December 2, 2015
MDH to add intractable pain as qualifying condition for state medical cannabis program
Minnesota Commissioner of Health Dr. Ed Ehlinger today announced his decision to add intractable pain as a qualifying condition for Minnesota’s medical cannabis program. He also called upon the state’s health care community to boost efforts to help patients deal with pain more effectively.
In making the announcement, Commissioner Ehlinger acknowledged a range of views on the issue as well as the difficulty of making a public health decision without the benefit of an abundance of solid, scientific evidence about benefits and risks.
“The relative scarcity of firm evidence made this a difficult decision,” Commissioner Ehlinger said. “However, given the strong medical focus of Minnesota’s medical cannabis program and the compelling testimony of hundreds of Minnesotans, it became clear that the right and compassionate choice was to add intractable pain to the program’s list of qualifying conditions. This gives new options for clinicians and new hope for suffering patients.”
When the 2014 Minnesota Legislature passed the law creating Minnesota’s medical cannabis program, it included a set of nine health conditions that would qualify a person to receive medical cannabis. The law tasked the health commissioner with evaluating what conditions to add, and required that the first of the conditions to be considered was intractable pain.
The 2014 law defines intractable pain as a condition “in which the cause of the pain cannot be removed or otherwise treated with the consent of the patient and in which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts.”
Under current law, patients certified as having intractable pain will be eligible to receive medical cannabis from the state’s two medical cannabis manufacturers on August 1, 2016. As with the program’s other qualifying conditions, patients seeking medical cannabis to treat intractable pain will need advance certification from a Minnesota health care provider. More information on the program’s certification process is available on the MDH website at Medical Cannabis: Intractable Pain.
The Minnesota Department of Health (MDH) Office of Medical Cannabis worked over the last few months to collect available scientific information, and developed a community engagement process that included 13 public meetings around the state as well as an online comment submission process. In the end, MDH heard from nearly 500 Minnesotans – more than 90 percent supporting the addition of intractable pain as a qualifying condition.
MDH also established an advisory panel comprised of clinicians and medical providers to look at the available evidence and deliver recommendations. A majority of the panel recommended not approving intractable pain for the program. According to Commissioner Ehlinger, the panel recommendations reflected the complex and divided views on the topic, as well as an interest in seeing more clinical evidence regarding benefits and risks.
“As a physician, I share the concerns of health care providers and I sympathize with their desire for more information,” Commissioner Ehlinger said. “In the end I determined that with Minnesota’s cautious and well-designed program, we can safely and responsibly give patients and providers the option of adding medical cannabis as a tool to treat intractable pain.”
Commissioner Ehlinger pointed to a number of provisions within Minnesota’s medical cannabis program that reduce the risk of misuse. First, the program has a strong medical focus, with features designed to generate real-world information about the product’s efficacy. Second, the program limits the form of cannabis to pill, liquid or vapor. This has the benefit of reducing the risk of drug diversion for improper use or for recreational use. Third, the program allows for just two manufacturers to grow and produce medication, with strong process controls and security measures.
Commissioner Ehlinger urged health care providers to exercise special scrutiny and care before recommending medical cannabis to members of certain groups for which there is more robust evidence to suggest potential risks associated with medical cannabis use. These groups include:
- Infants and children;
- Pregnant women;
- Nursing mothers; and
- Individuals with a personal or family history of psychosis.
Recognizing a need for helping health care providers learn more about the potential benefits and risks of medical cannabis for treating intractable pain, Commissioner Ehlinger directed the MDH Office of Medical Cannabis to provide additional education and guidance to the patients and the medical community about the appropriate use of medical cannabis.
MDH also will be asking providers to share information every six months regarding the positive and negative impacts of medical cannabis experienced by patients with intractable pain. This information will be summarized and shared with the public.
Finally, Commissioner Ehlinger indicated that the process of considering intractable pain as a qualifying condition showed that pain management remains a significant challenge for many patients across the state. In response, MDH will help coordinate a broader conversation with the state’s medical community about how to effectively address pain management.