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Multiple bills to expand New Hampshire’s Therapeutic Cannabis Program weathered a rocky legislative session – and for a group gathering a dispensary in Chichester this weekend, that’s reason to celebrate.
GraniteLeaf Cannabis is throwing a party to commemorate its “cannaversary” – eight years of providing medical marijuana to Granite State patients through the TCP. They’re also honoring the passage of House bills 1349 and 1278 which, alongside Senate Bill 357, expand access to the program and make it easier for patients and medical providers to navigate the certification process.
The TCP is currently the only way to legally sell, obtain and use cannabis in New Hampshire. It allows three state-approved corporations, called alternative treatment centers or ATCs, to grow and sell the product, and it provides a framework for doctors to recommend and certify patients and caregivers to use medical marijuana as a treatment for eligible conditions and symptoms. Efforts to further legalize marijuana narrowly failed in the legislature earlier this year.
Jerry Knirk, a retired orthopedic spine surgeon and former member of the state House of Representatives who now chairs the Therapeutic Cannabis Medical Oversight Board, said three main bills signed by the governor in the past month will make it easier for patients to get certified for medical marijuana.
Who can qualify for the TCP now?
HB 1349, which will go into effect on Sept. 10, adds generalized anxiety to the list of conditions that make people eligible for the program. The regulatory board voted 7-1 to support the bill in the legislature, Knirk said, because many patients who are certified for other diagnoses reported that cannabis also eased their anxiety. Plus, many people are already purchasing cannabis from non-official markets to treat their anxiety, where many products are unregulated and unlabeled.
“That would allow somebody who is not a patient, who was using cannabis off the black market, that they could get cannabis which is labeled and regulated, so you know it’s free of contaminants and they know what the THC concentration is,” Knirk said. “They also get the advice of the ATC and guidance for dosing so that they’re starting at a low level using low THC.”
He expects to see some increase in the number of certified patients under this broad addition to the list, he said, but “I don’t think it’s going to explode, by any means.”
HB 1278 loosens the restrictions placed on the list of qualifying conditions. The list includes an array of diagnoses such as autism spectrum disorder, cancer, lupus and Parkinson’s disease. Pain was added as a qualifying symptom a few years ago, which opened the floodgates – the TCP saw a noticeable increase in certifications then, Knirk said.
With the passage of HB 1278, come October, medical providers will have more leeway to use their own best judgment on who to certify. While they can still use the list of diagnoses, they won’t be bound to stick strictly to that roster of qualifying conditions and symptoms.
“A provider can say, you know, I think they have a situation in which, in my clinical opinion, the benefits of using cannabis will outweigh the risks,’” Knirk said.
Part of the reason the board championed this bill, Knirk said, is because they wanted providers to be able to certify patients that they feel would benefit from cannabis, even if they didn’t fit the exact parameters laid out by the state. Those parameters and statutory language can be “rigid” and take a long time to update, he said.
Whether this will make the qualifying conditions list obsolete, Knirk said he’s not sure. He does anticipate that because providers have more wiggle room, there might be fewer bills to formally amend the list in future legislative sessions.
It comes with a few caveats: It only applies to patients age 21 or older, and the provider must still report why they’re certifying someone. The law states it can only be used for terminal or “debilitating” conditions, the latter of which can be interpreted by providers. Knirk said “debilitating” typically means the illness or symptom is significant enough that it disrupts the patient’s day-to-day life.
Who can certify patients for the TCP?
SB 357 expands the types of medical providers who can enroll patients in the program. Before this law, only a physician or advanced practice registered nurse could certify patients to use medical marijuana. Now, physician assistants and any other medical provider in New Hampshire will be allowed to join the ranks.
To keep standards up, there are three commonplace requirements: The provider must be licensed to prescribe drugs to humans, be primarily responsible for the care of the condition they’re certifying the patient for, and have an active registration from the U.S. Drug Enforcement Administration.
Knirk said the board requested this legislation to help ease the certification process.
“We realized that there are other providers who might look after somebody and want to certify, but they don’t fit what was currently in statute,” Knirk said. “Those would be things such as naturopaths or dentists or podiatrists.”
He gave an example: If a podiatrist cared for somebody with foot pain, they previously wouldn’t have been able to certify a patient to use cannabis for that pain. The patient would’ve had to go through a separate physician to get that. Starting Sept. 24, that process will be more streamlined by allowing the podiatrist to certify someone themselves, Knirk said.
This applies to minors, too. They’ll still need certification by two medical providers, but the requirement for one of those certifications to be from a pediatrician has been loosened to include pediatric care providers – they don’t have to be a pediatrician specifically but could be another provider, like one from a family practice.
What’s next?
One of the bills the board had supported didn’t make it through the legislature. HB 1231 would’ve permitted patients and caretakers certified through the TCP to grow their own cannabis at home, which Knirk said would’ve improved affordability, accessibility and availability of the product. Medical marijuana isn’t cheap in the Granite State, and some people have to drive a long way to get to one of New Hampshire’s seven dispensaries, most of which are located in the southern half of the state. Allowing patients to grow their own cannabis would also let them produce various strains of the plant, which can have different medicinal properties and effects.
Looking forward, though, Knirk said there aren’t any glaring items on the board’s agenda for next year – they’ll act more in a reactive capacity to bills that pop up over the course of the session.
For now, Knirk said the bills passed this year will still help improve access to medical marijuana and will likely result in a slight increase of registrants for the TCP. He doesn’t expect a wide swath of new patients, like when pain was added to the qualifying conditions list, but said the effort “eases the burden on patients and reflects the realities of the healthcare system.”
“It’s not something where we’ve seen some kind of enormous pent-up demand or anything like that, so I think it’ll have a small effect, maybe, on the number of patients who are certified,” Knirk said. “It’ll primarily make their life easier.”
Charlotte Matherly is the statehouse reporter for the Concord Monitor and Monadnock Ledger-Transcript. Follow her on X at @charmatherly, or send her an email at cmatherly@cmonitor.com.These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.or