Minnesota expands medical cannabis access, adds two qualifying conditions

Minnesotans with obsessive-compulsive disorder or irritable bowel syndrome will be able to manage their conditions with medical cannabis starting in August.

The expansion of Minnesota's medical cannabis program, announced Wednesday, means 19 conditions will qualify for enrollment. Patients self-medicating for other conditions gained access this year in Minnesota to recreational gummies and other edibles containing THC — the psychoactive ingredient in marijuana — but the medical program remains tightly controlled.

"We are adding the new qualifying conditions to allow patients more therapy options for conditions that can be debilitating," said Jan Malcolm, commissioner of the Minnesota Department of Health (MDH).

Participation in the program hasn't slowed, despite this summer's legislative decision to expand recreational THC options.

More than 39,000 Minnesotans are enrolled, up from 29,000 in 2021. Almost all participants qualified because of intractable or chronic pain, and about a third reported post-traumatic stress disorder. Muscle spasms, cancer and sleep apnea also were common qualifying conditions.

Gastroparesis and opioid use disorder were not added as qualifying conditions, with mental health providers advising against the latter for people with addictions or dependencies to pain pills or illicit drugs. In public comments, one provider cited a study in which opioid-overdose deaths increased 23% in states allowing medical cannabis use.

The decision came in the face of a growing opioid overdose problem, and despite commenters stating that illicit or recreational cannabis had helped them.

"After having gone (through) nine years of painkiller use under medical prescription for pain, I know that the use of cannabis would help ease the withdrawal side of it," said one commenter, identified publicly by the initials TB. "I only use cannabis now."

Gastroparesis was an easy call because of evidence of potential harms, but opioid-use disorders presented a dilemma, said Chris Tholkes, director of MDH's Office of Medical Cannabis. Limited geographic access to existing treatment options, such as methadone clinics, weighed in favor of approval.

"We did struggle with this one," she said. Medical providers were concerned that "introducing another type of drug could lead to relapse. And in the case of opioid use, relapse can be fatal."

The new qualifying conditions offer a modest expansion — with an estimated 10% of adults having IBS and 1% meeting the diagnostic criteria for OCD.

"My daily life consists of constant fear and stress," said one man with OCD, who was identified by the initials RH and described himself as a working professional with a wife and two daughters. "Practically the only time I am free of the symptoms is when I am sleeping."

Although Minneapolis-based Allina Health opposed the move, Tholkes said cannabis could help OCD patients who often patch together limited treatment combinations that work for them. Anti-inflammatory benefits also supported cannabis' use against IBS, she added.

Minnesota is among 38 states permitting medical cannabis, despite federal laws regulating marijuana as a drug with a high potential for abuse and prohibiting prescriptions by doctors outside of research. The state considers its program to be a research experiment, producing studies on its usage patterns and effectiveness against PTSD and pain.

Participants must be certified by doctors as having qualifying conditions and then pay $50 to $200 in annual enrollment fees.

Growth this year was fueled by Minnesota's expansion to allow smokable flower forms of medical cannabis — a popular delivery method that isn't available in the state's legal recreational market.

Medical gummies are available in stronger THC concentrations as well, though people preferring cheaper recreational options can double what they take to gain equivalent amounts. Leaders of Minnesota's two medical cannabis manufacturers and dispensaries said their products come with more rigorous oversight and guarantees of quality and dosage.

No petitions were accepted this year to study the addition of anxiety — a common condition that could greatly expand medical cannabis usage. Similar petitions were reviewed and rejected in 2020 and 2021, and Tholkes said there hasn't been much change in the evidence regarding cannabis' use for the condition.