From: Timothy Feyma
Sent: Monday, March 02, 2015 7:32 AM
Subject: Minnesota Medical Cannabis
Friends,
At the Epilepsy Foundation meeting over the weekend, we
were treated to a discussion regarding the particulars known to date about the
plan to allow medical access to cannabis in MN.
Thomas Arneson MD (http://www.health.state.mn.us/news/pressrel/2014/cannabis100214.html
) led the discussion. I would like to share a very brief summary of what was
discussed. This will likely be redundant
in ways to some, but the specifics of how a prescription gets filled should be
interesting to most. As most are aware,
the state plans to have access available by 7/1/15 for patients!
The Minnesota law allows for medical use only of
cannabis. Recreational use is not
allowed under the law. There will be no
smoked form allowed. A liquid, oil, and
seemingly vaporized form will be available.
Conditions that will qualify include:
- Cancer
- Glaucoma
- HIV and AIDS with active symptomatic disease
- Tourette Syndrome
- ALS
- Seizures ("including those characteristic of
epilepsy")
- Muscle spasms possible due to multiple sclerosis
- Crohn's
- Terminal illnesses with life expectancy <1 year and
pain/n/v/cachexia
These conditions were decided upon as allowable based
upon legislative decision. For many of
the issues, a parent group or lobbying group pushed for inclusion. It is not clear that physicians helped to
devise the list.
As for producers, there are two approved growers made up
of Life line Labs (http://www.leaflinelabs.com/
) and Minnesota Medical Solutions (http://minnesotamedicalsolutions.com/
). There will be 4 distribution centers
opened. There will be no reciprocity
between our distribution centers and other states allowing cannabis
prescriptions.
As for the process of obtaining medical cannabis,
patients will have to follow this algorithm:
1) A patient must visit a certified health care provider
(NP, PA, MD, DO) to see if they will
qualify for access given defined definitions of qualifying criteria. Health
care provider requests for certification will begin in a few months and entail
state run training yet to be detailed fully, anyone can volunteer and no
additional DEA certification needed. Physicians will be re-verified on an
annual basis. The recertification
process is aimed to try and ensure 90% of cannabis approvals are not completed
by a small group of physicians that allow free access with minimal medical
investigation, understood?
2) A cannabis certified health care practitioner will
certify that a patient meets criteria
3) The patient then submits an application with fee to
the state after they are certified.
4) The state reviews the documents and then approves the
patient for cannabis prescription
5) The patient then goes to a dispensary and consults
with a pharmacist to decide which formulation of cannabis they will
receive. Some will be given strains
higher in THC, while others will receive strains comparatively higher in CBD
depending on the disease and pharmacist discretion. Only 30 day supplies can be filled at a time
and each return visit to obtain more from the pharmacy will include a review of
med benefits / side effects to perform a degree of clinical surveillance.
Medicaid and Medicare won't reimburse costs which will
likely be $100's per month, but a patient assistance program is being
developed.
There are many more details to be defined, but these are
the basics presented over the weekend.
Medical marijuana--the Colorado experience. See:
ReplyDeletehttp://extras.denverpost.com/stateofhope/#part3intro
Medical Marijuana: A Rapidly Evolving Field of Interest. See: http://reference.medscape.com/features/slideshow/med-marijuana?src=wnl_ref_critim&uac=60196BR
ReplyDeleteAs child protection clinicians are often asked to provide advice around whether parents' actions to give medical cannabis to their chronically ill child constitutes harm or risk of harm, a review of the evidence base is required.
ReplyDeleteSee: http://onlinelibrary.wiley.com/doi/10.1111/jpc.12876/abstract;jsessionid=17A53FE2B2944005B69DF9B18BC927BA.f01t03
Megan Yap, Laura Easterbrook,Jan Connors,Laura Koopmans. Use of cannabis in severe childhood epilepsy and child protection considerations. Journal of Paediatrics and Child Health, Volume 51, Issue 5, pages 491–496, May 2015
Physicians Cautious to Join Medical Cannabis Program, Survey Says
ReplyDelete[MMA News Now, June 4, 2015] A survey conducted by the MMA on June 2 shows that a majority of Minnesota physicians do not plan to participate in the state’s medical cannabis registry. Of respondents, 9 percent said they plan to participate, 68 percent do not, 16 percent haven’t decided and 7 percent noted that they don’t have patients who would have a qualifying condition.
The survey was sent out June 2 to 14,000+ physicians, both members and nonmembers of the MMA. By noon on June 4, 493 had responded.
The largest percentage of respondents identified themselves as family medicine physicians (32 percent), followed by internal medicine (11 percent), pediatricians (7 percent) and psychiatrists (6 percent). Of note, specialties that will likely have the most interaction with patients looking to be certified (neurologists, ophthalmologists and oncologists) were at 3 percent each.
Physicians who wish to participate in the program need to register with the Office of Medical Cannabis. Physicians (as well as PAs and APRNs) who choose to participate in the program are requested to certify that their patient has one of nine eligible medical conditions. For a list of conditions, click here.
The first few days of the state’s medical cannabis saw just a handful of physicians and patients sign up for the registry. According to the Minnesota Department of Health, 30 health care practitioners had signed up for the registry on the first day.
