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Information on Medical Cannabis in Pennsylvania

Legislation

Legislation to establish a medical cannabis program in Pennsylvania was signed in April 2016. The law is intended to provide a mechanism for citizens with a valid medical condition to legally obtain and use cannabis.1

Patient Eligibility

To be eligible for the medical cannabis program under the original legislation, patients must meet criteria for one of 23 serious medical conditions, including autism, anxiety, opioid dependence, cancer, Crohn’s disease, multiple sclerosis, and post-traumatic stress disorder.1

State residents who are certified by a doctor to meet these criteria are able to purchase cannabis in one of the approved forms from a permitted dispensary. Cannabis will be available for medicinal use orally (e.g. pills, tinctures, and other liquids), topically (e.g. gels, creams and ointments), and via vaporization (e.g. oils, concentrates).3 Cannabis in leaf form was approved in April 2018 and will be available to patients for vaporization.2

Patient Demographics

As of May 15, 2020, over 297,317 people had registered to become certified as eligible for the program.2 All approved patients must register with the State of Pennsylvania1, but their socio-demographic characteristics are currently unknown.

Compared to the general population of Canada, for instance, those accessing medical cannabis through a government-sanctioned program were older, reported a heavier burden of certain chronic conditions (e.g. HIV, arthritis), had lower rates of mental health conditions4, and higher educational attainment.5 In states with medical cannabis laws, those using cannabis for medicinal purposes are more likely to be female, older, out of the labor force, and report higher psychological distress than those who use recreationally6. Demographic differences among types of patients (rather than compared with non-patients) are largely unknown.

Medical cannabis users experience a higher burden of medical problems, pain, and mobility issues than those who use cannabis recreationally and those who do not use cannabis at all.7,8 Compared to recreational users, medical cannabis patients report more pain and gastrointestinal, psychological, and neurological issues.8 

Medical users of cannabis generally report that they began using cannabis recreationally and noticed medicinal benefits of cannabis.9 In California, where the parameters to receive a medical cannabis recommendation are much broader than in Pennsylvania10, most patients report seeking a recommendation to treat a range of psychological and pain problems.8,11 Patient profiles in a state system with different qualifying conditions, such as Pennsylvania, may be different.

Patient Practices and Preferences

There is a need for more information on patient cannabis practices to address serious medical conditions and related symptoms. Patients prefer specific strains over others to treat their medical and psychological symptoms.5 They use cannabis to treat multiple conditions, most frequently for pain relief, to fight nausea and increase appetite, and for psychological problems such as anxiety and depression.5 Those accessing medical cannabis for pain relief often use it for psychological ailments as well, and vice versa.5 Additional research can capture the range of patient practices and preferences.

Patterns of use among patients vary by age, with younger patients reporting heavier12 and more problematic use.13 

Daily use of cannabis ranges from 64% of patients in a study conducted in California11 to 94% in a Canadian study.5 

A growing body of evidence indicates that people with access to medical cannabis often reduce or cease opioid use14–16, are less likely to use other substances7, and perceive cannabis use as safer than alcohol and other drugs.17 However, those who use cannabis in combination with other substances are more likely to exhibit problematic patterns of use.18 

Roughly half of patients report use of cannabis edibles and concentrates.12 Medical cannabis users generally state a preference for smoking cannabis flower as opposed to using it orally or through vaporization.5,12 Given the recent changes in Pennsylvania’s regulation that allow for use of cannabis in flower form, it is unknown which modes of administration or forms patients will choose, including whether to vaporize dry leaf cannabis (recommended) or smoke cannabis (not recommended).

Qualifying Conditions

There are now 23 qualifying conditions under which Pennsylvania residents may be certified to use medical cannabis.1,2 Some of these conditions have strong evidence to support its use, while others have weak evidence or are inconclusive.

A systematic review of the evidence for and against the effectiveness of medical cannabis found evidence to support the use of cannabis for chronic pain, nausea, multiple sclerosis, and insomnia.19 Evidence was weaker for cannabis use to mitigate HIV-related weight loss, Parkinson’s disease, and post-traumatic stress disorder, among others.20 

Clinical trials have found cannabis to help relieve HIV-related pain compared to a placebo21 and may help Crohn’s disease patients achieve remission.22 

While research indicates that cannabis may be an effective substitute for opioid use14-16, no studies have examined cannabis as a specific treatment for opioid dependence.

