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Pennsylvania

Pennsylvania to consider more conditions that should qualify for medical marijuana

Natasha Lindstrom
| Tuesday, Dec. 4, 2018, 12:57 a.m.
FILE - In this June 26, 2017, file photo, Davis Cromar, center, holds his son Holden, 10, who suffers from epilepsy, while standing with other patients, caregivers and supporters during the Utah Patients Coalition news conference, in Salt Lake City. The Mormon church is backing a deal that would legalize medical marijuana in Utah, even if the ballot initiative fails in the November election. (AP Photo/Rick Bowmer, File)
FILE - In this June 26, 2017, file photo, Davis Cromar, center, holds his son Holden, 10, who suffers from epilepsy, while standing with other patients, caregivers and supporters during the Utah Patients Coalition news conference, in Salt Lake City. The Mormon church is backing a deal that would legalize medical marijuana in Utah, even if the ballot initiative fails in the November election. (AP Photo/Rick Bowmer, File)
In this Wednesday, Aug. 22, 2018, photo, marijuana samples are organized at Cannalysis, a cannabis testing laboratory, in Santa Ana, Calif.
In this Wednesday, Aug. 22, 2018, photo, marijuana samples are organized at Cannalysis, a cannabis testing laboratory, in Santa Ana, Calif.

Pennsylvania could soon make more conditions eligible for medical marijuana treatment.

The state Medical Marijuana Advisory Board approved a new process for amending and expanding the state’s list of 21 serious conditions for which patients may use cannabis as treatment, Department of Health spokesman Nate Wardle said.

In the coming weeks, the board will begin accepting research-based petitions for qualifying conditions to be added to the list, with tentative plans to discuss and vote on the first round of submissions during its next meeting Feb. 1.

Cannabis for anxiety, depression?

Patient advocates say they’re hopeful the change will extend eligibility to patients who have medical issues that could benefit from cannabis but remain excluded from obtaining it legally — such as those grappling with depression, anxiety and insomnia.

“Pennsylvanians have been using marijuana illicitly for years to treat a wide variety of conditions not on the state list,” said Dr. Roxanne Rick of Cannabis Care Certification Centers , which aims to offer people an alternative to opioids for the treatment of pain and addiction.

Since medical marijuana became available in Pennsylvania in February, the four-doctor organization has helped more than 1,000 patients with qualifying conditions get certified via offices and mobile outreach in Uniontown, Monroeville, Bethel Park, Delmont and State College.

Most patients turning to medical marijuana have sought help for the qualifying conditions of chronic pain and post-traumatic stress disorder, Rick said. Some are able to obtain a card to assist with an issue such as migraines — which isn’t on the list — if a physician describes their migraine problem as chronic pain, or recurring pain that lasts more than 90 days. Others benefit from marijuana as relief for a nonlisted health issue such as anxiety only because they also have a qualifying condition such as chronic pain.

“We definitely do get people calling us who we know would benefit from the medical marijuana, but they don’t fall into those 21 slots,” said Dr. Elizabeth Spaar of Verona-based Spectrum Family Practice, which focuses on treating children and adults for addiction, autism and PANS/PANDAS infection-induced autoimmune conditions. “Anxiety is a common one. It’s pretty well-established that marijuana is very helpful for treating anxiety, but it is not a qualifying condition, and so if they don’t have another qualifying condition to go along with it, we can’t offer it to them, which is extremely frustrating.

“In particular, I would really love to see anxiety, depression and ADHD added,” Spaar said.

Dr. John Metcalf , medical director of Releaf Specialists, which hosts clinics in Brookline, Monroeville, Washington and the North Hills, said medical marijuana could be extended to help not only non-listed mental health issues but also many types of physical issues, from migraines to Lyme Disease.

“As we expand the list, that’s to the benefit of the patient,” said Metcalf, who shifted his focus to helping certify medical marijuana patients after retiring from a 30-year career in primary care, urgent care and occupational medicine.

