NEW YORK (MainStreet)  Minnesota, which has just passed its first medical cannabis legalization legislation into law, is already facing pushback from patients and patients' rights groups for the highly restrictive regulatory mandate.

"Minnesota's medical marijuana law is very disturbing from a patients' rights perspective," said Kris Hermes, spokesperson for Americans For Safe Access, a national patients' rights group. "It excludes significant numbers of patients or even criminalizes many of them."

The new law allows for a narrow range of medicinal use, and authorizes only manufactured cannabis oils and pills manufactured in-state by only two (yet to be licensed or constructed) manufacturing plants. The end products will only be available from a mere 8 dispensaries state wide.

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Many activists and advocates are concerned that such a restrictive bill will have a huge and negative impact on patients who often turn to medical cannabis as a medicine of last resort for a long list of chronic ailments.

"The biggest impact of Minnesota's law on patients is that they will not be able to cultivate their own medical marijuana and if they are found possessing the dried plant they will be in violation of state law and could be prosecuted," Hermes said. "Most importantly, patients are prohibited from smoking medical marijuana, which is the most common of consumption. This, alone, will exclude huge numbers of patients and unnecessarily criminalize them."

Of concern to national groups, says Hermes, "Minnesota went even further [than other states] by restricting the method of consumption used by patients. Only the legislature knows why smoked medical marijuana was singled out, but it is likely due to unfounded and misperceived health concerns. It certainly wasn't developed with the input and feedback of patients."

And to many activists and advocates, it is this aspect of the bill that raises the most concerns.

Heather Azzi of Minnesotans for Compassionate Care, a state advocacy group, shares Hermes' perspective of the problem and its cause. "To make a long story short," she said, "this was a political solution to a policy problem."

Passage of the legislation was marked by ongoing disagreements between Governor Mark Dayton and the legislature resulting in a bill created more from acrimonious political posturing than a focus on patients' needs.

"Policymakers should be including the voices of patients in developing these laws so that they better meet their needs, and ultimately implement more effective programs," Hermes said.

Azzi shares these concerns. "There is widespread concern now among the advocate and patient community that the current law only protects about 5,000 patients with very specific medical conditions," she said. "Over 33,000 patients with a much longer list of ailments have now been left without access to medicine they need."

This extremely narrow access has already caused talk of boycotts within the medical user community, although there is as of yet no organized attempt to enact them. What seems to worry advocates most is the prospect of an unofficial boycott and that the majority of even qualifying patients in the state will take matters into their own hands.

"Many patients are reluctant to enroll in the program because they are afraid that the increased penalties contained in the law will apply to them if they find that the oils do not work and they are forced to return to the illegal market to purchase cannabis," Azzi said.

Hermes agrees.

"It's hard to tell whether a patient boycott will get the state to change its medical marijuana law, but it certainly indicates a significant level of dissatisfaction," she said. "I suspect that most patients will continue to use medical marijuana in smoked form, since that's what works best for them. Regardless of whether this is seen as a boycott, it's likely that patients will ignore the program to seek out dried marijuana on the illicit market and risk arrest."

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There is also a huge concern about access. Doctors in hospitals and other larger medical institutions who must write prescriptions are also now currently widely precluded from even prescribing cannabis to state-qualified patients by policies implemented by their employers, not the state. This along with a limited production and resulting supply will, advocates fear, create even more problems starting with how and when the law could be expanded to cover new conditions. Under current law in Minnesota, testing cannabis on people is currently illegal, so even research programs like the one underway at the University of Minnesota testing the drug's efficacy on people with Sickle Cell Disease will take years to implement under the current regime. Researchers are currently being forced to conduct experiments out-of-state in California.

According to Azzi, limited access and production is also already creating additional concerns about cost. "Patients are concerned that such a limited program will be prohibitively expensive," she said. "Health insurance will not cover the medical cannabis products or the associated doctor visits required for observational research."

Hermes concurred. "There will be shortages and waiting lists like there have been in other states with such limited production," she said. "With only two [manufacturing facilities], Minnesota's program just may be the most limited so far."

Some believe that medical cannabis obtained via this highly restrictive production and distribution program might be as much as 40% more expensive than in other states.

For the time being, however, medical patients in Minnesota do not have much chance of seeing fast change to a new law many believe does not go far enough in the first place.

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"Voters in Minnesota have no authority to force an issue to appear on the ballot by petitioning or collecting signatures," Azzi said. "To qualify for a vote, both chambers of the legislature must vote to send the question to the ballot. I think there is a possibility that legislators could use this mechanism to improve the medical cannabis program, but I think that it is much more likely that they will use the traditional legislative process to make the necessary improvements."

If there is one thing that the advocacy community agrees upon it is this: Minnesota may have taken its first steps into legalizing cannabis for medicinal purposes but it will not be the last. And in the meantime, the vast majority of patients in state may be tempted if not forced to continue to access medical cannabis in forms and via channels that are still outside the law.

--Written by Marguerite Arnold for MainStreet