Chronic Pain Patients May Soon Be Eligible For Medical Marijuana in Minnesota

September 11, 2015September 11, 2015 / Thomas Cohn, MD

Minnesota officials are considering adding chronic pain to the list of approved conditions for the state’s medical marijuana program.

Meetings about adding intractable pain to the list of approved conditions for medical marijuana began two weeks ago, but so far officials aren’t any closer to a decision. Should state officials add chronic pain to the approved list, chronic pain sufferers would be able to begin purchasing medical marijuana next summer.

Officials are a little leery about adding the chronic condition to the list for a few reasons:

How many would apply? – State officials say they are unsure how many chronic pain sufferers would apply for medical marijuana, and they don’t know if their suppliers would be able to meet the increased demand. Early estimates said it could eventually triple or quadruple the 5,000 patients they currently expect to apply.

Defining chronic pain – Many people deal with pain, but how would chronic pain be defined under the program? One insider suggested that chronic pain would be defined as pain for which “no relief or cure of the cause of the pain is possible,” though the definition could be open to interpretation.

How will doctors respond? – According to the advisory panel tasked with deciding on whether or not chronic pain will be added to the list of approved conditions, some doctors and clinics are leery about sending their patients to buy medical marijuana. There are so many compounds in marijuana, and we don’t have extensive knowledge of how all those compounds will interact with different types of chronic pain.

Decision Time

According to reports, the decision to add chronic pain to the list of approved conditions falls with Department of Health Commissioner Ed Ehlinger and his advisory panel. The panel is comprised of medical professionals and health experts who will help Ehlinger make a decision by the end of the year.

Additionally, the Minnesota legislature can expand Ehlinger’s decision should they feel it’s too strict, or they can place more restrictions on the program should they feel it’s too interpretive.

Related source: Star-Tribune

The First Phase of Legal Marijuana

June 8, 2015June 10, 2015 / Thomas Cohn, MD

The start of legalizing medical marijuana in Minnesota began last Monday. The initial step for patients is to be certified that one has a condition approved for treatment by this medication. Pain is not a condition approved for marijuana in Minnesota. Once certified as having an appropriate condition, the process in Minnesota applying for the medication can begin, and then obtaining the approved medication can occur. One can assume, the medical marijuana oils obtained in Minnesota, will be far different from recreational use marijuana.

In June, 2015, the lead National Geographic article is titled “Weed, The New Science of Marijuana”. It is an excellent review of the knowledge and science of cannabis. The use of marijuana dates back to at least to 3000 B.C.E., but did not become demonized until 1970 when it became a Schedule 1 drug, meaning it had no valid medical purpose. The truth about marijuana is much more complex. The study of marijuana really began only in the early 1960’s compared to the early 1800’s when opium and cocaine became known. Those drugs, which were once taboo, led us to the discovery of morphine and coco leaves. Will marijuana follow a similar path?

The Science Behind Marijuana

In 1963, a young organic chemist by the name of Raphael Mechoulam began experimenting with the compounds in marijuana. After isolating a number of compounds, Mechoulam tested the compounds on monkeys. Only one compound produced a significant effect. As Mechoulam wrote, “normally the rhesus monkey is quite an aggressive individual,” but when injected with this compound, the monkeys became quite calm.

Flash forward a few years, and Mechoulam’s research is helping 20,000 patients get treatment in his home country of Israel for a variety of conditions, including Crohn’s Disease, glaucoma, Tourette’s Syndrome and asthma. Mechoulman says he doesn’t believe the substance should be legalized for recreational use, but he hopes the stigma of studying the compounds for medical research fades now that more people seeing the medical benefits it possesses.

“We have just scratched the surface,” he says, “and I greatly regret that I don’t have another lifetime to devote to this field, for we may well discover that cannabinoids are involved in some way in all human diseases.”

In fact, researchers are using marijuana to combat cancers as we speak. Research in Spain found that some rats with brain tumors were cured of their condition after being injected with THC. The results are quite encouraging, but as biochemist Manuel Guzmán noted, “the problem is, mice are not humans. We do not know if this can be extrapolated to humans at all.”

Think about that for a second. We may have found another potential ally in the war on cancer, but there’s still so much hate for the drug that it’s impeding medical progress. We need to study these compounds in order to provide the best care possible for our patients.

Related source: National Geographic

Medical Marijuana in Minnesota: Chronic Pain Tabled ‘Til 2016

February 18, 2015 / Thomas Cohn, MD

Minnesotans will have to wait until 2016 to learn if the state will add chronic pain to a list of conditions approved to apply for medical marijuana.

