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.

Approved conditions • Cancer with pain, nausea or vomiting • Glaucoma • HIV/AIDS • Tourette syndrome • Amyotrophic lateral sclerosis (ALS) • Seizures, including epilepsy • Severe muscle spasms and multiple sclerosis • Inflammatory bowel disease, including Crohn’s disease • Terminal illness • Intractable pain • Post-traumatic stress disorder • Autism spectrum disorders (effective July 1, 2018) • Obstructive sleep apnea (effective July 1, 2018)

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."