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The state of Pennsylvania is considering making more conditions eligible for medical marijuana treatment.
Pennsylvania’s Medical Marijuana Advisory Board has approved a new process for amending and expanding the list of 21 conditions for which patients can use medical marijuana as treatment, according to Department of Health spokesman Nate Wardle.
In the upcoming weeks, the board will be accepting research-based petitions to add to the qualifying list of conditions with tentative plans to discuss and vote on the first round of submissions during the next board meeting on Feb. 1, 2019.
Patient advocates are hopeful the change will extend eligibility to patients who have medical issues and could benefit from the use of cannabis but are excluded from being able to obtain it legally – such as those grappling with insomnia, anxiety, and depression.
“Pennsylvanians have been using marijuana illicitly for years to treat a wide variety of conditions not on the state list,” says Dr. Roxanne Rick of Cannabis Care Certification Centers. The centers aim to offer an alternative treatment to opioids for pain and addiction.
Medical cannabis became available in February 2018. Since then, the four-doctor organization has helped over 1,000 patients with qualifying conditions become certified via offices and mobile outreach in Uniontown, Monroeville, Bethel Park, Delmont, and State College.
Rick says most of the patients who are turning to medical cannabis have the qualifying conditions of chronic pain and post-traumatic stress disorder. Some have been able to obtain a medical card to assist with specific issues like migraines, which is not on the qualifying list, however, if a physician describes the migraine issues as chronic or recurring pain that lasts more than 90 days, it qualifies.
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. 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,” says Dr. Elizabeth Spaar of Verona-based Spectrum Family Practice, which treats children and adults suffering from addiction, autism, and PANS/PANDAS infection-induced autoimmune conditions.
According to Dr. John Metcalf of Medical Marijuana Solutions, medical cannabis could be extended to help many types of mental health and physical issues from migraines to Lyme Disease.
“As we expand the list, that’s to the benefit of the patient,” says Metcalf, who certifies medical marijuana patients since retiring from a 30-year career in primary care, urgent care, and occupational medicine.
Metcalf and Spaar both noted that Pennsylvania is among only a few states that include autism on its medical marijuana list, with children 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. 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 calk a lot of that down, they tend to make progress and develop mentally.
Terminal illness and opioid addiction were added to the list of qualifying conditions in the spring.
With the opioid dependence patients, we’ve certainly had patients who were on methadone or suboxone who have been able to get off those and purely have medical marijuana. We’ve had other 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.
Pennsylvania doctors are encouraged by the new process for amending the state list, however, it is not far enough to expand access to the plant and giving physicians more authority to prescribe cannabis.
“I would love it if they would recognize the autonomy in medical decision-making of a physician instead of placing restraints on us,” says Spaar.
For instance, in California physicians can recommend medical marijuana to patients based on the 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,” says Metcalf.
Advocates, however, are still skeptical of how difficult it will be to get a new condition approved.
The terms for the new process are being finalized and will be posted to the Department of Health’s website later in December. There is a subcommittee of the state board will review the petitions for conditions submitted at least 15 days in advance of one of the advisory board’s quarterly meetings. The proposal will then be discussed and voted on during the meeting.
Pennsylvania Health Secretary Rachel Levine says that as more research becomes available regarding “the efficacy and utility of medical marijuana as medication.” Expanding the list may be a appropriate “to provide relief to patients and access to a drug that may be the only course of treatment of palliative care available.”
The change is unique to Pennsylvania and stems from the recommendation cited in the board’s May report, according to Wardle.
It is not clear 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 cards. The board is not sure of how many petitions to expect, says Wardle.
Medical marijuana is legal is 32 states, though cannabis in all forms is an illegal controlled substance under federal law. This fact severely limits U.S. research on the effects of medical cannabis.
“Pennsylvania has done things that other states have not 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,” says Metcalf.
Gov. Tom Wolf signed the bill into law legalizing medical cannabis in April 2016.
Dispensaries began selling medical marijuana in all forms: pills, tinctures, oils, and ointments in February, and then flower form on Aug. 1. The state Department of Health regulates the cannabis program, which still prevents patients from smoking dry leaf marijuana, it has to be vaporized.
As of December 2018, over 87,000 patients and 10,000 caregivers have registered for the medical marijuana program and over 56,700 patient certifications have been issued, according to Wardle.
More than 900 of 1,300 physicians have registered for the program and been approved as prescribers.
Pennsylvania’s 40th medical marijuana dispensary opened mid-November, Solevo Wellness-Jackson Pointe in Zelienople.
The 2019 meetings of the state Medical Marijuana Board will be held Feb. 1, May 15, Aug. 14, and Nov. 13.
Pennsylvania is not the only state to broaden the list of approved conditions for medical cannabis. Next year, Alzheimer’s disease will be added to the list in Minnesota. It will be the 14th health condition approves since the marijuana program began in 2015.
On Monday, Dec. 3, 2018, the Minnesota Department of Health announces it was adding the degenerative neurological disorder, despite limited evidence on the effectiveness of marijuana treatment. Some studies found that cannabis inhibits the formation of tau proteins that accelerate dementia and memory loss related to Alzheimer’s.
“Any policy decisions about cannabis are difficult due to the relative lack of published scientific evidence. However, there is some evidence for potential benefits of medical cannabis to improve the mood, sleep and behavior of patients suffering from Alzheimer’s disease,” says state Health Commissioner Jan Malcolm.
Six other conditions were submitted to Malcolm this summer, but they were not approved. The others were juvenile rheumatoid arthritis, hepatitis C, panic disorder, traumatic brain injury, opioid use disorders, and psoriasis.
The current list of approved conditions:
- Intractable pain;
- Post-traumatic stress disorder;
- Severe and persistent muscle spasms;
- Inflammatory bowel disease, including Crohn’s disease;
- Obstructive sleep apnea;
- Autism spectrum disorder;
- Terminal illness;
- Tourette syndrome;
Minnesota is the 12th state to allow medical marijuana for Alzheimer’s or related symptoms.
Dr. William Orr, a Minneapolis-based geriatric psychiatrist, supported the petition for Alzheimer’s disease and argues that the disease in its advanced stages can cause patients to be confused, combative, and aggressive. Benzodiazepines and narcotics can calm these patients, but those drugs are not federally approved for that purpose and can cause severe, mood-altering side effects.
I believe that advanced dementia patients with tremendous anxiety, restlessness and pain will benefit. Such patients are episodically distraught and become quickly angered and paranoid of staff trying to help them due to their confusion and inability to understand their circumstances.
The Minnesota Association of Geriatrics took a neutral position, saying that is supported further research on using cannabis to treat Alzheimer’s disease.
Malcolm said the limited favorable research combined with other factors convinced her to approve Alzheimer’s, which afflicts 94,000 people in the state and caused 2,220 deaths in 2016.
The risks of long-term marijuana use are not known, however Malcolm said they are not as much of a concern in the older Alzheimer’s population. The average age of onset is 75.
The absence of treatment options was additionally compelling. The U.S. Food and Drug Administration had not approved a drug for Alzheimer’s disease since 2003.
By Jeanette Smith
TRIB LIVE: Pennsylvania to consider more conditions that should qualify for medical marijuana
Star Tribune: Alzheimer’s added to Minnesota’s medical marijuana list
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