medical marijuana mn

Minnesota Medical Marijuana System Tough On Chronic Pain Patients

/ Thomas Cohn, MD

medical marijuana programOne of the approved conditions for medical marijuana in the state of Minnesota is intractable pain. Intractable pain is pain that can’t easily be tracked to a specific source and treated successfully, and many patients with chronic pain are deemed to have intractable pain. So you’d think the medical marijuana program in Minnesota would be beneficial for chronic pain sufferers? Well, according to a recent article in the Star-Tribune, it’s anything but easy.

Jumping Through Hoops

Minnesota is at least moderately progressive in that it allows medical marijuana as a treatment option for some conditions, but there are still a number of issues with the current state of the program. For starters, the majority of doctors in Minnesota – including those who specialize in treating chronic pain – are not approved to certify patients for the medical marijuana program. The reason being is that the health care system employers prohibit these doctors from prescribing it. Some doctors who treat rare and severe illnesses can prescribe the treatment, but the vast majority cannot.

So, most doctors are unable to prescribe it. You’d think the state would compile a list of doctors that could prescribe medical marijuana to those who qualify, but no state-provided list exists. Instead, patients need to search the web, call clinics and try to track down a doctor who can prescribe the treatment on their own.

Footing The Bill

Once you’ve tracked down a doctor and had your medical records faxed over to the clinic, you finally get to meet with a specialist who can prescribe medical marijuana. But, according to the Star-Tribune columnist who sought medical marijuana for her pain, since the appointment was for medical marijuana certification, her insurance wouldn’t cover it. So the $844 bill for the 90-minute session would come out of her pocket.

If she would be approved by the state, she’d have to pay a certification fee. That runs $200, and it needs to be renewed each and every year. Moreover, after you pay your certification fee, your treatment needs to be approved by the state. If you are approved, you then have to fill out a Patient Self-Evaluation Form. Finally, after that is approved, you can visit a Cannabis Patient Center, where any purchases once again aren’t covered by insurance, so you’re paying out of pocket. Oh, and forget writing it off as a medical expense, as medical marijuana is not legal under federal law, so the expenses can’t be written off.

The author detailed how she would need to return to the clinic four weeks after receiving the medical marijuana for a follow-up appointment that again would not be covered by insurance (and again at six months). In all, she estimated that her start up costs would fall just short of $2,000 just to get into the program – and that’s without purchasing any medical marijuana.

There are good intentions behind the legalization of medical marijuana in Minnesota, but the program currently has many faults. These patients who are in incredible pain are repeatedly being asked to jump through hoops and open their wallets just with the hope that they can get in the program and find a solution for their pain. The current system is broken, and while we’d like to see more money being poured into medical marijuana research to ensure we increase treatment effectiveness, we can’t expect the solutions to happen on their own. We need to revamp the process for getting medical marijuana for patients with intractable pain.

The Benefits and Drawbacks Of Medical Marijuana

/ Thomas Cohn, MD

Minnesota Medical Marijuana BenefitsRecently, the National Academies of Sciences, Engineering, and Medicine did a comprehensive review of the information available on the use of marijuana. The study looked at research published since 1999, and they came up with a number of conclusions. One of the most important findings is the current lack of good scientific information on marijuana. There is a clear need for good scientific research to guide healthcare professionals on the risks and benefits associated with marijuana use. Currently, to study marijuana or any of its derivatives, the federal bureaucratic hoops one must go through makes it extremely difficult to perform. The information available and the quality of the research at this point are limited. The conclusions are based mostly upon case report studies with limited controls.

The Complexity of THC and Marijuana

In Minnesota, medical marijuana is available to treat several specific conditions, and this year chronic pain was added to the list of approved conditions. The recent study also supports the idea that marijuana may be helpful to treat some people with chronic pain. For some it seems the non-THC (THC is the component that is responsible for the “high”) may help for pain. Since there are multiple causes of pain, it definitely is not indicated for everyone. Further, no studies have been done to determine what types of pain may be helped by components of marijuana, and it is not clear which of the 80 or more different compounds in marijuana are helpful. It is also known to be helpful for nausea from chemotherapy, and spasticity in multiple sclerosis. Marijuana may help in appetite with HIV, and there is limited evidence for help with bowel disorders, epilepsy, and Parkinson’s disease.

