Autism, Sleep Apnea approved as qualifying conditions for medical marijuana by the MN health dept

[Michael Komorn]

http://www.startribune.com/autism-sleep-apnea-added-to-minnesota-list-for-medical-marijuana/461063283/

Autism, sleep apnea added to Minnesota list for medical marijuana

State Health Department adds them to treatment list for medical marijuana. 

By Jeremy Olson Star Tribune

 

DECEMBER 1, 2017 — 10:15AM

GLEN STUBBE, STAR TRIBUNE Minnesota is expanding the pool of people who will be eligible for medical marijuana to include those with autism and obstructive sleep apnea.

Minnesotans with autism and obstructive sleep apnea will be able to use medical marijuana starting next July to manage their conditions, the state Health Department announced Thursday.

Health Commissioner Dr. Ed Ehlinger announced the additions following a state and public citizen review of medical research. Minnesota now permits medical marijuana for 13 conditions, including chronic pain and Tourette syndrome, and is the fourth state to specifically approve the use for autism, a developmental disorder.

Advocates this year had requested the addition of 10 conditions, including anxiety and dementia. Ehlinger selected autism and apnea due to "increasing evidence for potential benefits."

"Any policy decisions about cannabis are difficult due to the relative lack of published scientific evidence," the commissioner said in a statement.

Thursday's announcement caused tears of joy for Victoria Grancarich, whose son has severe autism. He had become increasingly violent toward himself and others, she said, and beat his own head so badly that he needed three hospitalizations last winter. Grancarich said her son, who is nonverbal, appeared to be experiencing extreme pain and other discomfort that existing autism medications didn't treat. "Basically, the hospital sent him home last January to die," Grancarich said. The 14-year-old's primary care doctor agreed to authorize cannabis for him because he already had two other qualifying conditions, inflammatory bowel syndrome and seizures. In weeks, his mother said, his outbursts ceased and he became healthy enough to return to school.

Minnesota has operated a tightly controlled medical marijuana program since 2015, with two companies approved to distribute cannabis in liquid or pill form to patients with qualifying conditions. Advocates also sought this year to add edible or smoked forms to Minnesota's program, but Ehlinger said no.

The program currently has 7,747 patients and 1,034 health care practitioners who can certify patients.

State officials said they don't know how many people with autism and sleep apnea are likely to seek certification for medical cannabis. Roughly 1 in 68 children has autism, and about 1 in 20 people suffer levels of sleep apnea severe enough to cause severe daytime drowsiness and other health complications.

Minnesota law grants the state health commissioner final authority to select qualifying conditions because the U.S. Food and Drug Administration technically lists marijuana as an illicit controlled substance and provides no oversight. Twenty-nine states permit varying forms of marijuana use for medical purposes.

Anecdotal stories such as Grancarich's appeared to have a persuasive effect on the department's decision on autism, because the evidence base for treating autism with medical marijuana hasn't changed much since last year, when the commissioner also considered it. The Health Department said Ehlinger wasn't available Thursday to elaborate on his decisions.

Two clinical studies in Israel and New York are getting underway to test the effect of medical marijuana on autism, said Dr. Tom Arneson, research director for Minnesota's office of medical cannabis.

Research also is finding links between autism and the body's natural endocannabinoid system, he said. The system affects brain, digestive and immune functions and theoretically is stimulated by an infusion of the chemicals in medical cannabis.

In the case of apnea, a condition in which reduced airflow disrupts sleep, the Health Department found modest research in support of medical cannabis, as well as reports showing that people struggled to stick with the existing treatment — wearing a CPAP air flow device at night. Medical marijuana will be permitted only for people who are formally diagnosed with sleep apnea, which means they will likely need to undergo an overnight sleep study first.

Problems between one of the state's distributors, LeafLine Labs, and a third-party testing company resulted in a shortage this week for some patients. State officials described the glitch as unique and said the two companies have been prepared to add capacity when the commissioner added new qualifying conditions.

Grancarich said she was overjoyed by Ehlinger's announcement because, unlike her son, many other children with autism don't have secondary conditions that would have qualified them for medical cannabis.

And, she said, she knows the severe toll the lack of treatment can take on children and their families. When her son was most at risk for violence, Grancarich said, they couldn't leave the house. She would keep her younger daughter confined to her room for protection. Even now, Grancarich flinches when her son approaches because of the trauma they endured.

"But now we can all be in the same room together," she said. "We can sit together. We can hug again."

 

 

 

 

Story of Julian, the 14 y.o. boy with autism whose mother came forward to share her story and petition to add autism to the list of qualifying conditions.

https://leaflinelabs.com/patient-firsts/2017/6/20/medical-cannabis-seizures-and-autism-julians-story

For 14-year-old Julian and his family, the past year has been the worst of their lives. His mother, Victoria, didn’t think his condition could get any worse until one day it did. Rather than inflicting harm on others, he turned to harming himself; a mother’s worst nightmare. It started with hitting himself in the head and kneeing himself in the teeth. Then, in October 2016, Julian was hospitalized after nearly beating himself to death. He was admitted with two black eyes, a fractured skull, and hematomas on his head. The doctors – as many others had done for the entirety of Julian’s life – attributed his actions to a behavioral issue and advised to treat accordingly, but his mother knew that wasn’t the problem.

