The New Hampshire House and Senate have crafted and passed a therapeutic cannabis bill that Gov. Maggie Hassan is poised to sign soon, and now we, the physicians of New Hampshire, must decide how to incorporate or not incorporate this into our practices.  New Hampshire's bill is unique, and, with input from NHMS, we helped make this the tightest therapeutic cannabis bill in the country by limiting its scope, eliminating the home-grow provision, establishing that there must be at least a three-month ongoing relationship with a physician or nurse practitioner and limiting patient possession to no more than 2 ounces.  

Because this is uncharted territory for physicians in New Hampshire, NHMS will work with the Board of Medicine and the Department of Health and Human Services to better understand the regulations and develop a CME program for you to make informed decisions in your practice.

Questions I am considering:

Should I decide in my practice to certify patients for the N.H. therapeutic cannabis program?  If so, should I do it for anyone with a certifying condition?

If not, why?

If I do certify patients, should I prescribe other potentially addictive medications such as opiates or benzodiazepines?

What policies will I put in place in my practice to make sure my partners and I are on the same page?

What, if anything, should I tell my patients about my participation or non-participation in the certification process?

In my own search to understand how this might impact my practice, I discussed the issue with a family physician in Oregon, where a therapeutic cannabis law has been functioning since 2006.  Currently, there are 53,117 patients who are enrolled in the "Oregon Medical Marijuana Program" (OMMP) with the vast majority having "severe pain" or "persistent muscle spasms" listed as their certifying diagnosis.  

My colleague indicated that she has written for only one patient over the past six years, and that is typical for physicians in Oregon.  However, a very small number of providers are certifying the vast majority of patients.  As part of the law, quarterly reports give a wealth of information about the OMMP, including that nine doctors certified more than half the patients in the program.  One of those physicians, a retired cardiac surgeon, has certified 4,180 patients and spends an average of four minutes with each of his patients once a year.  Another physician, who certified 2,776 patients, reports that he saw 40 to 80 patients a day to certify them into the program, but has since left this practice because of burnout.

Advocates for the OMMP argue that primary care physicians should be certifying more patients and they only see the high volume of patients because those in primary care are afraid to do their part.  On the other hand, most physicians are more cautious because they don't believe that marijuana is appropriate for many of the conditions for which patients seek marijuana use.

The New Hampshire bill requires an ongoing relationship with a minimum of three months of care and a face-to-face visit with a documented history and physical exam with a diagnosis and treatment plan.  

In New Hampshire the following conditions are specified in the bill:

Positive status for human immunodeficiency virus
cquired immune deficiency syndrome,
Hepatitis C currently receiving antiviral treatment
Amyotrophic lateral sclerosis
Muscular dystrophy
Crohn’s disease

Agitation of Alzheimer’s disease
Multiple sclerosis
Chronic pancreatitis
Spinal cord injury or disease
Traumatic brain injury
Or one or more injuries that significantly interferes with daily activities as documented by the patient’s provider

In addition to the above diagnosis a patient must have a severely debilitating or terminal medical condition that causes at least one of the following: Elevated intraocular pressure, cachexia, chemotherapy-induced anorexia, wasting syndrome, severe pain that has not responded to previously prescribed medication or surgical measures, or for which other treatment options produced serious side effects, constant or severe nausea, moderate to severe vomiting, seizures or severe, persistent muscle spasms.

The good news is that we have time before the program starts and we have time to prepare for it. 

I'm interested in your thoughts on this.  NHMS will have a member on the advisory council overseeing, among other things, the effectiveness of New Hampshire’s therapeutic use of cannabis program.  We need to hear from you!

If you are interested, you can read more about Oregon's experience here.

Please send your questions and comments to or post a comment below.


I am a physician and a cancer patient. With regards to medical marujuana, I would like to see the unbiased data that shows that this drug is effective where other medicines are not. I would like to know why I should tell anyone to smoke a "medicine". Please share the data that shows that marijuana is effective for the conditions listed, beyond subjective reports. I believe this is a backdoor effort to legalize marijuana. Legalization may be fine, but it is not a medical issue. I believe physicians should insist on objective data supporting the use of any substance, and I have not yet found that data. Otherwise, we are supporting the exploitation of our patients. I am very sad that physicians are going to be "pushers", gaining financially by "prescibing" an unproven, but popular, drug.

Congratulation for your success and I hope you'll help us a lot to live well. But chemotherapy-induced anorexia, wasting syndrome, severe pain that has not responded to previously prescribed medication info is more effective one lettering to me. elder care tucson