In April 2016, Pennsylvania became the 24th state to legalize medical cannabis. Governor Tom Wolf said that the primary goal was to “provide long overdue medical relief to patients and families who could benefit from this treatment.” (2) The program is expected to take 18-24 months to implement, and the Department of Health is still in the process of setting up all of the moving parts. In this article we’ll discuss those moving parts, recent updates, and point you in the right direction for more information.
Brief History of Hemp in Pennsylvania
Pennsylvania has a rich history of producing hemp – it’s believed that William Penn planned to grow hemp in the region when he founded Pennsylvania in 1681. In Lancaster county, the Hempfield township was considered the capital of hemp. It’s said that production continued until the Reefer Madness film propaganda of the 1930s hit and marijuana became illegal. With no way to discern industrial hemp from marijuana, many farmers who continued to grow hemp were arrested. (1)
Why Lawmakers Decided to Legalize Medical Cannabis
Some doctors and advocates of medical marijuana see it as a viable alternative to opioid painkillers to treat chronic pain, as opioid abuse and drug overdoses are a problem in Pennsylvania. The Philadelphia Veterans Affairs Medical Center cited that “states with medical marijuana laws have a 24.8% lower average annual, opioid death rate.” (3)
Medical Marijuana Program for Patients
Allowed Medical Conditions
According to the Pennsylvania Department of Health’s website, there are currently 17 conditions under which a patient can qualify to obtain a medical marijuana prescription (4):
- Amyotrophic lateral sclerosis
- Crohn’s disease
- Damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity
- HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome)
- Huntington’s disease
- Inflammatory bowel disease
- Intractable seizures
- Multiple sclerosis
- Parkinson’s disease
- Post-traumatic stress disorder
- Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective
- Sickle cell anemia
Steps for Patients to Obtain Medical Marijuana
- Fill out a patient profile on the Patients and Caregivers Registry on https://www.pa.gov/guides/pennsylvania-medical-marijuana-program/ (currently the registry isn’t live – the overall process is expected to take 18-24 months, so most likely early 2018.)
- Obtain a doctor’s certification that verifies that you suffer from one of the 17 aforementioned conditions.
- Return to your patient profile on the website in step one, and pay for a medical marijuana ID card, which is $50.
- Visit one of 150 planned approved dispensaries to get medical marijuana.
How to Obtain Medical Marijuana for a Minor
The steps are similar as the ones above, with the exception that you would apply to the registry as a caregiver. There is also an additional step, filling out the Safe Harbor application, which requires the following documentation:
- Completed electronic copy of the Pennsylvania background check
- Completed electronic copy of the Pennsylvania Safe Harbor physician letter
- If legal guardian – an electronic copy of the guardianship papers
- If caregiver – an electronic copy of caregiver status
- If spouse – an electronic copy of marriage certificate (7)
Legal Limits and Forms
In Pennsylvania, the legal limit for medical marijuana is up to a 30-day supply. There are six legal forms medical marijuana can be in:
- Topical forms, including gels, creams, or ointments
- Vaporization or nebulization (excluding dry leaf or plant form)
- Liquids (8)
Though the Department of Health’s website clearly states, “excluding dry leaf or plant form,” there may be a loophole in the actual law that will allow the plant form to be dispensed when the dispensaries open in 2018. If the state’s medical marijuana advisory board recommends it, it would then be up to the Secretary of the Department of Health to ultimately approve it. (22)
Private health insurers or government medical assistance programs aren’t required to reimburse for the expense of using medical marijuana nor the costs of accommodating usage in the workplace. (9)
Medical Marijuana Program for Growers/Processors
The process to apply and become a grower/processor of medical marijuana is pricey and long. A non-refundable, initial application fee of $10,000 is required, as well as an initial permit fee of $200,000 (which is refunded if the permit isn’t issued). Also, there’s an additional 5% tax on the sale of medical marijuana to a dispensary. With the government overseeing just about every aspect of the business, including background information on all people involved and the plan of operation, it’s a complicated undertaking. (10)
How to Apply
For Phase I, the first leg of setting up growers/processors is no longer accepting applications. Growers and processors are encouraged to wait for Phase II, in which additional growers/processors will be set up. That said, the application itself is a 33-page, Word document with fields to fill in and a scoring template that shows the points of each part. The parts include: Application Identification and Facility Information, Diversity Plan, Applicant Background Information, Plan of Operation, and Applicant Organization, Ownership, Capital and Tax Status. (10)
The operational checklist is even more elaborate than the application, with 54 pages of detailed requirements and the following fields to be filled out: timetable, grower/processor completed, department notified, and department approval. (11)
Failure to conform to the guidelines set forth in the operational checklist can result in any one of the following: permit suspension or revocation, a civil penalty of up to $10,000, plus an additional penalty of up to $1,000 for each day the violation persists, an order of funds restitution for anything unlawfully obtained, or a cease and desist order. (11)
Packaging and Labeling
There are a number of guidelines to follow when packaging marijuana, including an original seal that cannot be broken except by approved quality control. It should minimize oxygen exposure and be:
Labels must contain a unique identifier and be:
- Easily readable
- Weather-resistant and tamper-resistant
- Conspicuously placed on the package
Labels must include the date, name, address, permit number, and list the form, quantity and weight of the medical marijuana. The amount of individual doses and percentages of CBD and THC must also be included, as well as other information about the employee packaging it, the lot information, and warnings. (12)
There are a number of rules regarding transportation of medical marijuana, such as:
- It can only be delivered between 7AM and 9PM.
