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Cannabis and chronic rian Erickson, MD, has a perspective What was the sentiment in the few, if any, physicians in Minnesota medical community about medi- Bshare regarding and cal cannabis when Vermont was pain. Erickson, medical director of Health considering legalizing it? East’s Pain Clinic in St. Paul, previously There was very little public dis-

practiced in Vermont, where severe pain cussion or input from medical COURTESYPHOTO HEALTHEAST OF has been a qualifying condition for medi- providers compared with what cal cannabis use since 2007. (Medical can- I’ve experienced here in Minne- nabis became legal in that state in 2004.) sota. There was a feeling that if a Erickson saw patients at the University person was on , we didn’t of Vermont’s pain clinic, where he certified want them to also be using mar- some for medical cannabis use. With Min- ijuana. There was concern about nesota’s Commissioner of Health recently addiction and misuse. adding intractable pain to the list of con- The law that ultimately ditions for which patients will be able to passed in Vermont is a lot like obtain medical cannabis, Erickson shared Minnesota’s in that the can- his thoughts with Minnesota Medicine edi- nabis became available in the tor Kim Kiser. form of a tincture that could be used under the tongue or be Brian Erickson, MD, saw how medical cannabis You’re a psychiatrist. How did you get in- vaporized, and physicians had helped some of his pain patients in Vermont. volved in treating patients with pain? to certify that patients have one After medical school at the University of of the qualifying conditions, Minnesota and a psychiatry residency in which included HIV, nausea, cancer, and to decrease or get off opioids entirely. One Vermont, I practiced psychiatry in Duluth later, chronic pain. One distinction was who was on 100 mg a day of and worked with patients who had chronic that the patient had to have a six-month got off of it entirely. Another who was pain and were taking antidepressants. We relationship with the certifying doctor, on 80 mg a day of oxycodone got off of had a couple of psychologists in the group so the doctor knew the patient and their it entirely. It was very helpful for patients who did biofeedback and marriage and condition. with peripheral neuropathy, back pain family therapy who also were working and headaches, who weren’t responding to with patients who had chronic pain. It was Did your patients ask you about medical other medications. something I wanted to learn more about cannabis? because there is a lot of overlap between Some of my patients started reading about Were there problems with addiction? How psychiatry and chronic pain. We set up a medical cannabis, doing their own re- did you monitor patients? pretty involved chronic pain program at search and asking about it. Many of them There was concern about addiction, espe- St. Mary’s Duluth Clinic in 1993. were very sheepish—middle-aged teachers cially for patients who were on suboxone. About 14 years ago, I returned to who had never used marijuana in their life, We didn’t want them using marijuana if Vermont to practice at the University of people who didn’t want their kids knowing they were in recovery with suboxone. But Vermont’s pain clinic. At the time, it was they were using it. These were people who medical cannabis was different. The medi- mostly anesthesiologists doing chronic pain were desperate and at the same time a little cal cannabis formulation used for chronic treatment. I did a lot of medication man- embarrassed. I ended up certifying be- pain tends to be high CBD (cannabinoid) agement. During that time, I developed an tween 60 and 80 pain patients for medical and low TCH (tetrahydrocannabinol). interest in alternative and complementary cannabis use during my time in Vermont. THC is the psychoactive part of the drug. therapies. A number of my patients had The high CBD is thought to be helpful for tried many different medications and found Did it help their pain? pain and anxiety and nausea. So the for- they weren’t satisfactory or helpful. I really In my experience, patients ended up doing mulation they were using wasn’t the sort wanted to have alternatives. very well. Many of my patients were able

8 | MINNESOTA MEDICINE | JANUARY/FEBRUARY 2016 CONVERSATIONS SHORT TAKES of thing that would lead people to get high Have you shared your perspective with formation about the patients who got off and have amotivational syndrome. other clinicians? What were their thoughts? opioids or decreased their dose is We would talk to patients’ family mem- I talked about my experience at an MMA anecdotal. However, a recent study from bers, therapists and suboxone counselors forum. A number of doctors were inter- the University of Pennsylvania of 13 states and make sure we knew how they were ested. Some had already certified their that legalized medical cannabis reported doing. In general, their pain was better, patients for other things. Others thought a nearly a 25 percent reduction in the an- their function was better and they were adding intractable pain was going to open nual opioid overdose mortality rate after able to get off opioids. There wasn’t a doors to all kinds of problems and misuse. the cannabis laws were enacted. problem with addiction, and I never heard I can respect their opinions and concerns. There’s a lot of fascinating work to be from law enforcement about patients Clearly, we should be concerned about done with this. I think we’ll see some good diverting it. The high-CBD, low-THC for- adolescents and the developing brain, work around medical cannabis and PTSD, mulation wouldn’t have the street value a for example. Certainly, there is a risk and I think there are going to be some formulation with high THC would have. for addiction to marijuana. But with the interesting immunological findings that high-CBD, low-THC formulation, that come from this. What are you hearing from your pain risk should be relatively low. Some had At the national level, those who talk patients in Minnesota? concerns about patients using medical about medical cannabis and chronic pain My patients in Minnesota are very inter- marijuana and driving. But we have those are really saying marijuana has to be ested. Some have traveled to Colorado and same concerns about patients who are on changed from a Schedule 1 to a Schedule California and used what’s available there. benzodiazepines and opioids. 2 drug so it can be appropriately studied They found it helpful. I have a number of and understood. I think that’s important, patients who, despite our best efforts with In Vermont, did they collect any data or do and it’s a far cry from legalizing it for pharmacotherapy, acupuncture and physi- any studies about medical cannabis’ effect recreational use. cal therapy, don’t get the results they want. on pain? I do suspect they could get some benefit They weren’t doing any large-scale re- from medical cannabis. search on medical cannabis. So my in-

We believe in the delivery of hearing healthcare based on a medical model, not “the purchase of a gizmo online or from a big box retail store. Our patients receive doctoral level assessments to address Physician endorsed not only hearing loss but Edina & Burnsville lifestyle, cognitive abilities and budget. We thank our Pediatric testing (Burnsville) referring physicians for their continued referrals, belief Auditory Processing Disorder testing in this medical model and Audiological assessments ongoing support.

Hearing technologies —Dr. Paula Schwartz Tinnitus treatment ” At Tinnitus and Hyperacusis Clinic (Edina)

6444 Xerxes Ave. South • Edina, MN 55423 • (952) 831-4222 14050 Nicollet Ave. South • Suite 200 • Burnsville, MN 55337 • (952) 303-5895 Paula Schwartz, Au.D., Courtney Sterk, Au.D., Jason Leyendecker, Au.D., Doctor of Audiology Doctor of Audiology Doctor of Audiology www.audiologyconcepts.com

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