From politicians and policy makers, to the everyday public, few topics create the same level of controversy as medical marijuana.
Questions abound such as, should it be legalized, is it safe to use, and does it actually work to treat certain illnesses?
Medical marijuana sales in 2019 were estimated to be $5.2 billion and U.S. medical marijuana retail sales are expected to increase dramatically in the coming years, with retail sales generating up to 8.4 billion by 2023.
“As of February, 2020, there were 168,000 active card holders and 75,000 patients visiting dispensaries per week in Pa, according to the (Department of Health),” said Peter Marcus, communications director at Terrapin Care Station, a consumer-focused cultivator, processor and provider of medical and retail cannabis products.
What is medical marijuana?
According to the National Institutes of Health (NIH), National Institute on Drug Abuse, and the U.S. Department of Health and Human Services, the term “medical marijuana” refers to using the whole, unprocessed marijuana plant, or its basic extracts, to treat symptoms of illness and other conditions.
“The medical cannabis flower by itself is no different than the marijuana flower overall. The plant does not know that it is a medical plant. It simply knows that it is a marijuana plant. Where the difference comes in is in the formulation of products. Through production and processing, marijuana is formulated for a variety of medical impacts. Some strains work better on neurological conditions and therefore make for better oil processing for things like seizures. Some strains work better on anxiety. Some medical patients need high-potency THC, some need less THC potency with higher levels of CBD, the non-psychoactive ingredient in marijuana. When we refer to medical-grade marijuana, we’re referring to a wide spectrum of specially formulated products. In the end, however, it all comes from the same plant, and that plant doesn’t know that it has been designated “medical,” Marcus said.
While the use of marijuana products has become popular to treat various illnesses in the United States, it has still not been approved by the U.S. Food and Drug Administration (FDA). This is because clinical trials have not been conducted on a large enough scale to classify it as a medication. The FDA has, however, approved two medications that contain cannabinoid chemicals and, because of its popularity, many states have legalized marijuana for certain medical uses.
What are cannabinoids and what are their uses?
Cannabinoids are chemicals related to tetrahydrocannabinol (THC), the main ingredient in marijuana that people use to get “high” or euphoric. The marijuana plant contains more than 100 of these cannabinoids. The human body also creates cannabinoids, which play an important role in things such as memory, pleasure appetite and the senses.
The cannabinoids THC and CBD, that are derived from the marijuana plant, are particularly interesting to researchers. According to the NIH, THC has been shown to increase appetite and reduce nausea. In addition, it may also decrease pain and inflammation, and help to treat other medical issues. Cannabidiol (CBD), another cannabinoid, does not offer the same euphoria as THC, but does show promise in reducing pain and inflammation, as well as controlling epileptic seizures and possibly even in treating certain addictions.
In Pennsylvania, the following 23 serious medical conditions that have been approved for medical marijuana treatment are:
- Amyotrophic lateral sclerosis;
- Anxiety disorders;
- Cancer, including remission therapy;
- Crohn’s disease;
- Damage to the nervous tissue of the central nervous system (brain-spinal cord) with objective neurological indication of intractable spasticity, and other associated neuropathies;
- Dyskinetic and spastic movement disorders;
- HIV / AIDS;
- Huntington’s disease;
- Inflammatory bowel disease;
- Intractable seizures;
- Multiple sclerosis;
- Neurodegenerative diseases;
- Opioid use disorder for which conventional therapeutic interventions are contraindicated or ineffective, or for which adjunctive therapy is indicated in combination with primary therapeutic interventions;
- Parkinson’s disease;
- Post-traumatic stress disorder;
- Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain;
- Sickle cell anemia;
- Terminal illness; and
- Tourette syndrome.
Marcus also noted that Pennsylvania has adopted medical marijuana qualifying conditions for PTSD and opioid dependency.