Meanwhile, the MMA’s efforts to educate its members continue. Since March 31, the association has:
• held a forum on the new law for physicians along with the state’s Office of Medical Cannabis
• hosted several webinars to educate clinic administrators
• published a 12-page special report on medical cannabis (available online)
• created a Medical Cannabis Policies and Procedures Manual, a comprehensive, ready-to-use guide to help clinics manage medical cannabis patients.
“The medical cannabis program is unchartered territory for Minnesota physicians,” said Dave Thorson, MD, the MMA’s president-elect. “As the state’s largest physician advocacy group, we’re doing our best to help doctors navigate the new law and all that it entails.”
I appreciate your continued fair coverage of medical marijuana in the April/May issue (“Weed Backers,” bit.ly/WeedBackers). As a long-time advocate, I want to see rational and compassionate policies regarding marijuana and, of course, more research into its efficacy and safety. But we must also understand that almost every medicine has the potential for some level of harm. Many drugs are far more potentially harmful and addictive than marijuana, and yet they can be purchased legally. Medical marijuana should be held to the same standards as other legal medicines. When it becomes available at my local dispensary and I need to use it, I will appreciate knowing what I'm purchasing and what “dose” to use.
ReplyDeletePaul E. Robinson, PhD
Mansfield, OH
http://journals.lww.com/neurologynow/Fulltext/2015/11030/Straight_Dope.6.aspx
Weed Backers
http://journals.lww.com/neurologynow/Fulltext/2015/11020/Weed_Backers__Many_patients_and_advocacy_groups.18.aspx
Are there legal risks to physicians? After contacting national and regional malpractice insurance carriers, along with several state medical societies, we couldn't find a single instance of a physician being sued for malpractice over the negligent recommendation for medical marijuana.
ReplyDeleteHowever, although most experts say the legal risk to physicians is small and that state enforcement is often lax, a handful of doctors around the country have lost their medical licenses, and dozens more have been reprimanded by state medical boards for writing certifications for medical marijuana use in an improper or unsafe manner.
In two egregious examples, two Colorado physicians surrendered their medical licenses after the state board suspended them. One doctor wrote a recommendation for a 20-year-old woman whom he never physically examined. The woman was 28 weeks pregnant. The other physician met with new patients in tattoo parlors and hotels to write recommendations, and there was no follow-up care...
Physicians can only write letters of recommendation that the patient qualifies for a certification to use the substance, and only after a thorough examination and many other requirements. Physicians cannot dispense marijuana. The patient must go to a licensed dispensary to obtain the drug...
"A physician friend of mine was walking in Venice Beach, when a young man in a tee shirt and gym shorts rollerbladed up to him and said, 'Hi, I am kush doctor! Would you like to come over to my clinic and get a prescription for medical marijuana'?" Humphreys wrote on a blog called "The Reality-Based Community."
"As a cash-only business without any meaningful oversight, a medical marijuana practice is a dream come true for those who graduated at the bottom of their medical school class," he said. "There are plenty of ads in free newspapers from marijuana doctors saying, 'I'll write you a script for $50. No charge if you don't get a recommendation.'
See: http://www.medscape.com/viewarticle/845686_2
The Short of It
ReplyDeleteKalel Santiago, who lives in Puerto Rico, was diagnosed with cancer at 10 months old, and after he was cancer-free at 3 years old, he was diagnosed with severe, non-verbal autism. At age 9, he hadn't spoken his first word—until his parents tried a controversial treatment: Hemp Health, a hemp oil that includes a form of cannabis. Two days later, he was speaking.
The Lowdown
Kalel's parents sprayed the compound cannabidiol (CBD) in the boy's mouth twice per day, and they say the results were astounding.
"He surprised us in school by saying the vowels, A-E-I-O-U. It was the first time ever," dad Abiel told Yahoo Parenting. "You can't imagine the emotion we had, hearing Kalel's voice for the first time. It was amazing. The teacher recorded him and sent it to my wife and me, and we said, 'well, the only different thing we have been doing is using the CBD.'"
Soon he was saying full words. "He said, 'amo mi mama,' 'I love my mom,'" Abiel says. "I don't know how to thank [the CBD oil makers]."
The Upshot
If you have a child with autism, don't rush out and buy a bottle. Doctors say the results of cannabis sprays like this one have yet to be proven—the Santiagos' experience is purely anecdotal evidence. Also, the Food and Drug Administration (FDA) says products like Hemp Health haven't been proven safe and are unregulated. In fact, selling them as "dietary supplements" is illegal.
Still, perhaps stories like this will spur further testing and possibly help doctors determine some new, effective treatments for children with autism.
See: http://www.parenting.com/news-break/cannabis-spray-treatment-helps-9-year-old-autism-learn-to-speak
Cannabis Harms Brain, Imaging Shows
ReplyDelete"Our study provides definitive evidence that in heavy cannabis users, there is a detectable deficit of striatal dopamine release using an amphetamine challenge," said Dr Weinstein. "Within the striatum, the subdivisions seem to have a different pattern, in contrast to reports of other substance abuse. And our exploratory analysis suggests that the deficits we are seeing in dopamine release in the striatum have a functional significance — that lower dopamine release is associated with lower working memory and learning performance."...
