medical marijuana conditions in minnesota Archives - Minnesota Physical Medicine Blog

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.

Recently there have been excellent reviews on the state of the science of medical marijuana. Minnesota is about to start its program, but only a handful of people have been approved for the program and there are not many providers interested in participating. So why is medical marijuana off to such a slow start in Minnesota?

Medical cannabis is a complex subject, after attending many lectures on the subject, and reviewing significant amounts of literature, the one main conclusion is that the science behind cannabinoids is only in its infancy. For the average reader, the Time Magazine May 14, 2015 and the National Geographic July, 2015 issues have good information. At a higher level for medical science, the June 23/30, 2015 issue of the Journal of the American Medical Association has more data.

US Lags Behind

The United States has not been a leader in the study of marijuana. Since marijuana has been labeled a Schedule 1 compound by the DEA, its scientific analysis in the U.S. has been extremely limited. Some of the best research initially has come out of Israel where many of the cannabinoid compounds have been isolated, and in Spain where some of the cancer research and other studies have been done. The most recent issue of JAMA has reviewed a large number of medical studies with regards to a variety of conditions. For the scientist, it is clear there is a significant shortage of information supporting claims of effectiveness of the compounds for most conditions. Most information is based on a very limited numbers of study participants. Comparing the information to almost all other drugs on the market, these studies would barely qualify for drug approval.

The quality of studies for marijuana and chronic pain has been especially limited. The studies researched include neuropathic pain and cancer pain. Most of the studies just looked at a numeric pain scale to measure success and did not quantify any other objective measure like functional ability. The outcome was a modest improvement in reported pain level, but deeper evaluation did not show any changes in quality of life measures when compared to placebo or standard treatments.

After reading multiple articles on cannabinoids and pain, one clear message is present. First, there are a number of different cannabinoid compounds, probably well over a hundred. Second, the chemistry is poorly understood and the effectiveness to treat a variety of medical conditions is limited. Medicine has become a very science driven field. Physicians are constantly under fire to provide care that is safe and effective. The current status for medical marijuana is truly still in the research phase. We won’t be able to fully embrace medical marijuana as a viable option until we know more about all of its compounds.