Cassie Traun, a 24-year-old IT worker from St. Paul, went to the Capitol about a dozen times in April and May to lobby for medical marijuana.

She sat before committees of lawmakers, and even confessed to buying and using the drug illegally because she's convinced it effectively treats her Crohn's disease.

This week Gov. Mark Dayton is expected to sign a bill legalizing marijuana for about 5,000 Minnesotans, including sufferers of Crohn's, an inflammatory bowel disease.

But Minnesota's new law will not allow patients to possess or smoke marijuana in its plant form. For that reason, Traun and some of the medical users who fought hardest for the laws passage, have decided they won't participate in the new state program.

"They're asking me to remain a criminal if I want to continue the treatment plan that I like, and that my doctor approves of," Traun said.

Her plan for now is to keep buying marijuana from a black market dealer.

Under Minnesota's new law, eligible patients will be able to use marijuana only in oil or liquid forms. Some patients like Traun worry that marijuana-based oils are more potent and likely to intoxicate than are the plant's leaves and buds — a concern backed up by experts.

By denying patients access to plants, and prohibiting smoking of the drug, Minnesota will be unique as it becomes the 22nd U.S. state to legalize marijuana as a treatment for some afflictions. While the wider medical community remains split over the benefits of medical marijuana, several prominent doctors who have made the medicinal qualities of the cannabis plant a focus of their work are skeptical about the details of Minnesota's program.

State program 'different'

"All the other medical cannabis programs in the country are going to be watching what happens in Minnesota very carefully, because it's so different and unique," said Dr. Steven Jenison, a physician who was the first medical director of New Mexico's seven-year-old program and later chaired its medical advisory board. "There are aspects that are intriguing, but also aspects that a lot of us consider to be a bit mystifying."

Cannabis-based liquids are common for treating children with severe epileptic seizures; certain compounds of the plant are mixed with olive oil and administered orally. Parents of some of those children were among the most visible lobbyists for Minnesota's law.

But adult patients with conditions including Crohn's and other diseases also lobbied hard for the bill. Many wanted access to the medicinal qualities of the whole plant. When the active ingredient is extracted and condensed, it becomes a substance known on the black market as "hash oil." That oil can then be loaded into a vaporizer, where it is heated to a point short of combustion, then inhaled.

"A lot of patients dose the plant in minimal amounts. They're not trying to get high, they're trying to achieve symptom control," said Dr. Sue Sisley, a psychiatrist who has been conducting research at the University of Arizona into marijuana's possible benefits for post-traumatic stress disorder sufferers. "Why would they subject themselves to something far more toxic, something much more likely to make them intoxicated?"

Oil issues

Sisley said that anecdotal reports from users of the oil have found "reports of altered mental states, feeling emotionally blunted, zombielike." Lack of formal research has also meant little reliable information on what constitutes a safe, effective dose.

Traun was diagnosed with Crohn's when she was 16. The disease causes inflammation of the intestinal lining, which frequently leads to abdominal pain, bouts of nausea, severe diarrhea, weight loss and malnutrition.

For several years after diagnosis, Traun tried a series of pharmaceuticals that included steroids, a drug called Imuran used to help prevent transplant patients from rejecting new kidneys, and finally Remicade, an antibody partly produced from mouse DNA. None delivered long-lasting benefits and some had brutal side effects.

During her freshman year in college, Traun's symptoms worsened. For several months, she couldn't keep food down and survived on a liquid diet. She lost 30 pounds.

"That's when I tried cannabis," Traun said. "I actually started as a recreational user, but I quickly found that after I used it I was actually able to eat a little bit. A few months later I was in remission, and that's how it's been for five years now."

Traun said blood tests since showed year-over-year lessening of her intestinal inflammation, although she still suffers occasional nausea. She used to smoke marijuana, but more recently switched to a vaporizer. Traun said she also keeps a supply of hash oil on hand because it helps allay particularly severe instances of nausea, but she doesn't want to have to use it regularly.

"People say marijuana treats the symptoms but not the disease," Traun said. "But I believe it's treating my disease itself. I believe I have to vaporize daily to stay in remission."

Traun is not the only person who lobbied for the medical marijuana law and is eligible to join but leaning against it. Under the law, patients who enroll in a registry administered by the Department of Health will have their usage and outcomes monitored in what's being described as "observational research." The goal is to get patients access to the drug starting July 1, 2015.

Access at a price

But there's one big catch for those who already partake.

Patients who enroll in the program face greater legal jeopardy if they supplement with illegal plant marijuana.

Possession of small amounts of marijuana is a petty misdemeanor, but participants in the new program caught with the plant form can be jailed for up to 90 days, fined $1,000 and expelled from the program.

"I think I'm going to have to stick with my current arrangement," said Patrick McClellan, a 47-year-old Bloomington resident who treats severe pain from muscular dystrophy by vaporizing plant marijuana that he buys illegally.

He was a fixture at the Capitol while lawmakers debated medical marijuana earlier this year, and was among a group of advocates who met privately with Dayton in March.

"If I were to get into this program, and I get the oil and it's way too powerful and then I decide to go back to leaf, I could be prosecuted," McClellan said.

When McClellan feels symptoms starting, he puts a small amount of leaf marijuana in his vaporizer and takes one or two light puffs.

He's worried if he were forced to vaporize oil, "I would get stoned out of my mind. Patients don't want to be high. We just want to treat our symptoms."

Kendra Miller, a 26-year-old registered nurse and Crohn's sufferer from St. Louis Park, also lobbied at the Capitol multiple times.

She said that if the new law offered access to plant marijuana, she'd probably surrender her nurse's license and enroll. Miller does not believe the state would allow her to keep her nurse's license and be in the program.

"I don't believe this plan has enough of a likelihood of working, that doing that would be worth it for me," she said.

According to the Washington-based Marijuana Policy Project, which lobbies for legalization of marijuana for both medical and recreational purposes, the other 21 states with medical marijuana laws all allow patients to possess and smoke plant material. Fifteen of those states allow patients to grow their own plants.

Strict controls

Minnesota will feature one of the tightest distribution systems nationwide, allowing only two manufacturers and eight dispensaries statewide. Arizona, which approved medical marijuana by voter initiative in 2010, had 71 dispensaries by late 2013. The Illinois General Assembly last summer passed a law authorizing 60 dispensaries. Nevada's Legislature approved up to 66 dispensaries last year and New Mexico has 23 distribution sites.

Minnesota will also allow fewer eligible conditions than most other states: Cancer with certain symptoms; glaucoma; HIV/AIDS; Tourette's syndrome; Amyotrophic Lateral Sclerosis (Lou Gehrig's disease); seizure-inducing epilepsy; severe and persistent muscle spasms including those brought on by multiple sclerosis or muscular dystrophy; Crohn's disease, and terminal illness with a life expectancy of less than a year or which causes severe pain, nausea, severe vomiting or wasting.

Advocates had pushed for a more expansive Minnesota law that would have permitted plant marijuana, a wider distribution system and more eligible conditions. But Dayton insisted on a bill that was not opposed by law enforcement and the medical community. Law enforcement in particular opposed legal plant possession and smoking.

Sisley, the marijuana researcher at the University of Arizona, said she hopes Minnesota's program works. She said she would advise state health officials, as they build the program, to involve top researchers from around the country.

Miller said that while she doesn't intend to enroll initially, she will be watching closely as Minnesota's program rolls out.

"I do want there to be a workable law here," Miller said. "I think it's a matter of waiting and watching to see if people who do enroll will get access and find relief."

Patrick Condon • 651-925-5049