Intractable Pain Public Comments - Minnesota Dept. of Health

Intractable Pain General Public Comments

Comments posted 8/10/15

  1. Pain and intractable pain should most definitely be included on the list of qualifying medical conditions to receive medical marijuana in Minnesota. Minnesota has the strictest rules of all states that have legalized marijuana, for both medical and recreational purposes. This needs to be changed! Putting such tight limits on who can use MN medical marijuana is ridiculous & frustrating to medical patients who really need it. Look at the state of Colorado with recreational use allowed. They have so much marijuana tax money coming in they can fund nearly any project/issue they can think of. With the Low sign up rate at the time Minnesota's medical marijuana became legal, changes need to be made to include more health conditions, now!
  2. The human body currently has an endocannabinoid system that produces anandamine that is similar to THC and if the anandamine is providing pain relief it seems like a very easy step to make that a substance similar to the anandamine. THC also provides pain relief to the human body and it’s possible that some people don’t have an adequate endocannabinoid system and a plant could help supplement that. Contrasting that plant with opium or synthetic derivatives, it seems like a no-brainer that people with extreme pain should have access to it. Under the Minnesota medical cannabis statute, there are only liquids, oils or pills available, any of which would be a felony under Minnesota criminal law. Even one pill is a felony. Your decisions is: for patients that have intractable pain, should they have the legal right to possess these materials and not be branded a felon because they’re trying to take care of themselves? Everyone has the right to life—to preserve their bodies, liberty—to choose the substances they put into their bodies, and the pursuit of happiness—intractable pain results in depression. There are a lot of people that are suffering in Minnesota, and I ask that people on this panel try to be as empathetic as possible and listen to the stories that are out there. People are using this for therapy. If you practice listening skills you will learn that there are people in Minnesota that really need this for relief. Don’t look at medical studies only, and do this job as a whole human being.
  3. Just wondering why there has (to my knowledge) been any consideration for medical cannabis use for the disease now listed as the third killer after heart disease and cancer, EMPHYSEMA.  ????  There are many people who have had great benefit from cannabis oil for the disease that is otherwise non curable with western medicine. Also wonder why, in cases especially like this where there is NO KNOWN CURE that a patient cannot get the authorization for Cannabis oil USE.  ?????  Also wonder how a food/herb/plant can be called a drug???
  4. We would like to see chronic pain (i.e. a back injury, degenerative disc disease/spinal stenosis, arthritis, diabetes and/or fibromyalgia) to be added to the medical cannabis program. Pain medication for these conditions come with many side effects including diminished mental capacity where it has been proven that medical cannabis does not have these side effects. Thank you.
  5. I'm sure whoever you are, you can see that this great nation is changing.  We are getting back to our roots, back to what matters.    Human beings should not have to suffer because a 'drug' got a bad wrap from the gate, all in the shroud of public safety.  Though this has been a typical way to sneak fear into the hearts of Americans for the past 5+ decades, there has to be a means to an end.    Please make the right choice for tomorrow by supporting the addition of intractable pain the the list of qualifying conditions.   For the future, please make the right choices for user freedom as we pave our way toward full legalization.    Thanks!   [name redacted]

Comments posted 8/20/15

  1. I feel the condition's name and characteristics alone makes this decision an easy YES.    Why would it make any sense to allow suffering people with the other approved conditions access to potential relief and not these suffering people?   I'm sure you will get lots of inf. re. the science of cannabis and pain relief and I urge you to become educated.  Opioid overdose in other areas of the country that do allow intractable pain sufferers access to medical cannabis is significantly lowered because of synergism in the compounds.  The science available on this subject should be sufficient to demand a YES decision.   If science is not enough please use compassion and logic.  Thank You.
  2. There are many similarities between people that are terminally ill and people that have intractable pain.   1. The pain- No matter what the foreseeable outcome of someone's condition is, the pain they experience is the same. With both terminally ill patients and patients with intractable pain, there is no cure. As long as the patients live, they have to experience hardcore physical and mental pain.   2. The quality of life- Living with pain, whether terminally ill or not, influences the way the patients live their lives. Intractable pain often causes patients to have depression, just like terminally ill patients do. They all have less energy and they all miss out on various life events from being in too much pain.   3. Loved ones- Friends and family usually have an extremely difficult experience knowing someone with intractable pain as well as someone who is terminally ill. In both cases, there is nothing they can do. In both cases, they have to watch the person suffer. The difference is that people with intractable pain go through it much longer, and they don't receive as much understanding of their pain since there is often no official diagnosis.  Even though patients with intractable pain are not terminal, they can sometimes lose their will to live. This is also a tragedy. There is no way to understand what it is like to have intractable pain without personally experiencing it. Even those who have to watch a loved one experience it cannot really know what it is like. However, people with intractable pain can be given hope and a newfound will to live with this form of treatment.
  3. Premature Ovarian Failure diagnosis should qualify to use medical marijuana. I know of a lot of women that have used medical marijuana that it has helped with depression, early menopause, hot flashes, hormone levels, anxiety, back problems/joint problems to name a few of the many! In curable disease

Comments posted 9/2/15

  1. I believe people with chronic pain not helped efficiently with other medications should qualify as well
  2. Marijuana is an effective and affordable medication for a number of conditions, including pain. Pain can take over your every thought and rob you of your ability to enjoy life. Prescription pills Are killing Americans, they are highly addictive and for some, the side effects make them unsafe. Marijuana should be an option. The MN law is too restrictive.  This is something I read you should consider:  "You have heard the statement time and again from politicians and opponents of policy reform alike: “…we need more time to conduct research and study the plant before we think about changing the laws.”  This statement is largely disingenuous. The cannabis plant is actually one of the most widely studied plants worldwide. A search of the US Library of Medicine database, PubMed, revealed approximately 28,000 studies on the use of cannabis. The problem is that the vast majority of these studies come from outside of the United States.  Because marijuana is currently classified as a Schedule I drug under the Controlled Substances Act, it makes the regulatory burden for studying marijuana in the United States extremely high.  Earlier this year, in collaboration with our partners at MAPS, DPA put out a report at which explains the “Catch 22” scientists in the United States face when trying to conduct research on the health effects of marijuana. Additionally, most of the research being conducted around marijuana in the United States originates out of the National Institutes for Drug Abuse, and if the name of the agency doesn’t give you insight into the bias of its approach to research, the mission of the agency should give you a clue.  Nevertheless, there is promising research around the benefits of cannabis around a significant number of health conditions. One of the most promising and timely research studies which has come out this year looks at the growing evidence that cannabis can be used as a substitution therapy for prescription narcotics. The study in JAMA, looked at states which have reformed their laws around marijuana whether medical or recreational and found a 25 percent decrease in prescription overdose deaths.  Our friends at NORML and ASA have developed excellent websites which organizes research based on disease condition. However, it is only half of the battle to get access to a study if you have never been instructed on the proper way to read one. With this in mind, here’s a crash course on how to interpret a scientific study:  Abstract: This is the “Cliff notes” version of a scientific study. It quickly summarizes everything about the study from introduction to conclusion in about four to five sentences. After reading a good abstract you should be able to understand what the study is about.  Introduction: This section lays out the problem and rationale for why the study is taking place. Good introduction sections will even reference previous work which has been done in the area and what question the study in question is hoping to answer that will provide new information on the topic.  Materials and Methods: This is often the most overlooked section in a scientific paper, but is often the most important. This section outlines how the study was done, the number and type of people included and excluded from the study, and any statistical analysis conducted to arrive at the results. This section is important in order to determine whether or not the results can be applied to a larger audience.  Results: This section is pretty self-explanatory - it describes what the study found.  Conclusion: This section puts the results back in the context of the problem which was described in the introduction. It is also the section which outlines the limitations of a study and what future studies should consider exploring to provide more insight. Now that you have the basics on how to read a scientific paper, you should practice reading one yourself. Naturally it may be difficult and time consuming the first few times, but over time you will get better at it.  Not only with this make you better informed about the research that is coming out around cannabis, it will also better prepare you to take a critical look at the negative studies which come out around cannabis, many of which overstate the claims in order to make news.  Sincerely, The Doctors [name redacted] is a former surgeon and physician advocate. He also served as executive director of a medical marijuana nonprofit organization. [name redacted] holds a doctorate in Social Welfare and teaches classes on drug policy at the [organization redacted]."
  3. It is too bad that the reasons for legal use of marijuana are so restricted.  I know people who have chronic pain from lymes disease, know a lot of people that use this to help with anxiety and depression, and many people who use this to keep nausea at bay, chronic nausea... not from a cancer or terminal disease.   This could serve so many more people that could lead useful lives if they could manage their "ills".   Colorado has the right idea.
  4. Please add intractable pain to the list of qualifying conditions for medical cannabis in the state of Minnesota. It's just a small start to additional conditions that must be approved in the coming months. So far, this program has been a dismal failure and the laughing stock of the country. At this rate, there's no way these companies will even be in business by this time next year. The MDH needs to ensure that restrictions are loosened, access widened, and prices lowered. Right now, this program is completely pointless.
