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A state panel that spent months studying whether to expand Minnesota's medical marijuana program to pain patients came out in opposition to the idea Wednesday.

Minnesota has one of the most restrictive medical marijuana programs in the nation and as of last Friday, just 662 patients had enrolled in it. Adding intractable pain as a qualifying condition could potentially open the program to thousands more.

But the eight-member Intractable Pain Advisory Panel split 5-3 against the idea of adding intractable pain to the shortlist of serious conditions that qualify Minnesotans to enroll with the state Office of Medical Cannabis. It was a reversal of the panel's earlier support for the idea; the last time members weighed in, they supported expansion by a 5-2 margin, with one member undecided.

It was a fraught debate for many panel members, who were moved by the heart-wrenching testimonials they heard from pain-wracked Minnesotans at public forums, but troubled by the lack of hard scientific evidence that the drug will be able to help them. In the end, members were torn, saying they were voting "no, it should not be added, but …" the recommendation said.

"Panel members expressed concern that patients eligible to use medical cannabis for pain have expectations that it would provide total relief and that such a perception may leave patients to abandon other proven pain management methods, such as physical therapy," the recommendation noted. "Panel members agreed that medical cannabis should not be the first line of therapy in treating intractable pain, but that it could be an option after exhausting other standard treatments."

The panel's decision frustrated Cassie Traun, who enrolled in the state's medical cannabis program to treat her Crohn's disease. Not only does cannabis treat her Crohn's symptoms, she said, but it eases the pain of her arthritis as well, and she knows many other patients who use marijuana as a pain reliever.

"Cannabis is not a magic bullet. It's like any other medication," she said. "To restrict people who are in extreme amounts of pain, and unable to live normal lives; to restrict their treatment options is, honestly, criminal in my mind. It's really disappointing."

The final decision is in the hands of Minnesota Health Commissioner Ed Ehlinger, who has until the end of the year to decide the intractable pain issue. Ehlinger will hold a public forum on the issue at 4 p.m. Tuesday at Wentworth Library in West St. Paul.

"I am thankful for the time and effort the panel members and public participants put into this process," Ehlinger said in a statement Wednesday afternoon. "The recommendations reflect a range of views on the topic, as well as the desire for more clinical evidence regarding potential benefits and risks. While the recommendations are not binding, they are part of a set of information I will review."

Although pain is not yet a qualifying condition, many current patients come into the program in pain — terminally ill patients, cancer patients, patients who use cannabis to ease agonizing muscle spasms. Manny Munson-Regala, CEO of LeafLine Labs, one of the state's two medical marijuana producers, said those patients report to the company's pharmacists that their use of opiate painkillers went down once they started taking marijuana.

"What are we going to do about patients?" he said. "What do we tell patients who we know we can help, but we currently can't help them? That's the remarkably frustrating thing about this process that gets to me."

Medical marijuana is legal only in pill or liquid form in Minnesota. To enroll, patients must have their doctor or another primary care provider certify that they have one of nine qualifying conditions.

If the Health Department does expand its program to include intractable pain — serious chronic pain that does not respond to other treatment — the panel called for additional precautions and limitations on pain patients.

Among other things, the doctors, nurses, therapists and other medical experts on the panel recommended barring most pain patients under age 21 as well as patients with a history of psychosis or those who are pregnant and lactating. The panel also suggested taking extra precautions before allowing patients with histories of mental illness or substance abuse to enroll in the program.

The panel's recommendation will be one factor Ehlinger weighs before he makes a final decision. He also has testimonials from more than 400 Minnesotans who weighed in during the public comment period. Of the 417 patients, relatives and health experts who commented, 388 supported the idea of adding intractable pain as a qualifying condition.

Jennifer Brooks • 612-673-4008

Intractable Pain Advisory Committee recommendation