Medical Marijuana: Junk Science V

Medical Marijuana: Junk Science v. Miracle Cure

Presented by: Mark Kleinschmidt and Steven Halloran

© Copyright 2021 by Cousineau, Waldhauser & Kieselbach, P.A. All rights reserved. Current Minnesota Caselaw Medical Marijuana: Junk Inside a Medical Marijuana Science v. Dispensary Miracle How to Properly Defend Against Cure a Medical Marijuana Case

• Medical Cannabis Therapeutic Research Act was enacted in May 2014 - It was initially meant for terminal cancer pain treatment, but later expanded by the Commissioner of Health. - It now includes chronic pain, intractable pain, and others - Several attempts were made to make anxiety a qualified diagnosis to receive medical marijuana, but it has not been successful -Notably, medical marijuana remains a Schedule I narcotic on the federal level

Case Condition Prior Treatment Trial Judge Court of Appeals Musta v. Mendota Heights Neck Injury (Later Surgery, Chiropractic Care, Kirsten M. Tate The Employer and Insurer are required to pay for all Dental Center Intractable Pain) Injections, Physical Therapy, reasonable, necessary, and causally related medical Medical Management, Long- expenses. However, the issues of federal preemption is Term Opioids currently before the Minnesota Supreme Court.

Bierbach v. Digger’s Polaris Ankle; Consequential Surgery, Physical Therapy, William J. Marshall “The determination of the compensability of a Neck and Back injury Injections, Narcotic particular medical treatment for a work-related injury (Later Intractable Pain) Medications is squarely within a compensation judge’s jurisdiction. Minn. Stat. § 176.135. This includes the use of medical cannabis under the MCTRA.” However, neither the trial court nor the W.C.C.A. have jurisdiction to address the federal preemption question. The issue of federal preemption is currently before the Minnesota Supreme Court.

Warhol v. Corexpo, No. WC20- Chronic Pain (Cervical Cervical Disc Replacement Kristina B. Lund “The compensation judge did not err in refusing to 6373 (W.C.C.A. April 28, 2021) Spine) Surgery; Cervical Fusion consider appellants’ federal criminal preemption defense. The award of medical marijuana is affirmed.” The case is currently on appeal to the Minnesota Supreme Court. Brandia v. Keystone Auto, No. Right Elbow Injury As A Carpal Tunnel Release, Right Kirsten M. Tate Upheld trial judge’s decision that medical marijuana, WC20-6344 (W.C.C.A. Result of Repetitive Elbow Medial Epicondyle not the spinal cord stimulator, relieved the Employee’s September 10, 2020) Lifting Release, Stellate Ganglion pain. The decision was affirmed. Blocks, Long Arm Casting, Pool Therapy, Trial Spinal Cord Stimulator © Copyright 2021 by Cousineau, Waldhauser & Kieselbach, P.A. All rights reserved. Inside a Medical Marijuana Dispensary

• Currently only two companies authorized to provide medical marijuana – Green Goods and Leafline Labs • There are 13 locations across Minnesota

Europe • Medical Marijuana ineffective or poor efficacy for post-trauma or post-surgical NP (not recommended) Canada • Medical Marijuana 3rd line of treatment; requires close monitoring; contraindicated if psychosis in PMH UK • Medical Marijuana consistently worse than other treatment for relieving pain; low to very low evidence medical marijuana is better than a placebo Source: MN DOH, HCP Primer, 10/07/2019, pp. 7-10.

33%-66% achieved 30% reduction condition symptoms from baseline symptoms

IP at low end for conditions to maintain after 4 months*** • IP to achieve and maintain pain reduction past 4 months - 10.5% • IP PEG Mix after 4 months - 21.6% • Best Condition for Pain alone: Tourette’s - 45.5%

Best Conditions for Symptoms Complex: Tourette’s, Seizure; Crohn’s

Source: MN DOH, Benefits Report on the Patient Self-Evaluation, 11/15/2019, vs. News Release, 3/01/2018.

• In Schnider v. H.G. Schnider, 449 N.W. 2d 171 (Minn. 1989), the Employee suffered a work-related cervical spine injury. • The Employee requested a prescription from his orthopedic surgeon for “professional therapeutic massages.” His orthopedic surgeon issued a prescription, but it was not addressed to anyone and failed to state why the massages were to be given. • The Employee received about 40 massages from a “medically unlicensed masseuse.” The Employer/Insurer declined to provide reimbursement. • The Minnesota Supreme Court found the massages non-compensable because Minn. Stat. § 176.135 authorizes payment only under the direction and control of a doctor’s supervision. No supervision was present here, and there was no record showing the nature or effectiveness of the treatment.

1) Know Your Audience (Judge) 2) Identifiable Improvement (before/after) in Pain Level (0-10) 3) Measurable Improvement (before/after) in ADLs (Home/Hobby) 4) RTW Prospects or Restriction Improvement 5) Still on Other Long-Term Therapies (e.g. opiates) 6) Forestall or Eliminate Complex/Risk of Surgery

7) Medical Expert Reports

EE – Certified Qualifying Medical Condition under MS 152.22, subd. 14 (1-10) Intractable or Chronic Pain ER: a. Other Tx not exhausted b. MM not shown as helped with pain scale c. No dosage or frequency – “as he feels he needs it” d. Not safe (prior addiction history with risk of addiction) e. Not FDA approved/10/7/2019 DOH Studies cited f. Absence of Provider qualification other than licensed g. Limited Licensed Physician Direction/Supervision per 152.28, or onsite/video Pharmacist per 152.29, subd. Ross v. NSP; Schnider v. Schnider