Potential Drawbacks

There are multiple potential harms that may be caused by marijuana. There is strong evidence that its use can lead to schizophrenia and psychosis, especially among young and frequent users. It may also lead to depressive disorders. The claim that it can make you a better driver is simply false, as statistics have shown that it leads to inattentive driving, a main contributor to traffic accidents. In pregnancy, use can lead to low birth weight in infants. Smoking pot can also cause and worsen any respiratory condition. There is weak evidence that smoking marijuana can increase the risk of heart attacks. One can also develop an addiction to marijuana. Conclusions cannot be drawn with regards to school achievement, unemployment, or social function and marijuana use.

Understanding It All

The overall scientific conclusion so far is that marijuana may have some reasonable medical uses. However, the scientific research on the compound is extremely limited at the moment. In the United States, it has been classified as a compound with no medical value and harmful to society. What needs to happen is that national legislation is needed to reclassify marijuana as a controlled substance, then good medical research can be done to determine what compounds in this plant are helpful or harmful. Once good research is done, then the use of compounds can occur with everyone understanding appropriate risks and benefits like with any other drug now available.

Minnesota Expands Medical Cannabis To Chronic Pain Sufferers

/ Thomas Cohn, MD

Medical Marijuana Minnesota Chronic Pain IntracableThis past Monday, Minnesota expanded its medical cannabis program to include individuals who are suffering from severe, chronic and intractable pain. Opening the doors to these patients could bring relief to thousands of people whose pain has not been quelled by traditional treatment techniques.

Before the program opened up to intractable pain, the Office of Medical Cannabis announced that they had 1,827 active patients receiving medical marijuana. Although the numbers haven’t been released yet, likely because it will take some time to sift through all the applications and medical material, state planners project that the number of participants may jump to 5,000 or more.

Proponents hope that the influx of patients will ensure those in pain will get the treatment they need, while current members hope their presence will help lower what some feel are extremely high prices.

Watching Closely

While it’s certainly exciting that people with chronic conditions will have another potential treatment avenue, many doctors are hesitant to fully embrace medicinal marijuana for chronic pain. Many champion marijuana as safer than opioids, which cause more than 300 overdose deaths in Minnesota each year, but we really don’t understand all the compounds in marijuana. It may not lead to overdose deaths, but until we know more about all the compounds in cannabis, we’re not going to be able to treat any patients with pain with any degree of certainty.

Minnesota is one of 25 states that have legalized medicinal marijuana, and the vast majority of those states list chronic pain as a qualifying condition. Studies have also shown that overdoses have fallen in those states with medicinal marijuana, and doctors in those states are writing fewer prescriptions for potentially dangerous opioids.

Hopefully those who truly need relief will be approved and find help through the state’s medical marijuana program. I hope the state reinvests some of the profits into future studies to ensure we are doing everything in our power to keep our patients safe, and so we can better understand how cannabis and pain are related.

For more information about the program, including a list of eligible conditions or how to apply, click here.

Minnesota Doctors Not Sold on Marijuana

/ Thomas Cohn, MD

Medical Marijuana in MinneapolisThe Minnesota medical community is, according to January 12, 2016 article in the Star Tribune, not sold on medical marijuana. In reality, this is not very surprising. There are probably many reasons, but the most obvious reason is the idea that medical professionals like to base all their care on a scientific basis. From taking a history, to performing an exam and determining the tests and treatment, medicine is more of a science and depends on evidence for diagnosis and treatment of problems. If there is not evidence to support a treatment, medical professionals are trained to be skeptical of its use and purpose. Currently, medical marijuana definitely falls into this category.

Most important to the debate on medical marijuana is that there is very limited scientific research supporting many of the claims of usefulness. The research with regards to the management of most medical problems is related to a few small studies, and there are hardly any definitive studies that show significant positive value, and the study designs are often not blinded/controlled with any large number of participants. For pain management there is mostly incidental case report-type studies without mentioning which specific cannaboids are effective. Since cannabis plants contain over 100 different cannaboids and other compounds, using so many chemicals at once in a relative uncontrolled mixture is not a scientific approach to treatment. In a way it is like throwing a grenade at a problem and hoping everything does not blow up in your face.

