DHHS reports plateauing therapeutic‑cannabis enrollment, affordability pressures; oversight board backs access changes

Michael Holt, administrator of the Therapeutic Cannabis Program at the Department of Health and Human Services, briefed the Health, Human Services and Elderly Affairs committee on the program’s 2024 annual data report and the Therapeutic Cannabis Medical Oversight Board (TCMOB) annual report.

Holt said the program had 14,705 registered patients as of June 30, 2024, noting registration growth has slowed. He said New Hampshire’s per‑capita medical‑program enrollment is among the lowest nationally and that growth may be affected by program design, qualifying‑condition lists, proximity to states with lower costs and the availability of alternative supply channels. “It is the lowest number of patients, nationally for a, state per capita for enrollment in a medical program,” he said, citing Marijuana Policy Project data.

Key points from the department’s report and testimony: • 83 percent of registered patients were certified for a pain condition; PTSD (22%), insomnia (7%) and cancer (6%) were other common conditions. • As of the report date there were seven minor patients registered and DHHS described certification guardrails for minors as strong. • Approximately 1,400 providers had certified at least one patient; most certifying providers were family‑medicine or internal‑medicine clinicians, and most providers certified between one and nine patients. • Caregiver registrations roughly doubled since 2020 (now over 1,000), after fees and fingerprinting requirements were removed. • Product variety at alternative treatment centers (ATCs) increased and reported product costs have fallen in 2024, but high prices relative to neighboring states remain a major barrier; Holt said more than 30 percent of registered patients in 2024 never visited a New Hampshire ATC, often obtaining product across state lines. • ATCs reported more than $1.1 million in patient affordability discounts in 2024, and nearly 30 percent of their patients participated in affordability programs.

Holt outlined policy levers that could reduce patient cost, including allowing ATCs to outsource non‑intoxicating hemp‑derived cannabinoids (CBD), approving greenhouse cultivation to lower production costs, and permitting home cultivation — each of which is the subject of bills before the legislature. He also discussed a bill that would allow ATCs to convert to for‑profit status by board vote as another potential path to lower prices.

On the TCMOB report, Holt said the board met three times in 2024 and provided clinical review of proposed qualifying conditions, supported provider discretion for certifying adults when benefits outweigh risks, and worked on educational materials about risks to adolescents. The board has generally supported legislative proposals intended to improve patient access and lower costs, while opposing measures such as stricter THC concentration limits and THC blood‑concentration policies due to lack of evidence.

Committee members asked about county disparities in enrollment and provider numbers; Holt said those differences are in part explained by age‑adjusted population differences and known provider concentrations (for example, Dartmouth in Grafton County). Legislators also asked which bills might reduce costs; Holt identified the hemp‑CBD outsourcing bill, greenhouse cultivation and home cultivation as likely to lower prices to patients if enacted. Holt said the department has not increased program fees and recently moved to three‑year certification cycles to reduce barriers.

No formal committee vote was recorded on policy items; the department’s reports were received and committee members were directed to legislative calendars for bill action.