Medical marijuana patients in Pennsylvania are using cannabis to treat chronic pain more than any other affliction, according to an informal survey of dispensaries by the Inquirer.
"Between 60 to 70 percent of our patients are using the medicine for pain," said Chris Visco, president of TerraVida Holistic Centers, the state's largest medical marijuana retailer by volume. "Other common ailments patients report are post-traumatic stress disorder, multiple sclerosis, and cancer."
TerraVida — with stores in Abington, Malvern, and Sellersville — was the first to open a dispensary in eastern Pennsylvania. With what appears to be the state's largest cannabis product "menu," TerraVida has completed 56,000 patient transactions so far this year, Visco said.
Solevo Wellness, which is based in Pittsburgh and has two operating storefronts, is considered by marijuana growers to be the state's second largest retailer.
"We were the only dispensary in the city of Pittsburgh for about six months," said Sam Britz, Solevo's chief operating officer. "Even with more competition and more stores opening, our patient base continues to grow."
Britz said patients are using cannabis to treat multiple sclerosis, epilepsy, and autism. "We're seeing a lot of anecdotal evidence of success with those conditions," Britz said.
Compassionate Certification Centers, based in western Pennsylvania, has certified about 10,000 of the state's patients. About 65 percent of those patients, who pay $199 for the appointment, are asking for medical marijuana to treat chronic pain, said Bryan Doner, chief medical officer.
About 15 percent need it for PTSD, Doner said. Others are asking for it to treat various illnesses including cancer, inflammatory bowel disease like Crohn's, MS, and opiate-substitution therapy.
"The most common recommendation we write is for oral preparations such as capsules, tinctures, and oils," he said. "Inhalation can bring rapid relief, but with relatively short duration. Oral treatments have a 60 to 90 minute onset, but have a long duration, from six to eight hours."
The state department of health reported Friday that it has registered 84,000 patients, a large number considering the program has been up and running for about 10 months. Of those registered patients, 55,000 have received cards from Harrisburg allowing them to purchase marijuana at any one of the state's 37 operating dispensaries.
Cannabis producers and retailers may not make any specific medical claims for their products. The state has approved the use of marijuana to treat any of 21 serious medical conditions from autism to terminal illness.
At Restore Integrative Wellness in Fishtown, the first dispensary to open in Philadelphia, store manager Robert Stanley said increasing numbers are using marijuana as a way of reducing their dependence on harder drugs.
"We've seen a lot of people in the last month and a half here trying to get off opioids," Stanley said.
Josh Richman is senior vice president of sales for Denver-based Altus, which operates the Beyond/Hello dispensary in Bristol Township. The chain is scheduled to open a shop in Center City, at 12th and Sansom Streets, before the end of the year.
"We've found that what we're treating isn't always the qualifying condition 'on the card' but rather symptoms of the conditions," Richman said. "A patient with a cancer designation on their card is often receiving treatment for pain management, anxiety, and/or insomnia."
Patients new to cannabis generally start with tinctures — cannabinoids suspended in oils — "as they have more dosing control," Richman said.
The top cannabis brands vary by store and region. But Chicago-based Cresco, the first grower to sell in Pennsylvania, appears to hold the largest market share of the nine operating growers, according to the Inquirer's survey of dispensary managers. Dispensary owners and managers said up to 40 percent of their sales can be Cresco products.
Meanwhile, pain, PTSD, and opioid-use disorder are the most common ailments reported to staff pharmacists at Cure Pennsylvania, which operates dispensaries in Philadelphia, Phoenixville, and Lancaster. Patients primarily buy vape cartridges and pens there. Cresco, Standard Farms, and Moxie are the chain's most popular brands.
But Terrapin Pennsylvania, known for its value-priced vaporizable flower, is gaining.
"Cresco and Terrapin are huge," said Stanley, the manager of Restore. "And since flower came on the market in August, we can barely keep it on the shelves."
Terrapin, a grower with its corporate headquarters in Denver, sells more of the flower than any other substance in its product line.
"It's because it's a more familiar form and it's our lowest price," said Kobi Waldfogel, Terrapin's Pennsylvania sales manager. "A lot of patients are in their mid-50s and they're most comfortable with it. The flower is what they've known throughout their lives."
Other medicinal options include processed oils in vape cartridges. And those are beginning to claw back market share.
"The vape pens are discreet and fairly potent," Waldfogel said. "With flower you're looking at 18 to 30 percent THC [the psychoactive compound in marijuana]. The vapes can range from 70 to 90 percent. A lot of people buy based on the THC percentages."