No easy answers for state task force studying pain and pot

A state task force is finding that there may be no simple answer to the question of whether Minnesota should expand its medical marijuana program to pain patients.

Members have been studying the issue for months and are to make their final recommendation to Health Commissioner Ed Ehlinger next Tuesday. That recommendation may come with warnings, conditions and exceptions.

"What we want to make very clear, in any recommendation that we give, is that it has to be part of a partnership between the patient and the family and medical and mental health providers toward a goal of improving someone's quality of life," said Nancy Jaworski, a pediatric pain specialist and one of eight members of the state's Intractable Pain Advisory Panel.

Pain patients, who make up the bulk of medical marijuana consumers in most states where it is legal, have been lobbying to get into Minnesota's tightly regulated program, hoping cannabis will offer some relief from serious, chronic pain that does not respond to standard therapies. Opponents worry that there is too little scientific evidence to back up those hopes and too much risk that expanding the program would open it to abuse.

In an earlier survey, five members of the task force favored expanding the program to include intractable pain, two opposed the idea and one was undecided. But the debate was more nuanced than it looked on paper.

"No one was all-yes, and I don't think anybody was all-no," said task force member Dr. Erin Krebs, a pain researcher and Department of Veterans Affairs physician.

The panel's recommendation does not have to be unanimous, and Ehlinger does not have to follow it.

"It's not a cage match, wrestle-to-the-death until we have unanimous yeas or nays," said management consultant Charlie Petersen, who facilitated Thursday's meeting. Which was fortunate, since none of the panel members was ready to give unqualified support or opposition to the idea of bringing pain patients into the struggling program, which had 642 enrolled patients, as of last Friday.

Using evidence-based medicine won't work because "there is no good evidence," said Petersen, summarizing the main objection to expanding eligibility. But supporters of an expansion, he said, argued that "the risks associated with the use of cannabis are minimal, as long as use is avoided with high-risk groups."

At Thursday's meeting in St. Paul, the panel tossed around proposals that could limit the type of pain patients who could gain access to the program. The suggestions ranged from limiting the pain program primarily to adults, to allowing doctors to withdraw their certification if a patient responds badly to the cannabis, to barring patients with histories of serious mental illness or substance abuse.

Ehlinger will decide the issue before the end of this year. First, he will host a public hearing Nov. 10 at Wentworth Library in West St. Paul.

The panel's recommendation is expected to be posted on the Health Department's website on Tuesday.

Jennifer Brooks • 612-673-4008