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Smoke signals: with the Minnesota House debating recreational marijuana, the Senate moves to expand the state’s medical cannabis program

In response to an “intensifying” legalization conversation, Senate Republicans are pushing an effort to do away with Minnesota’s unique ban on letting medical users smoke marijuana. 

Passage of SF 1179 would mean Minnesota would no longer be the only state with a medical marijuana program that bans smoking of the drug.
Passage of SF 1179 would mean Minnesota would no longer be the only state with a medical marijuana program that bans smoking of the drug.
Photo by Kimzy Nanney on Unsplash

The aggressive push to legalize recreational marijuana in Minnesota has lit a fire under the ongoing effort to update the state’s five-year-old medical cannabis program, including ending the state’s unique ban on smoking dried leaf and bud.

Patients and practitioners have complained almost from the start of the program that Minnesota’s law was overly restrictive, with strict limits on the number of producers, the number of dispensaries and the number of conditions that could be treated. All that was due to the compromises made in 2014 to get the law approved by reluctant lawmakers and a doubtful Gov. Mark Dayton.

State Sen. Michelle Benson
State Sen. Michelle Benson
But with a reference to the “intensifying” legalization conversation — a bill in the Minnesota House would legalize and regulate marijuana for recreational use — Sen. Michelle Benson on Monday quickly moved a medical cannabis reform bill through her Senate Health and Human Services Finance and Policy Committee before sending it to the Senate floor.

“There’s some angst around updating our medical cannabis program and much of it is related to what we don’t know about medical cannabis and its place in the world of medicine,” Benson said. “But more of it is about a legalization conversation, which I know is intensifying. This is a sincere step to update our medical cannabis program. It is not a path to legalization.”

One of the most restrictive medical marijuana programs in the country

In the committee on Monday were a trio of bills aimed at modernizing the five-year-old medical marijuana program. All were ultimately combined under a bill, SF 1179, and passed. The bill now includes provisions to continue pandemic-related provisions such as curbside delivery; to add opioid addiction as one of the medical conditions for which marijuana can be authorized; and to allow producers to make and sell marijuana in dried flower form. The last provision would mean that Minnesota would no longer be the only state with a medical marijuana program that bans smoking of the drug.

That has been one of the biggest complaints about the state’s current program. Only oils and tinctures containing THC can currently be used in Minnesota — products that cost more to produce and purchase. That has left patients either to pay more out of pocket or to abandon the legal system and seek out illegal sales, and supporters of a bill in the Minnesota House to legalize recreational marijuana have used dissatisfaction with the medical cannabis program as one of the reasons to back their broader efforts. The House bill, HF 600, which has been moving through committees there on party-line votes, would benefit medical marijuana patients by making the drug cheaper for all users; it would also make those with medical authorizations exempt from any taxes imposed under the proposed recreational law.

Total number of patient visits to a Cannabis Patient Center that resulted in purchase of medical cannabis products, by month.
Minnesota Department of Health
Total number of patient visits to a Cannabis Patient Center that resulted in purchase of medical cannabis products, by month.
The ban on smoking in the medical cannabis program was just one of the compromises made in 2014, and Minnesota’s statute is considered one of the more conservative programs in the country. According to the state Department of Health, there are only two producers and 11 distribution clinics around the state for around 30,000 patients with nine health conditions who have received authorization from health providers. But that’s more than initially planned. As passed in 2014, the law allowed only eight distribution centers, and the health conditions covered would have meant only about 5,000 patients would have benefited.

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Since the law was passed, the state health commissioner has added six more conditions covered by the program and will add two more this year: sickle cell anemia and chronic vocal or motor tic disorder. Despite petitions from patients to add anxiety to the list, the health commissioner did not do so this year.

