Transcript Medical Cannabis

MEDICAL MARIJUANA
MINNESOTA
Central Medical Clinic, 2015
Alfonso Morales, M.D., DABPM
The Problem of Undertreated Pain
• World Health Organization has said that
undertreated pain is the number one health
problem in America
• Number patients with chronic pain in the
USA exceeds, diabetes, heart disease, and
cancer combined
National Center for health statistics. Health, United States, 2006 with Chartbook on Trends in the Health of Americans, Hyattsville,
Maryland; US Department of Health and Human Services; 2006: 68-71
Dual Public Health Crises
• Undertreated Pain
– USA today/ABC
– News/Stanford University survey
• Prescription drug abuse
– Whitehouse ONDCP
– DEA
Paradigm Shift
in Opioid Prescribing
• Competing Public Health Crises
– Undertreated Pain
– Prescription Drug Abuse
• Increasing Need for Safe and Effective Pain
Management
– Decreased barriers to appropriate opioid
use
– Increased safety in opioid use
DEA Facts on Prescription Drug
Abuse
• Nearly 7 million Americans are abusing
prescription drugs
– More than the number for abusing cocaine, heroin, hallucinogens,
ecstasy, and inhalants, combined.
– 80% increase in just 6 years
• Prescription pain relievers are new drug
users’ drug of choice, vs., marijuana or
cocaine
• Nearly 1/10, high school seniors admits to
abusing prescription painkillers
Three 2010 MJ Related Bills Pending
in US Congress
• H.R.2943: The Personal Use of Marijuana
by Responsible Adults Act
• H.R.2835: The Medical Marijuana Patient
Protection Act
• H.R.3939: The Truth in Trials Act
No Pot for Pain, High Court Says
• Many court rulings on MJ
• 2 supreme court rulings
• Restrict physicians and patients
www.potdoc.com
Medical Cannabis
• What are the Facts?
– In 2010, there were ~17.5 million monthly users
• 5.7% of the population (vs 68% for alcohol)
– Cannabis is the most widely used illicit drug in the
world. Among those who use cannabis ~9% met DSMIV criteria for cannabis dependence.
– In 2010, the most common primary drug of abuse in
adolescent drug abuse programs was marijuana (75%)
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• Cannabis “Addiction”:
• Lifetime risk of dependence is 9% for marijuana, 15% for
alcohol, 17% for cocaine, 23% for heroin, and 32% for
nicotine.
– The risk of dependence is essentially for those 25 or
less. It is extremely rare for a new user older than 25 to
become dependent.
– Vs Cocaine where risk continues until ~45.
– In those less than 18 who smoked reported smoking
marijuana in the last year, ~26% had a use disorder.
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• Marijuana and Pain:
– Reviews consistently show that cannabinoids are welltolerated and “modestly” effective in neuropathic pain.
• The best evidence in MS-related pain.
– Very little evidence to support its use in chronic low
back pain.
– In the trials, there was a large number of adverse
cognitive/perceptual disturbances.
• 30-80% of naïve users reporting psychosis-like
issues.
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Marijuana and Pain:
• Marijuana is not more effective for pain relief than any other
available compounds
• The most evidence for the use of marijuana for pain is for
HIV-neuropathy and spasticity due to MS.
– Review of California prescribing data show only 3% filled medical
marijuana prescriptions are for these diagnoses.
Medical Cannabis
Marijuana and Pain:
• Glaucoma is not a painful condition (acute angle closure is)
• Studies in the 1970’s showed that smoking marijuana
decreased IOP for 3-4 hours.
– NEI research studies from 1978-1984
– To adequately control pressure, would have to smoke 810x/day.
• AAO reports multiple superior options, therefore this is no
role for marijuana.
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What about Minnesota?
• Starting June 1, 2015, health care
practitioners will be able set up an account
to certify patients who qualify for medical
cannabis.
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Did you know that Minnesota is the First State
Program in the Country to offer only SmokeFree Medical Cannabis?
-No Smoke
-No Plants
-Only Pill, Liquid, or Oil.
Medical Cannabis
Introducing the Minnesota Medical
Cannabis Program
• Under the Minnesota Medical Cannabis
Therapeutic Act of 2014, a system has been
established for certain patients to pursue
access to medical cannabis that is legal
under state laws.
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The Minnesota Department of Health's Office
of Medical Cannabis (OMC) oversees this
legislation
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• A health care practitioner that has registered as such in the
Minnesota Medical Cannabis Registry does not prescribe
medical cannabis of any kind.
• The health care practitioner’s role in the program is to
determine, in the health care practitioner's medical
judgment, whether a patient suffers from a qualifying
medical condition, and, if so determined, provide the patient
with a certification of that diagnosis certifying that a patient
has a qualifying condition.
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• A health care practitioner certifies a patient’s qualifying
condition and the patient has registered and been approved
in the Medical Cannabis Registry.
• The patient will visit one of eight Cannabis Patient Centers
where a licensed pharmacist will incorporate the qualifying
condition, current medical conditions and medication taken
by the patient as well as other information provided on the
patient’s self-evaluation report to determine the form,
dosage and frequency of the medical cannabis to be taken
by the patient.
Medical Cannabis
Medical Cannabis
Two Manufacturers:
1)
2)
LeafLine Labs, LLC
Minnesota Medical Solutions, LLC
-Authorized
-Regulated
-Inspected
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• Three types of practitioners: doctors,
physician assistants, and advanced practice
registered nurse can certify that patients
have a qualifying condition for medical
cannabis.
