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Health Commissioner's View: Why I’m allowing the use of medical cannabis for intractable pain

Evidence available today isn’t sufficient to determine which patients suffering from severe and persistent pain will benefit from medical cannabis and by how much. But the compassionate decision is to allow patients and their health care providers the choice to try it (“State OKs medical marijuana for severe pain,” Dec. 3).

When the state Legislature created Minnesota’s medical cannabis program in 2014, the law included nine health conditions that qualify a person to receive medical cannabis. The law gave the commissioner of health authority to add additional qualifying medical conditions, but requiring intractable pain be the first condition evaluated.

“Intractable pain” is not just chronic pain. It is defined by law as a condition in which the cause of the pain cannot be removed or otherwise treated and for which no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts.

I knew my decision would not be easy. Not only are there strong views on this issue, we also lack the kind of solid, scientific evidence about benefits and risks that usually guide decisions on serious medications. Pain management is a very difficult process and existing tools such as opioids often carry their own serious risks of addiction or overdose.

In public health, we try to work with a foundation of solid evidence. Lacking that on this topic, we gathered what information was available. The Minnesota Department of Health arranged for the University of Minnesota to conduct a scientific literature review of clinical evidence and research. We collected online comments and conducted 13 public meetings around the state, hearing from nearly 500 Minnesotans. We established an eight-member advisory panel of clinicians and medical providers to make recommendations. Citing a desire for more clinical evidence, a 5-3 majority of the panel recommended last month that intractable pain not be added to the program.

As a physician, I share my medical colleagues’ desire for more information regarding specific benefits and risks for patients with various pain conditions. I sympathize with their desire to move cautiously. At the same time, I knew this decision was not just about objective science. It was about people who have been suffering without lasting relief from severe, persistent and intractable pain.

After weighing the information and statewide public input, I concluded that the right and compassionate choice was to add intractable pain as a qualifying condition.

Despite not having all the information I would like, there are several factors unique to Minnesota’s medical cannabis program that reduced my concerns: Our program has a strong medical focus with features designed to collect actual patient information currently lacking about the efficacy of medical cannabis for treating various medical conditions. Also, Minnesota limits medical cannabis forms to pill, vapor or liquid. No leaf or smoking is allowed in the program. This reduces the risk of drug diversion for improper use. And, finally, unlike other states, we have a strictly controlled process for growing and manufacturing medical cannabis. We have just two manufacturers with lab-tested process controls and security.

Even with the addition of intractable pain as a qualifying condition, there are certain groups who face more significant risks of harmful side effects associated with medical cannabis use. That is why I am cautioning providers and patients to give special scrutiny to the use of medical cannabis to treat any qualifying condition in infants and children, pregnant women, nursing mothers and individuals with a personal or family history of psychosis.

Over the next few months, the Minnesota Department of Health will step up outreach efforts to help health care providers better understand the available information about medical cannabis. We also will help coordinate a broader conversation with the state’s medical community about how to effectively address pain management. As always, participation in the program is strictly voluntary for providers and patients alike.

No one should consider medical cannabis a panacea for pain. However, based on what we know today, it is prudent to give health care providers and patients another tool for the difficult task of managing severe pain.

Dr. Edward Ehlinger is commissioner of the Minnesota Department of Health. He wrote this for the News Tribune.

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