MARIJUANA DEBATE SHARPENS

Attorney General, Supporters Face Off

State Attorney General Kelly Ayotte and county prosecutors have
aggressively pushed back against a bill that would legalize marijuana
for some seriously ill patients, sending lawmakers a letter calling
marijuana an addictive drug and claiming that reclassifying marijuana
as medicine could undermine efforts to keep youths from trying drugs.
The bill's supporters decry the letter as "misleading" and have
circulated a seven-page rebuttal of the two-page letter.

The bill easily passed the House in March and the Senate last month,
but its future remains in doubt. Gov. John Lynch has stopped short of
vowing to veto it, saying he has "serious concerns" and calling the
Senate version of the bill "unacceptable." In the House, supporters
put the brakes on the bill last week, voting not to accept the
Senate's amendments to the bill and instead calling for a conference
committee to hammer out a final bill - with an eye toward crafting
something Lynch will accept.

State Rep. Cindy Rosenwald said she met with senior Lynch staffers
and left certain that Lynch would veto the current incarnation of the
bill if it was sent to his desk. She left the meeting with a list of
eight issues flagged by the governor's staff, the most difficult one
of which is distribution. The current bill would allow medicinal
marijuana users - individuals who suffer from specific illnesses or
symptoms, who've been prescribed the drug by a doctor and who have
registered with the state - to grow their own marijuana. They're also
allowed to obtain it from other patients, including those from
patients in one of the 13 states where medicinal marijuana is legal.
Lynch, Rosenwald said, is "not comfortable with marijuana grown in residences."

"I was absolutely clear when I left the meeting that he would not
allow the Senate version to become law," said Rosenwald, a Nashua
Democrat. That, she said, "is why I asked for a committee of conference."

Debate over Ayotte's letter is a microcosm of debate over the bill
itself, an argument in which the urge to help human suffering
competes against fears about human frailty, where practical
considerations meet a backdrop of the decades-long national fight
over marijuana policy, including questions over whether the drug is
addictive and whether it is a "gateway" to other drugs.

Matt Simon, the executive director of the New Hampshire Coalition for
Common Sense Marijuana Policy, distributed a seven-page response to
Ayotte's letter peppered with footnotes. The response says the letter
co-signed by Ayotte and nine of the state's 10 county attorneys
"makes several points that are simply incorrect and several other
misleading statements," in particular taking on claims about
marijuana as an addictive, gateway drug.

"I wish they would cite their sources and say where they're getting
their information," Simon said in an interview yesterday.

Ayotte said she stands by every point in the letter and said there's
no incarnation of a medicinal marijuana law that she could support.
In addition to concerns cited in the letter, she cited practical
concerns and noted that marijuana hasn't been through a normal
approval process by the Food and Drug Administration. Marijuana
remains illegal under federal law, she said, despite the recent
statements by U.S. Attorney General Eric Holder pledging not to raid
marijuana dispensaries that are legal under state law.

"I have to say that, despite the attorney general's statement, the
law, the federal law is still the same," Ayotte said. "It's against
federal law. The law hasn't changed."

Medicinal Validity?

Ayotte's letter cut to the heart of the bill, questioning the
medicinal value of marijuana use.

"In fact, marijuana is an addictive drug that poses significant
health consequences to its users, including those who may be using it
for medical purposes," the letter said. "The use of smoked marijuana
is opposed by all credible medical groups nationwide."

Matt Simon, the executive director of the New Hampshire Coalition for
Common Sense Marijuana Policy, called that claim "simply untrue" and
"the most frustrating." His response includes a list of several dozen
medical groups that have "favorable medical marijuana positions,"
including the American Academy of Physicians, the American Nurses
Association and the American Public Health Association.

Not on the list: the New Hampshire Medical Society, which is not
taking a position on this bill. Also missing is the American Medical
Association, which for years has called for further study of
medicinal marijuana, a position that is extremely common among medical groups.

In a 2001 report, the AMA noted evidence that marijuana has helped
those suffering from certain ailments, such as HIV wasting syndrome
or chemotherapy-induced nausea, but concluded that a dearth of
serious study into the benefits and risks of the drugs prevented the
group from endorsing the drug.

"The lack of this evidence base continues to hamper development of
rational public policy," the association report said.

