HARRISBURG — Nurse practitioners and podiatrists would be able to approve patients for a medical marijuana card in Pennsylvania under proposals awaiting action from the state’s health secretary.
Currently, only licensed medical doctors or doctors of osteopathic medicine can certify patients for Pennsylvania’s medical cannabis program, which has hundreds of thousands of active patients.
If approved, the change could expand access to the program, a shift that supporters say would give patients more options. The executive director of a cannabis group told Spotlight PA the move could even help lower the price of obtaining a card. But at least one state official has said telehealth already makes the program widely accessible.
The recommendations from the state’s Medical Marijuana Advisory Board come as a bipartisan push in the state legislature aims to loosen restrictions for nurse practitioners and create a path for the professionals to operate independently from physicians.
While those efforts have hit roadblocks, the potential for them to approve patients for medical marijuana cards has met little public opposition.
A number of other states have allowed nurse practitioners to approve patients for medical marijuana for years. A guide from the cannabis certification company Leafwell lists more than 20 states where nurse practitioners or advanced practice registered nurses have the ability to recommend cannabis to qualifying patients.
“What is Pennsylvania scared of?” Judy Jenks, a nurse practitioner who runs a medical cannabis clinic in Virginia, said in an interview with Spotlight PA. “Is it the cannabis? Or is it the nurse practitioner?”
“If you’re scared of either one of those,” she added, “then you don’t understand either one of those.”
Left out
Nurse practitioners — who receive advanced medical education and training — provide a range of care in Pennsylvania. They can prescribe medications, diagnose conditions, and handle treatment plans, although that work is tied to written agreements with physicians.
State lawmakers did not authorize nurse practitioners to approve patients for the program when they passed the medical marijuana law in 2016. At the time, they made a number of compromises like this in order to gain enough support to get a medical marijuana legalization bill through the Republican-controlled House.
Lawmakers did give the state’s Medical Marijuana Advisory Board and health secretary the power to make changes, however. In 2018, the advisory board chose not to recommend expanding which medical professionals could participate in the program, but suggested considering the issue in the future.
The podiatrist proposal would limit the type of qualifying conditions they can certify — the related report provided by the department describes how they could approve patients based on severe, chronic, or intractable pain related to the feet.
The nurse practitioner proposal does not include similar restrictions, and its related report, which was also provided by the department, says they “treat all disease states” and “should have unrestricted ability to certify.” A Pennsylvania Department of State spokesperson said state law authorizes nurse practitioners to diagnose all medical conditions, although they must fall within a clinical specialty area in which the nurse practitioner is certified.
The proposal doesn’t offer specific guidance on how nurse practitioners should incorporate cannabis certifications into their agreements with physicians.
Under both proposals, nurse practitioners and podiatrists would still be required to apply for the registry and complete a four-hour training course, as physicians must.
Pennsylvania’s medical marijuana law gives the state’s health secretary, Debra Bogen, the power to approve or reject the nurse practitioner and podiatrist recommendations. The changes would not need approval from the legislature, multiple officials and industry experts told Spotlight PA.
The state’s Board of Nursing has shown support for the nurse practitioner recommendation.
The advisory board’s podiatry report said the Board of Podiatry agrees with the motion. A spokesperson for the Pennsylvania Department of State told Spotlight PA the podiatry board has not formally taken a position on the issue, however.
The health secretary is reviewing the recommendations, and a decision will be made by mid-November for the podiatrists and by late January for the nurse practitioners, according to department spokesperson Neil Ruhland.
State Rep. Dan Frankel (D., Allegheny), chair of the House Health Committee, told Spotlight PA “it makes enormous sense” to add nurse practitioners and podiatrists as certifying practitioners.
“I think they have the expertise in order to do it,” he said.
Is there a shortage?
Christine Roussel, the member of the Medical Marijuana Advisory Board who presented the nurse practitioner proposal at a public meeting in January, explained that a major rationale for the change is “to improve access to care for patients.”
A Spotlight PA request to interview Roussel was not granted, and a Department of State spokesperson said further comment “would be inappropriate.”
Last year, Laura Mentch, director of the Bureau of Medical Marijuana, said she had not received any complaints during her tenure about there not being enough practitioners in the program. At the time, she was testifying as part of a hearing for an individual physician seeking to return to the program.
Mentch said telehealth expanded options for patients.
“You’re not even limited to the drive time anymore,” Mentch testified at the hearing. “If you want to have a certified practitioner across the state, it’s just a matter of a phone call and a telehealth appointment.”
Asked about Mentch’s comments, Ruhland said Mentch is not responsible for making recommendations regarding changes to the types of medical professionals who can certify patients, and her testimony was not provided in connection to that issue.
Meredith Buettner Schneider of the Pennsylvania Cannabis Coalition told Spotlight PA the proposed expansion could create more options for patients and bring down the price of certifications. She said some patients aren’t comfortable with telehealth appointments.
“I think meeting patients where they are is super important and something that we definitely still need to work on,” she told Spotlight PA.
There are nearly 2,000 approved practitioners in Pennsylvania’s medical marijuana program, according to a recent health department presentation. That’s a relatively small percentage of all of the state’s physicians with an active license. Recent state data show there are more than 53,000 active M.D. licensees and more than 11,000 active D.O. licensees.
In some states, nurse practitioners play a significant role in the medical marijuana program.
In Maryland, a 2021 report showed nurse practitioners and certified nurse midwives outnumbered physicians and physician assistants in the state’s medical cannabis program.
In Virginia’s medical program, lawmakers in 2019 approved adding nurse practitioners and physician assistants. The bill was introduced by then-state Sen. Siobhan Dunnavant (R.), who is also a medical doctor.
“It was not controversial,” said JM Pedini, executive director of Virginia’s chapter of the National Organization for the Reform of Marijuana Laws.
At her Virginia medical cannabis clinic, Jenks collaborates with a team of nurse practitioners who certify patients. The business’s website offers telehealth appointments for state certification evaluations, as well as in-home custom visits. She said patient education services, which the website calls medical cannabis coaching, are available to people in Virginia and beyond.
Cannabis has helped patients with panic attacks, social anxiety, chronic pain, and other issues, Jenks said of the drug’s impact. She tells patients that cannabis is another tool to manage symptoms, she explained.
When state medical cannabis programs block nurse practitioners from approving patients, she said, they’re limiting access to care.
“Ultimately, this is about the patient,” Jenks argued. “This is about the patient having access to a substance that helps them.”
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