Prescription 420: Minnesota is poised to implement its new medical marijuana law

March 17, 2015

Jason Johnson
Zenith News

With Governor Mark Dayton’s signature on May 29, 2014, Minnesota became the 22nd state to legalize the medical use of marijuana, with Alaska and the District of Columbia about to follow.


Minnesota’s medical marijuana law is currently the most restrictive in the country. Slated to begin July 1, the Minnesota Medical Cannabis Program will not allow the plant form of the drug—only pill, liquid, or vapor.


Qualifying conditions are limited to glaucoma, HIV/AIDS, Tourette’s Syndrome, ALS, seizures/epilepsy, multiple sclerosis, Crohn’s disease, and terminal illnesses, including cancer, but only if life expectancy is under one year and the patient suffers from severe pain, nausea, or wasting.


“This law was designed largely to fail,” says Paul Armentano, Deputy Director of the National Organization for the Reform of Marijuana Laws, which advocates for regulated legalization of medical and recreational use. “At best, it could be seen as a half-step, but not a full step, to embracing the actual medical utility of cannabis.”


For one thing, chronic pain is not a qualifying condition in Minnesota. “There is a greater body of clinical evidence supportive of the use of cannabis—whole plant cannabis, I might add—to treat various forms of pain...than there is evidence supportive of the use of cannabis for any other medical indication. So, if one is to have a policy that is actually guided by what the clinical evidence says, chronic pain, or using cannabis as an analgesic, would be the primary condition that is covered under the law. It wouldn’t be absent from the law.”


Although the law directs the state Health Commissioner to consider adding chronic pain to the list, he declined to do so, which will delay its inclusion for at least a year. According to an Associated Press report last February, the Dayton administration believed adding chronic pain could exceed available supply by manufacturers.


But Senator Branden Petersen (R-Andover) doesn’t accept the administration’s explanation. Petersen has introduced a bill that would add chronic pain to the current qualifying conditions list, telling the Associated Press, “If we acted this session, we could do something that would serve the interests of those patients a lot sooner.”


Armentano finds this implausible because of the law’s limitations. “The number of producers is extremely limited; the number of providers is extremely limited. It is such a restrictive law that it is unlikely to adequately serve the patient population that it purports to target.”


Minnesota will have only two suppliers and eight dispensaries across the state—half of them in the Twin Cities and all but one in a major population area, including Eagan, Hibbing, Maple Grove, Minneapolis, Moorhead, Rochester, St. Cloud, and St. Paul. Minnesota Medical Solutions (MinnMed), one of the state’s designated suppliers, did not respond to requests for comment.


Earlier this year, the state Health Department conducted an online survey of potential medical marijuana patients. Out of 1,300 who filled out the survey, 1,000—fully 77 percent—said they plan to enroll in the Medical Cannabis Program. Based on that, the Health Department is planning on about 1,000 enrollees.


Assistant Health Commissioner Manny Munson-Regala admits he is “not confident” in the survey results.  “It wasn’t intended to be a representative sample, inasmuch as it’s intended to be sure that...our assumptions weren’t too far off.”


Whether the state can meet demand, “is a much bigger question. A lot of it is dependent on our manufacturers’ capacity to scale and produce. They’re in the right direction, but there’s a long time between now and July.”


Regardless of the exact number, Armentano anticipates greater patient demand than Minnesota’s law was written to handle. “And, again, I think this is a law that was largely drafted to be politically expedient as opposed to a manner that is actually workable and that is intended to serve the majority of patients that could benefit from it.”


Another obstacle is cost. No private or public insurance will cover medical marijuana, which could run $100 to $500 a month. Furthermore, the state requires patients to pay an annual enrollment fee of $200, or $50 for Social Security and MinnesotaCare recipients.


The pill and liquid forms of the drug are more expensive, but banning the leaf form was critical to winning the support of law enforcement and, by extension, Governor Dayton, who refused to support the bill without law enforcement onboard.


“The biggest sticking point when this law was going through the legislative cycle last year is that we wanted to ensure it wasn’t in leaf form, and that the current list of ailments it could be used for, we are comfortable with,” says Joe Sheeran of the Minnesota Police Chiefs Association, whose agency was one of several that opposed medical marijuana when the bill was initially introduced.


In January 2014, Duluth Police Chief Gordon Ramsay explained to the Duluth News Tribune his opposition. “My experience is, I’m not protected by a bubble. I live in the real world. I’ve seen the devastation that marijuana use can cause families and children. I don’t believe in it. I think it’s a bad thing...My hope is the pendulum will swing and this Colorado thing will turn out to be a disaster. And then, by the time it gets here, people will realize, yeah, this isn’t smart. Drugs are a scourge on our society...I’ll take off my police chief hat and say, as a taxpayer, I don’t want to be paying for anyone to grow marijuana or pay for anyone’s marijuana, period.”


Asked by the Zenith to discuss his reasons for opposing the bill, Ramsay said he has always supported it.