  5. Anyone with any compassion would give a loved one this drug for intractable pain.   Living with chronic pain is  a game changer  now we have the opportunity to help.  Legally.  End of conversation.
  6. If someone is truly in "intractable pain" and medical cannabis can help them in situations where other pain relievers are either ineffective or difficult to obtain, It would be simply inhumane to deny such individuals the pain relief they so desperately need.  If legal prescription medications could adequately address the patient's needs, then please allow doctors to exercise their best judgment and prescribe painkillers as needed, without fear of reprisal from the state and federal governments who monitor the doctors' prescribing habits.
  7. Minnesota Department of Heath:  As a citizen of the State of Minnesota, I implore you to include persons with intractable pain to the list of qualifying conditions in the Minnesota Medical Cannabis Program.  It's a no-brainer to treat pain with an effective medication.  It's downright silly to not consider the efficacy of medical marijuana on treatment of medical conditions.  Forget about the politics of recreational marijuana - give ill people relief!  Thank you for your consideration - [name redacted] Shorewood, MN
  8. Intractable pain most certainly should be a condition that qualifies for a medical marijuana prescription.  Whatever is necessary to relieve intractable pain is simply humane.  To deny someone relief is inhumane.
  9. Yes intractable pain and more qualifying conditions should be added. But why not make cannabis legal for everyone!
  10. I support adding intractable pain to the approved list of conditions to be treated with medical marijuana. There are millions of people still suffering and could benefit from the option for the treatment of pain. How can you say some people are suffering more than others? If it's going to be an option, please don't discriminate which conditions are worthy and which aren't. That should be a conversation and decision made between a patient and their physician. Thank you, [name redacted]
  11. Of course legalize it for intractable pain!  That is the only humane option.  Be kind not afraid.  I have seen people benefit greatly from this gift of nature during the final stages of cancer.
  12. Since marijuana is one of the least harmful treatments for chronic pain in our pharmacopeia, of course it should be legal for chronic pain. That it is not is no reflection on its value. But it is a reflection, and a bad one, of the self-serving and uncompassionate interests that have put it out of the reach of patients for so long, and that have condemned so many others to jail simply for enjoying its effects.
  13. yes pain should definitely be added as one of the conditions.  Continued over use of pharmacy medications are killing Americans every day. Cannabis is far safer then any of those opiate medications. Medical cannabis patients also need protections from employer drug tests, since we know all their really looking for is cannabis. People shouldn't lose their livelihood over a legal prescription.
  14. I think that medical cannabis use should be able to be perscribed by the doctors at their discretion. I know doctors are smart enough to know what may help with any pain their patient is experiencing.
  15. It's difficult for me to believe, as a health-care professional, that our government is more likely to encourage medical professionals to prescribe dangerous, addictive substances with limited results rather than a natural substance with documented success.  Such hubris, the law of the land has been due to a handful of small people with limited facts. Western medicine has only been around for the past  100 years. Eastern and Native American naturopathic medication have been around for thousands of years yet is discounted.  It's time Rolodex restrictions, fund and enable true medical research with less crippling federal restrictions and legalize medical use of cannabis as per a doctors order.  Stop opioid narcotic dependence now- these are the TRUE gateway drugs!!
  16. Why would we deny anyone a chance of minimizing or removing intractable pain? Of course intractable pain should be included as a qualifying condition for the medical cannabis program. I would caution that the current definition of intractable pain must be upheld and not "loosened up". Just counting "pain" or "chronic pain" is not acceptable - this has caused a significant slippery slope in other states (I hurt my wrist last weekend and it is chronic pain). Other standards of practice should be tried first before medical cannabis - in order to uphold the integrity of the medical cannabis program in Minnesota.
  17. Yes, intractable pain should be added. Some chronic pain sufferers take large amounts of prescribed narcotics with little to no relief. Certainly no permanent relief.
  18. Intractable pain not only causes suffering, but it also severely reduces quality of life.  Pain interferes with the healing process as well as the ability to cope with life in general.  To not allow a major possibility to alter and/or reduce intractable pain contributes to needless suffering and is not in line with compassionate care.  Please consider this request.
  19. Intractable pain should be added to the list of qualifying conditions in the Minnesota Medical Cannabis Program. [name redacted]
  20. I have no idea, why there is a question, that cannabis should be used to help folks with intractable pain.  Doctors prescribe narcotic pain relievers all the time.  I have bottles of it, that were prescribed, when I had knee replacement surgery.  These type of drugs cause more addiction problems, than cannabis ever would.  In my 20's, I smoked marijuana every day.  I went to work, raised my son and after 10 years of smoking, I needed to move on.  I was not addicted, nor did smoking marijuana lead to me taking other drugs.  If marijuana can help someone with chronic pain, why in the world hasn't it been legal to smoke, consume, etc.?  Could it be due to the fact, that the big drug companies would be the losers in this debate, as I'm sure folks would rather use cannabis, rather than consume all of the narcotic pain relievers on the market today.
  21. A person should be able to choose what medication are available to treat their pain. Why should they only be limited to pills? Why shouldn't a person be able to use natural oils to treat their pain? We already have one of the worst medical marijuana laws in the nation. It should definitely be expanded.
  22. Medical Cannabis should absolutely be legalized for those suffering from any type of pain! I also believe having it legalized for recreational use would benefit out state.
  23. I support the inclusion of intractable pain on the list of the Minnesota medical cannabis program treatable conditions list
  24. I know people who suffer significant daily pain. The medications available all have problems and side effects. It is cruel to deny them. The governor consulted who? Law enforcement? Their job is to enforce the people's laws, not be the source of them. It's time to do the right thing.
  25. Medical marijuana is the answer to prescription-painkiller abuse    Minnesota certainly does need a new strategy to fight opioid addiction (“Closing the gateway that leads to heroin,” editorial, Aug. 25). Unfortunately, Gov. Mark Dayton bowed to the pressure of law enforcement lobbyists and supported a limited medicinal cannabis law that excluded intractable pain. Studies have found that states with medical marijuana laws have fewer deaths from opioid overdoses than those without. Other studies have shown that cannabis has the potential to manage pain symptoms and at least reduce the dosage of opioids needed to manage severe pain. The risks of opioids include addiction and death from overdose. Cannabis is a much safer alternative. It has a much lower risk for dependence, and there has yet to be a documented death from overdose.    Minnesota’s medical cannabis law was designed with a research component, and the state is currently offering sessions for public input on adding intractable pain to the qualifying conditions list. Public testimony will be taken at a meeting of an advisory panel to be held from 4 to 9 p.m. Sept. 3 in the Minnetonka City Council chambers, and comments are being accepted online (tinyurl.com/psrkk8h). If the state truly intends to research this alternative to opioids, this presents the perfect opportunity to update the law by Jan. 1 as the current statute dictates.
  26. There has been enough medical research and personal testimonials to tell us Marijuana has great medical benefits that includes chronic pain. For many it's the difference between being able to function and be mobile or not.  To be able to wprl 40 hours+ a week or not. I personally know people who can't or couldn't manage the pain without it at least in addition to their other medication.  Honestly medical legalization for chronic pain shouldn't even be a debate at this point. We should be beyond the medical debate and onto the full legalization debate. Our state needs to follow other states that have made great progress in legalizing medical or recreational use. It's been amazing in Colorado. Crime is down, they have a huge boost in revenue, and no more wasted money on Marijuana crimes. The list goes on. It's time for progressive Minnesota to do the right thing and take a huge step forward! Let's get it done!
  27. Many veterans are forced to buy illegal marijuana. They suffer from PTSD and other combat related medical problems.  They government asked us to risk our lives and won't give us the medications that are most effective and least harmful. Minnesota turned away from the Veterans who gave so much.
  28. I think Intractable Pain should be added to the qualifying conditions for the Minnesota Medical Cannabis Program.
  29. No, I don't understand how businesses are supposed to regulate employee usage. Businesses are struggling immensely in Colorado about finding ways to test Marijuana levels and controlling the safety of employees. The more legal uses of marijuana, the harder it is to control workplaces for safety.
  30. I am in support of empowerment of patients to use cannabis for pain relief as indicated by medical guidance as long as it doesn't affect others.  However, I am very strongly opposed to legalization of the smoked or forms that could be smoked because, once an implement is lit, the choice to not smoke is taken away from anyone who is exposed.  While living in WA state, I had the experience of being unable to remove myself from the effects of smoked pot because even when people would smoke in private, they carried the third hand residue on their clothing and hair, and pot can still have effects on those who are exposed to this form. The pot smoke, and its effects, circulate throughout apartment complexes and managers often do not place priority on keeping the buildings smoke free, even when leases claim that the building is smoke-free. Even HUD doesn't get involved when people smoke inside because enforcement is too difficult. Keeping it illegal continues to allow recourse to keep it out of one's home. Once pot is legalized in smoked form, for whatever reason, it's impossible to get away from. This is not fair to anyone who doesn't want to be exposed, and especially for members of vulnerable groups.
