Post-traumatic stress disorder, or PTSD, is being added to the list of conditions covered by Minnesota's medical cannabis program, effective next August.

The expansion, announced Thursday by Health Commissioner Dr. Ed Ehlinger, adds an option for the estimated 8 percent of Minnesotans who, at some point in their lives, will suffer PTSD, a condition that can cause people to relive the emotion of traumatic experiences through panic attacks, nightmares and severe anxiety.

Minnesotans also petitioned to add arthritis, depression and six other conditions, but Ehlinger said the research to date didn't support the others as strongly.

"PTSD presented the strongest case for potential benefits and a relative lack of good treatment alternatives," said Ehlinger, who has discretion under state law to enlarge program coverage.

The medical cannabis program already covers seizure disorders, glaucoma, HIV/AIDS, Tourette's syndrome and intractable pain — which was added earlier this year and resulted in a surge of patients.

Roughly 3,500 Minnesotans with qualifying conditions are certified to receive medical cannabis, which for now is provided only in oil or pill form in the state. Ehlinger also said Thursday that the state will permit the use of medical cannabis in a topical form, such as patches or creams, starting next year.

PTSD's inclusion sets up a potential conflict with the U.S. Department of Veterans Affairs, which has concluded no convincing research exists to support the use of cannabis for the disorder. The agency doesn't permit its doctors to certify patients for its use or prescribe it.

If veterans go outside of their VA doctors to gain access to medical cannabis, it will not result in any loss of federal benefits or lack of access to VA care, according to a statement by Minneapolis VA Medical Center spokesman Ralph Heussner.

"In some cases, participation in state marijuana program may be inconsistent with treatment goals, and therefore VA clinicians may modify treatment plans for the health of the patient," the statement read.

Combat exposure is a particularly prevalent cause of PTSD. Studies have estimated from 10 percent to 25 percent of soldiers returning from deployments in Iraq and Afghanistan meet the criteria for the disorder.

The Minnesota Medical Association (MMA), the state's main physicians' organization, expressed caution about use and cited, as it has in the past, limited research on the effectiveness of medical marijuana.

"The MMA clearly supports efforts to improve care and outcomes for patients with PTSD," the group wrote in a statement. "However, patients with the condition frequently have co-occurring substance-use disorders, so we are concerned about adding it to Minnesota's medical cannabis program given the lack of well-controlled studies that prove its efficacy."

Ehlinger said he was swayed by research showing that cannabis "extinguishes the fear response" that PTSD patients would otherwise suffer when experiencing flashbacks of their traumatic events.

Heather Tidd, a member of the state task force that recommended PTSD and other conditions, said she was pleased that PTSD can now be treated on its own under the program. She said her son noticed reduced tremors from Tourette's syndrome after he started taking medical cannabis and also found that it reduced symptoms of his PTSD.

Tidd said she's concerned that all forms of medical cannabis could be jeopardized by the incoming administration of President-elect Donald Trump, whose vice president and key appointees are on record against it. Federal law still classifies marijuana as a tightly controlled Schedule I substance and prohibits its recreational or medical use. Current federal legal guidance permits state medical marijuana programs, but sterner legal interpretations and enforcement could change that.

"This has been life-changing," Tidd said of her son's medical cannabis. "We can't go back."

Ehlinger said the Trump administration could impose new rules, but that didn't dissuade him from expanding Minnesota's program now.

Minnesota has one of the most restrictive medical cannabis programs in the nation — requiring doctors to certify patients with applicable conditions and limiting production to two manufacturers. One of them, Minnesota Medical Solutions, hailed Thursday's decision as offering "new hope to an estimated 30,000 Minnesota veterans, as well as other survivors of traumatic and life-altering events, afflicted with PTSD."

Initial participation in Minnesota's medical cannabis program was less than expected, making it hard for the two manufacturers to stay in business. Ehlinger said that was not a factor in his decision.

"My role as health commissioner is to make sure we have a medical cannabis program that is as science-based as we can make it — that it is safe for the people who are using it," he said. "Whether the program grows or not is not the concern that I have."

Jeremy Olson• 612-673-7744