Pennsylvania will gain about $7.9 million from marijuana permit applicants this year.
Pennsylvania could see a drastic surge in medical marijuana prescriptions this August if the state approves this one ailment as a qualifying condition.
The proposed addition? Anxiety, which affects hundreds of thousands of Pennsylvanians.
Back in February, the medical marijuana advisory board approved adding anxiety to the list of qualifying medical conditions.. But ultimately the final decision lies with Health Secretary Dr. Rachel Levine, who has been studying the ailment and whether medical marijuana could help.
Shalawn James, a patient advocate who serves on the advisory board, also considers herself a mental health advocate. Last year, when the board approved the process that allows individuals to suggest new conditions on a rolling basis, James said she expected to see a larger push to make mental health conditions qualifiers.
Medical marijuana was legalized in Pennsylvania in April 2016.
"There is so much stigma surrounding mental health," James said. "And we ostracize the people who acknowledge their struggles. Instead of putting these people in a box, let's give them the validation they deserve and their illness deserves. You can't physically see the pain, but that doesn't mean it's not there."
Currently, there are 21 medical conditions for which people are eligible for a medical marijuana card. Of those conditions, the only mental health condition is PTSD.
When it comes to treatment for anxiety, medical marijuana is quickly gaining ground in states like New Jersey and West Virginia.
Some conditions allowed in Pennsylvania are covered in other medical-marijuana states, such as cancer, Parkinson's disease and Crohn's disease.
But Pennsylvania's law is one of the few to cover conditions like opioid use disorder, or addiction. It was the first state to add opioid addiction to the list of qualifying conditions for the medical marijuana program. New Jersey, Illinois and New York have since followed.
The fact that Pennsylvania is starting to take mental illnesses into consideration is a big step forward, said PA Cannabis Law attorney Judith Cassel.
"Anxiety can be debilitating," Cassel said. "And if you can put people on medical marijuana in lieu of the medications we hear about with so many side effects, it could have an impact parallel to what we saw with the opioid epidemic."
The advisory committee plans to meet again on Aug. 14. Levine said she will make her decision regarding anxiety before then.
"Medical marijuana is not a cure for anxiety. It's not going to make the anxiety go away. But it could dramatically improve the quality of life for someone," James said. "If it works for just one person, why not make it available?"
Not everyone agrees with that logic.
Sharon Engdahl, executive director of the American Mental Wellness Association, argues that medical marijuana can contribute to anxiety.
She fears Pennsylvania could be rushing into this decision. There hasn't been enough research done yet, Engdahl said.
"Doctors recommend medical marijuana, but don't monitor their patients after to see what side effects it has on them," Engdahl said. "In some scenarios, medical marijuana has put people in a manic."
Some people argue that medical marijuana is a safer alternative than prescribing pills to people suffering from anxiety — "that's a completely bogus argument," she said.
"A lot of studies have to be done to have those medications approved by the FDA," Engdahl said. "I'd rather have my loved one be prescribed a pill that we know the possible side effects of, rather than be given a medical marijuana card and never looked at again."
Engdahl said she is not against the medical marijuana program, but the rate at which conditions are being approved for it, concerns her.
"We made alcohol legal and look what happened," Engdahl said. "This is another nightmare waiting to happen, like the one we're seeing with opioids now. Soon anyone is going to be able to get one of those cards."
Number of patients: 1 in 5 adults in the United States have an anxiety disorder, according to the Anxiety and Depression Association of America
Evidence: There is little research surrounding marijuana's effectiveness when treating anxiety. Engdahl said that is because under the federal government's scheduling system, marijuana is considered as dangerous as heroin. The federal government classifies marijuana as a schedule 1 drug — the same category as heroin — meaning it’s perceived to have no medical value and a high potential for abuse.
A 2012 study by California researchers said marijuana could be promising, but more evidence is needed.
States that have approved this condition: New Jersey, West Virginia
Even if Levine doesn't sign off on anxiety, there are already over 20 conditions that could qualify a patient for the Pennsylvania medical marijuana program.
Dr. Rachel Levine, state physician general, speaks at Minnich's Pharmacy in York Dec. 5. (Photo: Paul Kuehnel, York Daily Record)
Under current law, qualifying conditions include: