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The Cannabis Question

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A Patient's Perspective

"I would use cannabis before any pharmaceutical," Kathy Rippentrop said. "I mean, I watched it. It was just- it was good."

The voices backing medicinal marijuana use in Minnesota are growing louder today. The bill has taken yet another step in the Senate and seems to be gaining momentum. Public Policy Polling says 65% of Minnesotans approve of legalizing medical marijuana, but the governor has said he won't sign it.

The Cannabis Question continues as Valley News Team's Hope Hanselman introduces us to the patients who are looking for relief and have, at one time, had to break the law to get it.

"The three of us were best friends, we did stuff all the time together," Kathy said holding pictures of her mother and sister. "It will be six years in May."

The bond between a mother and her daughters may be stronger than one of us, because long after Kathy lost her mother, Jane, to colon cancer she is still fighting for her.

"We all look back on that, and I am so thankful to God that we had that because when somebody you love that is very close to you is terminal it is very depressing. Very depressing," Kathy, the medical marijuana advocate, said.

Kathy says pot saved her mother in the last years of her life, "because she wasn't suffering. She would have been suffering without it. We weren't going to let that happen whether it was against the law or not."

At first, doctors had given Jane one year to live and a heavy chemotherapy regimen. Kathy explains the treatment made her mother extremely sick. Her family tried doctors and techniques all over the country, including Marinol, one of the few FDA-approved drugs containing components of cannabis. Her mother didn't find relief with it, however. The excessive vomiting caused by her chemo wouldn't keep the drug down.

Their last resort came from an unlikely source.

"So, dad got this wild idea that he was going to grow marijuana," she said. "I was shocked a the beginning."

But, it didn't take long to change either of their minds. Two and a half minutes, in fact. The amount of time inhaled cannabis takes for the active ingredients to reach the blood stream.

"Once she felt how good she felt, we didn't have to fight her on it."

Jane lived four years instead of one, traveled to countries around the world and left Kathy with a much happier image of her mother.

"To see mom laugh and have a good time, it would make us laugh and it would just make the whole experience not as bad," she said.

Kathy's story has been powerful for lawmakers, but perhaps not strong enough. They say an overwhelming number of medical marijuana patients aren't treating life-threatening illnesses. They're looking for relief from chronic pain. The typical patient is a man in his mid-30s, with a history of substance abuse... a person very much like Brandon Muhs.

"People assume that I'm a meth user because of my high anxiety levels; and I care not what people think about me," Brandon, who is clean from drugs including marijuana today. But, he says he's still suffering from stereotypes and severe pain.

"A good day for me would probably put most people down," he said.

Now, he says he doesn't want his past to influence his healthcare.

"I was paralyzed due to an illness of Meningitis Encephalitis in 2001. The lingering effects from that are severe nerve damage and chronic pain. Since I woke up, I was paralyzed from the mid-chest down," Brandon said.

Learning to walk again was a major milestone for Brandon. But, he didn't stop there. He wants relief for others like him.

"Overall, I get more sick from any kind of medication, any kind of pharmaceutical pills that I take has more of a detrimental effect to my body that's not worth it. I would rather suffer- which I do."

If Minnesota approves medicinal cannabis, Brandon would be approved for access. So would anyone else suffering from severe pain, multiple sclerosis, ALS, epilepsy, glaucoma, hepatitis-C and cancer.

"This just took the place of everything, as far as being nauseous and sick, as far as feeling better," Kathy said. "most of the drugs they give you would push you down, she wanted to live every minute of the life she had left."

Kathy's mom, Jane, is an example of a patient willing to break the law for relief. Brandon is an example of one willing to suffer so others won't have to. The two of them are a slice of a diverse population of Minnesotans seeking relief through marijuana.

"I could go somewhere where it's legal, but that doesn't do any good for the people who are here and need it," Brandon said.

Opponents of the bill are concerned legalizing medicinal use will be one step towards legalizing recreational use. They're also concerned over cannabis getting into the hands of kids and teens. The Senate bill has tried to reach a compromise by putting up some obstacles towards opening a dispensary, which would be called 'alternative treatment centers'. The application fee is $15,000 to open shop. If the state doesn't approve the applicant, the state keeps $1,000. The centers must be at least 1,000 yards from a school and may only be present in a city with a population of at least 20,000 people. Counties of 300,000 people or fewer may only contain one center. Anyone under 21 may not qualify for a medical marijuana card, work in an alternative treatment center or be inside one.

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A Doctor's Perspective

Could getting high soon become the doctor's orders? The future of alternative medicine in Minnesota is up for debate.

