Minnesota must strike a balance on medical marijuana and pain

It's a safe bet that Minnesota's Advisory Panel on Intractable Pain would have vetoed the state's entire 2014 medical marijuana law if its cautious members had been given a chance.

Thankfully, the panel's assignment was limited to making a recommendation on the addition of "intractable pain" to the state's current nine approved medical uses of the drug. On that question, the panel's eight members recently declined to deliver. Their rigid decision denies Minnesotans the flexibility to decide with their doctors whether medical marijuana is a good alternative to powerful but risky prescription pain drugs.

Minnesota Health Commissioner Ed Ehlinger will take the panel's recommendation into account as he makes the final decision before the end of year. The panel's advice shouldn't box in Ehlinger. He should consider it with care, but with an eye toward striking a balance between members' concerns and the Legislature's willingness to give Minnesotans in need a treatment alternative.

In saying no, the panel ignored the pleas of hundreds for whom other treatments are ineffective or have troubling side effects. Among those seeking an alternative: the family of little Elisa McCann, a St. Paul 2-year-old who suffers from a rare condition that causes her skin to blister at even the slightest touch.

The panel also dismissed multiple medical studies suggesting that the drug has value in treating chronic pain and spasticity. While these studies are far from robust, the evidence supporting the drug's use for this purpose is stronger than it is for many of the uses the state has already approved: AIDS or HIV, Crohn's disease, Tourette syndrome, glaucoma, ALS, seizures, muscle spasms, and cancer or a terminal illness that is accompanied by pain or wasting disease. The law allows marijuana only in pill or liquid form.

The panel members had good intentions. They wanted more research on the drug's dosing and effectiveness. Their point is legitimate. Much more study is indeed needed of marijuana's use in medicine.

But the toxic politics of marijuana have long prevented research from being done and will continue to do so. In the meantime, it's well-accepted in medicine that pain can be difficult to treat and that patients do not respond to pain medications uniformly. What the Minnesota law does is allow doctors to decide on a case-by-case basis whether medical marijuana may be useful. It's worth noting that doctors commonly recommend off-label use of many drugs to treat conditions for which data may be lacking.

It's also unclear how much weight the panel gave another important public health concern: the risks of powerful opioids such as OxyContin. The number of deaths linked to their use is considered an epidemic. A 2014 study suggested that prescription drug overdose deaths decreased by 25 percent in states after medical marijuana laws were passed.

If Ehlinger agrees with the panel and rules out medical marijuana for pain, it's likely that advocates will be back at the Legislature arguing for wide access to the drug. Ehlinger could head off that battle by making some uses allowable — such as neuropathy or rare conditions such as Elisa's — while attaching preconditions for use that require other remedies to be exhausted first. Doing so would be a compassionate compromise.