- Associated Press - Monday, November 23, 2015

Star Tribune, Nov. 20

Minnesota must strike a balance on medical marijuana and pain

It’s a safe bet that Minnesota’s Advisory Panel on Intractable Pain would have vetoed the state’s entire 2014 medical marijuana law if its cautious members had been given a chance.

Thankfully, the panel’s assignment was limited to making a recommendation on the addition of “intractable pain” to the state’s current nine approved medical uses of the drug. On that question, the panel’s eight members recently declined to deliver. Their rigid decision denies Minnesotans the flexibility to decide with their doctors whether medical marijuana is a good alternative to powerful but risky prescription pain drugs.

Minnesota Health Commissioner Ed Ehlinger will take the panel’s recommendation into account as he makes the final decision before the end of year. The panel’s advice shouldn’t box in Ehlinger. He should consider it with care, but with an eye toward striking a balance between members’ concerns and the Legislature’s willingness to give Minnesotans in need a treatment alternative.

In saying no, the panel ignored the pleas of hundreds for whom other treatments are ineffective or have troubling side effects. Among those seeking an alternative: the family of little Elisa McCann, a St. Paul 2-year-old who suffers from a rare condition that causes her skin to blister at even the slightest touch.

The panel also dismissed multiple medical studies suggesting that the drug has value in treating chronic pain and spasticity. While these studies are far from robust, the evidence supporting the drug’s use for this purpose is stronger than it is for many of the uses the state has already approved: AIDS or HIV, Crohn’s disease, Tourette syndrome, glaucoma, ALS, seizures, muscle spasms, and cancer or a terminal illness that is accompanied by pain or wasting disease. The law allows marijuana only in pill or liquid form.

The panel members had good intentions. They wanted more research on the drug’s dosing and effectiveness. Their point is legitimate. Much more study is indeed needed of marijuana’s use in medicine.

But the toxic politics of marijuana have long prevented research from being done and will continue to do so. In the meantime, it’s well-accepted in medicine that pain can be difficult to treat and that patients do not respond to pain medications uniformly. What the Minnesota law does is allow doctors to decide on a case-by-case basis whether medical marijuana may be useful. It’s worth noting that doctors commonly recommend off-label use of many drugs to treat conditions for which data may be lacking.

It’s also unclear how much weight the panel gave another important public health concern: the risks of powerful opioids such as OxyContin. The number of deaths linked to their use is considered an epidemic. A 2014 study suggested that prescription drug overdose deaths decreased by 25 percent in states after medical marijuana laws were passed.

If Ehlinger agrees with the panel and rules out medical marijuana for pain, it’s likely that advocates will be back at the Legislature arguing for wide access to the drug. Ehlinger could head off that battle by making some uses allowable - such as neuropathy or rare conditions such as Elisa’s - while attaching preconditions for use that require other remedies to be exhausted first. Doing so would be a compassionate compromise.

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St. Paul Pioneer Press, Nov. 21

If it must be spent, spend it on roads

More tax dollars than expected - the product of economic gains and, we argue, too much taxing - continue to accumulate in state coffers. We’ll know more next week, when Minnesota’s next budget and economic forecast is released.

The results likely will spark new skirmishes in the battle over how to spend the surplus. Our position is consistent: restraint, at the very least.

Rolling back the recent tax increases would be better.

In any case, we’ve observed that using one-time surplus dollars to fund ongoing government programs is like using a windfall for a new cable-TV plan with hundreds more channels that will amount to a bigger bill month after month. Better to fix the roof. In the state’s case, why not the roads?

It makes good sense to do so, Rep. Alice Hausman, ranking Democrat on the House Capital Investment Committee, told us.

Based on a House budget reserve and cash-flow estimate, and after accounting for the funding shifts prescribed by law, the St. Paul lawmaker said the state still will have a projected balance of nearly a billion dollars.

“We know that transportation infrastructure is essential to the economic health and competitiveness of the state,” Hausman told us, “so it’s a responsible way of using what could be one-time money.”

Further, use of such funds for transportation infrastructure “doesn’t add to the budget burden,” she maintains. “In fact, it takes off a huge burden in the future, should we have an economic downturn.

The problems are evident, and we need only look east from downtown St. Paul to see one of them, the Third Street bridge connecting Kellogg Boulevard to the East Side. Its outer lanes are out of service after discovery of a design flaw that dates back to its construction in the 1970s. Reports have listed its replacement cost at $40 million.