A bill to legalize medical marijuana just cleared another hurdle in the state Senate. Another committee hearing is scheduled Wednesday. As lawmakers weigh whether to approve marijuana as medicine this legislative session, Valley News Team's Hope Hanselman has been digging for months to track down the answers to your questions.

For the rest of the week, The Cannabis Question will investigate the issue facing Minnesotans and ask the tough questions to those who hold stakes in the matter.

Currently, two bills are stuck in the legislature that would legalize medical marijuana, they differ on how patients can consume the drug.

The Senate bill has received more action in the last week. That's the one that would allow patients with a doctor's note to smoke marijuana bought at tightly-regulated dispensaries in the state. However, the doctors who would write those prescriptions are at odds over the approval of cannabis as medicine.

"For doctors to prescribe a medicine, you have to be able to show doctors how the science works," Dr. David Thorson, of White Bear Lake, said.

Let's start with something on which we can all agree: medicine, in this country, is based on science. Science is based on evidence.

"I need to know what I'm prescribing, how it's going to affect, what the side-effects are, because I need to have that conversation with the patient," Thorson said.

Marijuana as medicine certainly isn't a new concept. Some anthropologists say cannabis shows up in the bible, ancient Greece and the Middle Ages. But, the drug is illegal under US federal law, meaning modern clinical trials are few and far between.


"You'll get no funding for study and it's basically illegal to use unless you have very restricted circumstances," Dr. Bob Koshnick, of Detroit Lakes, said.


Now, Minnesota doctors are facing the possibility of prescribing their patients 2.5 ounces of cannabis- the equivalent of about 50 joints.


"Physicians feel like they're being put in the middle of something on which we don't have the basis to make the right decision and how to treat it," Thorson said.

According to Koshnick, a number of doctors in the state are fearful a new US Attorney General will be less tolerant of states with medicinal cannabis laws. Currently, he says, the feds keep a close eye but largely allow doctors to abide by their states' rules. Some doctors believe a new Attorney General will start prosecuting those issuing prescriptions.

Twenty-one states, including the District of Columbia, now have approved medicinal cannabis. Those states have provided the backbone pushing some doctors, including Koshnick for access.

"I think what needs to be done is we need to have more states enacting laws that puts the pressure on the feds," he said.

On the other hand, the trend across the country is setting a precedent that makes other doctors, including Thorson, wary.

Dr. Thorson is the head of the Minnesota Medical Association, a group of professionals who have formally opposed the legalization of medical marijuana.

"The big problem I have, or the Medical Association has, is that it is not science or evidence-based. It's based on anecdote," he said. "It's hard when you see a young child with a seizure disorder and the mother is there saying this made my child much better."

The emotional stories of suffering that are swarming the House and Senate floors this year haven't swayed these doctors. They want research, not access.
"We have the FDA, who is supposed to look into the safety of the efficacy of medicine, and they have not looked into this," Thorson said.

However, the federal government does have a patent on cannabis, saying compounds in the plant called cannabinoids are proven to be useful in treating such diseased as AIDS.

Dr. Bob Koshnick says his Detroit Lakes clinic often sees patients using the drug illegally. He'd write a prescription... if he could.

"marijuana is a safer alternative to pain control than the opioids that we now use. I think it has many other medical uses," he said.
Both doctors agree, as with any drug, risks are involved with marijuana.

"The data would show that if you're exposed to marijuana earlier, the addiction potential is higher. But, there is a subset of patients that will be addicted to marijuana," Thorson said.

The National Institute of Drug Abuse says one in 11 people who try marijuana become addicted. For comparison, three in four people who try caffeine become addicted.

"Prescription opioids are killing about 17,000 people a year. That's not the case for marijuana," Koshnick said.

This science you want want to ignore: a person cannot overdose on weed and getting high, alone, has never killed anyone. Thus is the argument that has many doctors at odds over how much evidence is enough.

"There's a lot of data to suggest, for some patients, it is a big deal. So, I think making it over the counter, if you will, will allow people to say, hey, this must be safe," Thorson said.

Today's marijuana has become five times stronger since the 1960s. For many, that's a top 1960's concern and may be a contributing factor the rising rates of marijuana-related emergency room admissions.

Lawmakers trying to address that issue have included a stipulation in their legislation, saying cannabis plants would have to be professionally grown to help monitor the potency of the medication.
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How it Works

Showing signs of compromise, the future of medical marijuana in Minnesota looks to be closer than ever before. Law enforcement representatives announced they struck a deal with lawmakers over a House bill to legalize marijuana for patients with severe illnesses, saying patients can only use the drug under doctor or nurse supervision and it can’t be smoked.

Governor Mark Dayton has said he will veto any bill that does not have law enforcement support.

