Legal Aid: State Cannabis Program to Help Thousands of Chronically Ill

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																			April 22, 2015

On July 1, Minnesota opens its doors to a state-monitored program legalizing the sale of medicinal cannabis.

Proponents of the program say the medication will safely and reliably offer relief to thousands of Minnesotans suffering from some of the most disabling medical conditions.

Tom Arneson and Michelle Larson smiling
SPH alumni Tom Arneson and Michelle Larson are leading the State’s medical cannabis program.

Opponents fear the health and security risks, calling cannabis “the most dangerous illegal drug in our nation.“

Leading the program are Michele Larson and Tom Arneson, two School of Public Health graduates working at the Minnesota Department of Health (MDH).

Unlike other states where seemingly free use of marijuana is legal, Minnesota is adopting a pharmaceutical model for its program that authorizes two statewide companies to produce and sell cannabis-based medications under strict guidelines.

What’s more, patients in the program must participate in a registry and study aimed at increasing the limited understanding of medical cannabis’ effectiveness and side effects.

A public health issue

Larson, who directs the MDH initiative and oversees everything from creating educational campaigns to establishing rules for drug manufacturing, is doing the work because cannabis has the potential to help those who need it the most.

“At the end of the day, I’m doing it to help people with health conditions have a better quality of life, in a safe way,” she says.

MDH estimates 5,000 people will enroll in the program during the first year.

“[Legalizing medical cannabis] is a public health issue because we have a fairly large population of people with chronic diseases and compromised lifestyles who, until now, couldn’t obtain a drug that may alleviate their symptoms,” says Larson.

Safety first

The law permits patients who are physician-certified in nine illnesses — such as ALS, epilepsy or cancer — to receive up to a 30-day supply of medical cannabis. The medication will be precisely formulated with active ingredients and produced as capsules, drops or an inhalable vapor. The manufacturers will then directly sell the medication at a set price from company storefronts staffed by expertly trained pharmacists.

“Our number one priority right now is ensuring patient safety and that we’re getting carefully formulated medical cannabis products into the hands of the people who qualify for it,” says Larson.

Arneson is leading research aimed at adding to what we know about the safety and effectiveness of medical cannabis. A major component of that research is an upcoming observational study of participants.

“Most states aren’t following what patients enrolled in their programs are taking and what affect cannabis has on their health — that’s what our program intends to do,” says Arneson.

Through a patient health data registry, Arneson will gather information on individual cannabis use, dosages, patient experiences and side effects. Much of the data will be collected during consultations with pharmacists at the point of sale and through patient self-reporting.

“We’ll have much more definitive information on the exposure and effectiveness of cannabis because patients will be asked questions just days and weeks after they’ve used it,” says Arneson.

It’s a matter of reception

The effectiveness of cannabis as a drug seems to hinge on dozens of chemicals it contains called phytocannabinoids.

Phytocannabinoids are found inside trichomes, which are sticky, hair-like follicles that cover the leaves of cannabis plants. The oily phytocannabinoids provide a toxic shield against hungry omnivores and serve as part of the plant’s cleansing system.

The most widely understood phytocannabinoid — THC — is known for what it does for people. First isolated by researchers in 1964, THC has been long known as the “gets you high” component in marijuana.

In 1988, researchers found a cannabinoid receptor in the brain that’s highly sensitive to THC. Called CB1, the receptor is the pathway through which THC enters our system and interacts so potently with our minds and bodies.

That discovery was a breakthrough, but it pointed the way to something even more significant.

The presence of a receptor for a particular chemical that comes from outside the body implies the body itself is producing a substance similar to the chemical or else it would never have developed the receptors.

So if our brain is already wired to respond to plant cannabinoids, then it must mean our body is making and using cannabinoids of its own. And it is.

They are called endocannabinoids — endo meaning “within” — and their discovery led to finding a complex system of endocannabinoid receptors in the brain, nerves, GI system and immune system.

“We now know that we have this amazing thing called the endocannabinoid system,” says Arneson. “Endocannabinoids seem to have important purposes in appetite regulation, alertness and sleep, pain, and stimulation, among other functions.”

Discerning just how the system works is leading to more discoveries, including finding another type of cannabinoid receptor named CB2; characterizing the first endocannabinoid called anandamide; and identifying other molecules in the body that serve endocannabinoid functions.

Understanding differences

Along with recent research into cannabis and the body’s endocannabinoid system, Arneson believes it is crucial to explore how cannabis-derived drugs work in respect to differences among our bodies.

“Even though everyone has the same endocannabinoid system, we seem to uniquely respond to drug compounds,” says Arneson.

Early research and anecdotal evidence has already shown that therapeutic dosage levels vary among individuals. Additionally, drug side effects appear at both at higher doses and when there’s quick escalation of the amount of medication used.

Arneson says a key aspect in understanding how individual patients might respond to cannabis is factoring in how the delivery method changes its efficacy.

Medical cannabis can be taken in various ways — such as inhaled, swallowed or placed under the tongue — and the way the body absorbs it and puts it into the bloodstream could easily have an impact on how well it works.

Many major questions remain and there are countless studies still to be run before the use of medical cannabis is as understood and commonplace as other drugs. Nevertheless, one thing about Minnesota’s cannabis effort is certain: Its scientific and therapeutic approach to the drug means a potent form of relief may soon come for many of our State’s sickest citizens.

~ Post by Charlie Plain


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