Julian was certified in the Minnesota Medical Cannabis Program in January for his seizures (at one point he was having 30-40 per day, many of which were grand mal), but has several other conditions that will hopefully benefit from his new form of treatment as well. His mother has said, “I really think that if we didn’t get qualified for this that he would really find a way to kill himself. He’s in that much pain.”

Although born without any preexisting conditions, he was later diagnosed on the autism spectrum. Julian developed gastrointestinal issues as a young boy and suffers from neuropathic pain from a back injury that never healed properly. Julian endures Tourette Syndrome-like motor tics and often struggles to control his own body.

With Julian’s limited verbal skills (which he has worked extremely hard for), identifying the direct source of the pain is tricky, but Victoria knows an overwhelming amount stems from the region of his head. She can see when a headache comes on and his pain levels increase – he winces and looks as though he wants to crawl out of his own skin, often grabbing at his head, hitting himself, or banging his head into whatever surface is closest. Sometimes, he lashes out at others. It has become clear that Julian does not want to hurt himself or those around him, but he has not had the control of his body to deal with the pain he lives in every day.

When we spoke with Victoria in March, she told us that Julian’s days consisted of going to school and spending time at home. He required two adults with him to protect him from himself, he wore two helmets and padded braces around his elbows to prevent his arms from bending, and he slept under a weighted blanket each night. “If he can’t bend his arms, he can’t reach up to hit himself in the head,” Victoria said.

After Julian was released from his October 2016 hospital stay, he was put on several different medications and he had a stable month in terms of his aggression and self-harming. The side effects of his medications, though, caused him to sleep all the time and he seemed as though he no longer wanted to live; he was miserable.

In January 2017, Julian was hospitalized once again for the same reasons, and missed out on over a month of school. Once again, the doctors attributed it to behavior. Determined to find relief for her son this time around, Victoria searched for a physician who would certify Julian in the medical cannabis program. On the same day that he was certified, she made an appointment and met with a pharmacist at a LeafLine Labs patient care center.

After his first two doses of Cobalt, Julian’s parents noticed him begin to relax. His seizure activity was low and the severity drastically decreased. He barely hit himself. Within a few days and several more doses of medicine, they continued to see small, yet promising improvements. After a month, they started to see more significant, lasting results. His speech improved and he has started to retrieve words his parents had not heard him speak in months. His need for swaddling decreased and he started to gain more control of his limbs. Julian started to sleep through the night more often. He was successfully weaned off his psych medications, and his mother hopes to be able to wean him off several others, including his seizure medications.

Early in February 2017, he returned to school. “One day I was like, He’s really irritable, he doesn’t feel good. So, I give him a little Tangerine and he’s smiling before he leaves for school,” Victoria remembered, “I checked in and they said that he was having a decent day. We weren’t having any decent days. I think it’s really going to change his life.”

The most extraordinary part is that Julian started to smile again for the first time in over half a year. “I know it’s early on… but this is the first time in a year that I’m seeing him smiling again. He’s reaching out and he’s looking for help, he’s trying to problem solve. He’s trying to keep himself under his weighted blanket or doing whatever he can to keep from hurting himself rather than going and doing it. He didn’t start asking for help until he started the cannabis therapy,” Victoria remarked, “This is not a band aid medication. This is a healing medication. This is not something that is going to have damaging side effects on his liver. It’s not going to cause organ damage and breakdown of his organs. It’s not going to have all these neuro-psychiatric side effects like the psych medicines do. I don’t want him on any of that. It’s not addictive like an opiate. But it’s going to manage his inflammation, his pain. And it’s helping his brain to make connections again. It’s so huge to me.”

As of May 2017, Julian goes every day without wearing his protective gear – helmets and arm guards – or harming himself. Julian doesn’t need to sleep with a weighted blanket anymore or have two people to hold his arms back throughout the day. He can spend time around his sister, family members, and friends once again. He attends school five days per week. He flashes his million-dollar smile many times each day and laughter is becoming more and more common. He continues to relearn phrases and words he hadn’t spoken in years. His mother and father can tell that Julian is not in the pain that he used to be – they can see it in his eyes, they can tell by the way he moves about their home. Victoria swears that without cannabis, her son would not be here with us today. She describes it as nothing short of a miracle.

Medical cannabis has provided hope for Julian and his family that they had once lost sight of. Julian has faced many obstacles along his health care journey, but he is resilient and it is clear there is so much life inside of him. He is curious and enjoys going to school, looking at photos, and watching the History Channel and Wheel of Fortune. When he smiles, he speaks with his eyes and you can feel his joy. He loves his family, swimming, climbing, and spending time outdoors in the summer running around barefoot. Victoria’s goal is to get Julian back to summer camp in 2017 where he can play in the mud, swim, and live his life like the teenage boy he is.

