Signing up: Elisa McCann, 3, is enrolled and ready to become one of the first pain patients admitted to Minnesota’s medical marijuana program. Elisa has epidermolysis bullosa, which causes her skin to blister and tear at the slightest contact. (The Minnesota Star Tribune)
On Monday, the state will expand its medical cannabis program to include a new category of patients suffering from severe, chronic pain that is not eased by traditional drugs or therapies. Opening to intractable pain patients could bring relief to thousands, while bringing new customers into a program that has struggled with low enrollment and high prices.
In a state where more people die from prescription painkiller overdoses than from homicides, patients and their doctors are watching with mingled hope and worry.
Judy Severson sees only hope. Disabled by pain and exhausted by the debilitating side effects of opioids that make it an effort to read a book or wash her hair, she has an appointment booked Monday, as soon as the Bloomington clinic opens.
“I want people to know that a 70-year-old grandma with intractable pain is doing this,” said Severson, a mother of four and grandmother of eight who lives in Edina.
She has an inoperable cyst on her spine, fibromyalgia, and arachnoiditis — inflammation of the lining of her spinal cord that sends burning pain shooting through her body. The combined diagnoses have kept her housebound and hoping for some way to restore her quality of life.
“We take for granted the idea of meeting a friend for lunch, or ‘I have these errands to run,’ or ‘Let’s go for a drive.’ For me, right now, that’s not possible,” said Severson, who has tried almost every prescription opioid available and currently takes hydrocodone five times a day just to take the edge off her pain.
Severson wanted her story known, she said, to take away the stigma that lingers around medical cannabis — a drug the federal government still classifies as a dangerous narcotic with no recognized medical use, even though half the states have legalized its use.
“I’m not alone,” she said. “There are so many people suffering, and suffering much worse than I am.”
Hundreds enroll
Minnesota’s year-old medical marijuana program is one of the smallest and most restrictive in the nation. The state limits who can buy it, where they can buy it, and in what form.
As of Friday, the Office of Medical Cannabis had 1,827 active patients. State planners had estimated that 5,000 might enroll in the program’s first years — well short of the tens of thousands or hundreds of thousands of participants in other state programs. But that was before Minnesota expanded its program to pain patients, who make up the bulk of medical marijuana customers in many states.
Advocates hope an influx of pain patients will help bring prices down.
The first began enrolling with Minnesota’s Office of Medical Cannabis on July 1. By Friday, 481 had joined a program that usually averages 150 to 200 new certifications per month.
Despite the interest, doctors remain skeptical.
Prescription opioid overdoses killed 336 people in Minnesota last year and many doctors, having heard pitches about painkilling wonder drugs before, are leery about encouraging patients to pin their hopes on marijuana — a drug that is still banned at the federal level and has undergone relatively little medical scrutiny in the United States as a result.
Dr. Steven Bergeson, a family practitioner in Shoreview and director for care improvement at Allina Health, says it’s risky to turn to medical marijuana in the absence of research showing its potential harms.
“There was a lot of expert opinion early on that you couldn’t hurt people with opioids, either,” said Bergeson, who does not certify patients for medical marijuana.
Some patients with qualifying conditions have been unable to get into the medical cannabis program because their doctor, clinics or entire health systems have opted out and refuse to certify that they have cancer, epilepsy or one of the other handful of serious medical conditions that allow Minnesotans to legally buy medical marijuana.
Allina allows its doctors to certify patients. But Bergeson said the health system’s clinical practice council found the evidence in favor of medical marijuana to be thin, particularly in the area of pain management, and did not advocate that doctors pursue it as an option.
“There really wasn’t convincing evidence that it was helpful,” he said. “The kinds of pain that people will be coming in asking for help with are not the kinds of pain that were studied. Chronic low back, for one, wasn’t something that was studied.”
While many doctors remain unconvinced, some patients no longer wonder.
Two decades ago, an accident left Pete LePage in a wheelchair, wracked by muscle spasms and chronic pain that jabbed like a hot poker into the extremities he could no longer move.
“It just sort of pokes and pokes and pokes at you and you can’t do a thing about it,” said LePage, 43, of Woodbury. “All the opioids in the world won’t help.”