The investigation into the cannabis question continues, looking at how the laws work in other states and to show you the model that has our law enforcement concerned.


California opened up the gates for states to create their own marijuana policies. Tonight, we're joining you from a city, where every other mile you walk you'll run into at least one medical marijuana dispensary, but that didn't come without a fight. In fact, you might be surprised to find in what ways the drug hasn't caught on.

You’ll find them next to coffee shops, behind construction zones, usually in unkempt neighborhoods, and the majority of visitors have the same reaction.


“This is a lot different than I expected. We like that,” Carey Grafmiller, an employee at the Bloom Room, said.

Grafmiller is part of what he’s calling a new age in cannabis dispensaries.


“We started with a really basic model, as far as dispensaries go, with the bullet proof glass and the counter top,” he said. “It's expanded a little bit. There are a number of shops that create more of a homey environment.”

The Bloom Room is your friendly neighborhood dope distributor, a sort of Willy Wonka of weed, where stoners come in as many shapes and sizes as the goodies on the shelves.


“They get to know you, you get to know them and their needs and the kinds of things they like and they're looking for.”

You have your various strains of marijuana, which you can smoke, vaporize or dab. The Bloom Room also offers a variety of pretzels, popcorn, peanuts, chocolates, cupcakes, muffins, milk, espresso beans, brownies, cakes, caramels and suckers.


“One of my favorite patients is a retired New York City police officer that moved to town, and she's 70, 75 years old, the tiniest little lady and she's had a hundred surgeries on her back,” Grafmiller explained.  “She was just tired of popping pills every day and she found a little medicated, vegan, chocolate, hemp milk that just does the trick for her.”

Occasionally, he sees the patients who put his job into perspective.

“I’ve had like a crying father come in and say, you don’t understand how much you’ve helped my child just get through her day,” he said, with excitement.


These are the same patients who brought medical marijuana to the forefront in California back in 1992, and one elderly woman, a volunteer in San Francisco General Hospital’s cancer ward with a gracious heart and a plate of brownies.

“She was known as Brownie Mary, and these were cannabis brownies and she was arrested for doing that,” Dr. Donald Abrams, Head of Oncology and Hematology at San Francisco General, said.

Brownie Mary changed the course of the career for Dr. Abrams, as he picked up the gauntlet for more marijuana-related treatment.


“There’s not a day that goes by that I don't see a cancer patient who has nausea, pain, loss of appetite, insomnia, depression and I could write six different prescriptions for all of those concerns, all of those costing money and could interact with each other and could interact with the chemotherapy that I'm prescribing... or I could recommend one medicine and it's a plant that they could grow their own,” Abrams said.

Dr. Abrams has been an advocate for the herb since the early 90’s, but his first successful cannabis medical trial didn’t happen until five years after California didn'ted the Compassionate Use Act. According to Abrams, the legislation allowed patients to legally possess weed, but didn’t make it any easier for doctors to study I did. The real kicker here is the only legal source to get cannabis to do research with is from NIDA, the National Institute on Drug Abuse,” Abrams said. “NIDA has a congressional mandate to only study substances of abuse as substances of abuse, so they can provide cannabis but they can't provide funding for any clinical trials to show that cannabis may have a medical benefit.”


Under the Drug Enforcement Association, cannabis is classified as a schedule one controlled substance. That’s the same category as heroin, meaning the government believes it to have a high potential for abuse and no medical benefit. Methamphetamine and cocaine are both schedule two substances, so the government recognizers their medicinal properties and they can be accessed through a prescription.

“Because of the prohibition that we have in this country against this plant, this flower, to develop evidence which is what we need in this evidence-based medicine environment, people have to spend quite a bit of time and resources basically reinventing the wheel,” Abrams said.


In the 18 years medical cannabis has been legal in this state, Abrams has been able to complete just four studies, none of which show patients are negatively affected. 

Now, the industry that exists today is largely the result of unwavering advocates, people who have fought far beyond the state’s legalization for access to weed.

In fact, Grafmiller is on his second attempt at a dispensary. He was an employee at Medithrive, a dispensary that opened in 2009 and was forced to close in November of 2011.


“Back then, we were one of three I think, that had a nice looking façade,” Grafmiller said.

The federal government began sweeping closures of dispensaries across the state a few years ago. Hundreds closed their doors for what the US Attorney General said was standing too close to places children congregate.


“We're slowly dwindling and we're being pushed into more industrial neighborhoods, but then that’s kind of driving us to clean up the areas and make these industrial neighborhoods a little nicer.”


Californians are now dealing with the question of what’s best for their cities and people who live there.

Minnesota State Representative Carly Melin says this new deal struck with law enforcement is very likely to pas
s.

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