Marijuana photo by Scott Beale / Laughing Squid

Later today, the N.H. Senate will vote on House Bill 442, which would allow people to legally use marijuana to treat certain diseases, under narrow qualifying exceptions and with a medical doctor’s recommendation.

The bill has strong bipartisan sponsorship from both chambers, including Rep. Evalyn Merrick (D-Lancaster), the bill’s prime sponsor, and Sen. James Forsythe (R-Strafford). And the House overwhelmingly passed the measure by a 221-96 vote in March.

In a closer 3-2 vote and with many suggested changes, the Senate Health and Human Services Committee has given it a narrow recommendation. Among the many amendments the committee would like to see are a controlled patient ID system and state-licensed (but not state-funded) alternative treatment centers to distribute the drug. (You can read the complete amendment by going to the May 5 Senate calendar page here, then scrolling down the amendments in numerical order to HB 442.)

Veto History — and Future

Supporters say that, if passed, the bill would create the strictest medical marijuana law in the country. But Gov. John Lynch is not among the bill’s supporters. He vetoed a similar measure in 2009, and has vowed to do the same this year, saying there simply aren’t enough legal safeguards.

He’s not readying his veto pen yet, though. House Bill 442, if it passes the Senate today with the committee’s suggested amendments, will still need to go back to the House for approval of those changes. Only when it’s passed both chambers will it go to Lynch’s desk.

Two years ago, the House had enough votes to override the veto, but the Senate fell two votes short of the two-thirds majority required.

If it eventually passes this session, New Hampshire would join 15 other states — including neighboring Vermont and Maine — and the District of Columbia in permitting medical marijuana.

>> Wednesday, May 11, full Senate session beginning at 10 a.m. at the State House.

This Daily Briefing was written by Michael McCord, with contributions from Hilary Niles.

The often adversarial nature of politics — this session in the New Hampshire Legislature being no exception — begs the question of what it takes to find common ground. The reality is complicated. For all their public bickering, lawmakers often do get along, especially at the committee level. But that fact of life doesn’t make many headlines.

Enter the pharmaceutical drug take-back program.

The bill, which we’ve tracked since January, creates a new way for New Hampshire cities and towns to confront the issues of pain medicine addiction and water supply degradation. Several state agencies collaborate in setting guidelines for how communities and private entities, in conjunction with law enforcement, can collect unused medications. It’s “enabling” legislation, or a law that allows communities to take part in the program on a volunteer process. The goal is keeping prescription drugs off the street and out of the water supply (which happens when people flush old meds).

An earlier proposal had called for pharmacies to establish take-back programs, but a study committee recommended against it due to corporate liability issues. Lesson learned, a new mechanism was created. House Bill 71 is the product of a successful pilot program last fall — in which more than a ton of unused pharmaceuticals was collected statewide — followed by fine-tuning from legislative interim study recommendations.

Later today, the Senate Health and Human Services Committee will hold a public hearing on HB 71, which passed uncontested by a voice vote in the House last month. Sponsored by Rep. Chris Nevins (R-Hampton), the bill enjoys significant bipartisan support.

>> Thursday, April 7, 1:00 p.m., Senate Health and Human Services Committee public hearings on HB 71 and other bills (Legislative Office Building, Room 102).

This Daily Dispatch was written by Michael McCord, with contributions from Hilary Niles.

What’s your impression: Is the bipartisan time, effort and study that went into HB 71 the exception or the rule in New Hampshire’s legislative process? As a reader and a citizen of the Granite State, would you like to hear more of the success stories, or should media focus on the fights?

Share your thoughts in the comments box below (see policy first, please)!

To prepare for the flurry of activity, today we begin a series of dispatches looking at some of the bills we’ve followed from early stages through public hearings and committee votes. We start with bills that are on the “consent,” or voice vote calendar.

This process bundles up scores of new pieces of legislation and lets lawmakers agree to the committee recommendations on each bill, all by voicing just one vote. The official name for killing a bill is voting it “Inexpedient to Legislate,” commonly shortened to ITL. Short for “Ought to Pass,” an OTP recommendation means the committee supports the bill in question.

To help you follow along, the committee names in bold are linked to previous Front Door Politics dispatches covering these bills.

Education

The committee gave a unanimous Inexpedient to Legislate (ITL) recommendation for House Bill 39, which targeted the state’s curriculum requirements for an adequate education.

Election Law

House Bill 223, which would eliminate election-day voter registration, received an ITL recommendation.

Executive Departments and Administration

Back in November, we highlighted the progress of a study committee looking into establishing a state meat inspection service. House Bill 339 would establish just such a service, and received a unanimous Ought to Pass (OTP) committee recommendation.

Health, Human Services and Elderly Affairs

Two pharmaceutical take-back bills are headed for passage after receiving unanimous OTP committee recommendations. House Bill 71 would allow communities and private entities to establish drug take-back programs, and House Bill 426 would allow for institutions such as nursing homes and correctional facilities to re-allocate unused drugs.

