Minnesota Medical Marijuana System Tough On Chronic Pain Patients

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

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.

New Report Examines Benefits and Drawbacks Of Medicinal Marijuana

Medical Marijuana statsWe’re still in the early stages of managing how medicinal marijuana is used to treat certain health conditions. However, since the door has been opened, millions of dollars in funding has been given to explore the benefits and drawbacks of medical marijuana for treating specific health ailments. A new report from the National Academic of Sciences, Engineering and Medicine reveals some areas of potential and some points of concern when it comes to medicinal marijuana. We explore what the report found in today’s blog.

Medical Marijuana For Ailments

One of the major points the review found was that medicinal marijuana has beneficial effects for the treatment of chronic pain. The review committee found evidence that patients who were treated with marijuana for their chronic pain were more likely to experience a significant reduction in pain symptoms. A similar finding was made for individuals suffering from muscle spasms, and for patients suffering from chemotherapy-induced nausea and vomiting.

Furthermore, researchers found no evidence that smoking marijuana was related in an increased risk of cancer development, but they stated that more research was needed to see if there was a correlation between marijuana use and an increased risk of heart attack, stroke or diabetes.

Drawbacks of Medicinal Marijuana

So while medicinal marijuana can be helpful for some patients with chronic pain, it is not without its drawbacks. According to the review, there was evidence that cannabis slightly increased a person’s risk of developing schizophrenia, social anxiety disorders, and to a lesser extent, depression. Heavy marijuana users are also more likely to report thoughts of suicide compared to non-users, and cannabis use increased a person’s risk of being involved in a motor vehicle accident. There were also increases in the number of marijuana overdoses among children who accidentally ingested the drug compared to states where recreational marijuana use was not legal.

Marijuana could also make certain ailments worse. Researchers stated that regular cannabis use was related to an increase in episodes of chronic bronchitis and other respiratory ailments, like chronic coughing and phlegm production. They did note that is unclear if marijuana use worsens symptoms from respiratory conditions like COPD or asthma.

Potential Abuse & Other Drug Problems

Finally, researchers suggested that marijuana could lead to abuse or other drug problems. Evidence suggests that with greater frequency of use, there is an increased likelihood of developing problem cannabis use, and there was moderate evidence to suggest that there was a link between marijuana use and the development of substance dependence of marijuana or other substances like alcohol, tobacco or illicit drugs.

So while medical marijuana is certainly an interesting avenue for controlling pain, it is not without its drawbacks. Identifying these potential pitfalls is the first step. Now we need to learn how to mitigate these risks so chronic pain sufferers aren’t exposed to danger when pursuing medicinal marijuana for their pain.

Minnesota Expands Medical Cannabis To Chronic Pain Sufferers

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.

The Complexity of Chronic Pain

chronic pain treatment mnRecently the Star Tribune published an opinion piece titled “How not to treat chronic pain” by Ellen Stern.  The article was quite interesting, but seems to miss the mark in understanding pain and its management.  The author suffers from chronic low back pain.  She tried treating it conservatively with the traditional route of management from medications, to therapy, to injections – none were very successful.  She eventually underwent lumbar fusion and this also did not relieve her pain.  Despite all the treatment she continues to be in significant pain.

The Complexity of Pain

Chronic pain is very complex.  All of my patients understand the nature of pain and how difficult it is to find a good management option.  Furthermore, since I have chronic low back pain with significant spondylolisthesis and severe stenosis, and have close family with pain problems, I have a very deep understanding of all these issues.

Rule number one in pain management is that there is no magical treatment. Chronic pain is “managed” and not cured.  Complaining about the medical community may feel good but does not move you forward.  Adjust your attitude, if necessary get professional help, and concentrate on all the things that you can do and not on the negative.  If the physicians you are seeing are not helpful, it may be necessary to find someone who works with you better.

Opioid Abuse

The issue with opioids and abuse is nationwide.  It is now as much of a problem with accidental deaths as automobiles used to be and is ever increasing.  As the country has become more aware of the problem, all prescribers of these medications have become more cautious.  There are numerous ways to reduce abuse of opioids, and all patients who receive them are scrutinized.  As a prescriber, we are constantly trying to determine if a patient is appropriate for opioids.  Since our licenses and livelihoods are on the line when prescribing opioids, most of us are cautious when prescribing.  We all can tell stories of success as well as ultimate disasters, so please understand close monitoring of the patient receiving opioids comes with a certain level of danger.

Medical Marijuana

Medical marijuana in general is another complex issue.  As with all treatments for chronic pain, it is just another management tool.  Like any other compound, it works only for certain people and definitely not for everyone.  Further as noted in multiple previous writings, the science behind medical marijuana has been minimally studied.   There is very little rigorous research similar to any other drug that has been approved for medical use.  Many physicians are reluctant to recommend a compound that has not been adequately analyzed and has solid research behind it.  Many compounds in medicine have come on the market and we later find significant serious dangers caused by the compound.

Treating chronic pain is extremely complex.  There is no silver bullet of a cure.  There is much more that the medical community does not understand about pain than what we really know in detail.  The majority of the tools we use today are often quite crude and old.  Surgery is often quite brutal, and changes the body often in the wrong way.  Morphine and its opioid derivatives are the same concoctions that we used to treat pain over 150 years ago.  Research is slowly bringing medicine better understanding of pain.  Physicians are struggling with the problems of pain and its treatments and a lack of new and better solutions with good scientific basis.  Hopefully more funding and research will lead to better solutions in time since chronic pain does affect over 30% of the population worldwide.