TUESDAY, APRIL 19, 2016 D3

Plans are under way for dispensaries, regulations

to get to this point, moving this legislation through Pennsylvania is a
significant victory, he said. Its a
regulation-heavy bill in its current
form, but its been a bruising three
years to get this passed.
Jahan Marcu, a Philadelphiabased molecular biologist who
specializes in cannabis research
and oversight, is disappointed that
Pennsylvania prohibited the smoking of marijuana.
Its easier for those who inhale
to titrate their doses, he said. Inhaled cannabis also bypasses the
liver, and generally people using
medical marijuana are already on
other medications that are impacting their livers.
The health department has
discretion to make changes to the
law, and possibly allow smoking,
after the advisory board issues a
progress report within two years.
What has happened in other
states is these cannabis laws get
passed and shown to be nonfunctional, Marcu said. Then the laws
evolve with the help of advocates.
Dr. Suzanne Labriola works in
palliative care inside Allegheny
Health Networks division of supportive care and geriatrics. She
said shell recommend medical
marijuana to treat nausea and as an
appetite stimulant for her patients
with HIV and cancer.
Im really happy about this step
because I think it is going to help
some patients, she said. This also
opens the door for more research,
and thats extremely important for
us to learn more about what we
are using.

MARIJUANA FROM D1

What is it used for?

What do studies show?

Under the new medical

marijuana law, Pennsylvania
residents can receive treatment
for these conditions:

Use of marijuana for chronic pain, neuropathic pain and spasticity because
of multiple sclerosis is supported by high-quality evidence.
Six trials that included 325 patients examined chronic pain, six trials that
included 396 patients investigated neuropathic pain and 12 trials that included
1,600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be effective for
these conditions.
Medical marijuana is used to treat a host of conditions, a few of which have
evidence to support treatment with marijuana and many that do not. Physicians should educate patients about medical marijuana to ensure that it is
used appropriately and that patients will benefit from its use.

Cancer
HIV/AIDS
ALS or Lou Gehrigs disease
Parkinsons disease
Multiple sclerosis
Damage to the nervous tissue
of the spinal cord
Epilepsy
Inflammatory bowel disease
Neuropathies
Huntingtons disease
Crohns disease
Post-traumatic stress disorder
Intractable seizures
Glaucoma
Sickle cell anemia
Autism
Severe, chronic or intractable

pain in which conventional therapies, including prescription opiates, are ineffective

mined. The health department will

maintain a database of patients
approved to use medical marijuana.
Even after dispensaries are
operating in Pennsylvania, patients
wont be able to smoke medical pot.
The law prohibits dry, smokable
marijuana. Patients can consume
marijuana in the form of pills, oils
and tinctures. Liquid forms of cannabis would also be available for
vaporization.
Its going to be challenging for
the medical community to educate
patients about when it may or may
not be appropriate, said Dr. Todd

Source: The Journal of the American Medical Association, June 2015

Barron, medical director of WellSpan Neurosciences in Chambersburg. Barron has studied the use of
cannabidiol, a compound in marijuana for treating epileptic patients.
Theres a lot of hype surrounding
this. The medical community is also
going to need to be educated.
Education for doctors will most
likely come in the form of a fourhour online training course that
the state is developing. Robinson
said the health department plans
to create a medical marijuana
advisory board that will include
the secretary of health, physician
general, state police commissioner
and others.
During the next six months, the
state will put together a regulation
process for growers and dispensaries.
Its important to open it up to
competitive bid, Robinson said.
The health department is conducting a population study over the
next six months to determine how
many patients suffer from the
17 conditions and where they live.
We still need to figure out how

much medical marijuana were going to need, Robinson said.

Becky Dansky, a legislative analyst with Washington, D.C.-based
advocacy group Marijuana Policy
Project, estimated around 250,000
Pennsylvania patients could seek
the drug for medical purposes.
Among them are Diana Briggs,
whose 15-year-old son Ryan endures
hundreds of seizures a day.
Were very anxious to try it,
she said. I dont expect this to be a
cure-all, but I believe it could help.
Briggs, of Export, Westmoreland
County, is among about 30 families
associated with Campaign for Compassion, a grass-roots organization
dedicated to establishing legal medical marijuana in Pennsylvania.
I dont fear this at all, she said.
Ryan takes other medications
which have much worse side effects.
Whether it helps him or not, I dont
believe it will harm him in any way.
Despite the laws restrictions,
Patrick Nightingale of the Pennsylvania Medical Cannabis Society
said its a starting point.
Given how difficult it has been