“We have seen remarkable impacts from medical marijuana. Veterans have found it to relieve them of trauma. Opioid dependency has seen as much as a 6-8% drop in legal marijuana states. Children have curbed seizures. Mothers have reported almost miraculous impacts on their child’s autism. There are many reasons people turn to medical marijuana. Sometimes it’s for life-saving reasons, sometimes it’s simply to improve quality of life.”
How does a person get medical marijuana?
In Pennsylvania, getting medical marijuana involves four steps.
- Register for the program through the Medical Marijuana Registry.
- Have a physician certify that you suffer from one of the medical conditions that qualify for medical marijuana.
- Pay for a medical marijuana ID card.
- Get medical marijuana from an approved dispensary in Pennsylvania.
“To obtain medical marijuana, it is not considered a ‘prescription.’ It is considered a patient certification. To do so, prospective patients must visit an approved doctor in Pennsylvania who can issue a patient certification. Once someone is certified, they may visit any number of dispensaries across Pennsylvania to purchase products, or they can connect with up to two caregivers who can provide cannabis medicine for them,” Marcus said.
The caregiver can pick up medical marijuana on behalf of their patient, who must be 18 or older and qualify for one of the 23 conditions approved by the state.
However, Marcus added that minors also may get medical marijuana through a caregiver, or parent or guardian.
Dr. Mona Chang is a local family physician qualified to certify for medical marijuana and is affiliated with the Cornerstone office of Family Practice Center.
“We don’t really prescribe it,” Chang said. “Once they get their card in the mail, they visit a dispensary, which may require a one-hour appointment with the pharmacist initially, and then purchase whatever they want.”
There are dispensaries in Williamsport, State College, Bloomsburg and Selinsgrove, locally.
Chang said some people can take medical maijuana during the day and still function, but it should not be used during pregnancy or before driving a vehicle.
“Most take it at night and find it helpful for sleep,” She said. “Most people do feel better and find something that works; but there are some who get more anxious, nauseous or hallucinate, but hallucinations are rare.”
When asked if there were any reasons why a person should not use medical marijuana to treat one of the approved conditions, Marcus repplied, “We have not seen any reasons not to use cannabis for any of the approved medical conditions. That said, everyone is different. We encourage people to first start low and go slow. Experiment with a handful of products to see what formulation works best for you. As research on this subject expands, we will have more data to fuel conversations around medical marijuana. So far, we have seen great success, which is why health officials are working to expand the program. The biggest problem with Pa’s medical marijuana program has been a shortage of product. That’s because in the beginning, the Department of Health (DOH) wanted to slowly roll out products. There were prohibitions on what we could sell, like whole flower, and limits on how much product we could grow. As the DOH has realized, the incredible success of the program, and patient demand has increased, there has been a willingness to expand the program. So, we’re seeing the opposite of contraindication. We’re seeing indication, a reason to use this treatment for a wide population.”
How has public perception changed over the years?
Unlike marijuana grown illegally and sold on the street, growers, processors and distributors of medical marijuana must be approved by the state, Chang said.
“It’s chemically analyzed so you know the percentage of the many different chemicals in marijuana. It’s not just THC and CBD, but the terpenes can be helpful as well. It also comes in various forms: it can be vaped, taken under the tongue, applied topically for a localized condition or swallowed as a pill. Smoking and edibles are not legal at this point. You can find the complete list of approved indications on the DOH website, but I mostly see people using it for chronic pain and anxiety.”
Marcus said the change in public perception has been night and day, with 90% support in national polls and from two-thirds of Americans.
“The legalization movement has more or less won. Concerns from opponents that the sky would fall never came true, and Americans began to realize the impact of a failed drug war,” Marcus said.
Marcus boasted success around the world, as medical marijuana has decreased stigma and helped with life-saving treatments. Through it all, the public perception is key to decreasing the stigma, which he adds is “incredibly helpful.” “We’re beyond the conversation over whether this should be legal. Today, we’re talking about how,” Marcus said.