Minnesota's list of conditions that qualify for medical cannabis became largely irrelevant Monday, when revised state law allowed patients to gain access simply if their doctors recommend it.

Giving doctors broad discretion to recommend medical cannabis makes sense, because patients are just going to turn to Minnesota's recreational marketplace if they can't get what they want from the state's medical program, said Sen. Lindsey Port, DFL-Burnsville, whose legislation this session prompted the expansion.

"It just doesn't fit anymore" to have one of the nation's most restrictive lists of qualifying conditions, she said. "We want to make sure, if they have a condition that cannabis can help, that their doctor can help them find the right kind of cannabis. With the legal market open, there is really no reason to limit what doctors can prescribe because folks will be able to go out there and get anything."

Minnesota became the 22nd state to launch a medical cannabis program in 2015, starting with a list of eight conditions such as cancer and seizures that grew each year as residents petitioned to add more. The qualifying list grew to 19 conditions, based on emerging evidence that cannabis use also helped people with intractable pain and post-traumatic stress disorder. Participation surged from 18,000 people in 2019 to 48,000, and has increased even in the months since the recreational marketplace debuted.

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Minnesotans will no longer petition to add new conditions — an annual, adversarial process that forced the state's health commissioner to pick between patients who badly wanted cannabis and law enforcement officials and doctors who worried about unintended consequences. The state repeatedly denied requests to make anxiety a qualifying condition because of these disputes.

People still will be able to petition for new consumption methods, though, such as the gummies and smokeable forms that were added in recent years. This year's legislative expansion also allowed people to grow up to eight marijuana plants if a doctor has recommended medical cannabis for them, or if they are caregivers of people certified for cannabis.

Experience in other states suggests that only a few people will choose the home-growing option, and the medical cannabis marketplace will decline with the emergence of legal, recreational options. Port said it is important to maintain a commercial marketplace for medical cannabis, because the recreational market is only for adults. Some of the first advocates for medical cannabis in Minnesota were parents of children with seizure disorders.

"If we're not thoughtful about how we do it, the recreational market can put the medical market out of necessity," Port said.

Research about the risks vs. benefits of cannabis have been limited, because the federal government has classified it as a tightly-restricted Schedule I controlled substance that has high potential for abuse. Minnesota consequently set its medical cannabis program up as a broad research project that would take clinical and observational feedback from certified patients and build it into a database of what worked and what didn't.

Research will continue, even with this year's legislation moving the entire program from the Department of Health to the state's Office of Cannabis Management, which also governs recreational use. Data from Minnesota's early experience has already informed the ongoing federal process to reclassify marijuana as a less-restricted Schedule III substance, said Charlene Briner, interim director of the new state office.

"Minnesota is far and away the leader in the collection of data" on cannabis usage, said Briner. Her office is planning studies on everything from medical benefits to the frequency of impaired driving and first-usage psychosis.

Doctors and other health care practitioners still must be registered with the state program before they can certify medical cannabis for patients. More than 2,500 practitioners are registered, but the state doesn't maintain a list of their identities.

Other changes Monday include a waiver of possession limits if patients keep their certification and purchase information with their medical cannabis supplies. Veterans also can self-refer to the program or be referred by a registered provider. Doctors with the Department of Veterans Affairs still cannot refer patients because of how cannabis is federally classified.