  31. Intractable pain should ABSOLUTELY be on the list of qualifying conditions.  Why make people suffer??
  32. I feel medical marijuana should be available for use by anyone in pain that can find no relief by other means. Please allow its use for intractable pain.  Thank you.

Comments posted 10/7/15

  1. The issue of Marijuana should be settled once and for all. It assists more people than not and is nowhere nearly as bad as alcohol. The state should be legalizing this in order to profit from it and therefore better all Minnesotans. This additional money can be spent to fix our infrastructure problems where they exist as well as other key areas. On the issue of medical, expand. It will help many people.
  2. Cannabis should be allowed for everything, medical or not. Medical pot should be free at no cost.  And as far as pain goes, it fricking works!!!
  3. Intractable pain can be hugely lessened by cannabidiol, also known as THC. Over the last 30 or so years Dr. Raphael Mechoulam has done extensive research on the efficacy of cannaboid as a pain killer and has found it to be extremely effective with no side effects. Please view this video to learn more. http://www.medicaljane.com/2015/09/08/introducing-the-scientist-a-new-medical-marijuana-documentary/   What people who have intractable pain need is an effective painkiller without side effects. We have it here in cannabidoid.
  4. I fully support the use of medical cannabis for relief of chronic or intractable pain. In fact, as a frequent migraine sufferer who often can only experience relief through the use of medications containing butalbital and codeine, I support its use in treatment of recurring, severe, long lasting pain like what I experience.
  5. Approving patients for medicinal cannabis that suffer from pain will be a big win for everyone. There is a big increase in opiate overdoses all over Minnesota. If we can prevent getting patients addicted to these hard drugs it will be a huge improvement. I support this 100%! And I stand by cannabis medication all the way...
  6. There is a serious problem in this nation, it is the pain killer epidemic. It starts out small for maybe a toothache then the next thing people know they are addicted to opiates. Then for the hard stuff. And for some families the worst. I think it is our countries responsibility to come up with some other way to stop pain without adding more pain and medical marijuana can do that. The uses for marijuana are many and the benefits greatly outweigh any I'll effects. I know many people with opiate addiction some now have to go-to a methadone clinic because they cannot quit, they became addicted because a doctor prescribed them a pill legally! If they don't take that pill or go to the methadone clinic they suffer. But just think if the doctor was able to prescribe medical marijuana instead, I know it's not as effective as opiates but I'd rather suffer through a little extra pain then become an addict or see anyone else I love become one. I have frequent severe migraines and nothing helps I don't want to take pain killers as I am worried I will become dependent.  Please stop the creation of opiate addicts.
  7. Yes, intractable pain, including post-herpetic neuralgia and other nerve pain NEEDS to be included in the list of qualifying conditions.
  8. I absolutely believe that intractable pain should be added to the list of qualifying conditions in the Minnesota Medical Cannabis Program, among other ailments. As Minnesota is the state with most exclusionary medical cannabis program, it's as if it doesn't exist at all. Barely anyone qualifies, and doctors are either too afraid or misinformed or stuck behind bureaucracy to even entertain the idea of referring a patient to the program. There have obviously been countless studies and testimonials to the fact that cannabis is an effective treatment for pain. Minnesota has invested money in this program but it is too exclusive to get any sort of return which is a ridiculous business plan.
  9. Many of the drugs that are commonly prescribed for pain are more dangerous and harmful than cannabis is, have the ability to be abused, used for suicide, are addictive and dangerous to mix with alcohol, and can potentially harm people that are not supposed to take them (but do through nefarious means).  Yet, these medicines are easier to be prescribed in Minnesota. If this sounds odd to you, then it would be in your best interest to open up the medical cannabis market in Minnesota by allowing the people to use this medicine not just for intractable pain, but any pain in general.   Many studies have recently shown that cannabis is a pain relieving, and virtually harmless substance. You may question this line of reasoning, and that is okay, but when is the last time you heard of someone overdosing on cannabis? When is the last time you heard of someone dying because they ingested cannabis with too much alcohol, then the cannabis and alcohol had a synergistic effect and killed the person? Although some might agree that one of the worst things about cannabis is its addicting properties, others would compare the addiction rates to other legal and illegal substances. For example, a study conducted by the National Institute of Drug Abuse has concluded that 9% of people who ever try cannabis become addicted to it, and while some might agree that this is a concerning number, others tend to think that this is a very low number compared to the 15% addiction rate for alcohol, 17% addiction rate for cocaine, the 23% addiction rate for heroin and the 32% for tobacco.  Of course, addiction is something that we have to consider, but look at what happens to people when they become addicted to cigarettes and alcohol. Both of those substances are legal in Minnesota and cause a wide variety of health problems. To conclude, these rates of addiction are concerning, but it is safe to say that marijuana is significantly less addictive than many recreational substances that are legal today.  In conclusion, I just wanted to say that only the rich can afford this substance, currently, when it costs nearly $264 per month to obtain. This is because there is hardly a demand for this medicine, causing the price to supply it to effectively increase. While this could be a good strategy to keep the public from addiction, many are forced to use the black market to obtain a substance that they know very well treats their disorders better than the drugs that are commonly prescribed for pain and other ailments. This unnecessarily exclusive law is not doing anything but fueling a vastly growing black market and contributing to a societal problem. Please consider opening up this substance for other types of pain, not just intractable pain, but pain in general.  Thank you
  10. Intractable pain, as it is currently defined in MN statute, appears ambiguous and subjective. Other states which have authorized medical cannabis use for broad categories of patients, including pain, appear to have experienced abuse of the system as a result (O’Connell, T.J. & Bou-Matar, C.B., 2007). It seems reasonable to believe adding intractable pain to the list of qualifying conditions, as it is currently defined, may lead to a similar result.  The state of Delaware certifies pain patients for medical cannabis who have, “…not responded to previously prescribed medication or surgical measures for more than 3 months or for which other treatment options produced serious side effects (Del. Code tit. 16, 4902A, as cited in LawAtlas, 2014).” The state of Montana requires proof of diagnostic testing or confirmation pain diagnosis from a second physician who has examined the patient (Montana Code 50-46-302, as cited in LawAtlas, 2014).   I work in the field of public health and substance abuse prevention. I have been happy to see the thoughtful effort our Department of Health has made to reduce risk of diversion and ensure product safety in the medical cannabis program thus far. Consideration of how intractable pain is defined and verified seems a prudent way of continuing to ensure this program serves appropriate patients and minimizes risk for abuse of its original intention.  Sources: O'connell, T., & Bou-Matar, C. (2007). Long term marijuana users seeking medical cannabis in California (2001–2007): Demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal, 4-16.  LawAtlas. (2014). Medical marijuana laws for patients map. Retrieved from: http://lawatlas.org/query?dataset=medical-marijuana-patient-related-laws
  11. Expanding the list of qualifying conditions for medical cannabis has the potential to expand the positive dialogue in Minnesota about recreational marijuana use as well.  Medical cannabis cannot be smoked in Minnesota which, from a public health perspective, is an important strategy for reducing diversion and supporting law enforcement. Despite this, research suggests expanding medical cannabis access may increase social acceptance of illegal, recreational use.  Research over many decades has shown a relationship between community attitudes and individual health behavior (Asch, 1952; Cullen, 1983; Durkheim, 1938). These findings are mirrored by marijuana use behavior. As documented by the University of Michigan’s Monitoring the Future study, perceived risk of using among youth and youth use of marijuana have an inverse relationship. That is, as public perception of risk (attitude) decreases, marijuana use increases. States with medical marijuana laws have also been found to have higher odds for marijuana abuse/dependence than those without the laws (Cerda, Wall, Keyes, Galea, & Hasin, 2012).  These findings are particularly concerning in regard to our young people who are more susceptible to marijuana’s negative consequences and addiction. 17% of adolescents who use marijuana will become addicted (National Institute on Drug Abuse, 2014). Marijuana use has been found to decrease IQ over time and negatively impact multiple educational outcomes such as low grades and lower likelihood of graduation or college enrollment (National Institute on Drug Abuse, November 2014). Adolescents, age 12 – 17, reported considerably higher past 30-day marijuana use than teens in states without medical cannabis according to the 2012 and 2013 National Survey on Drug Use and Health (as cited in Cerda et al, 2012). The perception of risk for marijuana use has been decreasing among Minnesota youth since 2010. Perception of “great” or “moderate” risk has decreased by 12% points for males and 9% points for females among 9th graders alone between 2010 and 2013 according to the MN Student Survey.  Researchers surmise decreases in risk perception may be due to changing community attitudes on marijuana use, the medical endorsement of this substance, and increased availability (Cerda et al, 2012). In the spring of 2015, a local MN coalition conducted listening sessions with all outgoing 12thgraders at a large, metro area high school. Students were asked: “How, if at all, has the recent shift of marijuana laws across the country and here in MN changed your opinion on marijuana?” About 81% of the responses indicated the changing laws send the message that marijuana use is more socially acceptable and less harmful than previously thought. Only about 19% of the responses indicated the changing laws do not change students’ opinions on marijuana.  My concern as a public health professional is not about patients who are interested in accessing this medicine as a legitimate part of their treatment plan. My concern is about the impact these decisions have on the broader community and how we set them up for success to be healthy and safe.  Sources: Asch, S. (1952). Social Psychology. Prentice Hall: Upper Saddle River, NJ. Cerdá, M., Wall, M., Keyes, K., Galea, S., & Hasin, D. (2012). Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence, 120 (1-3), 22-27. Cullen, F. (1983). Rethinking Crime and Deviance Theory: The Emergence of a Structuring Tradition. Roman and Allenheld: Totowa, NJ. Durkheim, E. (1938). The Rules of Sociological Method. The Free Press: New York. National Institute on Drug Abuse. (2014, November). Marijuana use and educational outcomes. Infographics. Retrieved from: http://www.drugabuse.gov/related-topics/trends-statistics/infographics/marijuana-use-educational-outcomes
