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'Intractable pain' the next step for medical cannabis

HIBBING, Minn. -- As the second year of medical cannabis in Minnesota begins on July 1, patients for the first time will be able to get certified to be treated with the drug for intractable pain. A month later, certified patients will be able to ...

Amelia Weaver of Hibbing uses a liquid form of medical marijuana, given orally, to treat her severe case of epilepsy. She receives three daily doses of the oil that LeafLine Labs calls Cobalt. Bob King / rking@duluthnews.com


HIBBING, Minn. -- As the second year of medical cannabis in Minnesota begins on July 1, patients for the first time will be able to get certified to be treated with the drug for intractable pain.

A month later, certified patients will be able to start receiving medical marijuana from one of the state's two approved companies: LeafLine Labs and Minnesota Medical Solutions.

Interest already is being expressed.

"I've seen half a dozen patients in my practice already who have come to me wanting to know about the intractable pain," said Dr. Dave Thorson, who is part of a large family medical practice in the Twin Cities and is president of the Minnesota Medical Association.


The question is whether doctors will be willing to certify them.

"I'm not finding a lot of the chronic pain docs who are buying into this," Thorson said. "I think there are a lot of questions that we don't have answers to."

Minnesota Health Commissioner Dr. Ed Ehlinger announced on Dec. 2 that he was adding intractable pain to the nine conditions for which patients certified by medical professionals already can obtain medical marijuana. He did so even though the majority of those on a panel of clinicians and medical providers assembled by the Minnesota Department of Health recommended against adding the condition.

"The relative scarcity of firm evidence made this a difficult decision," said Ehlinger, who directs the health department. "However, given the strong medical focus of Minnesota's medical cannabis program and the compelling testimony of hundreds of Minnesotans, it became clear that the right and compassionate choice was to add intractable pain."

The state's medical cannabis law defines intractable pain as a condition "in which the cause of the pain cannot be removed or otherwise treated ... and in which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts."

Thorson said he understands that the commissioner wants to be compassionate, but said evidence that medical cannabis can address intractable pain is lacking. "Doctors are not comfortable not using evidence-based medicine," he said.

But there is evidence, said Dr. Andrew Bachman, CEO of LeafLine Labs, who touts medical cannabis as a much safer alternatives to opioid pain medications.

"It has been difficult to research it in the traditional, digestible form of controlled randomized doubled-blinded study," Bachman acknowledged. "But five thousand years of observational use with zero deaths ever attributed to this medication would suggest that it's (safe)."


By contrast, he said, the use of opioids to treat pain has led to tens of thousands of lives lost.

"Every 19 minutes an American dies from an opioid," Bachman said. "One out of every 550 opioid prescriptions results in an opioid death. It's a tragic form of Russian roulette that is now quite predictable."

But Dr. Charles Reznikoff, an addiction medicine expert at Hennepin County Medical Center, contests the opioid-marijuana comparison.

"It's the height of irresponsibility to suppose that we're going to cure opioid addiction with medical cannabis," he said.

Reznikoff acknowledged that cannabis is much safer than opioids. The false assumption, he said, is that patients who are prescribed medical cannabis will abandon opioids.

"What so often happens is that they do go back on opioids," Reznikoff said. "They end up on both cannabis and opioids, and you haven't changed the risk of death at all."

From a medical standpoint, Reznikoff would have joined the advisory panel's majority in recommending against adding intractable pain had he been on the panel, he said. But he added that Ehlinger was taking into account a public response that was overwhelmingly in favor of adding the condition.

"Did he make a mistake?" Reznikoff asked rhetorically. "Medically, from my medical point of view, I think so. But he has a different job description, so I'm not going to criticize him."


Michelle Larson, director of the state health department's Office of Medical Cannabis, said the advisory panel was never meant to be the final word on Ehlinger's decision.

"We weren't looking for a pro-con vote," she said. "More said no than yes. But even those who said no said we should keep looking at it."

The addition of intractable pain as a condition is likely to mean more patients will be asking their doctors about medical cannabis, Reznikoff said.

"I think it's going to force a lot of conversations that may be frustrating to patients and to docs," he said. "It'll be a minor kerfuffle. ... I think the pain thing will push it to the front ... and docs will be forced to make a decision."

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