Municipal and County Government

House Bill 144, a proposal to repeal the PACE, or clean energy district legislation from last year, has been amended to changes some funding mechanisms in a way that satisfied committee concerns about the new program. The PACE changes are headed for passage after a unanimous OTP recommendation by the committee.

This Daily Dispatch was written by Michael McCord.

Unused pharmaceuticals increasingly fuel addiction and environmental concerns, but two new bills could help keep New Hampshire’s excess medications off the streets and out of the water supply — while getting some of them to patients for whom costly pills are largely out of reach.

Unused, costly and life-saving medicines don't have to go to waste. (photo Hilary Niles)

Following up on a statewide effort last September to help communities safely collect and dispose of unused prescription drugs is House Bill 71. Sponsored by Rep. Chris Nevins (R-Hampton), the bill has bipartisan support. It would have state agencies (Department of Justice, Pharmacy Board, Department of Safety, and Department of Environmental Services) set up rules and guidelines to allow communities and private entities to establish pharmaceutical take-back programs.

Rep. Donna Schlachman (D-Exeter) is a co-sponsor of HB 71. She says it the product of an interim study committee recommendation. The original bill called for pharmacies to establish take-back programs, but that was considered unrealistic for liability reasons, she explains. But, last year a pilot project collected more than one ton of unused pharmaceuticals from homes across the state. Properly collected, these drugs can’t be abused or create environmental damage to water supplies.

“We use one or two pills (of a prescription) for pain but not the rest,” says Schlachman. “We just get lazy and don’t dispose of them. They just sit around and all too often fall into the wrong hands,” Schlachman tells Front Door Politics. “We don’t need ‘Pharm Parties’ where kids bring prescription drugs from home and share them with friends.”

The White House Office of National Drug Control Policy says that prescription drug abuse ranks second behind marijuana for teenagers.

Following its first public hearing on Jan. 11, HB 71 was sent to a subcommittee of the Health, Human Services and Elderly Affairs Committee, where it will be discussed today at 2:30. Schlachman isn’t sure why HB 71 was sent to subcommittee, which usually means the committee chair wants further study.

“I believe we had crossed all the Ts and dotted all the Is,” she says. But, overall, she is confident the bill will become law.

Also today at 2:00 p.m., the full committee will have its first look at another bill Schlachman co-sponsored, House Bill 111. This proposal would expand a law passed last year (HB 1184) that allowed unused drugs to be stored and re-presecribed in places like nursing homes. HB 111, whose prime sponsor is Rep. Sandra Keans (D-Rochester) would add unopened samples to that program. (You can see a 2010 Front Door Politics report on HB 1184 and a pilot prescription drug recycling program here.)

>> The Health, Human Services and Elderly Affairs Committee meets today in the Legislative Office Building, Room 205, for the following public hearings and work sessions:

2:00 p.m.         HB 111, relative to redispensing unused drugs, Room 205.

2:30 p.m.         Subcommittee work session on HB 71, authorizing establishment of pharmaceutical drug take-back programs, Room 207.

This Daily Dispatch was written by Michael McCord.

Marijuana photo by Scott Beale / Laughing Squid

Merrick, who was reelected earlier this month, has kept her promise. The cancer survivor has filed an LSR—or legislative service request, the first step in crafting a new bill—titled “relative to the use of marijuana for medicinal purposes.”

The 2009 measure, House Bill 648, would have established three nonprofit “compassion centers’’ to dispense two ounces of marijuana every 10 days to severely ill patients with physician’s approval. The state would have licensed the centers and issued identification cards to their staff, approved patients and caregivers. The bill had bipartisan support—one of the co-sponsors was Republican Sen. John Gallus of Berlin—and advocates said that the new law would provide relief to people with chronic or terminal illnesses.

Debate over the bill set off political fireworks and unrestrained verbal exchanges when Lynch vetoed the bill in July 2009. He said there were inadequate safeguards on the drug’s cultivation and distribution and expressed concern that the amount of marijuana allowed under the bill could prove addictive or damaging. Lynch said he was not convinced the centers would keep marijuana in the right hands, arguing the bill did not require sufficient oversight of volunteers working at the centers.

“We cannot set a lower bar for medical marijuana than we do for other controlled substances, and we cannot implement a law that has serious flaws,” he said in a statement.

Supporters like Merrick said the bill would have regulated the drug more tightly than in any of the 13 states where medical marijuana is legal. She said at the time that Lynch denied a measure that would have given relief to the state’s most vulnerable citizens and that limiting marijuana cultivation to the compassion centers would ensure its quality and security.

“This is clearly a politically directed decision, based on misinformation and lies,” Merrick said in a statement. “It appears the governor may not have thoroughly read the bill in its entirety.” House members overrode Lynch’s veto easily in 2009 but the Senate margin was only 14-10, two votes shy of the 2/3 majority needed.

