New Hampshire

New Hampshire-licensed providers:

• Physicians (MD or DO) licensed to prescribe drugs to humans under RSA 329
• Advanced practice registered nurses (APRNs) licensed to prescribe drugs to humans under RSA 326-B:18
• Physician associates/assistants (PAs) licensed under RSA 328-D, consistent with any applicable collaboration agreement
• Any other NH-licensed provider with prescriptive authority and primarily responsible for the patient's care related to the qualifying medical condition, including dentists, podiatrists, optometrists, and naturopathic doctors (expanded by SB 357, September 24, 2024)

Border-state providers (ME, MA, VT):

Physicians (MD/DO) and APRNs licensed in Maine, Massachusetts, or Vermont who are primarily responsible for the patient's care related to the qualifying medical condition may certify NH residents. Physician associates in border states may now also certify NH patients. The provider must be the patient's primary care provider or a specialist actively treating the qualifying condition.

All certifying providers must have:

• An active license in good standing from the applicable NH (or border-state) licensing board
• An active registration from the US Drug Enforcement Administration (DEA) to prescribe controlled substances to humans
• An established, bona fide provider-patient relationship with the patient, including a comprehensive assessment of medical history and current medical condition

New Hampshire does not require medical providers to register separately with the Therapeutic Cannabis Program or with any state licensing board before issuing written certifications. Any qualifying licensed provider with an established provider-patient relationship may complete the official DHHS written certification form.

The TCP does not maintain or publish a list of certifying providers and will not refer patients to any provider.

New Hampshire recognizes three pathways to qualify for the Therapeutic Cannabis Program. Patients may qualify with a stand-alone qualifying condition, a combination of a qualifying diagnosis and a qualifying symptom, or, if you are 21 or older, any debilitating or terminal condition your provider believes may benefit from therapeutic cannabis. These include:

Qualifying Diagnoses (in combination with a qualifying symptom listed below):

• • Cancer
  • Glaucoma
  • Positive status for HIV
  • AIDS
  • Hepatitis C
  • Amyotrophic lateral sclerosis
  • Muscular dystrophy
  • Crohn's disease
  • Multiple sclerosis
  • Chronic pancreatitis
  • Spinal cord injury or disease
  • Traumatic brain injury
  • Epilepsy
  • Lupus
  • Parkinson's disease
  • Alzheimer's disease
  • Ulcerative colitis
  • Ehlers-Danlos syndrome
  • Generalized anxiety disorder
  • One or more injuries or conditions resulting in one or more qualifying symptoms below

Qualifying Symptoms (in combination with a qualifying diagnosis listed above):

• • Elevated intraocular pressure
  • Cachexia
  • Chemotherapy-induced anorexia
  • Wasting syndrome
  • Agitation of Alzheimer's disease
  • Severe pain
  • Constant or severe nausea
  • Moderate to severe vomiting
  • Seizures
  • Severe, persistent muscle spasms
  • Moderate to severe insomnia

Step 1: Evaluate the patient.

Confirm an established, bona fide provider-patient relationship. A full assessment under administrative rule He-C 401.06(b)(4) must include: an in-person physical examination (not via telemedicine, for initial certifications); a medical history including prescription history; a review of laboratory testing, imaging, and other relevant tests; appropriate consultations; a documented diagnosis of the patient's current medical condition; and the development or documentation of a treatment plan appropriate for your specialty.

Telehealth:

Telemedicine is not permitted for the in-person physical examination required for an initial certification, per He-C 401.06(b)(4)(a). Telemedicine is permitted for follow-up care and for recertifications (renewals) by the same certifying provider. Source: He-C 401, DHHS Therapeutic Cannabis Program Registry Rules.

Required counseling:

• • All patients: Explain potential health effects of cannabis use.
  • Minor patients: Explain both the potential health effects and the potential risks and benefits of cannabis use to the minor's custodial parent or legal guardian.
  • Women of child-bearing age: Counsel about the risks of cannabis use during pregnancy and while breastfeeding.
  • Patients age 25 or younger: Counsel about the risks of cannabis use in adolescence.

Step 2: Complete the written certification.

Download and complete the official DHHS Written Certification for the Therapeutic Use of Cannabis form. You must complete all required fields. Certifications that are incomplete or signed more than 6 months before submission will be returned. Provide the completed, original form to your patient to submit with their application. Do not submit the form directly to the program.

When specifying card duration, the standard is 12 months; you may specify a shorter or longer period, up to 36 months. If extending an existing certification, the total duration, including extensions, may not exceed 3 years.

Step 3: Dispense instructions (optional).

If you have recommendations or instructions for the patient's therapeutic use of cannabis (such as the type of cannabis to be dispensed or the route of administration), you may send such instructions directly to the patient's ATC, which is required to follow them when dispensing to that patient. The program will facilitate the secure transfer of instructions to the ATC at your request.

Step 4: Maintain records.

Maintain medical records for all patients for whom you have issued a written certification, sufficient to support the certification of a qualifying medical condition. On the patient application, the patient will authorize the release of relevant medical information to the program if the program requires further information. The program may request, and you must supply a copy of such records for verification purposes.

Written certifications are valid for 6 months from the date of the provider's signature. After 6 months, the certification must be re-signed and re-dated to remain valid. Patient Registry ID cards are valid for 1 year by default. A provider may certify a patient for up to 3 years (including extensions), after which a new written certification and new patient application are required.

To extend an existing certification without requiring a new application, the same certifying provider who issued the original written certification may sign a Written Certification Extension form. Extensions must be signed and dated no later than the card's expiration date; a 30-day grace period applies. The total duration of a written certification, including all extensions, may not exceed 3 years.

Telemedicine is permitted for recertifications (renewals) by the same certifying provider. An in-person physical examination is not required at renewal.

For forms and instructions, visit the TCP forms page.

Medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the Medical Marijuana and Cannabidiol Research Expansion Act (Title III section 301) which became law on December 2, 2022, and the First Amendment (established by a 2004 United States Supreme Court decision to uphold earlier federal court rulings that doctors, and their patients have a fundamental Constitutional right to freely discuss treatment options).

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