Medical Marijuana: Why It’s Different

November 11, 2015May 10, 2016 / Thomas Cohn, MD

Recently, one of the two suppliers of medical marijuana to patients in Minnesota offered a tour of their facility to a small group of leading pain physicians. The business is fascinating and a completely different model from anywhere else in the country. In the rest of America, marijuana for medical purposes is not highly regulated, and is sold by minimally regulated distributors selling whatever types of marijuana they feel might be useful. Needless to say, it is basically the same marijuana that is being sold for recreational purposes to get high.

Minnesota has taken a very different approach to the legalization of marijuana. First, the legislature has recognized that there may be some legitimate medicinal value to marijuana, and that for certain conditions it may be helpful. The legislature also felt recreational marijuana had a spectrum of problems and wanted to avoid adding to the problems of abused substances. Therefore, in Minnesota, only medical marijuana is available, and it is tightly regulated.

There are only two producers of medical marijuana currently allowed in Minnesota. These producers can provide only to patients that have been certified with certain conditions approved to receive such medication. The patient receives extracts from the marijuana plant to ingest as a pill, concentrated liquid, or to inhale as a vapor. It is not available for smoking or as an additive in food. The formulation received by the patient is determined by a pharmacist, and adjusted as well as titrated to help with a patient’s particular symptoms. The pharmacist also will evaluate the effectiveness of the treatment every time the patient is seen, and information for the State is being kept on the treatment, its effectiveness, and what is being given to the patient.

Medical Vs. Recreational Marijuana in Minnesota

Medical marijuana is usually very different than the marijuana found on the street. For most medical conditions, the cannabinoids of interest are the “CBDs” and not THC, the part that gets one “high.” From research done around the world, plants with different amounts of CBD to THC are being grown to produce the desired amounts of these compounds to be used in the medications. Unfortunately at this time, isolating specific CBDs known to exist has not yet been the focus of manufacturing. The medications manufactured currently just have specific amounts and ratios of CBD and THC.

The producer that I visited was extremely interesting. The growing of the plants is very high tech. From the plants used to the growing conditions, all aspects are tightly controlled. After the plants are harvested, the components are isolated and carefully extracted and made into the medicines for each particular individual.

Not all patients who have been qualified by a physician will be accepted by the medical marijuana distributors. Further, since all medical marijuana is considered experimental, none of the cost of treatment is covered by insurance. Doctor visits regarding certification, follow up visits, and all drug and pharmacy costs are cash only and no credit cards are accepted. Medication costs are also fairly expensive since they are made at a custom pharmacy with strict quality controls for safety and purity.

Medical marijuana is truly a product currently for those who have failed conventional treatment. The treatment is only now for certain conditions. If qualified, it may or may not work for any individual. The cost is quite expensive, not supported by insurance, and is cash only. The benefit is medical marijuana is designed as another medication tool to help control symptoms of certain conditions. It is consistent and manufactured like most other drugs to be pure and safe. It is not designed for recreational use and getting high.

Intractable Pain and Medical Marijuana

November 9, 2015 / Thomas Cohn, MD

Medical marijuana for intractable pain is now on the agenda for Minnesota. The commissioner for the Department of Health is now evaluating whether to add intractable pain as a condition that will be included in its medical marijuana program. The commissioner received recommendations against adding pain from the medical advisory committee. There will be a public hearing this week and comments can be sent directly to the Department of Health, at health.cannabis@state.mn.us.

In Minnesota, intractable pain would most likely be handled differently than any other diagnosis for medical marijuana. Already, the medical panel has advised that it be restricted to people over the age of 21. Further, they want to make sure that anyone prescribed is not pregnant and that conventional treatments for pain have already failed.

What is Intractable Pain?

In Minnesota, intractable chronic pain is a legal definition set up by the legislature in the 1990’s. It means pain caused by some medical condition that is unresponsive to normal medical care including medication, physical therapy, and other management. If a patient has intractable pain, then they qualify for the use of opioid medication for management of symptoms. One other component of chronic intractable pain is that it must be certified by two different physicians. Unless new legislation is passed, chronic intractable pain would need to be certified by two physicians, not just one provider in order to qualify for the medical marijuana program.

Over the next month the Minnesota Health Commissioner is going to make a decision on adding intractable pain as a condition for medical marijuana, and it will affect both patients and healthcare providers. If you want to have input on the decision, now is the time. Past history has shown that the most vocal and persuasive voices will influence the decision on what diagnoses are on the list to receive medical marijuana. Mothers with children that had severe seizures were the main force that started the legalization in Minnesota. Patients and medical providers will be the force that determines if intractable pain is added to Minnesota’s list of conditions that are accepted for medical marijuana.

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.