Pennsylvania’s Medical Marijuana Program Expanded Significantly After Anxiety Was Added As A Qualifying Condition, Study Shows

Anxiety is now the number one health condition that Pennsylvania patients use medical marijuana to treat, according to a new study.

Relying on data from the Pennsylvania Department of Health, researchers with Johns Hopkins University and the University of Pittsburgh assessed trends in more than 1.7 million medical cannabis certifications from November 2017 to December 2023.

Of that group, about 1.6 million registered patients were recommended medical marijuana for anxiety disorders, the study, which was published in the journal Annals of Internal Medicine, found.

By contrast, 91,759 people received cannabis certifications for chronic pain, 21,671 for post-traumatic stress disorder (PTSD) and 28,991 for other conditions.

“We found that adding anxiety disorders as a qualifying condition for medical cannabis in Pennsylvania was associated with an overall increase in certifications, with anxiety disorders rapidly becoming the most common qualifying condition, comprising 60.26 percent of certifications since it was added” in July 2019, the study authors wrote.

“Although certifications for chronic pain and PTSD still increased, the percentage of total certifications using each of these qualifying conditions decreased by roughly one third after anxiety was added,” they said.

The study also speculated that the increased anxiety-related recommendations could be linked to stress during the coronavirus pandemic.

“This study illustrates how adding anxiety as a qualifying condition affects the overall count of cannabis certifications and alters the distribution of qualifying conditions,” they wrote. “These results are limited to Pennsylvania. We used Pennsylvania data for our analysis because it is the only state, to date and to our knowledge, that has released certification-level data on medical cannabis qualifying conditions.”

“Although Pennsylvania does have the second-largest medical cannabis program in the United States, findings may not generalize to other states,” the study concludes. “Furthermore, the data do not include patient information, limiting analysis of recertifications and differences by demographics.”

Coleman Drake, an associate professor at Pitt’s School of Public Health, caveated in a statement that adding anxiety to the state’s medical cannabis program “may inadvertently signal to patients that cannabis is effective for treating it, despite the lack of evidence, which is concerning.”

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This comes in the background of Pennsylvania lawmakers continuing their years-long debate over whether to legalize adult-use marijuana, as most of its surroundings states have done.

Bipartisan Pennsylvania senators introduced a bill last week to create a new regulatory body in the state that would begin overseeing medical cannabis while preparing to eventually handle the adult-use market as well.

The 52-page legislation is being sponsored by Sen. Dan Laughlin (R), along with 16 other members from both parties. While it wouldn’t legalize adult-use cannabis as the lead sponsor has supported, it would establish a regulatory infrastructure that could be used to oversee such a program.

Laughlin, who has sponsored legalization bills in the past, previewed the new measure in May, writing that Pennsylvania should first take steps to make sure the state is “ready to act when legalization becomes law” by establishing a Cannabis Control Board (CCB) now.

Meanwhile, Sen. Shariff Street (D), one of the original cosponsors of the new bill, said last month that he was working with bipartisan and bicameral lawmakers to develop a passable marijuana legalization measure as the legislature approached its budget deadline—telling supporters at the time that “we’re getting close” and they shouldn’t “ease up” on the fight.

Street thanked his bipartisan colleagues in the House—including Reps. Emily Kinkead (D), Abby Major (R) and Amen Brown (D), who have championed their own legalization proposals—for working with the Senate “in a collaborative way.”

Senate Majority Leader Joe Pittman (R) recently said marijuana legalization would not be included in the 2026 budget as lawmakers approached the deadline he expected they would miss. But Gov. Josh Shapiro (D) is still holding out hope that negotiators can “get it done.”

Whether Pennsylvania legislators will advance legalization this session remains to be seen. But two Democratic lawmakers—Street and Rep. Rick Krajewski (D)—recently said they’re aiming to reach a compromise and pass reform legislation before the budget deadline.

Also, in May, Sen. Marty Flynn (D) announced his intent to file a new bill to legalize marijuana in the state, calling on colleagues to join him on the measure.

While the House legislation Krajewski sponsored alongside Rep. Dan Frankel (D) was rejected in a Senate committee following its expedited passage through the House along party lines, Street said he’s “cautiously optimistic we’re going to be able to revive the bill and amend it and move forward with a work product that allows us to get a bill on the governor’s desk and realize revenue.”

Following the Senate committee vote, lawmakers from both chambers who support legalization have been trading criticisms about each other’s roles in the stalled push to end prohibition.

Krajewski, for example, recently wrote in a Marijuana Moment op-ed that Senate Republicans who killed his House-passed cannabis legalization bill are “stuck in their prohibitionist views of the past” and are “out of touch with the will of our Commonwealth.”

