Pharmacists play a key role in managing and distributing an appropriate dosage of medical marijuana in its various forms across Pennsylvania's 60 state-approved dispensaries.
Through Pennsylvania's guidelines, patients do not receive marijuana as medicine the same way they would receive a muscle relaxer or antibiotics prescribed by a doctor.
While physicians certify their patients to receive medical marijuana for any of 23 acceptable medical conditions, card-holders then sit down with dispensary pharmacists to determine what might work best for their ailments.
Laura Mentch, of Danville, is one of two pharmacists at the new Nature's Medicines facility in Selinsgrove, scheduled to open Thursday.
Mentch and her patients will talk through the symptoms present and what the patient wants to accomplish with medical marijuana.
Is it anxiety? Is it a sleep disturbance? Is it pain? Tourettes? Seizures?
"Anxiety is now a qualifying diagnosis," she said. "We would talk through the symptoms that are associated with the diagnosis. I also talk to the patient about what dosage forms they are willing to try."
After presenting their medical marijuana cards and photo IDs at the site's entrance, customers fill out registration forms and work with consultants to log all of the symptoms they struggle with, as well as any prescriptions and medicines they take regularly.
Before a product in any form is recommended, the drug is cross-checked with a patient's current prescriptions to avoid the potential for negative reactions, Mentch said.
'Finding what's right'
To Sarah Hassinger, her new Johnstown employer's Beyond/Hello dispensary name is fitting, compared to her past stops as a pharmacist for retail chains.
Before the world of medical cannabis caught her attention a year ago, Hassinger said she worked in pharmacies for a nationally-known big-box store and a drug store chain – which often meant exchanging a few words with customers before they left with their medications.
"We go way beyond that here," Hassinger said. "It's about finding what's right for each individual patient."
Beyond/Hello held its Johnstown store's grand opening this summer.
"It's just like any other medicine," Hassinger said. "Some of these products are stimulants. Some are sedating."
Staff will work with them to get a full picture of each patient's medical history before making recommendations, Hassinger said.
As long as a doctor does not note any specific limitations, Mentch said, "I'll sit down and have a consult with the patient. I would already know what your primary diagnosis is because I can see it on the DOH website."
"I look in the DOH website to make sure that certification is active and to check on any limitations that the doctor would have notated for the patient," Mentch said.
Mentch said she can add notes, but cannot alter what providers have already written.
Power to the patient
In the end, it's the patient's choice on the form and strength of medication to receive – whether it's through a topical lotion, a tincture or vaporized concentrate or another method.
"We're putting the power back in the patient's hand," Mentch said. "And they are treating their own disease. There are people who have never smoked, never vaped and would prefer the oral form."
She said some patients can't use a dropper or are uncomfortable using a dropper, so she recommends using pills or capsules.
"We work through that together and decide what kind of relief they are looking for from the symptoms they have," Mentch said.
At Beyond/Hello, staff are on hand seven days a week to answer questions, conduct follow-up meetings and continue working with customers to find the right medicines to bring them comfort, Hassinger said.
"We're providing treatment on an individual level – for the specific person," Hassinger said.
The local Beyond/Hello dispensary employs more than 20 people, including three pharmacists, staff have said.
The dispensary is operated by Franklin BioScience, which was acquired by Florida-based medical marijuana company Jushi Holdings.
The company is one of two that won the right to develop dispensaries in Johnstown this year. Harvest of Southwest Pa., a subsidiary of Arizona-based Harvest Health and Recreation, is awaiting final approval to open its downtown location.
Nature's Medicines is the first dispensary to open in the Susquehanna Valley.
Looking for alternatives
Certain forms of medical marijuana are more appropriate for certain diseases.
When Mentch talks about forms, it's really about how fast the patient wants the dosage to work or how long he or she wants the effect to last.
"Any kind of inhaled products are going to be the fastest onset of action," Mentch said, "but they are also not going to last as long. For patients that have severe pain immediately in the morning, it is a good idea to have your inhaled product at your bedside. Set your alarm 10 minutes before you have to get up and start moving. Then access that medication, use it, see if it takes the edge off your pain so you can get up and move."
If you are not someone who has severe and acute pain and you want something to keep your pain at an even level during the day, Mentch might suggest using tinctures – drops that go under your tongue and get absorbed through the mucous membranes. They start working in about 30 minutes.
Inhaled products start working in 5-10 minutes.
Mentch said there are capsules available that are filled with cannabis oil. For inhaled products, you can use a vape pen.
It is really all about treating the symptoms. Instead of a doctor prescribing that a pill be taken three times a day, the patient can control dosage based on days when their pain is excruciating and they need more medical marijuana.
"People are looking for alternatives," she said. "That's what we can offer."