  12. I have a number of concerns regarding the addition of intractable pain to MN's Medical Cannabis Program, most of which can be categorized under either concerns for the best interest of patients or concerns regarding the broader societal implications of this policy change. I hope the following facts will be taken into consideration, as the implications of this decision are wide reaching.   Concern for the best interest of the patient:  *Cannabis is addictive.   Residents of states with medical marijuana have marijuana abuse/dependence rates almost twice as high than states without such laws.1 One in 11 marijuana users becomes addicted, and the rate rises to 1 in 6 among teens.2 As many as 1 in 2 daily users becomes addicted to marijuana.3 Cannabis addiction is a real threat. Addiction, which is a chronic brain disease, can complicate the care and treatment options for patients who already have complex medical issues.   Sources:  1. Cerdá, M., Wall, M., Keyes, K., Galea, S., & Hasin, D. (2012). Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence, 120 (1-3), 22-27. 2. Anthony, J. (2006). The Epidemiology of Cannabis Dependence (R. Roffman & R. Stephens, Eds.). Cannabis Dependence Its Nature, Consequences and Treatment, 58-105. 3. Hall, W., & Pacula, R. (2003). Cannabis use and dependence: Public health and public policy. Cambridge, UK: Cambridge University Press.  *Cannabis is not a proven opioid alternative.  There are few, if any, legitimate, peer-reviewed studies documenting the relationship between cannabis use and opioid use. Medical cannabis use has not proven to reduce the use of opioids. According to the published meeting notes from a June 15th presentation to the Minnesota Department of Health’s Office of Medical Cannabis Advisory Panel on Intractable Pain, Dr. Miles Belgrade stated, “My experience is users are as likely or more likely to want to continue their opioid medication and continue at the same rate. No one has asked to be taken off the opioids. When e-cigarettes first came out, a study of veterans found that those who used e-cigarettes to quit were actually the least likely to quit.” He went on to say, “Of the patients that I treat that I know are smoking marijuana, it might actually make them opioid-seeking.”   Source: Belgrade, M. (2015, June 15). Chronic Pain: Are We There Yet? Lecture presented at the Meeting of the Advisory Panel on Intractable Pain, Saint Paul, MN.   *Cannabis negatively impacts mental health.   Cannabis and mental illness have well documented connections. Individuals who report ever using cannabis are at an increased risk for developing a psychotic illness, according to a comprehensive 2007 literature review published in The Lancet.1    According to the 2013 Minnesota Student Survey, students reporting significant problems with depression were 2.3 times more likely to report marijuana use. Minnesota students reporting anxiety were almost twice as likely to have used marijuana in the past 30-days than those who didn’t report anxiety.1   According to the National Alliance on Mental Illness, “The overwhelming consensus from mental health professionals is that marijuana is not helpful—and potentially dangerous—for people with mental illness. Using marijuana can directly worsen symptoms of anxiety, depression or schizophrenia through its actions on the brain. People who smoke marijuana are also less likely to actively participate in their treatment—missing more appointments and having more difficulty with medication adherence—than people who abstain from using this drug.”   People with chronic pain are already at a higher risk for depression and anxiety. Major depressive disorder rates among those with chronic pain range from 23% to 78% (compared with rates of 5% to 17.1% in the general population), and anxiety rates range from 10.6% to 62.5% (compared with 1% to 25% in the general population).2   Sources:  1. Moore, T., Zammit, S., Lingford-Hughes, A., Barnes, T., Jones, P., Burke, M., & Lewis, G. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. The Lancet, 370 (9584), 319-328. Retrieved September 9, 2015, from http://www.sciencedirect.com/science/article/pii/S0140673607611623 2. Adolfson, M. (2015). Mental Health and Substance Use 2015 Fact Sheet. Retrieved September 24, 2015, from http://sumn.org/~/media/167/MENTAL HEALTH 2015 SUMN Fact Sheet.pdf 3. Gatchel, R., Worzer, W., Brede, E., Choi, Y., & Asih, S. (2011, November 1). Etiology of Chronic Pain and Mental Illness: How To Assess Both. Retrieved September 10, 2015, from http://www.practicalpainmanagement.com/pain/other/co-morbidities/etiology-chronic-pain-mental-illness-how-assess-both Societal implications:  *Pain = More Patients = More Opportunity for Abuse of the System & Diversion.  Multiple state health departments publish medical marijuana statistics on patients, including the count and percentage of patients by each of the state’s qualifying conditions. Researchers who have analyzed such data, have stated that very few patients, as low as <1-2%, report serious conditions such as HIV/AIDS or cancer, and that pain accounts for as high as 94% of patients.1 The state health departments publishing the statistics, such as the Colorado Department of Public Health & Environment, make similar comments in their regular reports. It should be noted that patients very often qualify for more than one condition when pain is included in the state’s program, and therefore the counts aren’t mutually exclusive.   Even when looking at unduplicated counts, chronic or severe pain alone appears to be the top and sole qualifying condition for the majority of medical cannabis patients across the country who live in states including pain in their programs. According to an article posted on a pro-marijuana legalization website, the percentage of medical marijuana patients qualifying for pain only is 71% in Arizona, between 50% and 75% in Oregon, and between 65% and 87% in Colorado, Montana, and Michigan.2   In states that include severe or chronic pain as a qualifying condition, abuse of the system and diversion are common. According to a 2007 study of more than 3,000 medical marijuana users in California, 88% had tried marijuana before the age of 19, and many immediately became regular users or sporadic users prior to obtaining access to medical marijuana. Among Caucasians in the sample (average user was a 32-year-old white male), approximately 74% percent reported previous use of cocaine, and more than half reported having used methamphetamine at some point in their lifetime.3   “Diversion of medical marijuana is common among adolescents in substance treatment,” according to a 2011 study of 15-19 year-olds receiving treatment in Denver, Colorado. The study found that nearly half (48.8%) had obtained marijuana from someone with a medical marijuana license.4   Sources: 1. Sabet, K. (2013). Reefer sanity: Seven great myths about marijuana (p.71). New York, NY: Beaufort Books. 2. Belville, R. (2013, March 5). State Medical Marijuana Registries Debunk “90% Get a Card for Pain” Talking Point. Retrieved September 8, 2015, from http://radicalruss.com/state-medical-marijuana-registries-debunk-90-get-a-card-for-pain-talking-point/ 3. O'connell, T., & Bou-Matar, C. (2007). Long term marijuana users seeking medical cannabis in California (2001–2007): Demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal, 4-16. 4. Thurstone, C., Lieberman, S., & Schmiege, S. (2011). Medical marijuana diversion and associated problems in adolescent substance treatment. Drug and Alcohol Dependence, 118 (2-3), 489-492.  *Shifting cannabis laws impact youth perception of harm and marijuana use rates.  According to the American Academy of Pediatrics, “Legalization of marijuana could decrease adolescents’ perceptions of the risk of use and increase their exposure to this drug. Furthermore, data concerning adolescents’ use of the two drugs that are legal for adults (alcohol and tobacco) suggest strongly that legalization of marijuana would have a negative effect on youth.”1 One study that documents this pattern found that marijuana use rates were higher among youth ages 12 to 17 in states with medical marijuana laws (8.68%) compared with those without such laws (6.94%), and perception of riskiness was lower.2  As documented by the University of Michigan’s Monitoring the Future study, perceived risk of using among youth and youth use of marijuana have an inverse relationship. That is, as perception of risk decreases, use rises.     The Hazelden Betty Ford Foundation, a national leader in the treatment of substance use disorders, warns that, “Expanded social acceptance will almost certainly result in more new users, higher frequency of use among established users and increases in marijuana-associated health and social problems. Therefore, the Hazelden Betty Ford Foundation opposes any efforts that increase the availability of marijuana and minimize the dangers of its use.”3   Sources: 1. Joffe, A., & Yancy, W. (2004). Legalization of Marijuana: Potential Impact on Youth. Pediatrics, 113 (6), 632-638. Retrieved September 24, 2015, from http://pediatrics.aappublications.org/content/113/6/e632.full.pdf 2. Wall, M., Poh, E., Cerdá, M., Keyes, K., Galea, S., & Hasin, D. (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear. Annals of Epidemiology, 21 (9), 714-716. Changing laws impact youth perceptions of harm, which is highly predictive of use. 3. Statement Against Legalization of Marijuana. (n.d.). Retrieved September 8, 2015, from https://www.hazelden.org/web/public/legalization-marijuana-statement.page  *Cannabis impairs driving and contributes to an increased ris
  13. Adding conditions will have no effect until availability problems are addressed.  Only a handful out of thousands with qualifying conditions are able to obtain medical cannabis.  This is because very few health care providers are able to certify.  This could be remedied by allowing ANY provider to submit proof of a qualifying condition.
