FACTOID: None of the 1,703 physician health-care practitioners in the University of Minnesota medical system are registered to certify patients to use pain-relieving medical marijuana.

By ELLEN SCHMIDT/Murphy News Service

The medical cannabis program in Minnesota has faced a multitude of obstacles since its start in July, including opposition from health care practitioners, low patient enrollment, and unexpected cost hikes.

The new business has taken some hits, but industry leaders remain optimistic about its future.

Minnesota has two dispensaries, Leafline Labs and Minnesota Medical Solutions, which offer discount programs for low-income patients using medical assistance.

Many patients can’t keep up with the pricey drug that can be purchased for less on the black market — even with cost-cutting options for those who lack money to pay for medical cannabis. Some patients, with qualifying conditions such as epilepsy,
cancer, and Crohn’s disease, are choosing to get their medicine outside through illegal means.

University of St. Thomas student Cam Miller was diagnosed with acute lymphocyte leukemia in June. He started buying cannabis for medical relief off the black market to cope with symptoms resulting from chemotherapy treatments after no response from his doctors about medical cannabis.

“For me, nausea is a big issue,” Miller said. “The medicine they give me isn’t as good as weed.

“It’s instant relief,” he added. “I would love to get the medical, because it’s legal. I’d have a constant supply that was tailored to my condition.”

Miller said he sought out medical cannabis from three out of his 10 doctors, and they all confirmed it as a possibility to alleviate his side effects. But, instead, they upped the dose of the anti-nausea medication he was already taking. When he leaves school for home on the weekends to receive chemotherapy treatments, he can’t use illegal cannabis because his parents don’t approve, and goes on without reprieve from nausea.

Still, the companies’ tout their medical cannabis product as being a better quality and consistency than illegally purchased cannabis.

“People know exactly what they’re getting in our medicine. We let you know, down to the milligram, what you’re taking,” Dr. Kyle Kingsley, CEO of Minnesota Medical Solutions, said. “It’s a safer, cleaner, and more controlled product.”

Both dispensaries are required by the state to follow rigorous guidelines in the cultivation, production, processing safety and records.

Leafline Labs CEO Manny Munson-Regala noted that the dangers of buying cannabis illegally include breaking state law and using an inconsistent product.

“It’s purchasing [cannabis] in a sub-optimal way,” he said, adding the story of a patient who had been mugged the past two times she bought cannabis illegally because she could not afford to buy the medical option.

Medical cannabis costs can range from $100 per month to more than $1,000, Kingsley said.

As of Oct. 9, 422 health care practitioners in Minnesota are registered to certify patients to apply to use medical cannabis, the Minnesota Department of Health’s website showed. There are 598 registered patients and 53 caregivers who provide the medicine to patients who can’t obtain it themselves.

Out of the 1,680 physician health care practitioners at the University of Minnesota Medical Center, and the 23 at the U’s Boynton Health Services, none are registered to certify.

University of Minnesota Medical Center spokesman David Martinson said the hospital doesn’t have a policy for its health care practitioners about medical cannabis because the program is new and the medicine lacks research. He gave no reason as to why doctors and nurse practitioners at UMMC haven’t registered.

Some doctors at Boynton Health Services have expressed interest, said Boynton’s Chief Health Officer Gary Christenson, but haven’t had patient requests to encourage them to certify.

“It’s not a one-stop shop, it’s more of a long-term management of someone’s condition that would cause a certification,” Christenson said, adding Boynton doesn’t have the specialists who typically care for the types of conditions that qualify for medical cannabis.

“It would be very unlikely for someone in the student population to get certified at Boynton,” Christenson said, likely because the qualifying conditions won’t be hugely prevalent in young people. Boynton would remain open to the topic, he said, first by educating its providers about the possible scenarios that would lead to certifying a patient for medical cannabis.

Qualifying conditions such as cancer, epilepsy, and Crohn’s disease can occur in wide age ranges that could fall into the student population, he said when pressed.

Students obtaining medical cannabis don’t get an additional discount other than those for medical assistance, and probably won’t for a long time. Kingsley said a student discount is something they may consider down the road, but isn’t a current priority for Minnesota Medical Solutions. Leafline Labs won’t have a student discount any time soon either, Munson-Regala said.

The two dispensaries have competitive pricing options, and somewhat different products. Minnesota Medical Solutions offers 15 percent off to patients on medical assistance, and 50 percent off to new patients. In July, the company raised prices by 15 to 20 percent, and reduced medical assistance discounts because of low enrollment and a high number of people on medical assistance.

“We have the lowest prices in the state,” Kingsley said.

Leafline Labs has not raised its prices yet. It offers a 12-percent discount for patients on medical assistance, and a 15-percent discount to patients who buy a one-month supply. The company also plans to start a charitable foundation, Munson-Regala said, which will be funded by company revenue and donations. The foundation will help to provide medicine to any patient who can’t afford it, and cover support services such as transportation to the dispensary.

Medical cannabis allowed by the state comes in the form of pills, liquids, or by vaporized delivery.. Its main active ingredients are tetrahydrocannibinol (THC) and cannibidiol (CBD). The dispensaries make products that range in amount of the two components to accommodate each qualifying condition.

Product variations have prompted some patients to switch from Leafline Labs to Minnesota Medical Solutions for their medicine, and vice versa.

“They don’t have enough CBD content at Leafline,” Kingsley said.

A few dozen patients have switched from Leafline Labs to Minnesota Medical Solutions because of their cannabis’s price, variety, and quality, he said.

“We definitely have people going back and forth,” Munson-Regala said. “My real competition is oxycodone or Vicodin, and the existing pharmacopeia that isn’t working.”

Minnesota’s health commissioner will determine by 2016 whether intractable pain—defined by the state as a pain level that has not been abated after reasonable efforts—will be added to the current list of qualifying conditions.

The new qualifying condition will make more people in Minnesota eligible to seek medical cannabis. Kingsley said he thinks that it will bring more patients, but not a dramatic amount. Munson-Regala thinks it will bring in more patients too, saying that Minnesota’s definition of intractable pain omits patients who haven’t exhausted all other options to treat their pain.

“The more we can spread our fixed cost out on a larger patient base, the easier it is to keep the cost lower,” he said. “But we’re never going to be cheaper than the black market.”

Reporter Ellen Schmidt is studying journalism at the University of Minnesota.