Linda Horan is a terminally ill lung cancer patient with months to live. She resides in a state which allows medical cannabis use. Five of her doctors have approved her use of cannabis for palliative relief. She understands the implications of her diagnosis and, as far as possible, wishes to avoid the use of opioid medications in her end-of-life care.
And yet, until last week, it was quite possible that Linda would spend her last days on earth without the comfort of medical cannabis. This is because Linda lives in New Hampshire, where possessing cannabis for therapeutic use is technically legal, but functionally inaccessible.
Over two years ago, New Hampshire legislators approved a bill establishing a therapeutic cannabis program in the state. But patients there are still waiting to benefit from the program—the first dispensaries will likely open in Spring 2016, and until then, program regulators had refused to issue state medical cannabis registry cards.
State officials claimed that releasing the cards ahead of the arrival of functioning dispensaries would undermine their ability to control medical cannabis distribution in the state.
The best way to control medical cannabis distribution, of course, would be to fast-track dispensary permitting, dedicate adequate staff to the oversight team, and to get the program up and running. But issuing the cards is a step in the right direction.
Such cards would provide legal protection for New Hampshire patients who obtain cannabis for medical use, despite the fact that, without functioning dispensaries, patients have to rely on the illicit market.
Further, the cards offer legal access to New Hampshire patients who are able to visit Maine, because Maine’s law allows patients who have a certification from another medical cannabis state to obtain medicine here.
By refusing to issue medical cannabis cards prior to the opening of the dispensaries, New Hampshire was denying patients not only a legal protection for possession, but also access to one source of safe and legal medical cannabis itself.
So Linda Horan successfully sued New Hampshire’s Department of Health and Human Services to force them to issue the cards before the dispensaries open—a day that she and many other patients may not live to see.
This is a hard-fought victory, led by a patient who is spending precious energy in her final months to ensure that a seemingly-stalled program fulfills its compassionate mandate.
There is a moral and ethical dimension to any medical marijuana law: the belief that it is right and just that patients should have access to a natural plant remedy that can alleviate devastating symptoms and improve quality of life. That these programs should function in ways that do not set up unnecessary barriers to access.
Matt Simon is New England Political Director for the Marijuana Policy Project. Hours before last week’s ruling, he told me, “There is no question that New Hampshire legislators intended to protect patients such as Linda when they passed this law in 2013.”
But those good intentions were thwarted by agencies who wish to “maintain the criminality of” medical cannabis. He continued, “Sadly, as a practical matter, they have succeeded.”
Simon referred to the situation as a “nightmare” for New Hampshire patients: “(M)any patients have suffered needlessly, some have been forced to rely on dangerous prescription drugs such as OxyContin, and some have had no choice but to uproot their lives and move to a state that is more reasonable and compassionate.”
That’s not hyperbole—the situation was nightmarish. Barriers to access, caused by needlessly restrictive interpretations of statute, disproportionately impact the eldest, the poorest, and the most seriously ill of New Hampshire’s patients.
Despite Linda’s precedent-setting victory, there is no guarantee that New Hampshire DHHS will issue cards to other patients who have applied early. Department officials say they are reviewing the ruling. (Unlike in Maine, New Hampshire patients are not allowed to grow the plant for themselves.)
It seemed fitting that the ruling was issued mere hours before many of us sat down to a feast of thanksgiving.
But even if officials decide to issue the cards without further legal fights, the truth is that those who are too ill, too poor, too isolated to travel will remain Tantalus, condemned to grasp at the nourishing plant that remains just beyond their reach.
Linda Horan’s case reminds us that laws and regulations must be administered, tempered, and seasoned with compassion. That the definition of a successful medical marijuana program must include the fewest hurdles for the most seriously ill among us.
Further, she reminds us that individual citizens are a powerful force in holding government accountable. Perhaps her attorney, Paul Twomey, said it best:
“Linda is a hero. Facing death, she has chosen to fight for the rights of all the critically ill patients in New Hampshire, who should not have to fear arrest because they are sick. She may be dying, but we all owe her our thanks for showing us how to live.”