  14. Read the article by Yale doctors  Deepak Cyril D'Souza, MBBS, MD1,2,3; Mohini Ranganathan, MD1, published June 2015 in JAMA .....  Researchers from the University of Bristol in the United Kingdom reviewed findings from 79 different studies looking at the effect of marijuana on symptoms ranging from chronic pain to sleep difficulties and mental illness. At best, they found only moderate evidence indicating that marijuana reduced nerve pain and pain from cancer. When it came to other conditions, like nausea and vomiting due to chemotherapy, difficulties sleeping or weight loss among HIV patients, there was some anecdotal evidence suggesting that people may be helped by marijuana, but it was just that - anecdote.   In the absence of gold-standard evidence, what is the bar for legalization?” D’Souza asked Tuesday at the Middlesex County Substance Abuse Action Council’s spring forum. D’Souza believes that the state’s medical marijuana program is a “runaway train,” according to the event invitation sent by Betsey S. Chadwick, director of MCSAAC. While the consumer protection commissioner claims that the medical marijuana program is in a race against time to bring relief to more patients, one panel member physician (D’Souza) keeps championing the scientific method and voting down a quick expansion of marijuana use, the email said.   As a new round of diseases were considered by the state’s board of physicians, ultimately two conditions, including ulcerative colitis and amyotrophic lateral sclerosis, the latter better known as ALS or Lou Gehrig’s disease, have been approved for MMJ.   Those recommendations were approved recently by consumer protection Commissioner Jonathan A. Harris. D’Souza has often cast the sole dissenting votes in the state’s search to approve new, qualifying medical conditions under the medical marijuana statute.   During the hour-long talk Tuesday, the doctor at times lightly scratched the surface on a few highly technical, scientific details about the plant, existing studies and complication of its study based on its 483 separate constituents, or components, D’Souza said. “There is no single drug that can treat all approved conditions,” which are very diverse ailments with no “common pathophysiology.” Though many advocates of medical marijuana claim that stringent regulations will better control society’s use or legalization will reduce discriminatory punitive damages against an enormous number of drug offenders tying up the nation’s judicial and prison systems. “It’s unstudied. Marijuana has more than 400 constituents. Most available drugs have one or two,” said D’Souza. “The cannabis you get in Middletown may be different than what you get in New Haven.”  Plants now are engineered to produce more or less of certain components that are believed to help people suffering from chronic ailments and diseases. No one can compare the safety of marijuana from the 1960s to today, D’Souza said. “The THC content is rising, from ditch weed to skunk and sensimilla,” said D’Souza, adding that higher numbers of serious adverse events occur today from pot use, and related visits to the emergency room are up, too.  Why use something that has not been tested, D’Souza asked. Since any existing studies are not well-documented, “What are the risks?” It’s been determined that tolerance, dependence and withdrawal symptoms are all connected to long-term marijuana use, he said. Though marijuana’s effect may “reduce anxiety and distress,” it may not actually affect the disease process.  “We need to establish clear, transparent, scientific studies to validate why one condition gets approved and another is not approved.” Voting no to use it for Tourette syndrome and yes to ulcerative colitis shows an inconsistent response, according to D’Souza. Doctors need to be educated, he said.  “I’d argue there’s a lot of money to be made here by growers, the state and doctors that prescribe,” D’Souza said. “I wish it weren’t about money.”  .
  15. If there ever was a question that’s a no brainer this is it, easy. This program was set up so narrowly, it was almost doomed to failure. Intractable pain would be the first step. Minnesota says it has never been researched. Google Israel Cannabis Study. With every disease known to humankind: physical, emotional, mental, stress—Israeli soldiers, US soldiers—I hope this is the first step to fixing it. The $200 barrier is huge. We need thousands of patients, and there are thousands of sick people in Minnesota that could be helped by medical cannabis, and that needs to be fixed. I hope there are discussions after intractable pain. It needs to be widened. I’ve seen friends and relatives in Colorado, and it’s a miracle. Physicians give out opiates like they’re candy, and 16,000 die per year from opiates. I hope this gets turned around because I know it’s a start for those that need it. A lot needs to be done, and I hope it goes way beyond intractable pain because it needs to. Thank you. [Later in conversation] I just read a Colorado update. They’re under the microscope and the facts are pretty clear there underage use of illegal cannabis and traffic fatalities have fallen in Colorado. Their program is either $10 or $15 per year to register or maybe even for life.
  16. I work with a substance abuse treatment program and I’ll admit to being on medical cannabis, and I’m not making an argument for or against intractable pain because people feel passionately. If we’re going to go ahead, and it does benefit, I would like the Department of Health to consider that utilizing does for adolescence because it does affect them and lead to other stuff including other medicines. The state did a lot to prevent opiate use, and I would like to see work to prevent it getting in the hands of adolescences. As Minnesota, we need to come together around this. Thank you.
  17. I applaud the Minnesota Department of Health for taking on this process. We need to open up to other conditions, but I do caution on pain. I have pain but I don’t need medical cannabis. So like with the skin blistering, be more specific on uses. As mother of two teenagers, they’ll come home and say, “Mom, everyone’s doing it, no big deal. It’s legal in Colorado.” I want to caution Minnesota. I don’t want it to be like it is in Colorado. I don’t want to be on the roads with people that are high, people that are under the influence. And when they hear that it’s legal, its’ no big deal, it does change the perception of harm for kids. I do want Minnesota to proceed with cautions, but I agree we need to add some conditions.
  18. My daughter has lived in Colorado for 13 years, but I read their paper in the news every day but it’s one of the reasons it’s no longer a novelty or something for them to get their hands on. Heroin is the number one problem in schools, and everyone thinks it’s someone else’s kid, but heroin will kill them. Cannabis will not. And with restrictions in Minnesota, children can’t get a hold of them. I’d be more afraid of opiates, and people go into medicine cabinets of strangers to steal that. You’re not going to find that. I’ve worked in the healthcare field, and when you say you want a specific disease, some don’t even have names, just symptoms. I’ve got a bad knee; I took at injury on concrete. I don’t need it, but people seriously in 24/7 pain--you can see it in their face. And that severe pain should be treated just to ease that and any condition that a doctor would feel suited to say that. But Colorado is not a bad problem. They are seeing many positives because it’s controlled so well.
  19. One of the things they prescribe for fibromyalgia are opioids, and they don’t take pain away they make you not care about it and they’re addictive. Cannabis takes it away and isn’t addictive. 
  20. [Submitted Code of Federal Regulations Title 38 Section 3.317] This is the section that governs the Veteran’s Administration specifically on what we could call “Gulf War Illness.” No one knows whether it’s chemical we inhaled or what happened. You’re talking about intractable pain—Gulf War Illness encompasses that and other illnesses that aren’t diagnosable. There’s a list of systems in the CFR—fibromyalgia, muscle joint pain—some have to do with pain. I’m not a doctor. I’m the veteran’s officer. I know a lot of my veterans find relief in marijuana. I would like to see some of those symptoms, if not the entire thing, considered for inclusion. Thank you.
  21. I have been listening to people that have serious medical problems, and I would imagine we spend millions to develop this whole program. And now we have people that could benefit from it but can’t afford it, and that’s ridiculous. So for all these people with these complex medical problems, the state should come up with a way to help them pay for it.
  22. I have family in Minnesota. I have been watching the whole program. I see three problems. Minnesotans are very smart—they use the whole plant and you really can’t come up with a dose. Plus what they have to use is government-issued from Mississippi. 20 years ago they started grouping—they use the leaf and the whole plant. You can balance out different strains. I’ve been working with a lot of people, different plants. I have a caretaker license in California. I don’t get it when I talk about it by allowing plant to not be pure and grinding it up. But there are only 400 certified. I went and tried to find the smallest place I can and the license was over a hundred within an hour or two. I think everyone in Minnesota is going to be a lot of trouble. I’ve seen a lot of research and videos. I’ve dealt with a doctor in Arizona. I have family here; they waited so long. Everybody voted this in. It’s pretty much a joke. No one is going to get it here. I feel really, really terrible for the people. I’m sorry. I’m licensed in every state and I came to here to try and help you. Under state law if you test positive for cannabis and you take prescription opiates, they’ll take you right off, but studies show if you are on chronic pain you can use cannabis. It’s so sad the state voted it, and these people are telling the truth, and the saddest thing is what the researchers are struck growing. I don’t know if the government is doing this; it’s just not going to work. If you go back in history it’s two steps up from help. Give me an idea how you’re doing it. I work with doctors and veterans but Minnesota is close to my family. It’s just sad and believe me, I write to them all the time. It’s not just one flower; the leave is horrible. I remember the   1960s if you smoke it you got sick. And I wrote an article that finally channel 9 went and checked it out and he admitted to selling it.