Metcalf and Spaar noted that Pennsylvania is among less than a handful of states that included autism on its medical marijuana list, with children typically taking cannabis in tincture or capsule form.

“There are a lot of states where autism parents have been working very hard to get it included on the list and have not been successful, so we are fortunate in that,” Spaar said. “It’s extremely helpful for the aggression and rage that those kids can get, it’s also very helpful for obsessing …They tend to have a lot of stress, a lot of anxiety, and when they’re able to calm a lot of that down, they tend to make progress and develop mentally.”

In the spring, the state board added terminal illness and opioid addiction to the list of qualifying conditions.

“With the opioid dependence patients, we’ve certainly had patients who were on methadone or suboxone who have been able to get off of those and purely have medical marijuana,” Spaar said. “We’ve had others going straight off opiates with the medical marijuana, because it does help with the full gamut of withdrawal symptoms, and they’ve just reported a significant improvement in the quality of life.”

Physicians want more say

Several Western Pennsylvania doctors who prescribe medical marijuana said the new process for amending the state list is encouraging — but they also lamented that it doesn’t go far enough in terms of expanding access to cannabis and giving more authority to the physicians who prescribe it.

“I would love if it if they would recognize the autonomy in medical decision-making of a physician instead of placing restraints on us,” Spaar said.

In California, for instance, doctors can recommend medical marijuana to patients based on a list of conditions or “any other illness for which marijuana provides relief.”

“It makes sense to me that a patient’s personal physician should be able to review the research and the diagnosis with the patient to make the decision of whether it’s a viable treatment option for them or not,” Metcalf said.

Advocates remain skeptical of how difficult it will be to get a new condition approved.

Under the new process, whose terms are being finalized and will be posted to the Department it Health’s website later this month, a subcommittee of the state board will review petitions for conditions submitted at least 15 days in advance of one of the state advisory board’s quarterly meetings, Wardle. The proposal will then be discussed and voted on during the meeting.

In approving the board’s recommendation, Pennsylvania Health Secretary Dr. Rachel Levine said that as more research becomes available regarding “the efficacy and utility of medical marijuana as medication,” expanding the list may be appropriate “to provide relief to patients and access to a dug that may be the only course of treatment or palliative care available.”

The change is “fairly unique to Pennsylvania” and stems from a recommendation cited in the board’s May report, Wardle said.

It’s unclear just how much research and evidence the subcommittee will require to approve a new condition or how long it will take until patients with the newly approved condition can obtain medical marijuana cards. The board is unsure of how many petitions to expect, Wardle said.

Medical marijuana is legal in at least 32 states, though marijuana in any form remains an illegal controlled substance under federal law. That has severely limited U.S. research on its effects.

“Pennsylvania has done things that other states haven’t even come close to, such as autism as a condition, and we’re the only state in the union that has allowed eight medical schools” to begin using marijuana for medical research, Metcalf said.

Gov. Tom Wolf signed the bill legalizing medical cannabis into law April 2016.

Dispensaries began selling medical marijuana in pills, oils, tinctures and ointments in February, and then in dry leaf, or flower, form on Aug. 1 . The state Department of Health regulates the program, which still prohibits patients from smoking dry leaf marijuana. It must be vaporized.

As of this month, more than 87,000 patients and nearly 10,000 caregivers have registered for the state’s medical marijuana program and more than 56,700 patient certifications have been issued ,Wardle said.

Nearly 900 of more than 1,300 physicians who registered with the program have been approved as prescribers.

The state’s 40th medical marijuana dispensary opened two weeks ago, Solevo Wellness-Jackson Pointe in Zelienople.

Next year’s meetings of the state Medical Marijuana Advisory Boardwill be held Feb. 1, May 15, Aug. 14 and Nov. 13, 2019.

For more information, call (717) 547-3047 or email RA-DHMedMarijuana@pa.gov. Comments also may be submitted to the Pennsylvania Office of Medical Marijuana, Department of Health, Room 628, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, nlindstrom@tribweb.com or via Twitter @NewsNatasha.

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