New Hampshire Senate Bill 409, currently under consideration in the state House of Representatives' Health, Human Services and Elderly Affairs Committee after narrowly passing 13-11 in the Senate two weeks ago, proposes controversial legislation on the statewide legalization of medical marijuana.
Although the bill's sponsor, state Sen. Jim Forsythe, R-Strafford, said that legalization could provide much-needed relief to "500 to 1,000 New Hampshire residents," the bill concerns some law enforcement officials and medical experts, who said it could do more harm than good.
The bill has always had "strong support" in the House, and the remaining obstacle is Gov. John Lynch, D-N.H., who has expressed disapproval of the bill, Forsythe said in an interview with The Dartmouth.
"In order to override the governor's veto, we would need 16 senators to vote in favor of the bill," Forsythe said. "We are trying to work in the House subcommittee to get it to a place where either the governor or three additional senators could support it."
Sixteen states have already passed laws allowing patients to grow and use marijuana for medical use with permission from a physician, but Forsythe said New Hampshire's approach would differ dramatically from that of states like California, where marijuana can be grown in dispensaries. Bill 409 is a "home-grow" bill designed to keep marijuana use limited to those with a medical need, he said.
"The patients can either cultivate it themselves, or if they are unable or unwilling, they can get a caregiver," Forsythe said. "There is a limit on the number of plants that can be grown, a caregiver can only have one patient and neither the patient nor the caregiver is allowed to make a profit only [enough] to recoup their losses."
In California, the Department of Public Health maintains a registry of all patients who qualify for the Medical Marijuana Program, according to Matt Conens, an information officer at the CDPH Office of Public Affairs.
"The MMP identification card is used to help law enforcement identify the cardholder as being able to legally possess certain amounts of medical marijuana under specific conditions," Conens said. "The qualified patient must complete an application, provide identification and documentation, have a photo taken and pay the necessary fees."
Since the MMP began in 2003, the CDPH has issued a total of 59,302 cards, with 4,267 issued in fiscal year 2011-2012, according to Conens.
New Hampshire's bill comes in a "climate of more aggressive enforcement" by the federal government toward medical marijuana growth, according to Assistant New Hampshire Attorney General Karin Eckel, who heads the Drug Crime Prosecution Unit. Although several states have legalized medical marijuana usage, all uses are criminalized under the federal Controlled Substances Act.
"There was originally a policy that the federal government wouldn't arrest and prosecute medical marijuana patients," Eckel said. "Since then, states have enlarged their laws in one way or another, either through dispensaries or home grow, and now the government is moving forward with the prosecution."
The bill includes several requirements for patients and caregivers to be able to acquire a growing license, which are designed to avoid "a situation like California," Forsythe said.
"What patients have to have is a recommendation from a doctor or physician who is qualified to prescribe controlled substances, with whom they have had a relationship for at least three months to prevent doctor shopping," he said. "If they have one of the predetermined diseases, as well as certain symptoms of the disease, then they can apply to the Department of Health and Human Services. If they're a caregiver, they have to pass a criminal background check."
The bill would also make it a Class B felony for individuals in the program to sell to others, Forsythe said.
Despite the precautions, the bill remains a legal concern for state officials, according to Eckel.
"It would put doctors and patients in the center of what is really a legal feud between the states and the federal government," she said. "The ones who are in a position to lose are the states and the doctors."
The only action that would make legalization more viable would have to come from the federal government, in the form of "rescheduling" marijuana to a Schedule II drug. The process would allow researchers to determine whether marijuana actually has medicinal value and require the drug to pass the standard testing process of the Food and Drug Administration, according to Eckel. Currently, under its Schedule I classification, the federal government does not allow marijuana to be dispensed, prescribed or researched, Eckel said.
Legalizing the drug is "premature" considering the lack of research on the most effective way to use its active ingredient, tetrahydrocannabinol, more commonly known as THC, according to Benjamin Nordstrom, professor of psychiatry at the Geisel School of Medicine.
"There aren't good studies showing that medical marijuana is better than delivering THC by itself, which already comes legally in the form of a drug called dronabinol," Nordstrom said. "No one would argue that the cannabinoids aren't useful, but it's unclear as to what is the best way to get those different agents to the different receptors."
Data shows that THC is useful as an appetite stimulant and anti-nausea drug, as well as an effective painkiller, according to Nordstrom. The FDA has approved the legal pill version for the treatment of AIDS-related weight loss and chemotherapy-induced nausea and vomiting.
Nordstrom said that medical marijuana needs to be treated with the same scrutiny as all other drugs before it can be approved for widespread use.
"Nobody would say that we should smoke opium, even though that's a great way to get cough suppressant and it has pain-relieving medicinal properties," he said. "It's analogous to what we've seen with prescription painkillers in this country, where the number of people using them has exploded with the number of drugs available. Whether we're talking about Oxycotin or Xanax or marijuana for that matter, if doctors prescribe these things carelessly without good scientific evidence, they can actually spread addiction."
Legalization could also be an impetus for criminal activity in the state, according to Eckel.
"It's proven to be very difficult for patients to grow their own when they are very sick, and they often don't have the time or resources to engage a caregiver to set up proper growing operations," she said "It would be bringing people in who know there's a so-called legitimate marker for consumers in New Hampshire and drawing in even more of a criminal element then is already here."
The attorney general's office is also concerned with teen abuse of marijuana, which Eckel said is "already a big problem in New Hampshire."
"When you treat marijuana as medicine, it sends a message to younger people that it's a safe substance," she said. "Those of us who work in law enforcement do see the connection between marijuana use and troubled kids, addiction and criminal acts."
The strict regulations in the bill would significantly help negate these concerns, according to Forsythe.
"This can make a huge difference for a lot of people, whether it's allowing them to continue on with cancer patients or treating multiple sclerosis or glaucoma," he said. "We're making sure that people aren't getting into this program and diverting it for other uses, and we'll continue to work with law enforcement to see how we can address their concerns."
Nordstrom stressed the difference between decriminalizing the drug and legalizing it, as legalizing empowers a lobby and allows for advertising.
"Being able to champion something makes it into a public health problem, as you can recruit people into using it," he said. "Once you legalize something, there are first amendment rights to petition the government for redress of grievances and people can use their influences to trade off of the public good for private gain. Then you have the rise of a legitimized Big Cannabis,' which we need about as badly as we need Big Tobacco' or Big Alcohol.'"
This is the essence of the problem in California, where federal officials have begun to crack down on dispensaries, the number of which has exploded "far more than anyone anticipated," Nordstrom said.
"The city tried to close the dispensaries, but they now have legal grounds for their existence, which means they can fight their closing in court," he said. "There's also just been a proliferation of people getting cards for medical marijuana for conditions where there is no evidence of the kind of efficacy that would meet the standards for any other treatment."
Although the time for legalization has not yet come, this is far from the end of exploration into medical marijuana, according to Nordstrom.
"The benefits of cannabinoids are very real, and what we need to do is conduct research to figure out what is the best and safest and most effective way to use those chemicals and find out what conditions they are really useful for," he said. "Doctors really should not do things that are potentially dangerous without having a substantive body of literature and scientific evidence to back up their actions, and we're not there with smoked marijuana yet."
