New Hampshire’s approach to medical cannabis has undergone a significant transformation since its inception. Established under RSA chapter 126-X, the Therapeutic Cannabis Program (“TCP”) was designed to provide a legal, regulated pathway for patients suffering from certain afflictions to find relief. What began as a highly restrictive framework has evolved into a more compassionate, patient-centered model that recognizes the complexity of human health.
In the Granite State, cannabis is not viewed merely as an alternative treatment but as a legitimate clinical tool. As the program reached the end of its first decade, 2024 marked a pivotal turning point; legislative updates expanded the definition of “qualifying medical condition” in RSA 126-X:1, IX, reflecting a growing consensus on the efficacy of cannabis for mental health and providing healthcare providers with unprecedented autonomy in patient care.
There are two separate pathways by which a patient can qualify for the TCP: the Combination Path (diagnosis + symptom) and the Stand-Alone Path. These pathways arise out of the twin definitions for “qualifying medical condition” found in RSA 126-X:1, IX(a) and (b). Under the Combination Path, RSA 126-X:1, IX(a), a patient must have a qualifying diagnosis and also demonstrate that the diagnosis is causing at least one qualifying symptom.
Qualifying diagnoses include:
- Cancer
- Glaucoma
- Multiple sclerosis
- Parkinson’s Disease
- Positive status for HIV or AIDS
- Spinal cord injury or disease
- Traumatic Brain Injury (“TBI”)
- Epilepsy
- Lupus
- Muscular dystrophy
- Crohn’s disease
- Ulcerative colitis
- Hepatitis C
- Chronic pancreatitis
Despite the significance of these qualifying diagnoses, a diagnosis itself is not sufficient under the Combination Path; the diagnosis must also cause at least one of the following symptoms to fully meet the definition of “qualifying medical condition:”
- Seizures or severe, persistent muscle spasms
- Moderate to severe insomnia
- Constant or severe nausea
- Moderate to severe vomiting.
- Cachexia (wasting syndrome)
- Agitation Alzheimer’s disease
- Chemotherapy-induced anorexia
The Combination Path ensures that for these specific illnesses, therapeutic cannabis is reserved for patients experiencing the most profound and difficult-to-treat effects of their condition.
The second pathway to eligibility, the Stand-Alone Path, RSA 126-X:1, IX(b), involves conditions that do not require an additional secondary symptom because the condition itself is considered inherently debilitating:
- Moderate to severe post-traumatic stress disorder (“PTSD”) and conditions resulting in severe or chronic physical discomfort (such as chronic pain) are established stand-alone conditions. These categories represent a substantial portion of the patient population in New Hampshire, acknowledging that persistent pain and psychological trauma are often resistant to standard therapies.
- Autism is recognized as a stand-alone condition, but the program includes safeguards for younger patients. For patients under age 21, the law requires a consultation with a specialist who can confirm that other treatments have either been ineffective or have produced serious adverse side effects.
- To combat the regional opioid crisis, opioid use disorder (“OUD”) is a qualifying condition. It, however, carries the strictest requirements: the patient must exhibit symptoms of cravings and/or withdrawal, and the certification must come from a provider who is board-certified in addiction medicine or addiction psychiatry and is actively treating the patient for the disorder.
The year 2024 brought the most significant changes to the program’s eligibility criteria since its founding. Two major additions to the Stand-Alone Path that year fundamentally changed the landscape for New Hampshire residents.
First, in late 2024, generalized anxiety disorder was added as a stand-alone qualifying condition. This was a landmark shift, acknowledging that severe anxiety can be as debilitating as physical pain. Patients do not need to prove a secondary physical symptom; the diagnosis of generalized anxiety disorder itself when certified by a provider is a sufficient qualifying medical condition.
Second, and perhaps the most impactful update in 2024, was the legislative grant of provider discretion. The definition of “qualifying medical conditions” was amended to allow medical providers to certify any adult patient (age 21 or older) for “any debilitating or terminal medical condition or symptom for which the potential benefits of using therapeutic cannabis would, in the provider’s clinical opinion, likely outweigh the potential health risks for the patient.” RSA 126-X:1, IX(b)(8).
This means that if a provider believes, in their professional clinical opinion, that the potential benefits of therapeutic cannabis outweigh the risks, they may certify the patient even if their specific condition is not explicitly listed in the statute. This “patient-centered” approach removes the delay of waiting for the legislature to approve new conditions and places the power back into the hands of the doctor-patient relationship.
The evolution of New Hampshire’s Therapeutic Cannabis Program reflects a broader societal shift toward recognizing the nuances of chronic illness. By expanding the list of qualifying conditions to include generalized anxiety disorder and granting providers the discretion to certify any “debilitating or terminal” condition, New Hampshire has moved toward a more inclusive and compassionate healthcare model.
The 2024 updates signify that the state is listening to both patients and clinical experts. The program is no longer just a list of diagnoses; it is a flexible framework designed to provide relief for unique and complex medical needs that may not fit into a pre-defined box. As the program continues to grow, the focus remains steadfast on safety, regulation, and, most importantly, the improvement of the quality of life for New Hampshire citizens.