Muscle spasms are a qualifying condition for medical marijuana in Minnesota, and when LePage enrolled in the program last summer, he found that cannabis eased not only the spasms, but the pain that came with them.
A year later, he has stopped taking five prescriptions — for conditions ranging from muscle spasms to pain to anxiety — in exchange for $600 a month worth of cannabis oil from the LeafLine Labs clinic in Eagan. The clinic is clean, safe and professional and a vast improvement, he said, from the pre-legalization days when he tried to buy the drug off the street in search of relief.
“I’m so happy,” he said. “It’s amazing when you clear the fogginess [from the opioids]. … This is a product that makes people better and happier.”
Winning over skeptics
Twenty-five states have legalized medical marijuana, and pain is a qualifying condition in most of them. In many of those states, overdose deaths seem to decline, according to some studies.
A team of University of Georgia researchers recently reported that doctors in medical marijuana states seem to write fewer prescriptions overall. The study, which looked at Medicare prescriptions in the 17 states that had active medical marijuana programs between 2010 and 2013, found that doctors wrote hundreds fewer prescriptions for painkillers, antidepressants, anti-anxiety drugs and sleeping pills.
Those studies are winning over some skeptical physicians in Minnesota.
“Last year, it was easy for all of my doctors to say ‘no, no,’ ” said HealthPartners’ Dr. Arthur Wineman, who estimates that 15 percent of HealthPartners’ family practice doctors and internists will be certifying by year’s end. Three doctors recently called him with interest, saying they had patients who would be ideal for medical marijuana.
“This year, there’s a lot more interest, but there’s also still a lot of reluctance,” he said
Some doctors, still feeling burned by drug company sales pitches two decades ago that convinced them that opioid pain relievers were safe, don’t want a repeat mistake. Others don’t want to be the first to certify — and draw all of the patients seeking medical marijuana for pain relief.
The state’s use of “intractable” pain is a political term, not a medical diagnosis. Wineman said many patients mistakenly equate all forms of chronic pain with “intractable pain,” which by the state’s definition means a pain that hasn’t been addressed by any other therapies.
Doctors can use that strict definition to encourage patients to try remedies such as physical therapy before turning to marijuana.
“This is another way to get patients who are reluctant to try other things that might be more helpful for them,” Wineman said.
Hope for Elisa
A panel of physicians and addiction specialists last year recommended against opening Minnesota’s medical marijuana program to pain patients. But Health Commissioner Ed Ehlinger, a physician himself, opted to expand the program anyway, motivated in part by wrenching personal stories from the people who crowded into public hearings to testify about what it was like to live with pain.
Gabriella McCann attended those hearings, carrying pictures of a toddler born with a condition that left her small body covered with open sores, inside and out. As soon as enrollment opened, McCann logged onto the Minnesota Health Department website to sign up her 3-year-old daughter for cannabis oil.
Elisa McCann was born with a rare genetic condition, epidermolysis bullosa, that causes her fragile skin to blister and tear. She’s undergoing experimental treatments at the University of Minnesota Children’s Hospital, but there was no painkiller her doctors could prescribe to make it easier for her to play, or dance, or ride her tricycle while covered with wounds that feel like third-degree burns.
In the family’s living room in St. Paul recently, Elisa gave her mother a hug, then stretched out one tiny leg for inspection.
“It’s hurting right here,” she said, patting a spot just above her knee. Her mother rubbed the spot gently.
Cannabis oil, swallowed in drops or rubbed on the skin to speed healing, reportedly helps children with Elisa’s condition. The family has few other options.
“If you put a child on morphine when they’re 3, what are you going to do by the time they’re 6?” Gabriella McCann said.
Elisa, who has weathered 32 surgeries and taken every painkiller from morphine to oxycodone, smiled through the scrapes on her face from where she’d tripped while playing the day before. She cued up a music video on an iPad so she and her mother could dance.
Gabriella McCann plans to talk with Elisa’s doctor about dosages. On Monday, Elisa’s application status will switch to “approved” and her mother will make an appointment to pick up the cannabis oil.
Source: https://www.startribune.com/