  23. The biggest problem is that [Governor] Dayton is more worried what is going to affect the boys in blue instead of the people he’s supposed to serve.
  24. I’m from Fergus falls. I support the inclusion of intractable pain as a qualification and hope it is added soon because the intractable pain issue is the gatekeeper for all other conditions and the sooner this is resolved the sooner we can move on to other conditions. Thank you.
  25. First, I would like to thank you for coming to Hibbing, MN to explain and help us understand the program. Yes, by all means, I believe that intractable pain should be added to the list of qualifying conditions. This is in infant stages, let's hope that we can expand to other areas. I was a recreational user of pot, have since stopped because of employment, but it cured more than pain. Now I need sleeping pills. Thanks again
  26. Quality of life measures excluded, but all the population level, these are very important and increasingly used in studies because chronic pain follows a bio-psycho-social model. Therefore, ultimately quality of life measures are related to some pain outcomes. (was Israeli study with olive oil listed in the country of origin? I looked but didn't see it.) Chronic pain conditions can fall into categories (e.g. centralized pain), therefore not all conditions probably need to be studied. Pain outcome can be classified in several ways (worst, average, today). Under how the report those pain values
  27. I think that intractable chronic pain should be considered as a condition worthy of prescription components of marijuana. It should be a treatment alongside of PT, OT, chiropractic, and OTC meds and opioids.
  28. It's really a no-brainer that intractable pain should be added to the Minnesota medical marijuana plan. The real issue is adding beyond our "super restricted" plan. You need to add any disease/condition which as pain and or inflammation as cannabis deals with both, safely. Currently the law is set up to fail: minimal conditions so minimal clients so max cost as many more are needed to bring costs down. Max patient cost now as a result. Max cost -> $200/year reg=outrageous! CO program is $10?? only oils, liquids, pills=max cost. Allow flowers=lower cost but manage vaporizing/not smoking! Additional med needed -> any disease with pain and or inflammation!

Comments posted 10/25/15

  1. I am in favor of allowing the use of cannabis for intractable pain. There wouldn't be the difficult side effects (constipation and addiction) that one may suffer with opiates. I include migraine headaches as intractable pain because there are patients who suffer daily with migraines and haven't found relief.
  2. Of course, intractable pain should be added to the list of qualifying conditions in the MN Medical Cannabis Program.
  3. Obtaining relief for pain is widely available in all forms & avenues from the simplest over the counter remedies to high potent prescription drugs. I don't understand why adding one more form of it in cannabis for those with agonizing symptoms is getting such resistance. It's like common sense is not applied on this subject. I personally know a stage 4 cancer patient that has tried handfuls of all kinds of meds only to find the most effective remedy in relieving pain & being nauseous is cannabis.
  4. Please add chronic pain sufferers to the Minnesota Medical Cannabis Program.  The article about two year old Elisa in the Star Tribune on October 18th is just one example of the need to expand the program.  Please use common sense while thinking about this issue.
  5. Of course, intractable pain and more qualifying conditions should be added. But why not make cannabis legal for everyone! It is time Minnesota got into the 20th century and put this bad history in the past, where it belongs.
  6. The question of allowing broader eligibility rules for Medical Marijuana may be illuminated by a different perspective. There are many therapeutic drugs on the market that offer relief for pain but have side effects. Some of those side effects are significant, even harmful but not so significant as to outweigh the benefits of the relief. Cannabis-based drugs that offer relief from pain or malaise should be available to patients if the only significant side effect is the mild hallucinogenic sensation that accompanies its' use. It is the patient that is the priority here, not political discourse or narrow-focused opinion by non-medically trained persons or groups.   There are social and political implications for the use of medical marijuana, but they should not outweigh the potential relief for patients. If Physicians feel that the use of these drugs will benefit the patient and not cause unintentional or long term complications to the health of the patient, I believe that they should be allowed. Medical Ethicists should be consulted regarding this issue because it is not a purely medical criteria-based decision. If a child might benefit from the pain relieving effects of a cannabis-based medicine and no other effective medication has been found, then the Parents along with the Physician should have the option to try it.  Every parent suffers when their child or loved one is suffering. Offer them hope that it may be relieved. Those whose life altering diseases cause unrelenting pain should have the opportunity for relief, otherwise we are sentencing them to a cruel existence by our own civil or I should say "un-civil" rules. The common good of the populace will not be adversely affected by a decision to offer relief to these patients. Increased recreational use of Marijuana by individuals is not a good enough reason to deny this relief to those whose only other alternative is a narcotic or anti-inflammatory medication. Society as a whole can find a solution to the recreational increases; few can deal with chronic long-term pain. I am a retired medical professional, 65 years old. I have personally seen pain in all of its' forms and duration. If we trust our Doctors to make life and death decisions for us, surely we can trust them to help us relieve pain. [name redacted] Savage, Minnesota
  7. I think it's a no-brainer to add chronic pain to the list of approved uses of medical marijuana.  Quality of life should be the determining factor.
  8. It is a shame that there is even a question whether something that can help those in pain should be available for them.  How does a child - or anyone - understand that someone would deny them something that could improve their quality of life?  How can you look at a child in pain and say you will not help them even though help is available?  Those who would deny them that should be ashamed of themselves.  I'm sure they would feel differently if it was someone they loved: their parent, their sibling, their child, their grandchild, or even themselves.
  9. OF COURSE Intractable Pain should be added to the list of qualifying conditions in the Minnesota Medical Cannabis Program!   It is only a matter of time until marijuana becomes legal on a national level, why don't you get ahead of this and help those in pain??!!   It is shameful Intractable Pain was not on the initial list of qualifying conditions.
  10. Cannabis is the least toxic pain-relieving medicine known to man. Drugs used in medicine are routinely given what is called an LD-50. The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity. Cannabis effectively has No Lethal Dose.  In a U.S. Justice Department DEA hearing on the rescheduling of cannabis it was stated:   "8. At present it is estimated that marijuana’s LD-50 is around 1:20,000 or 1:40,000. In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette. NIDA-supplied marijuana cigarettes weigh approximately .9 grams. A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response.  9. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity."  It was also noted in this same hearing that 5,000 years of human: "There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality."  This despite estimates that 20 to 50 million persons in the U.S. use it regularly.  Compare zero deaths from cannabis use with alcohol which CDC says causes 88,000 deaths per year in the U.S. alone, or tobacco which they implicate in 480,000 deaths annually in the U.S.  Of course, we do not need "another alcohol" or "another tobacco". The point is, cannabis is neither of those.  The most widely use pain reliever, Aspirin, causes hundreds of deaths a year. As little as 40 tablets or LD50 of 20 times the recommended dose can cause death.  With Valium as little 10 tablets can cause death.  Many of the drugs used to treat patients with cancer, glaucoma and multiple sclerosis are highly toxic. The therapeutic ratio of some of the drugs used in antineoplastic therapies, for example, are regarded as extremely toxic poisons with therapeutic ratios that may fall below 1:1.5. These drugs also have very low LD-50 ratios and can result in toxic, even lethal reactions, while being properly employed.  Yet, many oppose the use of this non-toxic, effective, cheap substance under the theory it could be "abused" by someone, somewhere, somehow.    Perhaps it is because it makes people feel happier and large pharmaceutical companies cannot make money from something that grows everywhere like a weed.
  11. *Most Doctors are outright denying this possible "help" which is part of the reason there is low enrollment. *This action and that of price gouging please the big Pharmaceutical Companies that give millions to drs. as well as Politicians. *The price of said "help" has been raised do high that it is absolutely unaffordable to many even if they can have it prescribed. *There is a much bigger "drug" problem with narcotics such as Heroin and Oxycontin, etc....do the excuses to drag your feet on this is appearing to be either ill informed or biased.  What is wrong with this picture? People are suffering and there is an opportunity here to help those that are just dying for help that this "extract" can possibly (and has proven in many cases can) help. The political agenda that has to be behind this has pushed the public too far. Enough. "Do not harm". Isn't that the motto? Put it into practice and release the constraints on this least harmful "aid" to those who are suffering.
  12. Minnesota is so progressive in many ways, I hope they will come to understand and endorse the medicinal purposes of Marijuana, not just for intractable pain, but for all the medical uses studies show marijuana effective for.  In an time when there are 44 opiate overdose deaths a day in the United States, it is ludicrous actually, that marijuana, which there are no overdose stats, is illegal.   In addition, alcohol, one of the most dangerous drugs of all is legal. In addition to the serious life threatening realities of withdrawing from alcohol, do we not see the insanity of this? There is no physical withdrawal from marijuana.  Lets stop the insanity and start embracing this safe, effective medicinal miracle. Lets take the money from the drug lords and start taxing it and using it to make Minnesota and America great again.
