the vast majority of people with pain, and we support its use for that reason,” Elnahal said.

Elnahal said two large studies published last year showing a strong association with states that have medical marijuana programs and a reduced requirement to prescribe opioids in Medicaid and Medicare Part D.  That supplemented research from years before showing an association between states that had medical marijuana programs and lower opioid overdose mortality, he said.

“Lower mortality likely because doctors need to prescribe opioids less for pain,” Elnahal said.

The most recent expansion of the medical marijuana program is to allow its use to treat opioid use disorder. Elnahal said there are already about 200 patients being treated that way. Those patients are also on medication-assisted treatment, which combines medication with counseling and behavioral therapies. Elnahal called it “the evidence-based gold standard to get people into recovery.”

“So not only is it a tool to reduce the need for opioid prescriptions initially for pain, it can also be used as an adjunct for treatment to what we know works,” Elnahal said.