HARRISBURG – Nurse practitioners and podiatrists will be able to approve Pennsylvania patients for medical marijuana cards under proposals pending action by the state health secretary.

Currently, only licensed medical or osteopathic physicians can certify patients under Pennsylvania’s medical marijuana program, which has hundreds of thousands of active patients.

If approved, the change could expand access to the program, which supporters say will give patients more options. The cannabis group’s executive director told Spotlight PA the move could even help lower the price of getting the card. However, at least one state official said telehealth already makes the program widely available.

The recommendations from the state’s Medical Marijuana Advisory Board represent a bipartisan push from the state Legislature to loosen restrictions on nurses and give them a path independent of doctors.

While these efforts have faced hurdles, their ability to get patients approved for medical marijuana cards has met with little public opposition.

A number of other states have allowed nurses to approve patients for medical marijuana for years. Cannabis certification company Leafwell’s guide lists more than 20 states where nurse practitioners or advanced practice registered nurses can recommend cannabis to qualifying patients.

“What is Pennsylvania afraid of?” Judy Jenks, a nurse who runs a medical marijuana clinic in Virginia, told Spotlight PA. “Is that cannabis? Or is it a nurse?”

“If you’re afraid of any of them,” she added, “it means you don’t understand any of them.”

Omitted

Nurses who have received advanced medical education and training provide a wide range of care in Pennsylvania. They can prescribe medications, diagnose conditions and develop treatment plans, although this work is tied to written contracts with doctors.

State lawmakers did not give nurses the authority to approve patients for the program when they passed the medical marijuana law in 2016. They then made a series of such compromises to gain enough support to pass a bill legalizing medical marijuana through the legislative process. House controlled by Republicans.

But lawmakers gave the state’s Medical Marijuana Advisory Board and the health secretary the authority to make changes. In 2018, the advisory board decided not to recommend expanding the scope of healthcare professionals who can participate in the program, but suggested that the issue be considered in the future.

Podiatrists’ proposal would limit the type of qualifying conditions they can certify – a related report provided by the department describes how they could certify patients based on severe, chronic or incurable foot pain.

The nurse practitioner proposal does not include similar restrictions, and a related report, also provided by the department, states that they “treat all medical conditions” and “should have unrestricted ability to issue certificates.” A spokesman for the Pennsylvania Department of State said state law authorizes nurse practitioners to diagnose all conditions, although they must be in a clinical specialty in which the nurse is certified.

The proposal does not provide specific guidance on how nurses should include cannabis certifications in their contracts with physicians.

Under both proposals, nurses and podiatrists will still be required to apply for the register and complete four hours of training, just as doctors must do.

Pennsylvania’s medical marijuana law gives state Secretary of Health Debra Bogen the authority to approve or reject recommendations from a nurse and podiatrist. Multiple officials and industry experts told Spotlight PA the changes would not require approval from the Legislature.

The State Board of Nursing expressed support for the nurse practitioner’s recommendation.

The Podiatry Advisory Board report stated that the Podiatry Council agreed with the application. A spokesman for the Pennsylvania Department of State told Spotlight PA that the podiatry commission has not formally taken a position on the matter.

The health secretary is reviewing the recommendations, and a decision for podiatrists will be made by mid-November and for nurses by the end of January, according to department spokesman Neil Ruhland.

State Rep. Dan Frankel (R-Allegheny), chairman of the House Health Committee, told Spotlight PA that “adding nurse practitioners and podiatrists to the board of certifying physicians makes a lot of sense.”

“I think they have the knowledge to do it,” he said.

Is there a shortage?

Christine Roussel, a member of the Medical Marijuana Advisory Board who presented the nurse practitioner proposal at a public meeting in January, explained that the main reason for the change is to “improve patient access to care.”

Spotlight PA’s request to interview Roussel was not granted, and a State Department spokesman said further comment “would be inappropriate.”

Last year, Laura Mentch, director of the Office of Medical Marijuana, said she had not received any complaints during her tenure about not having enough people practicing in the program. During this time, she testified as part of a hearing for an individual physician seeking to return to the program.

Mentch said telehealth expands options for patients.

“You’re not even limited by driving time anymore,” Mentch testified at trial. “If you want a statewide board-certified doctor, a telehealth visit and phone call is all it takes.”

When asked about Mentch’s comments, Ruhland stated that Mentch is not responsible for making recommendations regarding changes to the medical staff who can certify patients, and her testimony was not provided in connection with this issue.

Meredith Buettner Schneider of the Pennsylvania Cannabis Coalition told Spotlight PA the proposed expansion could create more options for patients and lower the price of certificates. She said some patients don’t feel comfortable using telehealth visits.

“I think meeting patients on site is extremely important and something we definitely need to work on,” she told Spotlight PA.

Pennsylvania’s medical marijuana program has nearly 2,000 approved people, according to a recent health department presentation. This is a relatively small percentage of all state physicians with an active license. The latest state data shows there are over 53,000 active MD licensees and over 11,000 active DO licensees.

In some states, nurses play a significant role in the medical marijuana program.

In Maryland, a 2021 report found that nurse practitioners and certified midwives outnumber physicians and physician assistants in the state’s medical marijuana program.

In 2019, lawmakers approved adding nurse practitioners and physician assistants to Virginia’s medical program. The bill was introduced by then-state senator Siobhan Dunnavant (R), who is also a physician.

“It wasn’t controversial,” said J.M. Pedini, executive director of the Virginia chapter of the National Organization for the Reform of Marijuana Laws.

At his medical marijuana clinic in Virginia, Jenks works with a team of nurses who certify patients. Telehealth appointments for state certification assessments, as well as custom in-home visits, can be scheduled on the company’s website. She said the patient education services, called medical marijuana coaching on the website, are available to residents of Virginia and beyond.

Cannabis has helped patients suffering from panic attacks, social anxiety, chronic pain and other problems, Jenks said of the drug’s impact. He explains to patients that cannabis is another tool for managing symptoms.

She said when state medical marijuana programs block nurses from clearing patients, they limit access to care.

“At the end of the day, it’s about the patient,” Jenks argued. “The idea is that the patient has access to a substance that helps him.”