“The Minnesota Chiefs of Police are comfortable with the law as is,” says Sheeran, “that it’s limited in its uses and not in leaf form.”


Ironically, the ban on leaf form will result in patients getting less medical benefit—but more stoned, according to Armentano. “Oral administration is typically associated with greater psychoactivity than is inhalation. There are several reasons for this phenomenon. Oral administration is associated with greater THC bioavailability, resulting in greater variation in drug effect from dose to dose, even in cases where the dose is standardized.


“It is also associated with greater THC to 11-hydroxy-THC conversion. Because 11-hydroxy-THC is also psychotropic, this results in more intense overall drug effect, and potentially dysphoria. Inhalation is associated with far less 11-hydroxy-THC production.


“Oral administration possesses delayed onset making it harder for subjects to titrate (regulate) dosage. This delayed onset also often results in over-administration.”


Amanda Reiman, manager of Marijuana Law and Policy at the Drug Policy Alliance, points to a vicious circle in which marijuana remains illegal due a lack of research, which is not permitted because marijuana is illegal.


“The problem is, because at the federal level, the cannabis plant is deemed to have no medical value, the research needed to transform the plant into an FDA-approved medication has not been possible. This leaves a population of people who could benefit from cannabinoids without a source, while this issue spins round and round, as it has for over 40 years.”


Marijuana, of course, is still illegal at the federal level. Despite calls from the White House to end raids on marijuana dispensaries that are legal under state law, the Drug Enforcement Administration (DEA) has carried out 270 dispensary raids since Obama was elected in 2008.


Last December, Congress passed a law cutting off federal funding for raids on legal dispensaries, but it remains to be seen whether the DEA will pay any attention. Since 1993, its Diversion Control Program has been funded solely by doctor licensing fees and civil forfeiture assets.


Munson-Regala has only qualified comfort that such raids will not occur in Minnesota. “The way I read the federal guidance, it essentially directs US attorneys that if you’re dealing with a well-regulated state-based system, you should deploy your prosecutorial resources in other places. I think what happened in California is exactly a manifestation of what it means to not have a well-regulated cannabis system.


“Having said that, this is all guidance, right? It’s still a federal crime. So I think what I can say is, compliance with a strong state-regulatory system gives you comfort, but it’s not immunity.”


Federal restrictions on marijuana prevent doctors from actually prescribing it; they can only “recommend” it. “And that’s a very important distinction,” says Armentano, “because doctors and pharmacists have federal licensing and, therefore, there can’t be a prescription. There can only be a recommendation, which the federal court has acknowledged is not a violation of federal law.”


Therefore, the Medical Cannabis Program has few guidelines in place for doctors issuing a “recommendation.” Despite some negative associations between marijuana consumption and fetal brain development, or psychotic episodes in those predisposed to them, the program requires no patient screening for contraindications.


“We might get more comfort in...suggesting to docs that they look for certain things,” say Munson-Regala. “Do [the patients] have high blood pressure? Do they have a history of heart disease? COPD? I mean, you’re probably going to want those kind of questions, but part of that is that we need to develop the science.”


However, due to the federal restrictions on clinical research, these questions are likely to remain unanswered.


The Health Department will provide verification of a patient’s legal use, but it’s unclear whether that will help with passing a drug test. “In other medical marijuana states,” says Armentano, “various state Supreme Courts have ruled that legal protections providers to qualified patients under the law do not extend to the workplace and that employers do not have to accommodate patients.”


Though law enforcement and the Minnesota County Attorneys Association have eased their objections, those who were already being prosecuted for using the treatment before the law was enacted still face legal jeopardy.


Angela Brown, the Madison, Minnesota, mother who obtained medical marijuana from Colorado to treat her son’s traumatic brain injury received national attention after Brown appeared on The View. Brown was charged with selling marijuana (since dismissed) and she still faces a charge of child endangerment.


As Senator Branden Petersen told KSMP in January, “[Brown] did exactly what the chief executive of this state had suggested,” referring to comments Dayton made to a group of parents, suggesting they obtain a small amount of marijuana off the streets to treat their children, since the illicit market is widely available and possession of less than 1.5 ounces is only a petty misdemeanor. Dayton later denied making the comment, but seemed to say much the same thing during subsequent press statements.


An August study by the American Medical Association found a 25 percent drop in deaths from prescription painkiller overdoses in states where medical marijuana is legal. This could have a palpable effect in Minnesota, which has seen a steep increase in heroin deaths after the DEA increased restrictions on prescription opioids, making them harder for patients to obtain.


Although careful not to conflate correlation and causation, Reiman says there is evidence that increased heroin use may be “related to people trying to get access to opiates after not being able to get them at the pharmacy.”


A year after Colorado’s full legalization of marijuana, the Drug Policy Alliance issued a report card, noting the state’s increased revenue and a decrease in crime.


In the meantime, Minnesotans unable to obtain pain relief continue to wait and suffer, with little or no assurance that the upcoming Medical Canabis Program will ever  actually be able to help them.

 

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