State Sen. Mark Koran
State Sen. Mark Koran
Sen. Mark Koran, R-North Branch, said his motivation for work on the bills was to make the program work better for patients and to answer one of the biggest complaints — that the cost that isn’t covered by insurance is too high. That causes patients to either forgo the drug or go to the illegal market. The illegal market is also sought out by patients who prefer to smoke the drug rather than use more expensive oils and tinctures.

“The goal is to lower cost, increase accessibility to qualifying patents,” Koran said.

Kim Kelsey, a medical cannabis advocate, said her family has paid more than $65,000 over five years for CBD oil for her adult son Alec, who suffers from seizures and cognitive challenges resulting from a  case of encephalitis as a child. None of it is covered by insurance.

Count (%) of Active Patients by Condition* as of Dec. 31, 2020
Minnesota Department of Health
*Patients certified total more than 100% because 63.1% of the 28,522 patients are currently certified formore than one condition; this table counts each certified condition.**Refers to patients who are certified only for chronic pain (with no additional qualifying conditions).
Dr. Kyle Kingsley, the CEO of Vireo Minnesota — one of two producers of medical cannabis in the state — said Minnesota’s law limits the number of people who can benefit from what he called “a real alternative to opioids and other pharmaceuticals in the setting of chronic pain and other serious medical conditions.”

While the state is sometimes considered a leader in health care policy, it is “trailing the country” in access and affordability of medical cannabis, he said. He called the sale of dried marijuana plant a “simple change” that would bring the state in line with all other states that allow it. “Minnesota is an extreme outlier by not allowing the use of cannabis flower in the program,” Kingsley said.

One-half of 1 percent of the state population is enrolled in the program but other states have 2 percent of their residents in the program. “It will also squeeze the illicit cannabis market, which is currently accessed by 10 percent of the Minnesota population,” he said.

A bipartisan effort

During the hearing before the Health and Human Services Finance and Policy Committee, the tone was so different from most committee debates — there were no motives questioned, no party-line votes — that several members of the Health and Human Services Finance and Policy Committee felt the need to comment upon it. “If the public had watched this discussion, they think we fight about things. Because here we are in a bipartisan way from people all across the state trying to solve people’s challenges,” said Sen. Jim Abeler, R-Anoka. “There are times when we should notice how well things work here and this is one of those times.”

State Sen. Chris Eaton
State Sen. Chris Eaton
That it was all done around a controversial issue — at least in Minnesota — made it all the more interesting. One reason for the different tone was that some members have personal connections to the issue and others said the stories of patients changed their minds, from opposing the program to supporting it. “I’ve come from one end to the other on this,” said Sen. Chris Eaton, DFL-Brooklyn Center. “As a person in long-term recovery, I had some real qualms about supporting medical marijuana.”

But Eaton, who’s daughter Ariel died from an opioid overdose in 2007, said she now supports adding addiction to the conditions under the law. “This is certainly a safer alternative.”

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Eaton’s amendment, however, did attract the only significant opposition, from Sen. Carla Nelson, R-Rochester, who said there isn’t enough scientific evidence of cannabis’ use in helping opioid addiction. “I know it is well-intended, but I just cannot in good conscience vote for something that is not evidence-based,” Nelson said. Also speaking against the Eaton amendment was Ken Winter, a psychology professor at the University of Minnesota and co-founder of the state chapter of Smart Approaches to Marijuana. 

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State Sen. Matt Klein
Sen. Matt Klein, DFL-Mendota Heights, said he is torn because there isn’t sufficient data but agreed that the “margin of toxicity of cannabis” is extremely low and the burden of opioid addiction is very high and very dangerous. “I think it’s a reasonable intervention at this time,” said Klein, an internal medicine-hospitalist physician. 

Benson said it was testimony from Kim Kelsey and her son that altered her thinking. “I had doubts and hesitations and then I started hearing these successes around seizures,” Benson said. “That’s kind of what flipped me on medical cannabis. So you did make a difference and you did move early action on this bill.”

 

Correction: This story was changed to show that Sen. Matt Klein is a hospitalist physician, not an emergency room physician.