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Minnesota’s medical marijuana fight now turns to those in chronic pain

The state has relied on the lowest patient enrollment estimate if chronic pain becomes a legalized use — but the number could be low by up to 70,000 people.

Growth technician Mike Lottman moves through the marijuana plants in a medical marijuana center in Denver.
REUTERS/Rick Wilking

When lawmakers approved the state’s new medical marijuana program last month, they deliberately left out the largest group of potential patients: those with chronic pain.

But the debate is not over, and how state leaders sort out the issue of chronic pain and marijuana will determine whether Minnesota’s marijuana program expands by a few thousand people — or perhaps a hundred thousand.

During the last legislative session, compelling stories of children with seizure disorders and their families resurrected a once-dead bill, giving medical marijuana advocates their first victory after more than a decade of effort at the state Capitol.

The new law covers nine conditions such as cancer and epilepsy with each category expected to generate anywhere from 100 to 1,000 medical marijuana participants. In all, the state estimates 5,000 enrollees in the program, which is scheduled to begin providing the drug July 1, 2015.

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But pain is a game changer in the medical marijuana world. In Colorado and Oregon, two states with large programs, at least 94 percent of the medical marijuana program participants list chronic pain as a qualifying diagnosis.

In Minnesota, the state estimated adding “intractable pain” to the qualifying diagnoses would mean an additional 33,000 patients. But that number is a guess — and there is evidence to suggest that it might be low.

Colorado’s rate would equal 100,000 Minnesotans

State officials based their estimates on the medical marijuana program in Arizona, one of 21 other states that have such laws.

Arizona is one of three states, along with Oregon and Colorado, that keeps quality statistics on which state residents are using medical marijuana and why. But of those three, Arizona has the lowest participation rate: about 0.7 percent of the state population has a valid medical marijuana card.

In Oregon the participation rate is 1.5 percent. In Colorado the rate is 2.2 percent. In Minnesota, a 2 percent participation rate translates to 100,000 enrollees. Even if Minnesota’s experience is more like Arizona’s, the original estimate may prove low, since Arizona’s program grew 8 percent last year and more than 30 percent in the last two years.

No one actually knows just how many Minnesotans would participate if pain was allowed as a diagnosis. Current law does not allow marijuana users to smoke it — only liquid, pill or vapor use is acceptable — and the state estimates that restriction may reduce enrollment by 10 percent.

Another factor is that Minnesota’s drug abuse laws already contain a definition for intractable pain that is more detailed than those used by other states for their marijuana programs. If that definition is used for marijuana eligibility, Minnesota could create a higher hurdle for patients and reduce participation rates.

State2013 populationActive card holders% of popProjected card holders
Arizona6,626,62448,2310.7%
Oregon3,930,06559,1831.5%
Colorado5,268,367115,2082.2%
Minnesota (current law estimate)5,420,3805,0000.1%
MN with pain and AZ participation rate5,420,3800.7%37,943
MN with pain and OR participation rate5,420,3801.5%81,306
MN with pain and CO participation rate5,420,3802.2%119,248

Health commissioner can bypass lawmakers

What is clear is that the medical marijuana bill signed into law by Gov. Mark Dayton will not end the pain issue. Advocates, fresh from an impressive victory including winning 2-to-1 margins in both the House and Senate, promise to renew the debate next session. The House, the more reluctant medical-marijuana chamber, is the only one up for re-election in November, and could become even more friendly to medical marijuana.

Another path for gaining approval for chronic pain is inside this year’s bill. The law requires the state’s commissioner of health to rule in the next two years if intractable pain should be added to the list of medical diagnoses eligible for medical marijuana. Such a ruling would not need the approval of lawmakers.

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Saying “yes” to HIV/AIDS, glaucoma and epilepsy and not to chronic pain may be tricky for state officials. A review article in the New England Journal of Medicine this month highlighted promising research for treating each of those conditions with marijuana. The evidence supporting the state’s approved diagnoses appears to be no greater than the evidence for treating chronic pain with pot.

Modern medicine does not do a good job with chronic pain. The Institute of Medicine said in 2011 that chronic pain affects 100 million American adults costing up to $635 billion annually in treatment costs and lost productivity. Many with pain become dependent on opioid prescription pain medicine like Percocet or Vicodin and the use of such medications has increased dramatically in the last 15 years. And drug abuse experts say there is a direct link between the increased use of opioids and the increase use of heroin in the country.

KK Forss, a 47-year-old Cloquet photographer, credits smoking marijuana with saving him from a toxic level of pain medications like fentanyl, methadone and time-released morphine sulfate following a ruptured disc in his neck. Marijuana reduced his nausea, vomiting and muscle spasms. It allowed him to cut back on his prescription medications and he gained weight.

“I didn’t have a life — except agony. I told people I couldn’t live this way that I would go insane with the pain,” said Forss, whose eight-year nightmare of pain ended in 2012 after a successful surgery. “This is not a liberal versus conservative issue. It’s about getting people the help that doctors feel is best for them and to help people who are suffering.”

Pain remediation — for some

Minnesota opponents of medical marijuana are clearly frightened by the large number of potential users that could emerge with the addition of pain as a qualifying diagnosis. “This will only increase the potential for marijuana abuse in our state,” said a statement from a state coalition of law enforcement groups.

In addition, opponents of expanding medical marijuana’s use are concerned it will mean increased use among young people and increase in its recreational, illegal use.

Advocates say the potential for a greatly enlarged program should not lessen the strength of their argument.

“That number may intimidate some people,” said Heather Azzi, director of Minnesotans for Compassionate Care. “It won’t be a program where you can go to a doctor and say my knee hurts and get a prescription for medical marijuana. We need to trust our doctors … . This is medicine. That’s the fundamental part.”

Cindy Rollins, a 57-year-old woman from a small West Central Minnesota city who has debilitating pain from rheumatoid arthritis and other conditions, said it would be unfair to eliminate people like her from the medical marijuana program out of fear of large numbers of enrollees or worry that some might fake their pain to get the drug.

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“There are those who make stuff up. I get that,” she said. “But that should not hurt those of us who are suffering.”

The current law does allow medical marijuana to be used for pain by those with cancer and those with terminal diseases.

“I don’t have cancer, but I do have rheumatoid arthritis. What’s the difference in my pain? I’m not dying?” said Rollins, who cannot tolerate prescription painkillers because of the over-sedation they cause for her.