Prior to that vote, Pennsylvania’s Republican attorney general said that while he doesn’t currently support the House-passed marijuana legalization bill, he’s open to changing his mind about the policy change after continuing to review the details.

For what it’s worth, a recent poll found that Pennsylvania voters say they favor a model where cannabis is sold by licensed private businesses, rather than through a system of state-run stores.

The governor has repeatedly called for adult-use marijuana legalization. However, he hasn’t endorsed the specific idea of having a state-controlled model.

GOP lawmaker Major—who is sponsoring another forthcoming legalization bill that envisions a traditional private sales model alongside Democrat Kinkead—said during the House floor debate on HB 1200 that she stands opposed to the competing bill, emphasizing that she disagrees with the state-run stores proposal.

While Democrats control the House and governor’s office, they will still need to reach a deal with the GOP-controlled Senate to effectuate change. And in addition to the conflicting perspectives among pro-legalization legislators, another potential barrier to reform is exactly that political dynamic.

Regardless of which direction Pennsylvania lawmakers do—or don’t—go on marijuana legalization this session, a survey released in April shows a majority of adults in the state support the reform—and opposition to the policy change has fallen by nearly 50 percent over the last decade.

Kinkead has made the case in another recent interview that legalizing cannabis in Pennsylvania will help the state mitigate public health and safety concerns associated with the illicit market, including the fact that unregulated products can be laced with fentanyl.

The lawmaker previously introduced a separate bipartisan marijuana legalization bill, alongside 15 other cosponsors, last September. It did not advance, however.

Meanwhile, Laughlin recently called for the creation of a state “legacy” fund, using tax revenue from adult-use marijuana sales and gaming to make long-term investments in the Commonwealth’s economy.

The senator argued that, beyond using any resulting tax revenue to fund day-to-day projects and public services, the state should earmark a portion of those tax dollars for a fund to “provide a sustainable source of prosperity that lasts for generations.”

Another GOP Pennsylvania senator, Sen. Gene Yaw (R), is backing the push to legalize marijuana in the commonwealth, pointing out that, historically, prohibition “has not turned out well,” noting the country’s experience with alcohol criminalization.

Pennsylvania House Speaker Joanna McClinton (D) recently said that Democrats are ready to pass a marijuana legalization bill this session, but that the party “will need Republican support” to get the job done—adding that it will be a “heavy lift.”

Polls have shown bipartisan support for legalization among voters, but the reform has consistently stalled in the legislature, owing in large part to GOP opposition. But not all Republican members are against the policy change—and one recently said she felt her party should seize the “opportunity to snatch” the issue from Democrats.

Separately in March, the Pennsylvania House approved a bill sponsored by Frankel that’s meant to strengthen safety standards and oversight of the state’s medical marijuana program as lawmakers work to advance adult-use legalization.

While Pennsylvania’s medical cannabis program was enacted nearly a decade ago, lawmakers say the measure, which now heads to the Senate, is necessary to improve testing compliance, product audits and lab inspections, among other aspects of the industry.

Meanwhile, Pennsylvania Democratic lawmakers recently introduced a bill that would allow farmers and other small agriculture operators to sell marijuana they cultivate to existing growers and and processors if the state moves to legalize adult-use cannabis.

Separately, an independent Pennsylvania agency is projecting more tax dollars to be generated from adult-use marijuana sales compared to what the governor’s office has estimated, although it expects significantly less overall revenue from cannabis legalization due to differing views on licensing fees.

Pennsylvania officials have also launched a new survey that invites legal marijuana businesses across the country to provide information about their operations to help the state better understand the cannabis industry as lawmakers consider enacting adult-use legalization this session.

Also, in a video interview released in March, the governor emphasized that the state is “losing out” to others that have already enacted adult-use legalization, while maintaining a policy that’s enriched the illicit market.

“I think it’s an issue of freedom and liberty. I mean, if folks want to smoke, they should be able to do so in a safe and legal way,” he said. “We should shut down the black market—and, by the way, every state around us is doing it. Pennsylvanians are driving to those other states and paying taxes in those other states.”

The state’s agriculture secretary separately told lawmakers that he’s fully confident that his department is in a “really good” position to oversee an adult-use marijuana program if lawmakers act.

Meanwhile, in February, top Pennsylvania police and health officials told lawmakers they are prepared to implement marijuana legalization if the legislature moves forward with the reform—and that they stand ready to work together as the details of legislation to achieve it are crafted.

Amid the growing calls for marijuana legalization in Pennsylvania, a GOP state senator said prohibition has been a “disaster,” and a regulated sales model for cannabis—similar to how alcohol and tobacco are handled—could serve as an effective alternative.

A Republican Pennsylvania senator also recently defended the push to legalize and regulate marijuana, calling it “the most conservative stance” on the issue.