Rep. Donna Schlachman, D-Exeter, was a prime sponsor of the House version of the medical marijuana bill; the final version passed last month. She answered these questions from the New Hampshire Union Leader:
Are you satisfied with the legislation as adopted?
There are some disappointments, but it is a step forward. There is a concern that there is no provision for patients who have applied for an identification card and don't have it yet but have accessed marijuana. It's sort of saying, 'We're doing it for you, but we're not going to worry about protecting you until the dispensaries are open.'
I also feel very strongly about the self-grow provision that was taken out; it's disappointing. How much of a challenge was it to pass the bill? In terms of the legislative bodies, it was not a hard sell for most of them. The difficult part has been in the medical community, where we have some doctors who say, 'Please legalize this,' and others who say, 'It is not a medicine because we can't dose it and because we can't write a prescription.
Can the state broaden the ailments for which medical marijuana can be used? Yes, the bill itself says that a physician or licensed nurse practitioner can document the need and the applicant can submit it to Health and Human Services, which makes a determination whether to issue the card.
How many people are expected to use medical marijuana? If a large pool of users is expected, were those numbers a driving force behind the bill being passed?
I actually do not have reliable numbers. The best source is probably Matt Simon, who has been in contact more closely with the patient community over the years. It was not the numbers of patients, per se, that 'drove the bill.'
It was certainly, though, driven by the patients who have been frustrated with their illegal status, and the fact that they have to purchase cannabis from drug dealers. These are people whose primary care doctors and/or nurses have encouraged them to use cannabis because nothing in the 'legal' repertoire of drugs has worked for them. These are patients who are seen at Dana Farber Cancer Center, for example, and have the medical staff quietly saying to them, 'Get some cannabis, it will help you,' and things like this.
These are stories the patients tell. We heard testimony from someone who has moved out of New Hampshire to Vermont so he could legally get the cannabis needed to manage his disease. He wants to come home. It does not take a lot of these patients testifying to want to pass a law.
Is there a concern that the law will prompt 'doctor shopping,' with patients looking for another doctor if theirs is hesitant to certify a condition for which marijuana could be used legally? I have heard this opinion asserted by those not in favor of this law. There are strict guidelines spelling out the relationship between doctor and patients required for certification and there are provisions for the DHHS to collect data on patients' qualifying conditions and on who their providers are. This provision will enable DHHS to see if too few doctors are certifying patients.
If DHHS believes there is an issue, there are provisions for this information to be taken to the NH Board of Medicine or the NH Board of Nursing in the case of nurse practitioners. In my opinion, there are a lot of doctors who support this law and are ready to certify their patients.
Will some doctors get popular? Only if too many of the current practitioners are ignorant of the benefits to some of their patients or not comfortable with the idea that their patients are using something that the doctors do not know how to 'dose.'
Who will decide how much to charge for the marijuana?
The dispensaries will set the price. I believe this will be market-driven. In Maine, the cost is set so as not to be too far below the black market with the idea that if it is too low, patients could be tempted to sell any supply they do not need.
If it is too high, patients may continue to get what they need on the black market. (Of course selling by a patient, even to another certified patient, is illegal.)
Insurers don't have to cover the cost; is this statement correct? Will Medicaid pay for it?
Yes, you are correct, it is not part of any insurance company's 'formulary,' so they do not have to pay. Medicaid is a federal-state program and since it is illegal under federal law, I do not believe it will make its way into the Medicaid formulary anytime soon.
There is a requirement that Alternative Treatment Centers (ATCs) outline their plans for making the cannabis affordable to people on Medicaid or SSI. Cost is a concern. Though these are non-profit entities, the costs for complying with all the regulations, and actually growing cannabis in a safe, enclosed, facility are considerable. We call it 'weed,' but it is actually a difficult product to grow and harvest.
Where might the first two dispensaries be located? Will the chosen communities have a say? If a community sees an increase in crime that can be attributed to a dispensary, will the state provide any additional aid to that community for law enforcement?
The law is clear that geographic accessibility to patients is critical. With only two for the first two years, this will be a challenge. I would expect one in the Manchester area and one up north.
The application process requires that the department (DHHS) 'in partnership' with the town/city, solicit input from patients, caregivers and residents. An increase in crime is not expected, and no evidence to this was presented during the hearings. Patients who use cannabis are not an issue for law enforcement. Law enforcement's bigger drug problems are those who are abusing prescription opiates they get from pharmacies.
When we visited a dispensary in Maine, we heard that the local law enforcement are very supportive of the dispensary. They have no problems with the patients and the dispensary cuts down the people engaged in illegal purchases.
In answer to the last part of your questions: law enforcement currently gets a lot of federal money for their 'war against drugs.' The ATCs are taking illegal activity off the streets, so perhaps they will see a decrease. Patients should not even be on the radar of law enforcement. They are not now, so they should not be when they are legally using.
If there are only two dispensaries (with two more possible later), is there concern about the distance a patient will have to travel to get marijuana? Does the patient himself/herself have to pick up the drug, or can a proxy do so? Can anyone be a proxy?
This is a concern and a reason why the House had a self-grow provision. Traveling is hard in this state for some people.
The bill has provisions for 'designated caregivers' for those patients too sick to meet their own needs. Designated caregivers (who also have a non-transferrable ID card) can pick up the drug. There is an application process and specific qualifications for being a 'designated caregiver.' There is a criminal background check, and other requirements; you cannot have committed a drug-related felony.
Where will the dispensaries get the marijuana?
To get started and/or expand the strains of cannabis they will order it from other legal growers and suppliers in other states.
What will happen if demand outstrips supply, or vice versa?
Good question! I suspect this may be one of the areas where further legislation may be needed. Four seems too few from an accessibility standpoint.
The bill establishes a Therapeutic Use of Cannabis Advisory Council which reports to the DHHS Health and Human Services Oversight Committee. It is in section 9 of the bill. It has extensive duties in terms of monitoring every part of this law and making recommendations for changes.
Will the dispensaries be required to pay for on-site security?
Yes. The security and control provisions in section 8 of the bill are quite extensive. These are enclosed locked facilities. There is security in place, background checks on all employees, health standards to meet, inventory controls, etc. There is a lot of accountability in this law.
A patient can only possess two ounces. How will that be enforced? Will a dispensary be required to tell police if a patient appears to be buying an excessive amount of pot? How much is excessive?
The ATC have to keep detailed records on each patient regarding what they are getting, what strain, how much, side effects etc. This is reported to DHHS.
There is a large body of information (in medical publications and other publications) on strains that work best with specific symptom relief, methods of dosing, frequency, etc. The staff we met in Maine had a wealth of information and were able to make recommendations to patients.
Again, the consequences for violating this law are huge for patients. Patients will only have access to one ATC, which is printed on their ID card so they cannot go from one ATC to another to get more than their allotment. If they move closer to a different ATC, they would turn in their card and be issued a new ID card.
A patient would not be sold an 'excessive" amount.' We know that the maximum legal amount to possess of two ounces is going to be enough to last 10 days for most people. (In a month, that comes to the maximum per patients of six ounces available.) ATCs are directed to sell the least amount needed to meet patient needs. This means that many patients will be sold much less than two ounces when they come in. If they don't need it, it will not be sold to them.