"This study is striking in that it provides further evidence that long-term cannabis use is associated with alteration in the function of key brain chemical messengers — in this case dopamine, a key chemical messenger for motivation and attention," said Oliver Howes, MD, from the Institute of Psychiatry at King's College London, United Kingdom.
Dr Weinstein, Dr Abi-Dargham, Dr Howes, and Dr Bossong. Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2015 Annual Meeting: Abstract 32. Presented June 7, 2015.
See: http://www.medscape.com/viewarticle/846094?nlid=82547_3404&src=wnl_edit_medn_neur&uac=60196BR&spon=26#vp_2
Two weeks before the launch of Minnesota's medical marijuana program, there are more doctors signed up for the program than patients.
ReplyDeleteAs of Friday, the state had enrolled 14 patients in the program and 65 in all had been certified by their doctors to participate.
By the end of the same two-week enrollment period, 162 health care practitioners had contacted the state Office of Medical Cannabis to enroll patients in the program and 70 of them had been registered by the Health Department.
While there are a growing number health care workers willing to help patients sign up for the new program, patients may not know how to find them. The Health Department does not release the names of the doctors, nurses and other healthcare workers willing to certify patients, which makes it difficult for patients to get a referral if their primary care physician opts out of the program.
Medical cannabis will be legal in Minnesota on July 1. But before patients can get access to the medication, they need to find a health care practitioner willing to certify that they have one of nine qualifying conditions (see above).
See: http://www.startribune.com/medical-marijuana-program-has-registered-more-doctors-than-patients/307397981/
The study found that states that had legalized medical use had higher prevailing rates of teenage marijuana use before enacting the laws, compared with states where the drug remains illegal. Those higher levels were unaffected by the changes in the law, the study found.
ReplyDeleteThe report, published in The Lancet Psychiatry, covered a 24-year period and was based on surveys of more than one million adolescents in 48 states. The research says nothing about the effect of legalizing recreational use, however...
The overall rate of use among teenagers in states that passed laws was 16 percent, compared with 13 percent in those that had not, the analysis found. The researchers then compared samples of teenagers before and after laws passed in specific states: for example, before and after August 2013 in Illinois, and before and after April 2007 in New Mexico.
“We showed no hint of an increase at all after the laws were passed,” Dr. Hasin said.
The University of Michigan surveys have found that marijuana use among teenagers has been generally on the rise, in contrast to trends in alcohol, opioid and nicotine use — and perceptions of marijuana’s health risks are steadily shrinking.
Those risks are probabaly small for occasional users who are adolescents, most experts say. But heavy, daily users who start young are at risk of blunting their mental acuity over time, several studies have found, because of biological and social factors that are not yet understood.
See: http://www.nytimes.com/2015/06/16/us/medical-use-of-marijuana-doesnt-increase-youths-use-study-finds.html?rref=science&module=Ribbon&version=context®ion=Header&action=click&contentCollection=Science&pgtype=article
Minnesota doctors are slow to accept medical cannabis as a treatment option for lack of scientific evidence, fear of addiction and lack of educational programs, according to a new survey released to a state task force Tuesday.
ReplyDeleteDr. Charles Reznikoff, a member of the Task Force on Medical Cannabis Therapeutic Research, the group responsible for gathering information about the program, conducted the survey. Reznikoff is an addiction specialist who practices at Hennepin County Medical Center. He sought opinions of 262 doctors from four institutions who practice all across the state.
The majority of doctors said qualifying conditions need to be more clear. They said they didn't want to be burdened by the program; they're nervous to register patients; and cautious to prescribe medical cannabis when so many patients abuse opioids and heroin addiction is a concern.
"There is a lot of worry about the opioid thing," Reznikoff said. "They're scared of entering anything that could be that."
The survey also revealed that doctors' personal opinions about cannabis may be stopping them from certifying patients for the drug. Other physicians said they're not ready for the challenging conversations and disputes with patients that may lead them to leave their practice.
The Minnesota Department of Health reports 479 practitioners are registered and authorized to certify patients to purchase medical cannabis. The number of patients approved to get the drug is 844. The department added intractable pain to handful of qualifying conditions late last year after hearing from hundreds of patients suffering from chronic pain...
Jeremy Pauling, whose daughter Katelyn suffered from a degenerative brain disease before she died last year, said he's been educating his own small town of Montevideo about the benefits of medical cannabis.
"They were not on our page to start with," Pauling, a member of the task force, said. "Everybody has embraced it."
Although medical cannabis is legal in Minnesota, marijuana is still a Schedule 1 drug under federal law. The law lists cannabis in the same category as heroin, LSD and Ecstasy.
Maria Botker, task force member and parent of a medical cannabis user, said the group should push to make the drug less of a controlled substance.
"Doctors wouldn't be fearful of this if it wasn't a Schedule 1 and it didn't impede on their license in their mind," Botker, of Clinton, Minn. said.
http://www.mprnews.org/story/2016/01/13/doctors-slow-prescribing-medical-marijuana