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

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

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.

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.

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.

“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.

Comments (6)

  1. Submitted by Dennis Litfin on 06/29/2014 - 11:10 am.

    I would like to see some of the reasons why Chronic Pain is not included in Minnesota’s version.

  2. Submitted by David Kessler on 07/02/2014 - 01:59 pm.

    Cannabis and Chronic Pain

    Chronic pain was often behind early efforts to legalize medical cannabis. Cannabis is reported to be as beneficial as opiates in releaving some types of pain and can reduce the need for opiate medicine by about half in many people allowing them to live more normal lives. For people like Cindy Rollins cannabis might help with the associated pain and swelling of rheumatoid arthritis. Either an alcohol tincture or a vegetable glycerin infusion of cannabis might provide a lotion to help with the pain and swelling. If pain is a problem during the day Cindy might consider smoked or vaporized cannabis or edibles. Prior to the passage of the Marijuana Tax Act in 1937 many lotions and tinctures of cannabis were available and in widespread use without problems in the US. Until 1942 cannabis could be prescribed by doctors in the US. It is time to once again allow the use of an organically grown and natural herbal medicine that really does work.

    • Submitted by Joseph Johnson on 08/30/2014 - 08:52 pm.

      On the Button

      As a person with chronic pain nothing really helps. Painkillers didn’t work and my stomach has been messed up because of them. One day at a friends I asked for some ibuprofen and he ask if I would try marijuana. After debating about it for 20 some mins I said OK and well three hours later after taking 3 hits he brought me home and went to sleep, it was the first time since my car accident in 07′ where I have slept for more than 4 hours without tossing and turning and I tell you those 9 hours of tossless sleep were a godsend. I was in less pain and felt relaxed in my back. Since then I smoke before bed 3 to 4 times a week. I know it’s illegal but I am a fully functional working tax paying citizen so please don’t judge my doctor don’t she said. Yes I am currently letting my doctor know and go in for a physical every so often, surprised!

  3. Submitted by dAnn Johnson on 12/01/2014 - 11:08 pm.

    Medical Marijuana and chronic pain

    I like Cindy Rollins have Rheumatoid Arthritis, I have had it for 53 years – getting it at age 3! I have seen many doctors through out the state and have had many medicines prescribed. All of the pain meds I have taken have either left me feeling dragged out, haven’t worked or played a part in additional internal maladies

    Because of my arthritis, I have had several joint replacements and had 3 vertebrae in my neck fused naturally. Joint replacements are great and mostly clear up the harsh pain in those respective joints, but Arthritis affects more than joints – it delivers pain even into the bones and tissue around the joints and bones.

    Nobody can gauge the pain level that another has. Not even the pain charts at the doctors office – a #5 on a chart from 1-10 is not the same #5 someone else has, because eveyone’s pain scale is different.

    Over the counter and prescription drugs all have some type of risk of additional side effects, especially with ongoing high dosage use.

    I have been using marijuana for pain control since approx. age 18. Unlike some others, I have always kept it’s use to myself – fearing that doctors would not understand the ‘illegal use’ of marijuana. I have been drug tested upon getting hired to past jobs and nobody has ever said anything – which may have something to do with the number of drugs I have listed as being prescribed by doctors.

    But the people who do know me, know that I am in Chronic pain every day of my life and have been. I am now not afraid to say that I use marijuana to manage my pain – unfortunately, because of the bill that has been passed in MN, I still have to search for it and hope I don’t get any with PCP or anything else sprayed on it.

    I will never condemn someone for using it for pain management.

    • Submitted by Louis Boyd on 04/05/2015 - 10:21 am.

      Pending legalization of marijuana on Mn. Reservation’s.

      Much has been the talk regarding the legalization which should include decriminalization. This could as for seen by law-enforcement as increase to crime and abuse. But potential grower’s face a threat of gang like; which could attempt to remove a garden, and pose a threat to the grower.We as grower’s could pay for community security for just that purpose. Also the threat to children could be reduced to little; as grower’s we could have a central buying system for production distribution of medical marijuana products. Reducing public dealer’s. Allowing those to grow for personal use, and possess.

