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Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months

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Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months INTRACTABLE PAIN PATIENTS IN THE MINNESOTA MEDICAL CANNABIS PROGRAM: EXPERIENCE OF ENROLLEES DURING THE FIRST FIVE MONTHS Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months INTRACTABLE PAIN PATIENTS IN THE MINNESOTA MEDICAL CANNABIS PROGRAM: EXPERIENCE OF ENROLLEES DURING THE FIRST FIVE MONTHS Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months Minnesota Department of Health Office of Medical Cannabis PO Box 64882 St. Paul, MN 55164-0882 651-201-5598 [email protected] Office of Medical Cannabis website (http://www.health.state.mn.us/topics/cannabis/index.html) As requested by Minnesota Statute 3.197: This report cost approximately $51,000 to prepare, including staff time, printing and mailing expenses. Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. Printed on recycled paper. 1 INTRACTABLE PAIN PATIENTS IN THE MINNESOTA MEDICAL CANNABIS PROGRAM: EXPERIENCE OF ENROLLEES DURING THE FIRST FIVE MONTHS Contents Executive Summary ..................................................................................................................... 4 1. Introduction ............................................................................................................................ 8 2. Patients and Caregivers Registered in the First Program Year ............................................... 9 Description of Patients Enrolled in the First Program Year .................................................... 9 Qualifying Condition............................................................................................................. 9 Age by Qualifying Condition ............................................................................................... 10 Race and Ethnicity .............................................................................................................. 10 Registered Caregivers and Parents/Legal Guardians ......................................................... 11 Geographic Distribution ..................................................................................................... 11 Primary Cause of Intractable Pain ...................................................................................... 12 3. Registered Healthcare Practitioners Certifying Early Intractable Pain Patients ................... 15 Healthcare Practitioners By Type ......................................................................................... 15 Certifying Physician Specialty ............................................................................................... 15 4. Medical Cannabis Use Patterns ............................................................................................ 17 Description of Purchased Products ....................................................................................... 17 Most Frequently Purchased Product(s) ................................................................................ 20 5. Benefits ................................................................................................................................. 26 Summary ............................................................................................................................... 26 Benefits Reported on Patient Experience Survey and Health Care Practitioner Survey ...... 29 Survey Methodology .......................................................................................................... 29 Survey Data Preparation .................................................................................................... 29 Patient-Reported Benefits ................................................................................................. 30 Patient Perceptions of Benefit from Medical Cannabis ..................................................... 31 Patient Suggestions ............................................................................................................ 33 Healthcare Practitioner-Reported Benefits ....................................................................... 34 Healthcare Practitioner Perceptions of Benefit from Medical Cannabis .......................... 35 Healthcare Practitioner Reports of Reduction in Pain Medications .................................. 38 Patient and Health Care Practitioner-Reported Benefit Scores by Pain Cause ................. 39 Health Care Practitioner-Reported Pain Assessment Score .............................................. 40 2 INTRACTABLE PAIN PATIENTS IN THE MINNESOTA MEDICAL CANNABIS PROGRAM: EXPERIENCE OF ENROLLEES DURING THE FIRST FIVE MONTHS Healthcare Practitioner Suggestions and Clinical Observations ........................................ 43 Benefits Reported on the Patient Self-Evaluation ................................................................ 44 Standard 8 Symptom Data ................................................................................................. 44 PEG Scale Data ................................................................................................................... 45 Research Objectives ........................................................................................................... 45 Results: Standard 8 Measures ............................................................................................ 47 Medical Cannabis Use Preceding Initial Symptom Improvement ..................................... 50 Results: PEG Scale .............................................................................................................. 51 Results: PEG Composite Stratified by Primary Cause of Pain ............................................ 54 Benefits Reported on the Patient Self Evaluation: Conclusions ........................................ 59 6. Adverse Side Effects .............................................................................................................. 60 Summary ............................................................................................................................... 60 Adverse Side Effects Reported on the Patient Self-Evaluation ............................................ 62 Severe Adverse Side Effects ............................................................................................... 65 PSE-Reported Adverse Side Effects: Conclusions .............................................................. 68 Adverse Side Effects Reported on Surveys ........................................................................... 73 Patient-Reported Negative Effects of Medical Cannabis ................................................... 73 Healthcare Practitioner-Reported Negative Effects of Medical Cannabis ........................ 74 Adverse Event Reporting to Medical Cannabis Manufacturers ........................................... 77 Appendix A: Healthcare Practitioner-Reported Primary Cause of Intractable Pain ………… 5 pages Appendix B: Patient-Reported Benefits from Medical Cannabis …………………………………… 59 pages Appendix C: Patient Suggestions for Improving the Program ………………………………………. 46 pages Appendix D: Healthcare Practitioner-Reported Benefits from Medical Cannabis …………. 25 pages Appendix E: Healthcare Practitioner-Reported Reduction of Pain Medication …………….. 11 pages Appendix F: Healthcare Practitioner Suggestions for Improving the Program ……………… 10 pages Appendix G: Healthcare Practitioner-Reported Clinical Observations ……………………………. 8 pages Appendix H: Baseline Responses on Symptom Measures in the Patient Self-Evaluation … 7 pages Appendix I: Medical Cannabis Products Purchased Prior to Initial ≥30% Improvement .. 29 pages Appendix J: Patient-Reported Negative Effects from Medical Cannabis ………………………. 29 pages Appendix K: Healthcare Practitioner-Reported Negative Effects from Medical Cannabis 11 pages 3 INTRACTABLE PAIN PATIENTS IN THE MINNESOTA MEDICAL CANNABIS PROGRAM: EXPERIENCE OF ENROLLEES DURING THE FIRST FIVE MONTHS Executive Summary In May 2014, Minnesota became the 22nd state to create a medical cannabis program. Distribution of extracted cannabis products in liquid or oil form to qualified, enrolled patients began July 1, 2015. Intractable pain was added to the list of qualifying conditions for the program effective August 1, 2016. Intractable pain is defined in the program as, “pain whose cause cannot be removed and, according to generally accepted medical practice, the full range of pain management modalities appropriate for this patient has been used without adequate result or with intolerable side effects.” This report draws on data from enrollment, purchasing, symptom and side effect ratings at time of each purchase, and survey results to describe the experience of patients newly enrolled in the program for intractable pain during the first five months it was a qualifying condition. Participation Between August 1 - December 31, 2016 a total of 2290 patients were enrolled in the program under the qualifying condition of intractable pain; 45 of these patients were previously enrolled in the program under an additional qualifying condition. This report focuses on the 2245 patients who were certified for intractable pain and enrolled in the program for the first time during this interval Note that patients who took advantage of pre-enrollment during the month of July were given an effective enrollment date of August 1 for this report.
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