- It can’t be transported outside of the state.
- GPS must be used.
- Vehicles cannot have identifiable markings that indicate their purpose, and they must be temperature-controlled with a secure cargo area or lockbox.
- Delivery teams must have two individuals, one of which remains with the vehicle at all times.
- Delivery personnel must have access to secure communication with the grower/processor.
- The grower/processor must be in communication with the Department, to include delivery schedules and reportable events.
- Vehicles are subject to inspection and may be stopped en route. (13)
Medical Marijuana Program for Dispensaries
The process to apply to become a dispensary of medical marijuana is also complex. A non-refundable, initial application fee of $5,000 is required, as well as an initial permit fee of $30,000 per dispensary location, with up to 3 locations or $90,000 (which is refunded if the permit isn’t issued). (10)
How to Apply
For Phase I, the first leg of setting up dispensaries is no longer accepting applications. Dispensaries are encouraged to wait for Phase II, during which additional dispensaries will be set up. That said, the application itself is a 28-page, Word document with fields to fill in and a scoring template that shows the points of each part. The six parts include: Application Identification and Dispensary Information, Diversity Plan, Applicant Background Information, Plan of Operation, and Applicant Organization, Ownership, Capital and Tax Status, and Community Impact. (14)
The operational checklist is even more elaborate than the application, with 40 pages of detailed requirements and the following fields to be filled out: timetable, dispensary completed, department notified, and department approval. Some of the categories include: Sanitation and Safety in the Facility, Visitor Access, Staffing Transport Vehicles, and Labels and Safety Inserts. (17)
There is a four-hour course and certification required to work in a dispensary. The cost of training ranges from $250-$300. (15)
There are currently 27 entities that were selected in Phase I, with 52 total locations across the six regions designated. All but six of the companies are based in Pennsylvania, and the entire list is available by clicking here. (16)
Penalties for dispensaries are similar to those for the grower/processor: permit suspension or revocation, a civil penalty of up to $10,000, plus an additional penalty of up to $1,000 for each day the violation persists, an order of funds restitution for anything unlawfully obtained, or a cease and desist order. (17)
Keystone Releaf lawsuit
In September 2017, a lawsuit was brought forth against the medical marijuana program after the Keystone Releaf company was denied a grower/processor permit. Though the company sent in an incomplete application and missed the deadline, they claimed that other companies were allowed to submit after the deadline and that the selection process is “flawed.” They’re asking for the entire program be revamped, which would cause considerable delays in getting medical marijuana to patients in need. The Health Department has 30 days to respond, but there’s been no update as of yet. (18)
Medical Marijuana Program for Doctors and Caregivers
How to Register
Registration is open to physicians on the Department of Health’s website. To be able to prescribe medical marijuana, a physician must first register and then do four hours of training. An animated GIF exists to guide physicians through an example registration. (19)
There are currently four providers available for training on the Department of Health’s website:
- TheAnswerPage Inc
- Extra Step Assurance LLC
- The Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University
- University of the Sciences
The cost currently ranges from $299-$325. (19)
The physician’s role in prescribing medical marijuana is to assist the patient in finding an alternative pain control method to opioids and other pain drugs that may have harmful side effects. A physician is allowed to issue a patient certification when:
- The patient has a serious medical condition
- The patient is likely to receive a “therapeutic or palliative medical benefit”
- The patient’s prior medical history and controlled substance history has been reviewed (20)
How Pennsylvania’s Program Stacks up to Other States
The list for what a physician can issue a patient certification for is more comprehensive than many states’, in comparison, providing a broader set of conditions for which a doctor can prescribe medical marijuana. However, the guidelines for prescribing it for chronic pain dictates that it’s for when “conventional therapeutic intervention and opiate therapy is contraindicated or ineffective.” This hints that patients may still have to endure opioid treatment before getting a prescription for medical cannabis. Pennsylvania is the first state to list its use for all types of autism, but it doesn’t include Hepatitis C, which nine states have. (21)
What Can Be Done Now
Currently, the program isn’t in full force yet, so most people are left waiting for it to go live. The only provision for out-of-state procurement of medical marijuana is in the case of a minor with a serious illness – a caregiver that legally obtains medical marijuana from another state doesn’t violate the law. (23)
In the meantime, there are other healthy alternatives to try for pain management, for example, CBD oil. Also derived from hemp, it contains minimal traces of THC, the psychoactive ingredient that causes a “high,” so it’s legal in all 50 states and many countries. People have found it calming and soothing, and it can assist with chronic pain. For more information on CBD oil, check out this comprehensive resource guide. If you’re interested in purchasing it, this guide on buying CBD oil outlines its different forms and what to look for to find a reputable manufacturer.
The medical marijuana program has complex requirements for growers/processors and dispensaries, as well as steps for patients/caregivers to take to be able to access medical marijuana. This program is in its infancy, and as the recent lawsuit illustrates, there will likely be a few bumps along the way.
The fact that physicians can now register illustrates the progress being made in the program, bringing Pennsylvania patients one step closer to an alternative pain method for their chronic illnesses. By keeping informed about all of the steps involved in the program, as well as important updates and implementation progress, you can be sure you’re staying compliant within the law.
So what do you think? Are you in favor of the current Pennsylvania medical marijuana program, or do you think there are too many restrictions?