With medical marijuana soon to be legal in Minnesota, some Grand Forks area physicians said they were unsure of its implications.
Gov. Mark Dayton is expected to sign a bill symbolizing the most restrictive law of its kind in the country. Minnesota is now the 22nd state to legalize medical marijuana.
Under the new law, marijuana extracts could to be used to treat an estimated 5,000 qualifying Minnesotans per month with certain medical conditions.
While some families have expressed relief over the bill’s passage, some local physicians said they were unsure of its usefulness for patients.
Monjur Alam, a family physician and department chairman of Sanford Health in East Grand Forks, said 2 to 4 percent of the 400 or more patients he sees per month could qualify for medical marijuana.
“I think that it’s going to be helpful for patients with certain clinical conditions when it is done under strict supervision and control,” he said.
Laura Lizakowski, a palliative medicine physician at Altru Health System in Grand Forks, said she didn’t think it would affect her practice at all. Even her patients who used a legal drug producing similar effects haven’t had consistently positive results, she said.
Under a compromise reached by the House and Senate Thursday, Minnesota will authorize two manufacturing operations to distribute pill or liquid forms of the product to qualified patients in eight distribution points in the state in mid-2015.
Targeted at the state’s most ill patients, medical marijuana can be used to treat a list of ailments including HIV and AIDS, some forms of seizures and Crohn’s disease. But as local clinics treat patients who live in North Dakota and Minnesota, the question of whether access to the legalized form will be based on residency is still unclear.
“Legislators and community leaders will have to come up with something so patients won’t get affected in a negative way,” said Alam.
Lizakowski’s cancer patients haven’t had success using marijuana or even a pill intended to produce similar results, she said.
A cannabinoid called Marinol, used to stimulate appetite or treat chronic pain and nausea, has been available to patients nationwide for some time now. In the past five years, she’s used it to treat nausea with patients maybe four times, she said. Most discontinued the pill because of its cost, she said.
In her experience, opiates are still the most popular treatment, she said.
“There are so many other things we can do to get their pain managed,” she said.
However, Alam said the chemical formulation of medical marijuana will likely be quite a bit different than the one in Marinol, which can contain more than 2.5 milligrams of synthetic marijuana per dose.
“I’m not aware of any head-to-head comparison between Marinol and medical marijuana, but I think the main difference is going to be in the chemical composition,” he said.
Both physicians shared concerns about potential abuse, how the medical use of the drug will conflict with state law and any side effects, long-term or otherwise.
“We know there are some chemicals which can be carcinogenic when marijuana is smoked, but the other forms, like pill form or liquid form, I’m not sure yet what we’re going to find,” Alam said. “We’ll just have to see. It’s going to be a trial-and-error thing.”
The federal government’s categorization of marijuana as a Schedule 1 drug has hindered research on its use for treatment, another concern for physicians.
According to the U.S. Drug Enforcement Administration, these drugs have no currently accepted medical use, a high potential for abuse and are the “most dangerous drugs” of all the classified drugs that have “potentially severe psychological or physical dependence.” But some preclinical studies have found cannabinoids useful in inhibiting tumor growth, destroyed liver cancer cells and might protect against colon inflammation, according to cancer.gov.
‘Wait and see’
The Minnesota Medical Association has said in news reports it would not oppose the bill, while the North Dakota association on Friday said it does not hold an official policy position.
“Our members are reviewing the developing research in the field and NDMA will continue to study the issue until such research can be adequately assessed,” said Courtney Koebele, executive director, in a release.
North Dakota had an short-lived attempt at a marijuana law in 2012.
A Fargo legislator proposed to make using and growing the drug for medical purposes legal, but a petition failed when some signatures turned out to be fake.
Alam said the only way he could say if it’s a positive thing is when they have more experience with it.
“I think it’s a wait-and-see thing,” he said. “I’m sure we’ll have more conversation among our physician communities to come up with a guideline and follow the American Academy of Family Physicians and see how we can approach this.”