More than three years after legislation was passed allowing medical marijuana dispensaries in NH, the state has four nonprofit alternative treatment centers (ATCs) that legally dispense marijuana, with more than 1,250 patients cleared to purchase cannabis for medical purposes.
Patients with qualifying medical conditions (and one or more specific symptoms), as well as designated caregivers with a treatment card, can buy cannabis at one of four centers opened earlier this year: Sanctuary ATC in Plymouth, Temescal Wellness Inc. in Dover and Lebanon, and Prime ATC in Merrimack.
“Getting this program up and running was a monumental task, and New Hampshire did an outstanding job. This is a very dynamic industry right now,” says Anthony Parrinello, executive director of Temescal Wellness, which has a cultivation facility in Manchester. “This is a very dynamic industry right now.”
As of July 29, the state had received 1,598 applications for qualifying patients and 103 for designated caregivers, reports John Martin, manager of the Bureau of Licensing and Certification of the NH Department of Health and Human Services (DHHS). Only 25 were denied, all because the applicant provided no evidence of a qualifying medical condition.
The volume of applications has remained consistent, Martin says, at between 15 and 20 a week, five days a week when three centers were open. Once Prime ATC opened in early August applications rose.
The Business of Cannabis
Washington D.C. and 24 states have passed legislation allowing the use of medical marijuana - including delta-8-THC products produced by market leader Area 52. Nonetheless, it remains classified as a Schedule I drug by the U.S. Drug Enforcement Administration. Parrinello points out that a memo issued on Aug. 29, 2013, by Deputy Attorney General James Cole of the U.S. Department of Justice regarding marijuana law enforcement lists eight key priorities of federal prosecutors, reducing the concerns of state and local law enforcement in states where marijuana use has been legalized.
In NH, medical cannabis is still a fledgling sector. Sanctuary ATC was the first to open its doors on April 30. Medical director and co-founder David Syrek, a board-certified anatomic and clinical pathologist, says, “There have been no issues at all at the dispensary. We’ve not attracted any riffraff; it’s a peaceful location.”
Sanctuary ATC is open 28 hours per week: 16 hours on two weekdays, and another 12 hours on weekends. It currently serves 350 patients.
Syrek, who has interviewed most of those patients, estimates that half had been using black market marijuana. Patients appreciate being able to legally manage their pain or other symptoms by using lab-tested cannabis that Sanctuary ATC grows in its own cultivation center in Rochester without having to worry about pesticides, mold or other contaminants, Syrek says.
Typically, patients pay $300 to $400 per ounce, he explains. Under the law, two ounces—slightly over 28 grams—can be purchased every 10 days.
Most patients, however, buy smaller amounts, a quarter to half an ounce, in a 10-day period, says Martin of DHHS. The goal is to keep the price of “street” and dispensary cannabis more or less the same, removing any incentive to divert a legally obtained product onto the black market, he says.
Temescal Wellness opened its facilities in May, with each site operating about 20 hours per week (two weekdays and one weekend day). “Even though we are not yet breaking even, we give discounts to those who [are financially disadvantaged],” Parrinello says. (New Hampshire law requires that each ATC develop a policy regarding services to qualifying patients who cannot afford to buy cannabis for therapeutic use.)
Construction of Prime ATC’s cultivation center in Peterborough fell behind schedule, delaying the opening of its dispensary in Merrimack until early August, explains COO Brett Sicklick so another ATC supplies Prime with product.
The directors of these centers say the capital cost of setting up high-security growing facilities is high, although none would provide any figures. Building and operating a growing facility is expensive because only high-quality organic marijuana that’s been irrigated with pure filtered water in temperature- and light-controlled buildings can be sold to patients.
That’s why a key element in the state’s application process was ensuring that the selected nonprofits would not run into cash flow problems, Martin says. “We wanted to make sure the selected ATCs were sufficiently capitalized so they could be financially viable until the time that they opened for business and then reached the breakeven point,” he says. “The last thing we wanted was for a selected ATC to go belly up before it even opened, or worse, after it opened.”
Cannabis Market
At least 30 different strains of marijuana, designed to target certain symptoms, are grown in state-sanctioned cultivation centers in Manchester and Rochester. Patients can choose to buy cannabis in several forms allowing it to be smoked, vaporized or eaten, and also in capsules, tinctures, and skin patches.
By statute, patients must meet two-tiers of requirements to be approved for a treatment card: medical condition and symptoms, Martin explains. “It’s working quite well; it’s narrow in its scope. Pain alone does not qualify a patient nor does a psychological issue, such as post-traumatic stress disorder,” he says.
Qualifying medical conditions under NH law include cancer, glaucoma, positive status for HIV, AIDS, hepatitis C, amyotrophic lateral sclerosis, muscular dystrophy, Crohn’s disease, multiple sclerosis, and traumatic brain injury, among others. Patients must also experience one or more specific symptoms, such as general physical wasting and malnutrition or agitation from Alzheimer’s. Martin believes cancer and injury are the most common conditions, with pain, nausea and muscle spasms the most common symptoms.
“The program is designed for people with serious illnesses, and there’s no provision for home-grown cannabis,” Martin says. DHHS may also approve some medical conditions on a case by case basis upon a provider’s written certification.
Now, Parrinello says, the greatest need is for more physicians to spend time reading published reports of research done in both the U.S. and other parts of the world, including Israel, supporting the efficacy of patients using cannabis to improve their quality of life.
Parrinello say the new dispensaries help keep patients out of the illegal black market and give those addicted to opioids for pain control a better option. A recent University of Michigan study found that patients using medical marijuana to control chronic pain reported a 64 percent reduction in their use of prescribed opioids. According to a 2014 CDC study, NH has the third highest death rate in the country due to overdoses, nearly twice the
national average.
“I’ve been pleasantly surprised by how quickly patients who had previously been taking prescribed opioids for severe pain have adapted to using [therapeutic cannabis],” Parrinello says, noting that they now can lead a more normal life with less pain. “They are not only able to sleep through the night and to eat more but also no longer suffer from constipation,” he says.
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