  13. While I am very happy that Minnesota has enrolled a mmj [medical marijuana] program, I am on the other hand outraged. I personally use cannabis on a daily basis to control severe anxiety, depression, and sleep problems. I have also have had more than one very close relative die of different kinds of cancer. I have seen personally what its like for someone to be dying of throat cancer and wither away to nothing in the most imaginable type of pain. And I also have seen this past summer how much cannabis can truly help someone with extreme pain live Their life as normal as possible. For this state to roll out a mmj program and restrict who has access more than any other state in this country is just beyond ridiculous. I invite any politician, police, or even the governor to take a trip to California, Colorado, Washington or any other state who has mmj programs well in place and ask ANY patient in line how cannabis improves their well being. I have also personally been to Colorado 3 times since their legalization, and when I get home I just shake my head on how ridiculous this home state of mine is. Its very simple to just look at the numbers. Less teen use of marijuana when legalized. There is less drug crime, less other drugs as well. In fact there is evidence to support that in states with mmj, the use of other "harder" drugs dramatically decreases. Lets just talk about the money aspect of mmj. Perhaps the most persuasive point of any states marijuana legalization is the tax money. Millions. MILLIONS of dollars going to out schools and roads, and also the economy.   I could sit here and type pages and pages of arguments for widening the list of qualifying conditions in this state. what the state of Minnesota is missing is the fact that you guys continue to drive patients who would gladly buy their medication from you, into the black market, thus continuing to financially support crime and crime organizations. Please don’t wait until you or your family member ends up in a condition that marijuana could treat, before you change this unjust law.  End this failed drug war. You are making criminals out of citizens who pay their taxes and work just like anyone else. It’s sickening to say the least. How much longer must this go on?
  14. By all analysis, 'chronic pain'  is greatly subject to interpretation by doctors.  There is no 'test' for chronic pain, and in discussing this with health officials,  it is plainly clear that this is a line that our state should not cross.  It can be faked by individuals and the proposal needs only one doctor to be fooled by this to grant access to a mind altering drug?  yes, there can be a case here or there that can be made for it, but a handful of subjects versus a population that will try to claim 'persistent pain' in order to have legal access to drugs far outweighs any benefits.   No one doctor should be able to clear a patient.  This could lead to not only lying abuse for the claimant but also potential dealing to others of this highly potent product produced in the state.      Also, lets not forget...this  is completely illegal under federal law.  A new administration can quickly stop all state's sales of cannabis and there is still zero studies done have been done showing the benefits and risks of this drug....as must be done for every other drug prescribed.
  15. The program needs to expand. This is becoming a lack of common sense.
  16. I am in favor of expanded coverage of medical marijuana for pain. Marijuana has been demonized far beyond what is truthful or useful for our society. It's time to treat this as a benefit that can provide valuable pain relief without use of opiates. Please allow expanded use of medical marijuana in Minnesota.
  17. I strongly support medical marijuana for the treatment of intractable pain. I appreciate there are law enforcement concerns. But I cannot accept that those concerns outweigh the legitimate needs of people suffering  pain that can be reduced or prevent through the use of medical marijuana.
  18. I believe you should open medical marijuana to people suffering from pain.  If it works for one person, it is worth it.  If someone tries it and it doesn't work for their pain, they probably won't continue with it, due to the costs.  It is my understanding that medical marijuana is the cannabidoil (sp?) (CBD) part of marijuana, not the THC part. THC is the "fun" part of it!  If potheads think they can get high with CBD, they will be disappointed, from what i understand.  They want the THC -- the "fun" part.  They'll quickly stop buying a product/medicine that doesn't work.  I'd like to see if CBD actually does ease pain.   Or has other medical uses.  And the only way to find that out is to make it legal so you can control it and then research it.  I also understand that hemp may have been a victim of cotton farmers many years ago, who wanted their product to prosper, when in reality, hemp is an arguably better product.  Growing it requires no fertilizers or pesticides and it can grow in "bad" soil.  But the cotton producers public relations people confused the public with hemp and marijuana and craziness, hence outlawing hemp and letting cotton grow and prosper.  Also, you have built this huge infrastructure in Minnesota for the purpose of providing medical marijuana to people who might benefit from it.  Why don't you let the people try it and tell YOU if they like it.  Maybe medical marijuana will prove to be a bust...doesn't work.  But I doubt it.  I believe it is a hidden gem in all sorts of ways from clean farming to industry to medicine.  Let's use the infrastructure and maybe even profit by it, instead of letting all the plans be for naught.
  19. I have such a hard time with the government making a literal killing off the sale of the two deadliest substances-alcohol and cigarettes-yet all this concern over medical cannabis? The hypocrisy is sickening. Whatever laws or logic allow cigarettes and alcohol to be legal should legalize pot. A woman I work for just lost her dear friend to lung cancer, she never smoked a day in her life-but her husband did. She refused all treatment because she was so distraught over the loss of their daughter 5 years earlier to lung cancer-she was a non-smoker as well. Just a matter of 3 miles or so from my home there are 5 white crosses in the ditch. A drunk driver ran an intersection and killed all but one family member in the minivan. They were mostly children, found dead in car seats thrown violently from the vehicle...it wasn't his first DWI. I remember distinctly the stories in high school-coming back on Monday and this girl or that girl had drank too much and a host of guys took advantage of her once she passed out...my son now in college tells the same horror stories. NONE of this happens under the influence of pot, yet here we are trying to convince the government why cannabis use should be allowed by people in pain? It's insulting really. If the government could profit off it they wouldn't care how deadly or dangerous it was-as proven by what IS legal in this country. If the police are so concerned about it then what efforts are they making to end the sale of alcohol? How many murders, rapes and assaults are fueled by alcohol, not to mention drunk driving deaths. Again I say the hypocrisy is sickening. Legalize cannabis across the board, put the money into conservation efforts and our suffering school systems-invest in something that matters-something substantial....NOT stadiums.
  20. Beware: your Intractable Pain "diagnosis" will turn MN into another Colorado.  Notice that kids without well thought out college plans now increasingly want to go to universities and colleges in Boulder, Colorado Springs and Denver.  And the riff-raff now traveling to Colorado?........   Why is that?  Colorado has diluted the controls over cannabis such that anyone can get it.  That's why.  For every legitimate MN intractable pain patient, there are hundred's of illegitimates out there licking their chops hoping you make this mistake.  They know its easy to get some Dr to make that diagnosis.  And notice you are pressuring doctors to be ever more liberal with their diagnoses in order to justify the state government's involvement in this costly industry.   Everyone knows the patient numbers are not what you predicted.  You desperately want higher numbers to justify this expensive government control - to make it look better. And remember, there's a silent majority out here who think this same way but won't take the time to comment.  Meanwhile, you will be inundated with comments from those "licking their chops", stuffing the comment "ballot box" in order to influence your thinking.  Beware.
  21. Please add intractable pain as a condition.
  22. YES, "Intractable Pain" (without specific bodily-ailment or restricting disease source categories) SHOULD BE ADDED as a qualifying category for cannabis use and treatment options.
  23. Please allow medical cannabis to be included to be used as a prescription for intractable pain. It is a drug and if it helps those with this severe pain, that should be allowed.
  24. I would like to reiterate my support for the comments under no. 52.  These comments and citations should be given serious consideration for NOT including intractable pain in the MN Medical Cannabis program. Additional medical conditions could be added to the list of acceptable items one by one.  The Minnesota Department of Health has done a very good job with an impossible task so far. My main goal is to keep from legalizing another deadly drug - besides alcohol and tobacco - that can and does cause serious problems for society and families and individuals alike.   Legalization means greater access and a lower perception of the drug's risks by teens, leading more kids to use and hijacking their potential success in school and in life.  It affects the brain - especially in adolescents - impairing intelligence, reasoning, judgment and clarity of thought. Promoting the use of marijuana to our youth can affect them for life. Several studies associate workers' marijuana smoking with increased absences, tardiness, accidents, workers' compensation claims, and job turnover. Is this what we want for our youth?   I think it's important to note that the group representing the nation's pediatricians issued a statement in January of 2015 opposing the legalization of marijuana.  The drug can be harmful to adolescent health and development, according to the American Academy of Pediatrics (AAP).  Contrary to what some people believe, marijuana is addictive. Estimates from research suggest that about 9 percent of users become addicted to marijuana; this number increases among those who start young (to about 17 percent, or 1 in 6) and among people who use marijuana daily (to 25-50 percent).  Marijuana use is also significantly linked with mental illness, especially schizophrenia and psychosis, but also depression and anxiety.  Is this what we want for our youth?  The Washington Traffic Safety Commission (WTSC) released new data revealing that the number of drivers involved in fatal crashes who tested positive for the presence of marijuana increased 48% from 2013 to 2014. This data is particularly useful because it distinguishes between those drivers who had marijuana metabolites in their system (Carboxy-THC, an inactive metabolite that can remain present in the body for weeks) compared to those with delta-9-THC, the impairing substance in marijuana. The presence of delta-9-THC in the blood indicates recent use of marijuana and potential impairment at the time of driving whereas the presence of metabolites indicates past use only.  This new data reveals that the majority of drivers involved in fatal crashes who tested positive for marijuana had driven shortly after using the drug and speaks to the need to better educate the public about the dangers of driving high as well as the enhanced crash risk associated with combining alcohol and marijuana.  Thank you for your careful consideration in making a decision that will affect the lives of Minnesotans for many years to come.
