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Physicians demur as cannabis-for-pain nears

Chris Steller//January 13, 2016

Physicians demur as cannabis-for-pain nears

Chris Steller//January 13, 2016

Tweaking Minnesota’s relatively new medical marijuana law isn’t in the cards this year.

That was the word from the 2014 law’s Senate sponsor, Sen. Scott Dibble, DFL-Minneapolis, after Tuesday’s meeting of the Task Force on Medical Cannabis Therapeutic Research, which Dibble co-chairs.

The panel heard that many doctors are proving resistant to adopting medical cannabis as a therapeutic drug, even as the list of qualifying conditions under the state program grows to 10 next summer with the addition of intractable pain.

The task force also set its sights on submitting a report to legislators that was due last February sometime while the House and Senate meet between March and May. A subcommittee will work on hammering out what remains to be done on a draft report posted at the task force webpage.

But unlike some other Capitol task forces, commissions and committees, the medical cannabis task force wasn’t massaging proposed pieces of legislation to get them primed for approval during the coming short session.

They also didn’t take public testimony as they did at past meetings, to the consternation of some citizens heard grumbling on the way out of the hearing room after co-chair Rep. Pat Garofalo, R-Farmington, gaveled adjournment.

Instead, the task force got updates from Michelle Larson, director of the state’s new Office of Medical Cannabis; Dr. Edward Ehlinger, commissioner of the Minnesota Department of Health; and committee member Dr. Charles Reznikoff, a specialist in addiction at Hennepin County Medical Center. (You can watch the full task force meeting on Session Daily‘s YouTube channel.)

Larson said the latest figures from her office, updated online each Friday, show that 479 health care practitioners are registered and authorized to certify patients for the program. The number of patients who have been approved to join the state’s registry for procuring medical cannabis stands at 844. Background checks are complete on 93 patient caregivers who are now approved in the registry.

Larson offered highlights on the profile of patients participating in the program: For instance, 35 percent are 51-70 years, while 6.8 percent are 71 years and older. Males constitute the better part — 57 percent — of the patient pool. The leading conditions for which patients are using cannabis are (in order of prevalence) severe muscle spasms, seizures and cancer with chronic pain.

Ehlinger discussed his decision in December to exercise an option legislators expressly provided him in the medical cannabis law — adding intractable pain as a reason Minnesotans may be approved to get marijuana.

The benefits to patients far outweighed the risks, he said. Among patients facing risks from the therapy are children (for whom marijuana affects their developing brains); pregnant women (a group currently including task force member and House sponsor of the 2014 law Rep. Carly Melin, DFL-Hibbing); and people with psychotic illnesses (for whom marijuana may exacerbate their other conditions).

But Ehlinger said he did not feel those groups should be excluded from the choice to receive medical cannabis — only that that decision should be left to health care providers in consultation with their patients.

Melin cited her own experience to advocate for more information for pregnant women on marijuana as well as other drugs. “Being pregnant myself, and having been pregnant just a couple years ago as well, there’s not really thorough counseling for pregnant women on what they should or shouldn’t be consuming when they’re pregnant,” she said. “They go through sort of a standard questionnaire. And obviously it’s common sense to people who are educated and who have resources available [regarding] what they should and shouldn’t be using when they’re pregnant, as far as drugs and alcohol go.

“You are making the warning for medical cannabis, and I think that you should be. I think it’s really important that pregnant women and children have the resources available to know what the potential side effects would be. But I would like to see that in other areas of our public health as well to make sure we’re addressing that issue head on, as far as heroin or other pain medications go. Perhaps my doctor hasn’t had a conversation with me because I’m not on any medication. [We] haven’t felt the need to go in depth. But I think it’s an issue that we should be addressing as a public health issue statewide.”

When Ehlinger’s decision takes effect Aug. 1, 2016, intractable pain will be the 10th condition for which patients in Minnesota may gain certification to receive medical cannabis. The other nine already in effect are:

  • Cancer (when associated with certain symptoms, including severe or chronic pain, and nausea or severe vomiting);
  • Glaucoma
  • Tourette syndrome
  • Amyotrophic lateral sclerosis (ALS)
  • Seizures (including epileptic seizures)
  • Muscle spasms that are severe and persistent (including spasms characteristic of multiple sclerosis)
  • Crohn’s disease
  • Terminal illness, if the patient has a life expectancy of less than one year and the illness or treatment produces severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting.

Reznikoff presented results of a survey of 262 Minnesota doctors that he described as unscientific but still suggestive of generally held attitudes among professionals in the state.

A sizable plurality did not agree that intractable pain should be a qualifying condition for medical cannabis, he said. Large majorities said they didn’t feel they had sufficient knowledge about marijuana as a therapy to discuss it with a patient, or to go about certifying a patient and managing their treatment.

Reznikoff cited a number of factors for doctors’ wariness about medical cannabis, including a lack of knowledge, a need for more educational opportunities, and the fact that doctors aren’t required to know about the treatment. Also, he said, the medical profession is suffering from a kind of post-traumatic stress disorder from the ongoing heroin and opioid abuse crisis, making them unready for another pain treatment with social complications — in marijuana’s case, the fact that it is still illegal under federal law.

Larson said it was preliminary but her office was looking at other states where learning about medical marijuana is a requirement for doctors.

Ehlinger conceded the definition of intractable pain in state law left something to be desired in terms of clarity.

“It is … elaborate,” said Garofalo.

But Dibble said in an interview he didn’t expect lawmakers to attempt any amendment of the definition this session.


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