Pennsylvania needs prescription-strength oversight for medical cannabis | Opinion – pennlive.com
By Dr. Ari Greis
In Pennsylvania, physicians who treat chronic pain operate under two very different systems of accountability when it comes to controlled substances.
For opioids, strict e-prescribing regulations and mandatory documentation in the state’s Prescription Drug Monitoring Program (PDMP) create important safeguards against misuse and diversion. These measures allow clinicians to track each patient’s medication history, identify warning signs early, and coordinate care effectively.
The value of these systems is reflected in the steady decline of prescription opioid misuse and overdose deaths in recent years. Strong, transparent oversight has saved lives.
Medical cannabis, however, sits outside this structure entirely. After a patient receives approval for medical cannabis, dispensaries can recommend a wide array of products, potencies, and formulations—with almost no clinical oversight.
Physicians have no direct access to dispensing records and must rely solely on patient self-reporting, which is often incomplete, confused, or inconsistent. There is no integration with the electronic health records or data systems that help keep patients safe in every other area of clinical medicine. This lack of accountability leaves patients vulnerable to unpredictable dosing, drug interactions, and adverse effects. It also creates a situation in which medical cannabis, intended partly as a harm-reduction tool, can unintentionally adopt some of the same risks we worked so hard to reduce during the opioid epidemic.
These gaps play out daily in clinical encounters. Many patients arrive having sampled multiple cannabis products from different dispensaries, each with varying THC/CBD ratios, extraction methods, and dose strengths—without any structured oversight or documentation.
Without a statewide electronic prescribing system, physicians cannot coordinate care, tailor dosing, or identify early signs of problematic use. This double standard is troubling, especially as more patients turn to cannabis specifically to avoid long-term opioid therapy. When the state holds cannabis to a lower regulatory standard than opioids, patient safety inevitably suffers.
Recognizing these issues, Pennsylvania lawmakers have begun taking steps to address the oversight gap.
House Bill 33, introduced by Representative Dan Frankel, focuses on improving the scientific and quality-control foundation of the medical cannabis program. It expands the Department of Health’s authority over practitioner registration and strengthens standards for laboratory testing. Under this bill, approved labs would be required to upload results to a centralized state monitoring system and conduct more frequent testing—particularly for products that sit on dispensary shelves for long periods, where potency and stability may degrade. These changes are designed to ensure that patients receive products that accurately reflect their labeled contents and therapeutic intent.
From a clinician’s perspective, consistent and accurate lab testing is essential.
When patients use cannabis for medical purposes, physicians must trust that the products they rely on are precisely what the label describes. While HB 33 requires initial investment in improved oversight, these costs are expected to be offset by modest licensing fees and long-term savings from more efficient program management, fewer quality failures, and reduced patient harm.
Senate Bill 49, sponsored by State Sen. Dan Laughlin and a bipartisan group of colleagues, addresses oversight from a structural standpoint. It proposes establishing an independent Cannabis Control Board to consolidate regulatory authority currently scattered across multiple agencies. A dedicated regulatory body could make oversight more efficient, streamline communication, and help clinicians and patients navigate the medical program more consistently. The bill also seeks to regulate the rapidly growing market of unregulated, hemp-derived intoxicating products—such as delta-8 THC—which are currently sold in convenience stores without standardized labeling, potency limits, or age restrictions.
Bringing these products under consistent safety and accountability standards is a critical public health step.
HB 33 and SB 49 signal meaningful progress. They demonstrate an emerging recognition that a therapeutic substance used by hundreds of thousands of Pennsylvanians requires structured oversight, quality assurance, and reliable testing. However, neither bill addresses the most consequential clinical gap: the absence of electronic prescribing for medical cannabis and real-time physician access to dispensing data.
Without these tools, medical cannabis remains the only controlled substance in the state for which physicians cannot monitor patient use, confirm dosing, or intervene when patterns of risky behavior emerge. These capabilities are foundational to safe prescribing and were central to Pennsylvania’s success in improving opioid safety. Extending these principles to medical cannabis is not about restricting access—it is about bringing the same standard of care to a widely used therapeutic agent.
Pennsylvania’s approach to opioid prescribing has shown that transparency, accountability, and coordinated data systems protect patients and improve outcomes. By applying similar oversight to medical cannabis—and building upon the groundwork laid by HB 33 and SB 49—the Commonwealth has an opportunity to enhance patient safety, reduce medical and regulatory costs, and preserve the therapeutic potential of cannabis as a safer, well-regulated alternative for chronic pain.
Holding dispensaries and cannabis producers to the same high standards expected of opioid prescribers is not only reasonable—it is essential for safeguarding the health and trust of all Pennsylvanians.
Dr. Ari Greis is a member of the board of the Rothman Institute Foundation for Opioid Research & Education, and an assistant professor of Orthopaedics at the Drexel University College of Medicine.
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