  25. Intractable pain should be added to the list of conditions. We are churning out addicts and people are suffering who don't want to take opiates. People do not want this expensive medicine to get high. We want relief from pain that impacts every facet of our lives. Pain takes you away from your family, friends and job. Medical cannabis can put families back together, people back to work and out of or in some relief.
  26. Marijuana heals many different things it also makes conditions bearable
  27. It should
  28. Intractable pain triggers other health problems due to painkillers used to improve its condition. Cannabis is an option for some patients to treat their pain without damaging other parts of their body. I. E., liver.  Thank you.
  29. Cannabis clearly has pain relieving and inflammation relieving effects. One would assume intractable pain would automatically be included as an approved use yet am almost not surprised. When one realizes the vast profits generated from the sale of prescription opioid pain killers, and considers the amount of lobbying that takes place on behalf of their biggest manufacturers, it's clear why intractable pain was not originally included.
  30. It's high time we legalized it (pun intended)
  31. Please approve use for intractable pain. It makes no sense to let people suffer when a remedy is available. Thank you.
  32. As the recent issue of National Geographic outlined: We are just beginning to understand that cannabis is a far reaching tool that can bring relief to many "Hurting" people. Let's not delay a healing touch for the young and very old. It is inhuman to protract pain when relief is possible. I know if I was in this situation I would try almost anything to relieve gut-wrenching pain, including illegal methods, so let's do it legally and help many more people.
  33. Please add intractable pain to the qualifying conditions for the Minnesota medical cannabis program.  Medical cannabis is a superior solution to opioid drugs for the management of chronic pain. Cannabis is not addictive, has few side effects, it and is cost-effective. I believe it would be socially irresponsible for Minnesota not to include this as a qualifying condition. Please have the compassion to allow chronic pain sufferers every possibility for managing their pain. Thank you.
  34. Intractable pain is most certainly ameliorated by marijuana in a number of patients, as noted anecdotally by the overwhelming number of oncologists, physiatrists and pain medicine specialists I have consulted.  While I do not agree that it will help every patient, every patient deserves treatment with the medication that works best and has the least number of side effects.  My biggest concern about including intractable pain addition as a qualifying condition for the Minnesota Medical Cannabis Program is that legal cannabis will remain so cost prohibitive that my patients will continue to use the less expensive cannabis they can purchase "on the street".
  35. STEP 1 : Intractable pain should ABSOLUTELY be added to conditions that qualify for MN med cannabis. The current option of prescription painkillers is a deadly option, with 16,000 US deaths annually from prescription painkiller overdose. No person has ever overdosed on cannabis, despite millions that use it medically or recreationally.  If the current painkillers don't kill you, they are highly addictive and have nasty side-effects. Furthermore, in states with medical cannabis the OD deaths have dropped almost 25%, showing that medical cannabis is a GATEWAY DRUG OFF OF OPIATES !!!  Adding intractable pain is a baby step in the right direction. Other conditions need to be added ASAP as people are dying out here. Medical cannabis strength lies in it's miraculous ability to deal with pain and inflammation in the human body. Pain and/or inflammation are part of almost every disease/malady known to mankind.  An Israeli PTSD cannabis study with their vets has shown "SPECTACULAR RESULTS" yet our US vets (every one a hero) with PTSD currently get pumped full of drug cocktails that are addictive, dangerous, non-effective, and usually make the problems worse. They deserve better and they deserve it now!  Cannabis has been shown to help: prevent Alzheimer's, lower blood pressure, heal broken bones where they are stronger than before/ help build up bones to prevent breakage (think preventing elderly hip fractures which equal a death sentence), deal with MD,  arthritis, cancer, asthma, chronic pain and the list goes on and on and on. This list is just the tip of the iceberg.  Why is MN so afraid of letting suffering patients get the medicine they need/ to try cannabis? No one has ever died of a cannabis overdose and it is proving to be the most versatile medicine there is. Nothing else helps so many medical conditions yet MN wants to super-restrict it, like cannabis is the killer drug while the real killer drugs (the oxy-killers) get handed out like candy. It should be approved for any disease/ condition which has underlying pain or inflammation. ..........................................................................  STEP 2 :   Having cannabis listed as a Federal Schedule 1 drug is a HUGE problem. Schedule 1 drugs, like heroin and meth, have absolutely no medical value. Cannabis got a "bad rap" being thrown in with them as nothing could be more untrue. Cannabis is proving to be a true miracle drug and it is insane for it to be listed as a Schedule 1.  In my opinion, this likely is a reason many Dr's and facilities are opting to not certify qualified MN patients. It also prevents research.  Can the MN Health Dept please take the lead in petitioning the Feds for immediate removal?  You could put together a coalition of the MN Health Dept, Mayo Clinic, Univ of MN, and other state's health depts to ask/demand that it be removed.  .............................................. STEP3:  the MN Med Cannabis Law is clearly NOT "what's best for the patient". Can the Health Dept take a lead in getting it changed?  items not in patient's best interest include; -- registry process is cumbersome and bureaucratic, especially when patients cannot even find a cooperating Dr when they  have an approved condition. -- $200 is a HUGE financial barrier when meds are not covered by insurance. CO State fee is $15 and they have a sliding scale where a family of 4 with $44,000 income gets the $15 waived. Why is MN trying to make this a "cash cow" and milk the cow dry before the program even gets going? -- only 2 manufacturers is a duo-opoly where no competition = high prices -- not allowing "flowers" = high cost. A recent study shows pills/ liquids/oils cost 5X. Why not allow flowers BUT mandate vaporizing/ no smoking allowed? -- so few conditions qualify = low patient numbers = high cost of product -- not allowing home grows which are working fine in other states. This would be least expensive for patients. ......................................................................................................  FROM COMMITTEE NOTES/ areas where comm had issues or questions: 1. Consider social harm, public safety, etc.   CO is a study in itself where traffic fatalities are down, underage cannabis use is down, painkiller ODs are down, and they are keeping cannabis $$ from going to drug cartels and gangs. 2. A comm member questioned if cannabis is addictive. A recent study showed that cannabis is almost identical (in fact same chemicals in body I believe) to a runners high. So, totally different from a real addiction. Cannabis user who is getting med results will want to continue, of course, but it is not an addiction. 3. A comm member said his/her experience was when an opiate user has cannabis added, they don't use fewer opiates. Maybe they had small sample size as this is clearly not the case. States with med cannabis had opiate deaths drop almost 25% so clearly cannabis can help minimize opiate use and in some cases get them off opiates entirely..  .......................................................................  I have spent hundreds of hours studying medical cannabis and at first assumed the benefits were "made up". The more I study the issue, read research results from around the world, and communicate with med cannabis patients via the internet, the more I am now convinced that cannabis benefits are real. It is truly a miracle medicine as nothing else in the world can help so many conditions (physical, mental, emotional, spiritual) yet have so few side effects AND it is nearly impossible to OD on it.  MN needs to approve it for intractable pain, for chronic pain, for intermittent severe pain, for intermittent moderate pain, for all pain and inflammation. Our citizens deserve it and need it. Thank you for any efforts to expand medical cannabis as widely as possible.
  36. Possible abuse, these are people that will not be using it for fun, they are using it for medicinal use and these patients will most likely not be using it for recreational use. 
  37. The state is asking "Should we add intractable pain to the list of qualifying medical cannabis conditions?" I think that's the wrong question. The question they should be asking is, "Can we live with the status quo?" The status quo has no problem prescribing people like me, who have muscle spasms and constant phantom limb pain due to losing a foot after being hit on my bike by a careless driver, psychotropic pills that create physical addiction and death. According to an August article <http://www.startribune.com/minnesota-needs-state-strategy-to-fight-pain-pill-heroin-addiction/322746411/> in the Star Tribune, drug overdose is the leading cause of death in America. Half of those are from prescription pills. The status quo kills 20,000 people every year. The status quo of prescribing opiates turns surgery patients, accident victims, mothers, fathers and kids into addicts. The status quo commonly leads to heroin, a cheaper alternative to prescription opiates, crushing the dreams of people who just want relief from pain. The status quo prevents people from medicating with a plant with no recorded overdose deaths and a growing catalog of other health benefits. As a MN medical patient who detested cannabis because high school experience caused paranoia and vomiting, I was reluctant to try it as a "medicine". But after being able to stop taking what had been increasing doses of the status quo that could kill me, I'm a believer in the medical benefits of cannabis. Allowing intractable pain sufferers access to this safe medicine is the prudent, moral and responsible thing to do. I hope that you will.
  38. I applaud Minnesota taking a more conservative approach to this program as the entire medical community continues to learn more about marijuana. As a former resident of Colorado, a state which I believe jumped into something and is learning the effects on the back end instead of learning more at the beginning of dosage. Let’s take our time and help those in need without opening flood gates too soon.
Updated Monday, August 15, 2016 at 03:06PM