Stephen Arch, a 60-year-old filmmaker from Moon Township, is prescribed the drug Klonopin for his Post-Traumatic Stress Disorder, which he said stems from childhood trauma.
He said it helps keep him calm, but because he takes it on an as-needed basis, he sometimes runs out before he can refill his prescription. Because the drug is a benzodiazepine, it can lead to physical and psychological dependence. Arch said when he doesn't take Klonopin, he experiences withdrawal symptoms.
"I get almost flu-like symptoms, very high levels of anxiety and I can't sleep at night," said Arch.
He said hopes that medical marijuana will provide similar anti-anxiety benefits without the harsh effects, but that neither his primary care physician nor his psychiatrist are willing to help him get it.
"They don't want anything to do with this, so I'm kind of on my own with this one," said Arch.
PTSD is one of 17 conditions that qualifies a patient for a medical marijuana card in Pennsylvania. So far, more than 10,000 patients have signed up for the program, including Arch, but in order to actually get medical cannabis, a patient has to be certified by an approved doctor.
As of Dec. 27, about 250 physicians in Pennsylvania had completed that process, which involves registering online, paying a small fee and taking a four-hour course. That amounts to about 40 patients in the state wanting to try medical marijuana for every doctor that’s approved to help them get it.
"The initial physician response we had, in Pennsylvania at least, I was encouraged by," said Bryan Doner, an emergency medicine physician and CEO of Compassionate Care Centers, or CCC. "What you see now is the number of patients growing exponentially, whereas maybe the number of physicians hasn’t kept up with that.”
At CCC, doctors can certify patients like Arch who provide documentation of their condition and proof that conventional treatments haven’t been effective.
Doner said he didn't know what the ideal patient to doctor ratio is, but that an imbalance could cause problems like appointment back-ups and long commutes for people who live in rural areas.
"We've had people drive from Harrisburg, from Johnstown, just because they couldn't find another physician that was that close to them," said Doner.
Antoine Douiahy is a professor at the University of Pittsburgh Medical School and a psychiatrist at UPMC, where he is part of a committee that’s working on internal medical marijuana rules and guidelines for their physicians. Douaihy said, right now, they’re not actively instructing doctors to register with the state.
"The challenge is that in the medical marijuana field, there is not much of that evidence base, scientific, research-based studies," said Douaihy.
A spokesperson for Allegheny Health Network said in an email that it is also working to formalize its approach.
Doner said he understands why doctors would be hesitant to recommend a treatment that has so little hard evidence proving its effectiveness, but he said he’s been convinced in large part by his own experiences.
"Some physicians, like myself, practicing in the ER, have been exposed to patients who took medical marijuana and had tremendous results," said Doner.
Now that the state program is up and running, Doner said physicians should at least make an effort to learn what they can from the information that does exist.
"As physicians and providers, whether we believe in this treatment or not, we have an obligation to our patients to be able to have a meaningful and beneficial conversation with them about medical marijuana," said Doner.
New York has also struggled with doctor participation in its medical marijuana program, which launched at the end of 2015. In 2016, the state opened up the program to nurse practitioners and physician’s assistants.
Doner said, in Pennsylvania, the key will be getting large healthcare entities like UPMC and Allegheny Health Network buy in.
"You’re talking about organizations that have thousands if not tens of thousands of providers and also access to tens if not hundreds of thousands of patients," said Doner.
Arch, whose primary care doctor is affiliated with AHN, said he got his certification from Doner's partner at CCC, and is now awaiting his official medical marijuana card from the state.