Further research is needed to draw conclusions about the effectiveness of cannabis to treat each qualifying condition outlined by the Pennsylvania law. No study has tracked patients and their symptoms upon enrollment and over a subsequent time period.

References

  1. Pennsylvania General Assembly. Medical Marijuana Act.; 2016. http://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2016&sessInd=0&act=1.
  2. Pennsylvania Department of Health, Medical Marijuana Advisory Board. Medical Marijuana Two-Year Final Report - May 15, 2020; https://www.health.pa.gov/topics/programs/Medical%20Marijuana/Pages/Advisory-Board.aspx . Accessed June 19, 2020.
  3. State of Pennsylvania. Pennsylvania Medical Marijuana Program. https://www.pa.gov/guides/pennsylvania-medical-marijuana-program. Published 2018. Accessed March 3, 2018.
  4. Capler R, Walsh Z, Crosby K, et al. Are dispensaries indispensable? Patient experiences of access to cannabis from medical cannabis dispensaries in Canada. Int J Drug Policy. 2017;47:1-8. doi:10.1016/j.drugpo.2017.05.046.
  5. Lucas P. It can’t hurt to ask; a patient-centered quality of service assessment of health canada’s medical cannabis policy and program. Harm Reduct J. 2012;9(1):2. doi:10.1186/1477-7517-9-2.
  6. Lin LA, Ilgen MA, Jannausch M, Bohnert KM. Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample. Addict Behav. 2016;61:99-103. doi:10.1016/j.addbeh.2016.05.015.
  7. Roy-Byrne P, Maynard C, Bumgardner K, et al. Are medical marijuana users different from recreational users? The view from primary care. Am J Addict. 2015;24(7):599-606. doi:10.1111/ajad.12270.
  8. Lankenau SE, Ataiants J, Mohanty S, Schrager S, Iverson E, Wong CF. Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev. 2018;37(2):237-246. doi:10.1111/dar.12534.
  9. Lankenau SE, Kioumarsi A, Reed M, McNeeley M, Iverson E, Wong CF. Becoming a medical marijuana user. Int J Drug Policy. 2018;52:62-70. doi:10.1016/j.drugpo.2017.11.018.
  10. Kleber, Herbet and Dupont R. Physicians and medical marijuana. Am J Psychiatry. 2012;169(6):564-568.
  11. Reinarman C, Nunberg H, Lanthier F, Heddleston T. Who Are Medical Marijuana Patients? Population Characteristics from Nine California Assessment Clinics. J Psychoactive Drugs. 2011;43(2):128-135. doi:10.1080/02791072.2011.587700.
  12. Lankenau SE, Fedorova E V., Reed M, Schrager SM, Iverson E, Wong CF. Marijuana practices and patterns of use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Depend. 2017;170:181-188. doi:10.1016/J.DRUGALCDEP.2016.10.025.
  13. Haug NA, Padula CB, Sottile JE, Vandrey R, Heinz AJ, Bonn-Miller MO. Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients. Addict Behav. 2017;72:14-20. doi:10.1016/j.addbeh.2017.03.006.
  14. Lucas P, Walsh Z, Crosby K, et al. Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev. 2016;35(3):326-333. doi:10.1111/dar.12323.
  15. Piper BJ, DeKeuster RM, Beals ML, et al. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol. 2017;31(5):569-575. doi:10.1177/0269881117699616.
  16. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668. doi:10.1001/jamainternmed.2014.4005.
  17. Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. A safer alternative: Cannabis substitution as harm reduction. Drug Alcohol Rev. 2015;34(6):654-659. doi:10.1111/dar.12275.
  18. Novak SP, Peiper NC, Zarkin GA. Nonmedical prescription pain reliever and alcohol consumption among cannabis users. 2016;159:101-108.
  19. Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: A clinical review. JAMA. 2015 Jun 23-30;313(24):2474-83. doi: 10.1001/jama.2015.6199.
  20. The National Academics of Sciences Engineering and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC; 2017. www.nap.edu.
  21. Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology. 2007;68(7):515-521. doi:10.1212/01.wnl.0000253187.66183.9c.
  22. Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM. Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. Clin Gastroenterol Hepatol. 2013;11(10):1276-1280.e1. doi:10.1016/j.cgh.2013.04.034.