It was months before Prince's fatal fentanyl overdose when state Health Commissioner Dr. Ed Ehlinger took a gutsy step to reduce prescription painkillers' tragic toll in Minnesota.
Despite a panel of experts saying more research was needed, Ehlinger in early December added "intractable pain" to the list of nine health conditions that can be treated in Minnesota with medical marijuana. The state's 2014 medical marijuana law, which limits cannabis to liquid or pill form, is one of the nation's most restrictive, but it gave Ehlinger the discretion to make intractable pain the 10th condition for approved use.
Patients whose health practitioners determine that their condition qualifies as intractable pain are eligible to receive medical marijuana beginning Aug. 1. Providers could begin the certification process July 1.
In adding intractable pain, Ehlinger heeded the pleas of hundreds of patients who have not found pain relief from mainstream medications or fear taking them. His decision now seems prescient after Prince's death spotlighted widespread use and abuse of opioids.
With the certification process now open, Minnesota health providers should overcome lingering reluctance to consider the drug as one of their options to treat patients suffering from painful conditions. Practitioners' reservations about marijuana, long an illegal drug, likely helped to keep patient participation in the program low during its first year. There are now 1,588 enrollees. Some patients have reported difficulty finding a doctor willing to certify medical marijuana's use.
Marketing campaigns for years oversold the safety of opioids and, as a result, doctors increasingly relied on them to help patients suffering acute and chronic pain. But many patients have become hooked on the drugs, turning to illegal suppliers of the painkillers — or heroin when the supply ran out. Nationally, the number of deaths from prescription opioids and heroin now tops 28,000 a year. In Minnesota, 317 died in 2014 — a sixfold increase since 2000.
A 2014 study in a leading medical journal noted that states with medical marijuana access often saw significant drops in opioid overdose deaths. That was a key reason the Star Tribune Editorial Board urged Ehlinger last fall to add intractable pain to the list of approved uses. His decision expands the pool of people eligible for certification to use medical marijuana. It's also a group at high risk of becoming addicted to prescription painkillers.
Medical marijuana shouldn't be viewed as a simple replacement for opioids. Instead, it's one addition to the list of other therapies — less-potent painkillers, physical therapy, exercise, yoga, acupuncture — that can help control difficult-to-treat pain.
The state Health Department just issued a checkup on its medical cannabis program in May. Patients and providers were surveyed. High percentages of both groups reported perceived benefits from medical marijuana's use. Negative effects were minor. The drug appears to be a "safe option for most patients," the report said, a conclusion that more Minnesota providers will hopefully heed.