 

 

Press release from the MN Department of Health on adding autism to the list of qualifying conditions.

 

https://content.govdelivery.com/accounts/MNMDH/bulletins/1c8901f

 

 

News Release: Medical cannabis program to add autism and obstructive sleep apnea as qualifying conditions

Minnesota Department of Health sent this bulletin at 11/30/2017 11:03 AM CST

Medical cannabis program to add autism and obstructive sleep apnea as qualifying conditions

Minnesota Commissioner of Health Dr. Ed Ehlinger today announced the decision to add autism spectrum disorders and obstructive sleep apnea as new qualifying conditions for the state’s medical cannabis program.

“Any policy decisions about cannabis are difficult due to the relative lack of published scientific evidence,” said Commissioner Ehlinger. “However, there is increasing evidence for potential benefits of medical cannabis for those with severe autism and obstructive sleep apnea.”

This year, as in years past, the Minnesota Department of Health used a formal petitioning process to solicit public input on potential qualifying conditions. Throughout June and July, Minnesotans were invited to submit petitions to add qualifying conditions. The process included public comments, a citizens’ review panel and a set of research summaries for each condition prepared by Minnesota Department of Health staff.

Petitioners put forward a total of 10 conditions for consideration this year, including anxiety disorders, autism, cortico-basal degeneration, dementia, endogenous cannabinoid deficiency syndrome, liver disease, nausea, obstructive sleep apnea, Parkinson’s disease and peripheral neuropathy. There were also petitions to add cannabis delivery methods including infused edibles and vaporizing or smoking cannabis flowers. These requests were not approved.

Autism spectrum disorder is characterized by sustained social impairments in communication and interactions, and repetitive behaviors, interests or activities. Patients certified for the program because of autism must meet the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th edition) for autism.  The health department’s autism research brief (PDF) found a growing body of research indicating that the human body’s endocannabinoid system may play a role in autism symptoms. In support of adding autism, the review panel report (PDF) noted the lack of effective drug treatments, the potentially severe side effects of current drug treatments and anecdotal evidence of Minnesota children with autism already receiving benefits from medical cannabis taken for other qualifying conditions.

Obstructive sleep apnea is a sleep disorder involving repeated episodes of reduced airflow caused by a complete or partial collapse of the upper airway during sleep. Patients certified for the program because of obstructive sleep apnea must meet published diagnostic criteria for the condition, including interpretation of a formal sleep study.  Over time, sleep apnea can result in long-term health effects such as hypertension and cardiovascular problems, reduced cognitive function, decreased mood and quality of life, impaired performance at work and while driving, and even premature death. The review panel and the health department’s research brief (PDF) identified some scientific evidence of effectiveness of cannabis treatments. Continuous positive airway pressure (CPAP) is a very effective treatment already in use, but people with the condition often struggle to stick with that therapy.

Under current state rules, patients certified to have autism or obstructive sleep apnea will be newly eligible to enroll in the program on July 1, 2018 and receive medical cannabis from the state’s two medical cannabis manufacturers beginning Aug. 1, 2018. As with the program’s other qualifying conditions, patients will need advance certification from a Minnesota health care provider. More information on the program’s certification process is available from the Office of Medical Cannabis.

When the 2014 Minnesota Legislature authorized the creation of a medical cannabis program, the law included a set of nine medical conditions that would qualify a person to receive medical cannabis. State rules also direct the commissioner of health to consider the possible addition of other qualifying conditions and delivery methods. The list of current qualifying conditions includes:

• Cancer associated with severe/chronic pain, nausea or severe vomiting, or cachexia or severe wasting
• Glaucoma
• HIV/AIDS
• Tourette’s syndrome
• Amyotrophic lateral sclerosis (ALS)
• Seizures, including those characteristic of epilepsy
• Severe and persistent muscle spasms, including those characteristic of multiple sclerosis
• Inflammatory bowel disease, including Crohn’s disease
• Terminal illness, with a probable life expectancy of less than one year
• Intractable pain
• Post-traumatic stress disorder
• Autism spectrum disorders (effective July 1, 2018)
• Obstructive sleep apnea (effective July 1, 2018)

-MDH-

 

 

[Michiganmeds1982]

Have we made any positive movement on getting autism added here in michigan?

[t-pain]

very soon petitions to add more qualifying conditions including autism will be submitted to the state.

 

autism was approved by the michigan medical marijuana review panel , but was denied by the health department director here a few years ago. so they are going to resubmit the petition.

 

http://www.michigan.gov/documents/lara/lara_Final_Determination_Medical_Marihuana_Autism_08272015_498519_7_548732_7.pdf

is the letter the director wrote when denying the petition last time.