DULUTH-Almost three years after marijuana was legalized for some medical purposes in Minnesota, some providers, patients and patients' loved ones say the program is frustrating, and the medicine, for many, is unaffordable.
"I just think it's so sad why we can't set up a program that someone would find easier than (it is)," said Pat Mullen of Duluth. "They've got to find a way to inform people."
When Mullen's fiancee, the late Linnea Stephan, was fighting brain cancer, they sought a prescription for medical marijuana to counter the nausea caused by chemotherapy, he said. But they couldn't find any oncologist at either Essentia Health or St. Luke's Hospital in Duluth willing to certify her for that condition.
Unable to find a certifying provider in Duluth, the couple turned to a Twin Cities clinic.
"It wouldn't surprise me if there's someone in Duluth, but that's part of the problem is how would I find out?" Mullen asked. "How would I know who it would even be?"
There's no provider directory on the website of the Minnesota Department of Health's Office of Medical Cannabis. The department "cannot say" what providers are in the registry, said Dr. Tom Arneson, research manager for the cannabis office.
That came as a surprise to the Health Department's boss when she was asked about it during a visit to Duluth last week. "That's a new one on me, that we don't do that," said Jan Malcolm, who Gov. Mark Dayton appointed as health commissioner in late January.
Different hospitals, different approaches
Patients may find more difficulty obtaining medical marijuana certification at certain hospitals.
At St. Luke's, oncologists are the only practitioners who are on the registry, said Dr. Gary Peterson, the hospital's chief medical officer. That's not to say that an oncologist would necessarily agree to certify a particular patient.
"I would think that each individual cancer patient ... would be evaluated individually as to the appropriateness of medical marijuana," he said. "We wouldn't expect that to be the first-line treatment."
But the decision about whether to certify patients is left up to the practitioners, Peterson said.
Essentia Health takes a more centralized approach. Dr. Jeffrey Lyon, an internist who is on the medical cannabis committee at Essentia, said practitioners are asked to try "evidence-supported treatments" before considering medical marijuana as an option. If the clinician then wants to recommend medical marijuana, he or she first must refer the case to the committee, which then rules on whether the patient can be certified.
An expedited process is allowed for terminally ill patients with "intractable nausea," he said.
Lyon has led the committee since the beginning of the year, and there hasn't been a single request during that time, he said.
Arneson said he senses frustration from prospective patients in the Duluth area.
"We get complaints about not being able to find (a practitioner) to certify a patient from all over the state, don't get me wrong," he said. "But we have received a number from the northeastern part of the state with specific complaints about organizations."
Income may be a factor in holding down the number of participants from some parts of the state.
"Most people can't afford this program," Arneson said. "That's just the reality of it. So it depends a little bit on the distribution of income, I would say."
The average monthly cost for marijuana patients in Minnesota is $150, Dr. Adam Locketz said.
Locketz is a practitioner for TimeWise Clinic, which operates in Duluth and Lake Elmo, Minn. He has certified close to 2,000 patients for medical marijuana, some referred from larger clinics.
But there are other costs before the patient even gets to the marijuana distribution center, especially in the first year. Locketz said he charges $250 for the first visit to certify a patient, with declining rates after that. The state charges another $200 to place the patient on the registry, and then $50 every succeeding year. A patient must be recertified each year.
The costs and the hurdles have created a problem for the state's medical marijuana program, Lyon said.
"The state has created this system, and they're not seeing the number of people buying their product that they had hoped for," he said.
Nonetheless, state data shows growth in the patient registry every month since the program started accepting patients in June 2015. The curve became steeper starting in August 2016, when intractable pain became a condition for which marijuana could be prescribed.
As of March 31, 9,435 patients were enrolled and in active status in the registry, the Office of Medical Cannabis reported. That was up from 5,119 a year earlier.
Nearly two out of three Minnesota patients who received medical marijuana are certified for intractable pain.
Those patients may be able to break their dependence on opioids, Locketz said.
"Daily I'm seeing patients back who, over a period of years, have been able to use this to come off of fentanyl patches or oxycodone," he said.
But while data coming from states with legalized medical marijuana shows a trend toward lower opioid use, Lyon said there's still a lack of quality clinical research in the field.
"Maybe medical marijuana will be a significant tool in decreasing opioid abuse," he said. "We just don't know."
Conditions for which Minnesota residents may be eligible to receive medical marijuana:
• Cancer associated with severe/chronic pain, nausea or severe vomiting, or cachexia or severe wasting
• Tourette syndrome
• Amyotrophic Lateral Sclerosis (ALS)
• Seizures, including those characteristic of epilepsy
• Severe and persistent muscle spasms, including those characteristic of multiple sclerosis
• Inflammatory bowel disease, including Crohn's disease
• Terminal illness, with a probable life expectancy of less than one year
• Intractable pain
• Post Traumatic Stress Disorder
Two conditions will be added this year. Patients can enroll beginning July 1 and pick up medication beginning Aug. 1:
• Obstructive sleep apnea
To learn more
Visit the Minnesota Department of Health's Office of Medical Cannabis online at health.state.mn.us/topics/cannabis.