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Anxiety disorders won't be added next year to qualifying conditions for medical cannabis in Minnesota.

State Health Commissioner Jan Malcolm found too little evidence of benefits of medical cannabis use when compared with risks and existing treatments.

While Minnesota will expand its program by allowing the sale of medical cannabis in gummy and chewable forms, Malcolm announced Wednesday that it would be limited to the existing 17 qualifying conditions. Minnesota is among 38 states with medical cannabis programs, including North Dakota and three others that include anxiety disorders as qualifying conditions.

"We received many comments from health care practitioners treating patients with anxiety disorder, and they urged us to not approve it as a qualifying medical condition," Malcolm said.

Medical cannabis use surged in Minnesota following the launch of the program in 2015 with nine qualifying conditions. Active registrants authorized by medical providers to receive medical cannabis increased from 837 in 2015 to 28,522 in 2020.

Registrations jumped in 2018 after the state added post-traumatic stress disorder as a qualifying condition and increased by more than 10,000 in 2020 after the state added intractable pain. About 85% of medical cannabis use in Minnesota relates to those two added conditions.

Advocates hoped the PTSD approval would pave the way for expansion to anxiety disorders, which have been proposed for addition to Minnesota's program since 2016. A state analysis earlier this year noted in a sampling of 5,200 people with PTSD that 41% reported improved symptoms four months after receiving medical cannabis. Among them, 62% reported continued symptom reduction or management in the next four months.

Dozens of commenters offered personal appeals to Minnesota leaders, with some noting that medical cannabis for other health problems also relieved their anxiety.

"Especially with COVID, things have been really hard and my anxiety has been so much worse. Without the medical cannabis, I am not sure how I would get by. It would be absolutely awful," said a commenter with the initials MN, who qualified for medical cannabis to manage pain. The state deleted full names from the publicly available comments.

The National Institute of Mental Health estimates that 19% of Americans suffer anxiety disorders each year, but mental health providers suspect that number has grown amid the stress of the COVID-19 pandemic. Regardless, adding anxiety disorders as a qualifying condition would be one of the largest expansions of Minnesota's medical cannabis program, which includes less common conditions such as Tourette syndrome, AIDS and Alzheimer's disease.

The Minnesota Psychiatric Society and several psychiatrists urged against the addition of anxiety disorders, which can include short-term symptoms for which there are effective treatments.

"These symptoms may likely pass when the situational issue resolves and psychological support is provided," the society said in a position statement to state leaders. "These transient situational problems are best treated with support, compassion, understanding and psychological tools that are effective in time-limited situations."

Malcolm considered approving only a limited set of anxiety disorders for medical cannabis use but cited a lack of scientific evidence in her final decision. The addition of gummy and chewable forms adds new options beyond the existing pills, vapor oils, liquids, topical compounds, powdered mixtures and lozenges.