The American Academy of Physicians went a step further last year,
calling for a review of marijuana's current classification federally
as a schedule 1 drug, the most serious classification, for drugs that
lack medicinal use and carry a high potential for abuse, along with
LSD and heroin. Cocaine is a schedule 2 drug.

"A clear discord exists between the scientific community and federal
legal and regulatory agencies over the medicinal value of marijuana,
which impedes the expansion of research," the report said. It
concluded: "Evidence not only supports the use of medical marijuana
in certain conditions but also suggests numerous indications for
cannabinoids. Additional research is needed to further clarify the
therapeutic value of cannabinoids and determine optimal routes of
administration. The science on medical marijuana should not be
obscured or hindered by the debate surrounding the legalization of
marijuana for general use."

Ayotte said those reports don't counter her claim that medical groups
oppose smoking the drug.

"I think the letter expressly says that smoked marijuana is opposed
by medical groups," she said.

It's unquestionably true that many medical groups have often urged
scientific research into ways of getting the medicinal benefits of
cannabinoids that don't involve smoking. A 1999 report by the
Institute of Medicine, for example, likened smoking marijuana to
smoking cigarettes: "Smoking marijuana is clearly harmful, especially
in people with chronic conditions, and is not an ideal drug delivery system."

As for addiction, the Institute of Medicine report found that a
"vulnerable subpopulation" of marijuana users may be at risk of
becoming dependent but considered addiction "relatively rare"
compared with other drugs.

Simon said marijuana's potential for dependence should be considered
in the context of other drugs, such as cigarettes, alcohol and painkillers.

"The addiction possibility of pharmaceutical painkillers are off the
charts compared to marijuana," Simon said.

Other Concerns

Ayotte's letter also delves into longstanding debates about marijuana
policy, including whether it is a "gateway drug."

"One of the most harmful consequences of marijuana use is the role it
plays in leading to the use of other illegal drugs. Studies have
shown that very few young people turn to illegal drugs such as
cocaine or heroin without first experimenting with marijuana,"
Ayotte's letter said. "The New Hampshire law enforcement community
works diligently to discourage young people from venturing down that
path. Those efforts will be significantly undermined by the passage
of legislation legalizing the use of marijuana to any degree."

Simon said that claim had no merit. "The gateway theory has never
been substantiated by any science, despite repeated attempts to prove
its validity," he said.

He pointed to the 1999 Institute of Medicine Report, which found
there was no conclusive evidence that marijuana's drug effects cause
users to move on to other drugs.

"In the sense that marijuana use typically precedes rather than
follows initiation of other illicit drug use, it is indeed a
'gateway' drug," the report found. "But because underage smoking and
alcohol use typically precede marijuana use, marijuana is not the
most common, and is rarely the first, 'gateway' to illicit drug use.
There is no conclusive evidence that the drug effects of marijuana
are causally linked to the subsequent abuse of other illicit drugs."

Ayotte said her experience as a prosecutor has shown otherwise. She
said if she were to ask officers of the undercover drug task force,
which is run through her office, "many of them would tell me that,
unfortunately, marijuana is a gateway drug."

Ayotte's deputy, Assistant Attorney Karin Eckel, pointed to another
part of the Institute of Medicine report that dealt with the gateway
drug question. The report discussed marijuana as an entree into the
social environment of drug use, a theory that is "supported, although
not proven, by the available data."

Sen. Kathy Sgambati, a Tilton Democrat who supported the bill, said
she didn't find the gateway drug debate relevant to the medicinal
marijuana bill. She was moved, she said, by testimony from cancer
patients and others who said they'd been able to find relief by
smoking marijuana. Many of those who testified had legal access to
extremely potent medicines, she said.

"Ninety percent at least of the people who testified have medicine
chests full of opiates," Sgambati said. "So this is not somebody
seeking a stronger drug."

Only one of the 10 county attorneys didn't sign the letter: Coos
County's Bob Mekeel. He cited two reasons.

"The first is, really just as a general principle. It's my job to
enforce the laws. It's not my job to make them," he said. "I just
don't think it's appropriate to tell the Legislature what the law ought to be."

His second: As a personal-injury lawyer for 25 years, he represented
people who were in "terrible plights" and had lost limbs.

"In those instances, really if anyone in that situation can get
relief from anything, I just don't think I should stand in the way of
that," Mekeel said.

So far, he said, he hasn't heard much negative feedback on his stance, he said.

"I just think reasonable minds can disagree," he said.