New Hampshire Nurse Practitioner Association
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In the Spotlight ~ Lisa Withrow APRN

Posted about 2 years ago by Mary Bidgood-Wilson

Legal medical marijuana reaches milestone in NH

Lisa Withrow, APRN, owner of Palliativity Medical Group in Bedford, has certified hundreds of patients for therapeutic cannabis. (Allegra Boverman/Union Leader) 

It's been one year since New Hampshire's first therapeutic cannabis dispensary opened, and more than 3,000 Granite Staters are now registered with the state as patients.

But some doctors reportedly are still reluctant to participate in the state-run program. A recent report to lawmakers by the program administrator identified "patient access due to lack of provider participation" as an ongoing challenge.

As of April 7, 722 medical providers have certified patients for the program, according to the state Department of Health and Human Services.

Bedford family nurse practitioner Lisa Withrow, who said she has certified hundreds of patients for the program, said many of them have told her they can't find another provider willing to certify them for medical marijuana. She said one concern among providers is the Drug Enforcement Administration's listing of cannabis as a Schedule I drug, meaning it has a high potential for abuse and no accepted medical use.

Two years ago, Withrow, an advanced practice registered nurse (APRN) started Palliativity Medical Group, an outpatient palliative care center. Formerly the director of palliative care services for Elliot Health System, she also has worked as a home-care nurse, hospice visiting nurse and hospital oncology nurse.

Palliative care, Withrow said, "is a medical specialty that focuses on the patient and how they're feeling as they're living with chronic and serious illness or illnesses." She said cannabis can improve the quality of life for such patients.

"I'm not saying it's a wonder drug, but for the right person, for the right condition, it can really bring some benefit," she said.

Most of her patients don't want to smoke cannabis; they rely on edibles, tinctures and salves to relieve their symptoms, Withrow said.

New Hampshire's therapeutic cannabis law specifically states that providers are not required to participate. It also says those who do cannot be subject to arrest or prosecution by state or local law enforcement.

For a patient to obtain medical marijuana here, a doctor or advanced practice registered nurse (APRN) must certify that the patient has both a "qualifying medical condition" (such as cancer, glaucoma, HIV or Parkinson's disease) and one of the symptoms specified in the law (such as severe nausea, vomiting, seizures or chemotherapy-induced anorexia).

Providers must have a relationship with patients for at least three months before they can certify them for the program. They don't write prescriptions for cannabis; they only certify that their patients have qualifying conditions and symptoms. Patients then send that certification with their applications to DHHS, which issues patient registry cards.

Michael Holt, therapeutic cannabis program policy administrator at DHHS, said he hears anecdotally from patients that physicians are either unwilling to sign the certification papers "or are prohibited by their practice or hospital group from participating in the program."

But officials at Dartmouth-Hitchcock, Elliot Health System, Catholic Medical Center and Lakes Region General Hospital in Laconia all said they have no such prohibition. And a spokesperson for the New Hampshire Hospital Association said she knows of no hospital here with such a policy.

"We leave it to the individual physician's discretion to determine the most appropriate treatment for the patient," said Clarence Adams, spokesman for Dartmouth-Hitchcock.

Greg Baxter, chief medical officer for Elliot Health System, also said it's up to physicians to decide whether to certify certain patients for the program. "I neither direct them to nor prohibit them from doing so."

Baxter said he regularly interacts with other chief medical officers and is unaware of any that have such policies either.

When New Hampshire was first creating its medical marijuana program, Baxter attended a medical conference where he and his peers were discussing how they were going to handle the issue. And the answer was simple, he said: "We're not. The doctors are going to decide whether they're going to access this regimen, and that's how we're going to handle it."

When patients say their doctors won't certify their medical conditions or symptoms, Holt said he recommends that they check with their other medical providers. But he said, "If all their doctors say no, it is up to the patient to identify a provider who will certify them, and perhaps switch their medical care."

That's not ideal, Holt acknowledged, which is why he cited the lack of providers as an ongoing challenge in his recent report on the program for a House oversight committee. "I want to make sure that the Legislature knows this is one of the issues that patients are facing," he said.

Brett Sicklick is chief operating officer for Prime Alternative Treatment Center in Merrimack, the last of the four state-licensed ATCs to open last year. As of last week, there were 938 patients registered with his facility.

Sicklick said he hears from his patients all the time that their doctors are unwilling to certify them for medical marijuana. "It's unfortunate, because that patient then has to start a relationship with a new provider, really just for the purpose of certifying them for the program," he said. "It's sad, but it's one of those realities."

Lawmakers this session have passed similar versions of House and Senate bills to add chronic or severe pain to the list of qualifying conditions. But they rejected proposals to add opioid addiction and post-traumatic stress disorder (PTSD) to that list.

APRN Withrow testified at legislative hearings in favor of adding chronic pain and PTSD to the list of qualifying medical conditions.

Withrow said 90 to 95 percent of the patients she has certified have chronic pain. "All of them have shown significant reduction" in the amount of opioids, muscle relaxers and psychotropic drugs they take, she said, and many have gotten off those medications altogether.

"That's what the patients want," she said. "They don't want to be on these things."

David Landry of Hillsborough took painkillers for 15 years after he injured his back while working for a moving company. Along the way, he realized he was addicted, and he got into a methadone program.

After Landry underwent lung surgery recently, his doctor at Catholic Medical Center suggested cannabis could alleviate both his chronic pain and his dependence on opiates. He began using cannabis edibles, tinctures and oils, weaning himself off the other drugs.

And now, for the first time in 15 years, he said, "A little over five weeks, I've been clean."

Landry, who is married and has four children, said his health is improving and he's trying to get back into the workforce.

"I'm proud of where I am now," he said. "I need to get back into the real world."

He credits his doctor for suggesting cannabis. "I was actually surprised with her bringing it up to me," he said. "I'm also really grateful that she did, because I wouldn't be where I am today without her."

The state's therapeutic cannabis program may be gaining acceptance, but the Legislature continues to oppose recreational marijuana use.

While voters in Massachusetts and Maine legalized marijuana last year, Senate lawmakers here last month killed a bill to do. The House did pass a bill to decriminalize possession of small amounts of marijuana; it is currently before the Senate Judiciary Committee.

Sicklick from Prime ATC contends cannabis is safer than "a lot of the medications that are being prescribed all day every day without much regard."

"This was used for medicinal purposes for thousands of years, and it's only within the past 70 years or so that it hasn't been deemed to have medicinal purposes," he said.

"If we found this plant in the Amazon today," he said, "it would be hailed as the greatest miracle for health care that we've come across."