With Pennsylvania’s first-in-the nation medical marijuana research program WHERE? still gearing up, doctors across the state are already working with patients using the substance to treat a wide variety of serious conditions.

That leaves physicians facing some unfamiliar territory.

Where their knowledge of traditional pharmaceuticals enables them to prescribe specific dosages in an effort to achieve well-known outcomes, when it comes to medical marijuana they do not write prescriptions at all. Instead, they certify that patients have one of the 23 conditions eligible to be treated with medical marijuana — with forms and dosage levels to be determined.

“If you have one of the neuropathic conditions, for example, severe painful diabetic neuropathy, we don’t know what dose of what specific tincture to even recommend,” said Dr. Anthony Colantonio of Meadville Medical Center’s Clinic for Specialty Pain Services.

“That has to be figured out with the patient at an individual level,” he said. “Unlike prescription agents that go through a formal study and FDA approval — those questions are answered.”

The state’s medical marijuana website lists hundreds of the practitioners who have registered to certify patients for medical marijuana. Five of them, including Colantonio, practice in Crawford County. After completing a Pennsylvania Department of Health training program, Colantonio began seeing patients for certification in September 2018.

Colantonio’s approach to medical marijuana differs in two important ways from the practices of many other physicians on the list, HE SAID?.

First, he reserves the treatment option only for patients who have worked with the clinic extended periods. Also, he certifies patients diagnosed with only two of the 23 conditions approved for treatment with medical marijuana.

The list of approved conditions includes irritable bowel syndrome, post-traumatic stress disorder, schizophrenia, glaucoma and multiple sclerosis and was most recently updated in June to include anxiety disorders. Colantonio, however, only certifies patients experiencing the two pain-specific conditions, both related to neuropathy.

His cautious entry into the field of medical cannabis results from what he considers his role in providing such a new treatment involving a substance still classified as illegal by federal authorities despite having been medically approved by Pennsylvania and more than 30 other states.

“I feel like that’s my biggest role actually in certifying a patient — to help them understand the risks,” Colantonio said. “Those can be medical risks. Those can be legal risks. Those can be financial risks. We cover all of that with our patients. It is not nearly as straightforward as many have believed it to be. We’ve oversimplified what using medical cannabis involves, and we’ve underestimated the risk.”

Colantonio’s caution comes in response to relatively little research on medical marijuana compared to more familiar FDA-approved drugs. The scarcity has resulted from the classification of marijuana as a Schedule I drug, like heroin or LSD, under the U.S. Controlled Substance Act, he said, which means it has “it has no identified medical benefit in the eyes of the federal government.

Unlike human clinical trials for traditional pharmaceuticals, in which hundreds of patients taking the medication are monitored and subsequently evaluated by the Food and Drug Administration, Colantonio said most of the knowledge medical professionals possess about cannabis comes from animal subjects, especially in studies involving pain treatment.

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The 2016 bill that legalized medical marijuana in Pennsylvania and others that have followed it acknowledged a need for additional research. A research program featuring medical schools partnered with growers and dispensers — the first program of its kind in the nation — was established by Act 43 of 2018. Eight medical schools were certified to participate in May 2018. In December, however, applications from the first round of eight clinical partners were rejected.

“Research is an essential part of our efforts to ensure that patients can find relief from their serious medical conditions with medical marijuana,” Health Secretary Dr. Rachel Levine said at the time. “Our goal is to ensure that our research program operates at the highest standards. We are disappointed that awards were not made, but must uphold the standards set out in the regulations.”

Three clinical registrants — organizations that hold permits as both growers and dispensers of medical marijuana — were approved in June. On Sept. 5, the Department of Health released another round of applications in hopes of finding partners for the remaining five medical schools.

Despite the slow launch, Levine in June painted a positive picture of the future for Pennsylvania-based research into medical marijuana.

“Pennsylvania is on the forefront of clinical research on medical marijuana,” she said. “This research is essential to providing physicians with more evidence-based research to make clinical decisions for their patients.”

Despite what he sees as the rudimentary state of the research supporting it, Colantonio still favors medical marijuana legalization.

“It has not been a panacea or utopia for anyone, and quite frankly, that’s not what we expected it to be,” Colantonio said. “If it was going to be that, I think we would have been onto this as a resource for our patients decades ago. What I’ve seen my patients benefit the most with has been the anxiety that accompanies their pain and their painful episodes. As well there have been patients who have benefited with their pain.”

Tyler Dague can be reached at 724-6370 or by email at Mike Crowley can be reached at 724-6370 or by email at