The state has been dragging their feet in regards to adding chronic pain to the list of approved conditions for medical marijuana, and now they’ve decided to table the idea until next year. State officials said they feared approving the condition could overextend medical marijuana manufacturers who are already in high gear prepping for the program’s launch this summer. The state said potentially adding tens of thousands more medical marijuana patients could be troublesome for Minnesota’s two marijuana manufacturers.

Manny Munson-Regala, assistant commissioner of the medical marijuana program’s launch, said he “didn’t see a way to do this in a thoughtful, structured way,” in terms of having the medicine available for 2015. I do think more testing is needed, as chronic pain can be caused by a myriad of internal issues, but citing supply and demand issues seems like a weak excuse. Under the current timetable, the earliest a chronic pain sufferer could get medical marijuana would be August 2016, if the condition get’s added to the list.

Senator Branden Peterson, R-Andover, was disappointed by the decision. Peterson had a bill that would have made chronic pain an eligible condition starting July 1, 2015. He wasn’t the biggest fan of the state’s supply and demand excuse either.

“I don’t see why we need to wait that long,” said Peterson. “If we acted this session, we could do something that would serve the interests of those patients a lot sooner.”

Although about 88,000 Minnesotans are currently being treated for chronic pain, the state estimates that only about 5,000 would apply for medical marijuana if it were approved.

New Timeline

Here are the important dates now that the state has updated their timeline regarding chronic pain and medical marijuana.

Spring 2015 – A new panel will examine the pros and cons of adding chronic pain to the approved conditions list.

December 2015 – The panel will submit their final recommendation to Health Commissioner Ed Ehlinger.

January 15, 2016 – Ehlinger would have to add chronic pain to the list of qualifying conditions by this date to give lawmakers the opportunity to block the condition if they see fit. If it is not added by January 15, patients would likely have to wait until 2017 at the earliest.

Medical Marijuana: A Growing Acceptance

February 11, 2015 / Thomas Cohn, MD

The world’s view on marijuana appears to be rapidly changing. Marijuana was thought of as solely a recreational drug only a few years ago. It was basically slid into a role as something to use only to escape the world and get high. It has been classified by the DEA as drug in Schedule 1, with no medical value. It was put into the same category as heroin and LSD. More recently, medical professionals have been starting to recognize the research on cannaboids and the beneficial compounds marijuana holds. The public perception of marijuana is starting turn in its favor.

Last week there were three main events that advanced the growing acceptance of the medicinal value of marijuana. The first was that the American Academy of Pediatrics (AAP) came out in favor of re-classifying marijuana to a Schedule 2 drug, just like other narcotics like morphine or Percocet. This would change the federal status from being illegal on all fronts to being considered a drug, and thus legal to study and to be prescribed for certain medical conditions. Currently, with its Schedule 1 status, doing adequate medical research is extremely difficult, stifling the development of medical knowledge and its usage. Preliminary research does show medical value of various cannaboids for seizures, nausea, cancer and pain. However, which cannaboids of the about 100 known compounds work best with the least amount of risks is poorly understood. Furthermore, we do not know if it is a combination of compounds or if a specific delivery mechanism is necessary.

The new US Surgeon General, Dr. Vivek Murthy, M.D. has also joined the chorus. This week he indicated that he supported reclassifying marijuana to Schedule 2 drug. He also reported that cannaboids did have medical value in certain conditions. Again, the reclassification would allow widespread research and development of cannaboids for their medicinal value.

Marijuana in Minnesota

In Minnesota, medical marijuana appears to be slowly moving forward. The growers of marijuana have been selected and several locations for dispensaries have been chosen. It still will be limited in use, and it will not be available for the use in pain management, at least in the early stages. The state will investigate marijuana’s potential benefits for chronic pain suffers during the first year medicinal marijuana is available. Furthermore, several Indian tribes are considering whether they will make medical marijuana legal and available on their reservations. The rules that apply on Indian reservations will be up to the individual tribes since they act as sovereign nations with their own laws.

The value of cannaboids to treat many conditions appears to be more positive, and the research is catching up. Changes in the legal drug status hopefully will become reality soon, and the knowledge of how to use these compounds as medicine will become more solid. For now, it is still illegal to use marijuana, and most physicians, due to legal constraints and lack of definite knowledge of risks, do not actively recommend its use.