Fixing The Marijuana Issues

The proponents of medical marijuana often bring to the table multiple examples of the wonderful help that various individuals have experienced with its use. However these are individual cases, and not necessarily what will occur with every individual. When a new drug is brought to market, we all want to have extensive testing performed to make sure it is safe, to ensure it performs correctly and that the same effect will occur each time it is taken. With medical marijuana we do not know most of these things. We have no idea what exactly is in the extracts, and we have no studies on how animals or humans will react to the compounds over time. Any other drug besides marijuana with this lack of scientific research would never even be considered to be used widely as an intervention. It is not surprising most medical professionals have a huge degree of skepticism about certifying patients to use medical marijuana and endorsing treatment.

In pain management there are many treatments available that have been shown to be reasonably effective. A pain management expert often can help a person through the maze of management options and help find an effective plan. There are a portion of patients with extremely complex problems without great solutions to control symptoms at this time. Failure of standard treatments may be a reason to want to try medical marijuana. Those who do go this route need to know at this time it should be considered truly an experimental treatment, and that the short and long term side effects and problems are not really known. There are a huge number cannaboids contained in medical marijuana, and while some may be helpful, others can be harmful. It may be a significant risk to use these compounds and until they are better studied and understood, and it is unlikely that the medical field will endorse such treatment without serious reservation.

New Laws on Chronic Pain and Medical Marijuana in Minnesota

/ Thomas Cohn, MD

Medical Marijuana chronic pain minnesotaEarlier this month Minnesota added intractable pain to the list of conditions that qualify for medical marijuana. It was a decision made by the Commissioner of Health, Dr. Ehlinger, in accordance to provisions of the legislation passed. In August of next year patients will be able to obtain prescription cannabis through the state approved pharmacies if they have been qualified. The exact rules are not yet in place, but there are some clear indicators of restrictions will be present. It is also not homegrown marijuana or any other marijuana; it is just from approved dispensaries that are strictly controlled.

Intractable pain in the State of Minnesota is chronic pain that has failed to be adequately managed by traditional medical care. This means that one has to have tried to manage the pain, gone through what is considered acceptable and approved treatment regimens, likely medication, physical therapy and possibly invasive management, and these treatments have been unsuccessful. One cannot just say they have pain, not have a diagnosis, and not go through standard treatments and expect to be able to obtain medical cannabis. Lastly, it is likely that two qualified medical providers (not just one) will both have to evaluate you and approve, and that the pharmacist at the dispensary also will have to agree.

Intractable Pain and Medical Marijuana

If you have chronic, intractable pain, it will not be easy to obtain medical marijuana. There will be good providers who will consider it an option as part of treatment. However, it is likely to be a choice only after one has failed reasonable standard treatments. The patient will have to be psychologically stable, and for most practitioners, it is likely that they will want them to be well controlled if they do have depression. Many providers will also look into any potential past substance abuse, and receiving both opioids and medical marijuana is likely not to occur. The better pain providers will likely want to closely monitor the patient receiving the alternative treatment and be in touch with the dispensary and pharmacist to know what is exactly being prescribed.

Medical marijuana is not a panacea. It is another possible treatment that may have benefit for some patients. The science and effectiveness behind its use is just in its infancy. Like all other medications there are side effects and problems. It is not an FDA or DEA approved substance and is very much considered experimental. Therefore it is not approved at this time by any insurance. Expect all management and treatments associated with its use to require cash (not credit card or check) payment up front for any services including doctor as well as pharmacy visits. Treatment is likely not to be cheap and it very well may not be readily available. Many physicians may be reluctant to be involved with this treatment, and as a patient, if you are at all mean, abusive, obnoxious, inappropriate, or otherwise difficult with a provider or their staff, this would likely close the door for further management with that office.

The State of Minnesota over the next several months will likely clarify the rules and regulations of medical marijuana for patients in the state. There will likely be a number of hurdles to climb to obtain the high quality pharmaceutical cannaboid for pain management. If it is the correct management tool when all else has failed, it may be worth the effort. It is not a simple solution, and it is not going to be a legal way to just get street quality marijuana for personal recreational use.