I am writing in response to the recent article by Ray Duckler about the listening session hosted by the Therapeutic Cannabis Medical Oversight Board (TCMOB) regarding the New Hampshire Therapeutic Cannabis Program.
The session was not “to review the pot policies in the Granite State.” The goal was to hear from patients, caregivers, medical providers and members of the public regarding the functions and operations of the Therapeutic Cannabis Program so that the Board can better provide oversight of the medical and public health aspects of the program.
The Board is invested in issues affecting therapeutic cannabis patients, such as cost, availability of product, accessibility, employment issues and barriers to certification, along with stigmatization and anything else that possibly diminishes the program’s intent to provide high-quality, laboratory-tested cannabis products and education through licensed Alternative Treatment Centers (ATCs) to the more than 13,000 patients in the state, the majority of whom are in their 50s and 60s.
Therapeutic cannabis patients often face stigmatization as “potheads” or “drug users.” The article, with its use of the label “pot” rather than therapeutic cannabis, its preoccupation with smoking as the route of administration and its conflation of therapeutic cannabis with recreational use perpetuates such stigmatization.
Cannabis has been demonstrated to be of therapeutic value for many medical conditions such as pain, PTSD and others. The Therapeutic Cannabis Program, administered by the NH Department of Health and Human Services (DHHS), has been operational for more than five years.
To enroll in the program, patients must be certified by their medical provider as having a qualifying medical condition established in law. The provider does not prescribe cannabis but state law requires that they certify that the patient has a qualifying condition. Any physician, APRN or PA who is licensed in New Hampshire and has a DEA license can certify their patients, but there is no requirement for them to do so, and many providers choose not to certify patients.
Once certified and approved by the state, patients and caregivers are issued a Registry ID Card which allows them to access one of seven ATC dispensary locations in New Hampshire where they are counseled regarding the most appropriate cannabis strains and routes of administration. Dosing starts low and is titrated slowly to achieve the therapeutic effect, trying to avoid the unwanted side effect of intoxication. Cannabis products available from the ATCs are tested for potency and contaminants to ensure quality and are labeled with the testing results.
TCMOB, composed of the medical director of DHHS, a patient representative, an ATC clinical representative and ten medical providers representing different specialties is responsible for the oversight of the clinical, quality and public health-related matters of therapeutic cannabis in New Hampshire. I represent orthopedics and serve as the chair of TCMOB and as the legislative liaison.
TCMOB advises the legislature and DHHS, reviewing medical and scientific evidence pertaining to proposed qualifying conditions and other changes to the program which have clinical implications. TCMOB takes into account both the existing scientific literature and anecdotal testimony from public hearings to make recommendations about qualifying conditions. The House and Senate rely on the Board’s work and defer to its expertise.
One of the strengths of TCMOB is the diversity of viewpoints. Our board members range from very cautious physicians who initially opposed therapeutic cannabis to providers who are long-term supporters. As chair, I lead them through robust disagreements working towards compromise and eventually to consensus on our recommendations.
TCMOB has developed educational materials for medical providers about therapeutic cannabis and best practices for managing patients, has developed educational materials for providers and patients about therapeutic cannabis use during pregnancy and breastfeeding and in adolescence, and has reviewed educational materials used by ATCs and the laboratory testing program.
There is more work to be done, clinically, legislatively and perhaps most importantly of all, to destigmatize the use of this legitimate and legal therapy used by thousands of New Hampshire citizens for managing their medical conditions and symptoms.
The state Legislature refers to this program as the therapeutic use of cannabis program. Mr. Duckler, the Concord Monitor and others would be serving the citizens of the state well by, at the very least, showing the same respect to the patients of New Hampshire who use therapeutic cannabis by not publishing language that is stigmatizing, demeaning and disrespectful.
(Rep. Jerry Knirk, MD, represents Carroll County District 3. He is chair of the Therapeutic Cannabis Medical Oversight Board. For more information about the program, visit dhhs.nh.gov/oos/tcp/index.htm.)