As medical marijuana becomes a reality in New Hampshire, many doctors are trying to navigate their way through it

Monday, January 18, 2016
New Hampshire’s roll out of its medical marijuana program has been slow, but the coming months will see four new dispensaries opening their doors across the state.

With 180 patient applications filed and 62 therapeutic cannabis registry ID cards issued so far, the New Hampshire Department of Health and Human Services officials say they’ve been fielding lots of calls from patients with a similar complaint: their doctors won’t agree to sign paperwork needed for an ID card.

“We’re getting calls from patients with concerns that their doctors are unwilling to certify them for the program for whatever reason,” said Michael Holt, administrative rules coordinator for the department. “Patients are taking the initiative and starting conversations with their doctors.”

Whatever the reason, many patients aren’t saying, making Holt think that doctors aren’t giving patients a reason for their refusal.

“The reasons for that are theirs,” he said, adding the newness of the program may be a factor.

“It’s a brand new program,” Holt said. “It’s only been a few months and a couple weeks.”

Under the state’s therapeutic cannabis law, doctors technically don’t prescribe medical marijuana to their patients. A doctor’s sole responsibility under the law is to certify their patient has a condition and symptoms that would qualify them to use medical marijuana, such as multiple sclerosis, cancer or debilitating chronic pain.

After doctors sign off on the paperwork, they are then essentially putting patients in charge of their own treatment, under the guidance of dispensaries.

For doctors used to prescribing medication with exact dosages, the wide range of cannabis strains and consistencies available is a whole new frontier.

“You’re not going to have any way of knowing that before they go and pick it out,” said Dr. Stuart Glassman, a Concord physiatrist and the New Hampshire Medical Society’s physician representative to the state’s Therapeutic Cannabis Advisory Council.

And many doctors in the state have little formal training on the issue.

“Nobody in medical school received training on the medical use of cannabis,” said Dr. Seddon Savage, professor at Dartmouth’s Geisel School of Medicine and director of the Dartmouth Center on Addiction, Recovery and Education. “We’re recognizing that doctors really need guidance.”

Savage is one of two physicians in New Hampshire working on a set of guidelines for doctors faced with medical marijuana as a new option in the state. The other is Dr. Gilbert Fanciullo, who works at Dartmouth-Hitchcock Pain Management Center in Lebanon. Fanciullo also serves as a consultant to Prime Alternative Treatment Centers of New Hampshire, which plans to open a dispensary in Merrimack.

Hospital spokesman Michael Barwell said Fanciullo was not available for comment for this story, but confirmed a task force at Dartmouth-Hitchcock is currently developing policies around therapeutic cannabis.

“The issues associated with therapeutic cannabis are complex and still-evolving,” Barwell said in a statement. “As an academic medical center, we are working to fully understand the scientific and clinical impacts, as well as legal implications, of therapeutic cannabis for our patients.”

Though marijuana is still illegal under federal law, President Obama’s administration has made clear it won’t interfere with states with medical marijuana laws on the books. But that could change, depending on who becomes the next president.

Even though the state’s medical marijuana law asks little of doctors, Savage said the question of whether or not to sign the paperwork is complex. For instance, a patient could have a history of substance use disorder, or a medical condition that could be worsened with cannabis use.

“You have to make sure you know all the issues for a patient you might certify,” Glassman added. “We want to help our patients but not do any harm.”

In addition to the guidelines Savage and Fanciullo are writing, the New Hampshire Medical Society has also held a few education sessions on therapeutic cannabis for physicians across the state. HHS officials are also holding educational events, Holt said.

New Hampshire’s dispensaries are also taking their own steps to have medical input for patients. Sanctuary ATC, opening a dispensary in Plymouth, will have medical director and Nashua-based Dr. David Syrek on site to answer patient and provider questions, according to its website.

And state law sets forth a number of educational requirements for dispensaries, according to John Martin, manager of the HHS Bureau of Licensing and Certification.

“That’s going to be a big part of what they do, the education component,” Martin said. “One of the things we know, certain types of conditions respond to certain strains of cannabis.”

When terminally ill cancer patient Linda Horan traveled from her home in Alstead to Portland, Maine, dispensary Wellness Connection last month, dispensary officials helped her choose from a wide range of products. Horan, whose disease has made her lose a lot of weight, selected strains that would help with pain and boost her appetite.

She was first sent home with a few different strains to see which ones would help the most, and Wellness Connection director of community and education Becky DeKeuster said subsequent visits would be tailored to getting Horan the strains that fit her medical needs.

No matter the circumstances, Savage said, a doctor’s responsibility is always to guide and advise his or her patients.

“Generally, as physicians we are obligated to counsel patients on their actions,” she said. “You have a medical responsibility. Simply signing off and saying, ‘You’re on your own’ isn’t medically responsible. We wanted to make sure it was handled as safely as possible for patients.”

As New Hampshire’s dispensaries open, Glassman said physicians will be looking to gather information from their patients on how effective therapeutic cannabis is.

“I guess we’ll have to collect some good data from patients going to treatment center to know if it’s really helping,” he said.

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)