A behind-the-scenes look at Spotlight PA’s analysis of 1 million medical marijuana certifications

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For Spotlight PA’s latest investigation into Pennsylvania’s medical marijuana program, we analyzed more than 1 million records of anonymized patient certifications — data the newsroom obtained after a 15-month legal battle with the state Department of Health.

These certifications allow hundreds of thousands of patients to legally use cannabis in the state. Our analysis offers the first comprehensive look at how the decision to add anxiety disorders as a qualifying condition transformed Pennsylvania’s program, and, in the eyes of some, made it possible for basically anyone to get a medical marijuana card.

Here’s what you need to know about our reporting.

Why did Spotlight PA obtain this data?

This story began nearly 20 months ago, in June 2021, when Spotlight PA reached out to the Pennsylvania Department of Health with a question: How often did medical marijuana patients qualify for the program because they had opioid use disorder?

At the time, Spotlight PA was reporting on the overdose death of a Bucks County man who was wrongfully denied addiction treatment funding because of his medical marijuana card.

The department initially refused to provide details about certifications for opioid use disorder, writing that it “cannot share specifics regarding patient use.”

Spotlight PA challenged that response using the state’s public records, or Right-to-Know, law. The department had released similar information before, and the newsroom had not asked for details identifying patients. When the department again denied our request, we appealed to the state’s Office of Open Records, which ruled in favor of Spotlight PA.

The Department of Health continued to push back, taking Spotlight PA to Commonwealth Court to prevent the information’s release. That legal fight could have cost Spotlight PA thousands of dollars, but Paula Knudsen Burke, an attorney with the Reporters Committee for Freedom of the Press, represented the newsroom at no cost. Last August, Commonwealth Court ordered the department to release the data.

What did the Department of Health release?

The department provided Spotlight PA with anonymized data on each certification created by a doctor over a six-year period. These records included the creation date, the certification’s status, the patient’s ZIP code, and the patient’s qualifying conditions.

At one point, the health department sent revised information for one year, saying the original data inadvertently included duplicates. The department provided updated data for that year, and a spokesperson told Spotlight PA that the agency had reviewed the other data and “found no issues.”

In total, the health department spreadsheets provided details on more than 1.13 million certifications created from November 2017 through August 2022.

Did Spotlight PA exclude any certifications?

We excluded about 31,000 of the 1.13 million certifications — or 2.8% — from our analysis.

The health department placed certifications in one of nine status categories. Our analysis looked at two of those: active and expired. We excluded the other seven categories, such as ones that were created in error, never used, or canceled at the request of the practitioner. Those seven statuses accounted for a small percentage of the total certifications.

We also excluded three additional certifications that did not have any qualifying condition listed, and 408 certifications that were created before 2021 and still labeled as active in the records the state provided. The maximum time period for a certification is 12 months.

Why did Spotlight PA focus its reporting on anxiety disorders?

Our analysis found that anxiety disorders have become the dominant qualifying condition in recent years. In fact, anxiety disorders were a factor in more than 231,000 certifications created in 2021 — or 60% of the total for that year.

To better understand the significance of these data, we compiled our findings and discussed them with more than 20 medical professionals, patients, and others. They represented a range of backgrounds and offered nuanced views on anxiety as a qualifying condition.

How did other conditions compare?

Severe chronic pain ranked second. Doctors listed it as a qualifying condition on more than 161,000 certifications — or 42% percent — created in 2021, the most recent year with complete data.

Pennsylvania has 23 approved qualifying conditions, and the data showed the others were used significantly less often.

Opioid use disorder, the condition that sparked our original data request, appeared as a qualifying condition on more than 13,000 certifications created in 2021. And for more than 5,000 certifications that year, opioid use disorder was the sole qualifying condition, meaning that was the only reason a person was eligible to use medical marijuana.

Have others urged the Department of Health to release more data?

Yes, and for a variety of reasons.

“The Department of Health and the medical marijuana office do not do a good job of sharing program information with the public, with elected officials, or with permit holders,” said Meredith Buettner, executive director of the Pennsylvania Cannabis Coalition, an industry trade group.

Buettner thanked Spotlight PA “for fighting this fight” to get data out of the department.

The Pennsylvania Psychiatric Society, which has objected to anxiety disorders and opioid use disorder as qualifying conditions, also wants the department to collect and publicly release more data about the program.

“This data is of great interest to us,” Marina Goldman, a psychiatrist speaking on behalf of the group, said after reviewing Spotlight PA’s findings.

“I think there’s a great deal of overlap between what we’re asking to see and the data that you are starting to obtain.”

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