5 key takeaways from Spotlight PA’s investigations into Pennsylvania’s medical marijuana card system

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HARRISBURG — Doctors are the gatekeepers for obtaining a medical marijuana card in Pennsylvania.

But a series of Spotlight PA investigations has revealed weak oversight by the state Department of Health and raised questions from experts about the quality of care many patients receive. Some doctors issued more than 5,000 patient certifications in a single year — with a few exceeding 10,000.

The findings have prompted lawmakers to propose changes to the state’s medical marijuana law.

Here’s what you need to know about the investigations, what they revealed about Pennsylvania’s medical marijuana program, and what comes next as lawmakers in the Capitol consider legalizing recreational cannabis for adults.

1. A small number of doctors approve an outsize share of medical marijuana cards.

There are tens of thousands of doctors with an active Pennsylvania medical license. But a relatively small percentage are registered in the state’s medical marijuana program. And an even smaller number approve a disproportionately large share of certifications, as revealed by a Spotlight PA investigation examining the volume of patients approved by some top certifying doctors.

There were about 1,900 approved practitioners in the program as of November.

A Spotlight PA analysis of physician records released by the health department found that in 2022, 17 doctors were responsible for nearly one-third of all certifications issued statewide. These physicians represented 1% of all doctors who issued at least one certification in Pennsylvania’s program that year.

Some of the top certifiers in the program previously faced discipline on their medical license, Spotlight PA reported in August.

For now, doctors remain the gatekeepers.

In November, Pennsylvania’s health secretary, Debra Bogen, rejected recommendations to add podiatrists and nurse practitioners to the list of medical professionals who can approve patients for the program. Bogen cited limitations in the law, but she also said in each decision that the recommendation didn’t indicate that the expansion “would be necessary to meet patient needs.”

Unlike most neighboring states, Pennsylvania hasn’t legalized recreational cannabis use. An adult-use legalization proposal from Democratic Gov. Josh Shapiro failed to pass last year. The recreational issue could see more action in Pennsylvania’s Democratic-controlled House in the new legislative session.

2. Pennsylvania regulators say they have limited power.

Some medical marijuana doctors support random audits of physicians in the program as a way to assess the quality of patient care. But a health department spokesperson told Spotlight PA that the “Bureau of Medical Marijuana has no legal authority to conduct such an audit.”

During an administrative case that Spotlight PA reported on last year, a health department attorney wrote that the state’s medical marijuana law and regulations don’t give the Bureau of Medical Marijuana “the same investigation resources or authority to require extra requirements to prove compliance” that other agencies, including a licensing board, hold.

In response to oversight concerns raised in late 2022, the Department of Health said it “does not have the authority to inspect licensed health care practitioners or their offices” but does investigate all complaints received.

State Reps. Tim Twardzik and JoAnne Stehr, both Republicans from Schuylkill County, cited limitations on the department’s authority in memos to colleagues as they sought support for legislation to increase the agency’s oversight powers.

3. There are risks for patients.

Patients, researchers, and doctors hold a range of views on the impact of easily granted certifications.

Some noted the drug’s relative safety — there are no reported deaths from an overdose of marijuana, according to the Drug Enforcement Administration.

But there are “both benefits and harms” to cannabis use, according to a report last year from the National Academies of Sciences, Engineering, and Medicine. The report said that products with a high concentration of the cannabis compound THC “are associated with a higher risk of psychosis and cannabis use disorder.” The report described other harms of cannabis use, including increased risk of motor vehicle collisions, respiratory symptoms, and lower birth weight for children exposed during pregnancy.

Some patients and medical marijuana supporters have criticized the cost burden of having to pay for a new certification at least once a year. And in a recent Spotlight PA story, one medical marijuana doctor described potential problems for patients if they make an appointment through a third-party company and can’t reach their certifying doctor afterward.

4. The oversight issue is getting greater attention in Harrisburg.

In late 2022, some members of Pennsylvania’s Medical Marijuana Advisory Board publicly questioned the health department’s oversight of doctors. The state’s health secretary faced scrutiny from a state senator in April 2023 on the issue. Twardzik and Stehr cited Spotlight PA’s investigations as they proposed increasing the health department’s oversight powers.

Similarly, the executive director of a group focused on preventing substance misuse recently cited Spotlight PA’s reporting in his call for changes to the medical program, including eliminating third-party companies that charge fees to connect patients to doctors.

Certification issues also appear to be drawing greater scrutiny from state regulators. A spokesperson for the Department of Health told Spotlight PA in November that discussions with the Department of State — which enforces licensing standards for medical professionals — about “certification data and patient consultations escalated over the last year.” That period follows a series of Spotlight PA investigations into the state’s medical marijuana program.

But the Pennsylvania Department of Health has also said there are limits to looking at certification numbers alone. The agency spokesperson said the number of certifications for each doctor “can vary widely due to factors such as the practitioner’s specialty, practice setting, patient population, and geographic location.”

5. Spotlight PA legal victories led to greater transparency.

The Pennsylvania Department of Health provided certification data for individual doctors after a legal fight with Spotlight PA.

This type of data is also available in some other states.

Reports in Colorado give information about the number of medical marijuana recommendations written by providers without identifying them. And a 2023 report from the Michigan Office of the Auditor General raised concerns about the number of certifications approved by a relatively small number of unnamed physicians.

Florida publishes annual reports that list the total number of certifications issued by individual doctors and identifies them by name. These reports also provide additional information compared to what the Pennsylvania Department of Health provided to Spotlight PA.

A previous Spotlight PA court victory led the health department to release data on why patients qualify for the program — and the department now posts that type of information online.

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