We’re not alone. St. Paul Mayor Chris Coleman has met with city leaders from across the state in an effort to advocate for more funding for road repair.

“We’ve never seen as many bills introduced for specific transportation projects” as in the last couple of years, Hausman told us. “That tells me that people all over the state are feeling the stress.”

While wear-and-tear mounts, other funding options apparently are out of the running. “I absolutely do not believe we’re going to raise either the gas tax or the sales tax” this election year, Hausman said.

There’s also misunderstanding about “the limits of the bonding bill,” which Hausman maintains should be reserved for traditional projects ranging from construction and maintenance needs at the state’s higher education institutions to wastewater infrastructure.

“Thinking that the bonding bill is going to solve our transportation problems misunderstands both the pressure on traditional bonding and the pressure that we’re feeling in transportation,” she said.

House Speaker Kurt Daudt told us he expects the projected billion-dollar surplus will grow slightly in the months before the session begins in March. With the cushion, “we do have some flexibility,” he said, to talk about infrastructure and funding it, a Republican priority, along with tax relief.

In addition, lawmakers approach the session without shutdown pressures or budget deadlines. If they can’t agree, “anything we leave unspent will simply sit on the bottom line,” Daudt said.

When it comes to timing, we posed an idea to Hausman and other key observers: Why not set the dollars aside to spend later, reasoning that - in the event of an economic downturn - construction work could be had for a better price and projects would provide jobs for those who need them.

“The timing would confuse Minnesotans,” Hausman told us, “because they are desperate for these projects.”

Peter Nelson of the Center of the American Experiment also has some reservations: A larger budget reserve should help smooth out the surplus-deficit cycles the state has experienced. It should help avoid the need for the education shifts and other budget gimmicks used in the past to help balance the budget.

As for our save-now-spend-later approach, it’s not a good idea, he said, “to think that all of a sudden we should be expanding our spending” when a cycle turns down.

If lawmakers do spend the surplus, it should be “on something where you get a high value, without creating an obligation” that will require continuous funding when you hit the next downturn, University of St. Thomas economics professor John Spry told us.

Lawmakers risk just such a scenario as they consider universal pre-K, Spry warns, noting that it amounts to a “new commitment by the state to spend indefinitely.”

Surplus dollars for transportation don’t have those long-term strings attached.

If they do choose to spend, the opportunity to address statewide needs with one-time dollars that produce lasting benefits could be compelling for lawmakers. The bottom line for Hausman: “You could do a lot with that cash on the bottom line.”

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The Free Press of Mankato, Nov. 23

Autism Issue: Condition not linked to criminal acts

The good news about the outcome of the John LaDue alleged bombing case was that the courts and legal system recognized the troubled young man needed help and not prison time for his autism spectrum disorder.

The bad news is that the high-profile case may have created a dangerous misunderstanding of autism and its cause and effect on a number of behavioral problems.

As experts pointed out in an in-depth Free Press story last week, autism is not the cause of violent behavior. Many people with autism spectrum disorder can live very normal lives and be taught to use strategies that help them overcome the sensory deficiencies that can come with autism.

While it may appear in many criminal cases that violent behavior was committed by a suspect with autism, it does not mean the two are linked, especially directly.

Experts say people suffering from autism often have difficulty reading another person’s body language and sensing emotions, and this makes it difficult to respond appropriately in social settings. When others see these somewhat muted or confused reactions by people with autism, they tend to ostracize or isolate them, and that, in turn can lead to other isolating behaviors, one being violence.

James Gilbertson, the court-appointed forensic psychologist in the LaDue case, testified that autism spectrum disorder of LaDue contributed to his actions that caused him to be assessed as a public safety threat. Gilbertson agreed that autism alone was not the cause of LaDue’s violent thoughts. He notes, however, that many of the suspects in these kinds of cases have autism in some form and therefore more research is needed on the connections between violent behavior and autism. Autism coupled with another mental illness may together create violent thoughts, though mental illness was not a factor investigated in the LaDue case.

Autism is considered medically a developmental disability that can cause social and behavioral problems, but it is not considered a mental illness.

Those who advocate for autism education make a good case to not further ostracize those who suffer from autism by assuming autism comes with violent behavior. The Free Press report noted that one person with autism worried that such news accounts that connect autism to violent behavior would make it even more difficult for people with autism like him to exist in normal social circles. He worried he would lose his friends because of the LaDue report that seemed to link autism to violent behavior.

That may be the biggest reason for all of us to make the effort to understand this complex condition and welcome those who struggle courageously to overcome it.


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