      For the protection of our enrollees, and silent investors. we want to set it it up as a legitimate business entity in structure.

      On a documentary by Sanjay Gupta; who went to Israel and toured their research facility sponsored by the Israel’s Govt. Following that in Spain; regarding Marijuana and cancer research. Our facility could include our own research on some thing for sugar diabetes, alcoholism. producing pain substitutes could reduce the chemical drug abuse and protect our children and other train other would be researcher’s.

      We are dependent on the local medical facilities to provide the medications for pain which develop pill-heads and babies born with problem’s. The Drs. Sanjay Gupta interviewed declared, that marijuana is a pain killer.

      In a secured facility the growers would have their crop tagged for grower’s weight and set standards for non chemical growth / organic. Payment transferred to a banking system and personal debit card’s. The facility would be the processor and distributor of the medical marijuana products,

      As one allergic to pharmaceutical Drug’s, My diverse medical problem’s has given me to know that my brownies give me all the pain relief that i need.

  4. Submitted by Louis Boyd on 04/05/2015 - 01:31 am.

    Legalize / decriminalize Marijuana on a Reservation in Mn.

    I am a Leech Lake reservation enrollee, We wish to organize our new cash crop, in interests of legal and medical. In viewing a documentary by Dr.Sanjay Gupta, who talked to various Dr.s, who speak about MJ as a pain killer. In Israel and Spain their government sponsors research on it for a cancer cure.

    From my community there could be a silent partner if a solid legal plan could be developed, protective of his investment. In turn, we need security and protection from intrusive and abusive interests of our growers. Since it would be as the approach for us harvesting wild rice; cutting balsam branches for Christmas decoration. They would have to have a buyer. Looking to find a buyer? a reservation facility could be the buyer and as one sells it goes to his bank acct. no. That bank card would be the protection against crime. We as grower investors we could sponsor good paying offers for security officers.Co-operative speaking we need to protect our investment for new homes and the many other programs it could sponsor along side the federal Govt. and gaming and tribal law enforcement.

    Our approach is the investment of a facility that extracts the use products for such research and utilize expertise to train our youth in the field’s of study.

    I saw the video of the little girl who had over a hundred seizures a week, they found a medicine, but artificially made, was costly. Then they found some angels of mercy growing a plant that came from the marijuana plant except it had no THC in it. The plant that produced the medicine the little girl needed who now has one a month. The product produces medicine against arthritis and heart problems.

    I am 74 I have received medical assistance from IHS Hospitals including Sanford, Bemidji where i received treatment for staph infection; a stroke and heart attack . Due to spinal injuries to my spine and neck i developed cervical spondylosis of my neck and
    osteoarthritis of my spine. from early whip lash injuries.

    i received Tylox, Darvocet’s, morphine Hydrocodone, percosettes and Duloxitine. In all My system developed an allergy to them.

    To combat severe pain i was having from a large lipoma next to my spine which was enflamed; affecting a nerve that came from my spine between my ribs around to the front of my chest so severe; beyond 10. I couldn’t sit walk sleep or stand. all I could do was scream and cry. Tylenol and Ibuprophen were un-effective.

    I cooked some powdered shade leaves with a bakery mix. Ate some, went to sleep woke up about 4 or 5 hrs.later; the pain was gone. It’s been gone since.I have to buy and cook my medicine which treats a muscle disease and arthritic pain. Legal or not I have to grow. It’s cheaper. And there’s no stomach sickness.

    Also in Canada, a spiritual leader treats newborns whose mother’s were abusing such pharmaceuticals. Makes sense to find an alternative. I’m being treated with holistic medicine for prostrate cancer. Also I’m a candidate for medical marijuana / per medical recommendation

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