States learning what works, what doesnt

Pennsylvania has a
pretty comprehensive
conditions list, said Becky
Dansky, a legislative analyst
with Medical Marijuana
Project, a Washington, D.C.based group that advocates
for ending marijuana prohibition.
Pennsylvania is the first
state to allow medical marijuana as a treatment for all
types of autism, and only
the 11th state to explicitly
authorize the drug to treat
PTSD, Dansky said. Like
17 other states, Pennsylvania allows patients to use
marijuana to treat chronic
pain, though the law says
marijuana should be used
when conventional therapeutic intervention and
opiate therapy is contraindicated or ineffective.
The state joins five others
that authorize medical marijuana for Parkinsons disease. Pennsylvania doesnt
include Hepatitis C, which
nine states include.
Regulations vary, with
some states such as
Maryland, Massachusetts
and California giving doctors authority to

recommend marijuana for

unlisted conditions when
doctors determine it would
be beneficial or other treatments have proven ineffective. Pennsylvania does not
provide that authority. The
new state law does not allow
recreational use, which is
legal in Colorado, Washington and Oregon.
Delaware allows cannabis
for people with autism who
are prone to injure themselves or behave aggressively, Dansky said.
No clinical trials have
evaluated cannabis as a
treatment for PTSD or
autism, said Marcel BonnMiller, an adjunct assistant
professor at the University
of Pennsylvania Perleman
School of Medicine who
studies the drug.
Bonn-Miller has launched
what he said will be the first
randomized controlled trial
of cannabis as a PTSD treatment.
The science just isnt
there yet, Bonn-Miller said.
Its a little scary; you dont
want to have people that
have bad reactions.
Marijuana remains illegal
under federal law. Partly

because the government has

restricted access to it, few
high-quality medical studies
have assessed its value for
treating disease.
Studies have shown
marijuanas value for treating chronic pain, multiple
sclerosis and the nausea that
results from cancer treatment, said Bonn-Miller. But
the studies lack certainty because of the high variability
of chemicals in marijuana
plants, Bonn-Miller said.
The drug contains about
120 types of chemical compounds known as cannabinoids, including the most
common, Tetrahydrocannabinol, known as THC.
Along with its medical
benefits, marijuana particularly THC has been
shown to increase anxiety
in some who smoke it, and
in some people, the drug is
addictive, he said.
The chronic pain findings
are especially important in
states battling opioid epidemics, Dansky said. While
opioids can kill people,
marijuana is not fatal, experts said. Dansky cited one
study that showed opioid
overdose deaths decreased

by a quarter in the first

year in states that legalized
medical marijuana. While
acknowledging the studys
promise, Bonn-Miller noted
it did not prove medical
marijuana laws caused the
decreased deaths.
Bonn-Miller praised Pennsylvanias law for allocating
a portion of new taxes to
medical marijuana research,
which he said only Colorado
and California have done
so far. The law imposes a 5
percent tax on the sale of
marijuana from growers to
distributors but does not tax
sales to patients.
More states could soon
follow Pennsylvanias
lead in legalizing medical
marijuana, Dansky said.
Louisianas law, which is
dysfunctional because of a
technicality, could be fixed
as early as June, she said.
Ballot initiatives could appear in November in Ohio,
Florida, Missouri, Arkansas
and Nebraska, she said.
Every state has its
own problems and its own
strengths, Dansky said.
Wes Venteicher is a Tribune-Review staff
writer. Reach him at 412-380-5676 or
wventeicher@tribweb.com.

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take that long to set up a medical

marijuana system with up to
150 designated state-regulated dispensaries. The states new medical
marijuana law, signed Sunday by
Gov. Tom Wolf, takes effect in about
30 days.
We think we have thought it
out pretty well, Robinson told the
Tribune-Review. But Im sure as
we get started, it will be a learning
process, for sure.
There are plenty of places to
start, including erasing the notion
that doctors will prescribe medical
marijuana. They wont.
Doctors cannot legally write
prescriptions because marijuana
is currently listed under the
Controlled Substances Act as a
Schedule 1 drug, meaning the Drug
Enforcement Administration considers it to have no medical value.
The DEA has said it will decide
this year whether to reclassify pot,
given the national groundswell of
medical marijuana policies.
Under the new state law, patients
after consulting with doctors
can apply for a state-issued medical
marijuana card if a doctor certifies
that they have one of 17 qualified
medical conditions, including epilepsy, autism and cancer. Robinson
said the state plans to post certification forms online for patients to
download and take to their doctors.
After patients obtain identification cards, theyll be able to purchase forms of medical marijuana
on their own at dispensaries. Robinson said the state plans at least one
dispensary per county with more
in densely populated areas, such as
Pittsburgh and Philadelphia. The
locations have not been deter-