• MDH will not maintain or publish a list of
practitioners who are certifying these
conditions.
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• Qualifying Conditions:
– Cancer associated with severe/chronic pain, nausea
or severe vomiting, or cachexia or severe wasting.
– Glaucoma.
– HIV/AIDS.
– Tourette Syndrome.
– Amyotrophic Lateral Sclerosis (ALS).
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• Qualifying Conditions:
– Seizures, including those characteristic of epilepsy.
– Severe and persistent muscle spasms, including those
characteristic of multiple sclerosis.
– Crohn’s Disease.
– Terminal illness, with a life expectancy of less than one
year, if the illness or treatment produces
severe/chronic pain, nausea or severe vomiting,
cachexia or severe wasting
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• Possible Qualifying Condition:
–Intractable Pain
Definition of Intractable Pain
Intractable Pain is definited in the 2014 Minnesota Statutes.
Recent History
1997 152.125 New 1997 c 124 s 1
152.125 INTRACTABLE PAIN.
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• § Subdivision 1.Definition.For purposes of
this section, "intractable pain" means a
pain state in which the cause of the pain
cannot be removed or otherwise treated with
the consent of the patient and in which, in
the generally accepted course of medical
practice, no relief or cure of the cause of the
pain is possible, or none has been found
after reasonable efforts.
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• Qualifying Conditions
Your health care practitioner must certify
that you have one of the nine qualifying
conditions prior to enrolling in the system.
You must also be a Minnesota resident.
• Registration Process
Find out if you have a qualifying condition,
how to get certified, how to register, and how
to get your medication.
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• Locations
Medical cannabis will eventually be available
at eight cannabis patient centers across
Minnesota.
• Costs
All patients with a qualifying condition must
pay an annual registration fee in order to be
eligible to purchase medical cannabis.
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• Annual Registration Fee
• Full fee: The annual fee is $200.
• Reduced fee: Patients on Social Security Disability, Medical
Assistance, CHAMPVA or Medicaid are eligible for the
reduced fee of $50. A copy of your Social Security
Disability, CHAMPVA, Medical Assistance or Medicaid ID
card must be provided during registration.
• Payment: the registration fee is paid online via credit/debit
card or check at the USBank website once you login to the
Registry.
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• In addition to the registration fee, there will
be a fee for the medical cannabis you need,
payable at the cannabis patient centers.
• No insurance companies in Minnesota
currently cover medical cannabis treatment.
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• "As a practitioner, am I protected?“
• The legislature has amended Minnesota's
medical cannabis statute to address
patients' use of medical cannabis in health
care facilities, such as hospitals.
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• "As a practitioner, am I protected?“
Under the amendment, protections and immunities
are extended to employees of health care facilities to
possess medical cannabis while carrying out their
employment duties, including providing care to or
distributing medical cannabis to a patient who is
registered in the Minnesota Medical Cannabis
Patient Registry and is actively receiving treatment
or care at the facility.
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• "Do I have to participate?"
No; participating in the Minnesota Medical
Cannabis Program is optional
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• "What is my role in the Program, and
what are my responsibilities?"
– To use medical cannabis, all patients must
register with the Program and have their
condition certified by a qualified health care
practitioner. (Patients must renew this
certification annually with a qualified health care
practitioner.)
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• "What is my role in the Program, and
what are my responsibilities?"
– In your role as a health care practitioner in the
Program, you do not prescribe medical
cannabis to patients. Instead, you are expected
to assess your patient's health and:
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• "What is my role in the Program, and
what are my responsibilities?"
– Certify if your patient has a qualifying medical
condition; by doing so you attest that you:
– Have sufficient knowledge of your patient's
history, physical findings and test results to
make the diagnosis
– Are available for ongoing management of your
patient's medical condition
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• "What is my role in the Program, and
what are my responsibilities?"
– Indicate if your patient has a disability that
prevents him or her from accessing or
self-administering medical cannabis (in
this situation, your patient would require a
caregiver)
– Acknowledge a legitimate medical
relationship with your patient
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“Where can I learn more?”
• For your convenience, Program-related
resources including the latest legislative
news, fact sheets and clinical research, are
available in the website:
mn.gov/medicalcannabis
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“I thank everyone who worked together to
craft and pass this legislation. I pray it will
bring to the victims of ravaging illnesses the
relief they are hoping for.”
Governor Mark Dayton
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If you have additional questions, please call
the Office of Medical Cannabis or send an email: [email protected].
Office of Medical Cannabis
P.O. Box 64882
St. Paul, MN 55164-0882
(651) 201-5598 Metro
(844) 879-3381 Non-metro
Medical Cannabis
Which of the following has the most evidence
for long term treatment of pain?:
a.
b.
c.
d.
Acetaminophen
Duloxetine
Marijuana
Opioids
Medical Cannabis
Which of the following has the most evidence
for long term treatment of pain?:
a.
b.
c.
d.
Acetaminophen
Duloxetine
Marijuana
Opioids
Medical Cannabis
For which pain condition does “Medical
Marijuana” have the most evidence?
a.
b.
c.
d.
Arthritis
Back Pain
Glaucoma
HIV Neuropathy
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For which pain condition does “Medical
Marijuana” have the most evidence?
a.
b.
c.
d.
Arthritis
Back Pain
Glaucoma
HIV Neuropathy
Medical Cannabis
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