We’re not sure how far supporters of medical marijuana will get in this session. But, if the bill gains any traction in Concord, it will be another interesting and provocative debate about culture, compassion, myth, liberty, law and order.

This is the first in a series that examines new bills being filed for the 2011 legislative session.

This Daily Dispatch was written by Michael McCord.

Unused, costly and life-saving medicines are now routinely thrown away, even when the state has paid for them. (photo by Hilary Niles)

Unused prescription drugs could soon be donated to some uninsured or underinsured patients in New Hampshire.

The Board of Pharmacy is working with three test sites in Hanover, Rochester and Exeter to roll out the Unused Prescription Drug Program created by the Legislature in 2006.

Under the program, some prescriptions that normally would get thrown away—due to a patient’s recovery, allergy or death, for example—could instead be re-dispensed to people who can’t afford them. This matters most to program advocates as a social cause, especially as insurance and health care costs increase and more people laid off are losing benefits.

The bonus is that it could also save the state money down the road.

“It has huge ramifications,” says Rep. Judy Day (D-North Hampton). She sponsored amendments to the program this year with House Bill 1184. It passed the House on Feb. 17, and it may help end the four-year delay in putting the original law to use.

the hold-up

Mostly for safety and liability reasons, the donated prescriptions have to be handled differently than prescriptions made fresh. From acceptable expiration dates and re-labeling to physical storage and database management, a host of details have bogged down progress.

House Bill 1184 allows for temporary storage, and clarifies that the system is voluntary and patients must know they are getting re-dispensed drugs. Immunity for pharmaceutical companies in the case of mishandling had already been provided, and HB 1184 extends that to the pharmacists who will do the re-dispensing, provided all rules are followed.

Rule-making authority for the program lies with the Board of Pharmacy. But as Day explains, they’ve faced a chicken-egg dilemma. “They couldn’t figure out the rules without knowing the programs the rules would be written for,” she says.

Enter the test sites, which actually more chose themselves than got chosen for the pilot. Representatives from Rochester Manor and SeaCare Health Services both brought the idea of an unused prescription drug program to the Board of Pharmacy, only to find out that it had already been created, but not yet implemented. They started working with the Board to help create the rules, and Dartmouth-Hitchcock also joined.

chain of control

The program depends on a strict “chain of control,” meaning no drugs that have been in the hands of patients are eligible for donation. Only doses dispensed individually by a professional can be used. This is why the three test sites are significant: They each have a different chain of control.

Chain of control can be simple, but it must be strictly documented. (photo by Hilary Niles)

Dartmouth-Hitchcock has its own pharmacy, but it’s not a retail site open to the public. Rochester Manor is a skilled care center with a consultant pharmacist, but without its own pharmacy. SeaCare Health Services in Rockingham County screens and refers uninsured patients through a pro bono physician network. It has no pharmacy, and it’s an open network rather than a closed system.

Each place dispenses medicine differently, so each will have to develop its own procedures for chain of control. Once operational, the sites will be models for more facilities like them to follow. But, depending on the site, the procedures could take anywhere from a few weeks to more than a year to put in place.

patience

“I’m leaving for Florida for a week on Monday,” says Rochester Manor consultant pharmacist Gene Johnson, “and I want to start this when I get back.”

Johnson is both a pharmacist and a lawyer—a background that likely helped him prompt the Board of Pharmacy to action. Johnson drafted his own procedures for Rochester Manor, and Day says his proposal gave a focus to the Board, around which it could start creating rules.

Gretchen Colpritt and Gene Johnson of Rochester Manor in Johnson's office, which will double as temporary storage for unused prescriptions. (photo by Hilary Niles)

His gumption also helped. “If people can benefit from something, why wait for the bureaucracy,” asks Johnson. “If you can identify a problem now, let’s fix it now.” He is clear that efficiency, more than patience, is his strong suit.

The Board of Pharmacy did not return calls or emails by press time to confirm that Rochester Manor is indeed empowered to move forward according to current rules, but Johnson is not expecting to wait.

It will be a different story at SeaCare. Given their decentralized operation, executive director Kathy Crompton expects it could take up to a year to finalize procedures.

But with the Board of Pharmacy’s recent progress, she has more clarity with which to return to the task. Since SeaCare serves the public in 21 towns, it has a much broader reach, and she is motivated to achieve it.

Dartmouth-Hitchcock could not be reached for an update on that facility’s progress.

potential

All involved are optimistic about the pilot, and see even more potential for the program. It could include controlled substances, and it could also be used in the state prison system.

Day says that’s where the state could really save money. Inmates lose Medicaid upon incarceration, she says, but the state is not allowed to deny heath care, so it must pick up the bill.

In the meantime, she’s thrilled with the current progress. She found that of the 30 or more other states that have created similar programs, very few have implemented them.

“I’m not saying it’s not hard to do,” she says, but she still expects it to get done.