How we investigated misleading addiction claims on Pennsylvania cannabis websites

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>> Read the complete investigation here

HARRISBURG — Prompted by Pennsylvania’s opioid epidemic, the Wolf administration in 2018 officially endorsed cannabis as a treatment for opioid use disorder — an unusual move.

A few other states followed, but the endorsement also met strong resistance from the Pennsylvania Psychiatric Society, the American Society of Addiction Medicine, and others who warned of the potential harm of cannabis use or its potential to lead patients away from treatments with ample evidence behind them.

While covering the debate over the policy in Pennsylvania, and the unintended confusion it created, Spotlight PA came across a 2020 medical journal article that examined claims made by cannabis dispensaries online.

In the study, epidemiologist Chelsea L. Shover and her colleagues found that unsupported medical claims about using cannabis to treat opioid use disorder are more prevalent in states like Pennsylvania, where the condition is an official qualifying condition.

Shover and her fellow researchers warned that misinformation could have fatal consequences if it leads people with opioid use disorder to turn away from evidence-based treatment.

Those treatments have widespread support in the scientific and medical communities. For instance, a 2019 report from the National Academies of Sciences, Engineering, and Medicine found people with opioid use disorder are about 50% less likely to die when they are being treated long-term with methadone or buprenorphine, two of the three federally approved medications for opioid use disorder.

Spotlight PA decided to conduct its own review of websites that promoted cannabis dispensaries, as well as those for physicians and certification companies.

These websites are important resources for patients. Dispensary websites frequently provide instructions detailing how people can obtain medical marijuana cards, feature testimonials from patients, and analyze research. The Pennsylvania Department of Health public list of cannabis dispensaries includes both their physical addresses and websites. Some of those dispensary websites in turn link to the websites of specific physicians or companies that help certify patients.

The review took weeks. Spotlight PA reporter Ed Mahon began with the Department of Health’s public list of dispensaries. He eliminated duplicate websites and companies that appeared to no longer operate in Pennsylvania. In the end, he analyzed 31 unique dispensary websites.

Mahon visited the websites, noted whether they mentioned opioid use disorder or opioid addiction, and recorded the claims they made about cannabis. He also compared the statements to published research in peer-reviewed journals and reports.

Mahon also documented whether those dispensaries linked to specific websites where the dispensaries said people could receive a medical marijuana certification. Some of those websites were for companies that connect patients with a health-care practitioner who could certify them. Others websites were for individual physicians or practices that focused on marijuana certification or offered it. For a few of those websites, Mahon didn’t find any mention of medical marijuana certifications, but a practitioner name or address matched with a Department of Health list of medical marijuana practitioners. In the end, Mahon analyzed 32 unique websites in that certification category.

The review of certification websites wasn’t meant to capture all or even most of the over 1,600 approved practitioners in the state’s medical cannabis program. Spotlight PA’s analysis focused specifically on ones that cannabis dispensary websites referred customers to.

In late October and early November, Spotlight PA compiled our findings and shared them with a range of experts who focus on public health policy, cannabis, or addiction treatment. We included examples from specific websites, as well as overall trends.

Our findings focused on statements made about opioid use disorder, including the connection between medical cannabis laws and opioid overdose rates in states; the potential benefits of the cannabis compound CBD for addiction treatment; and the potential benefit of using cannabis to replace medication approved by the U.S. Food and Drug Administration to treat opioid use disorder. Spotlight PA also looked at whether cannabis companies listed the full criteria for qualifying for cannabis for opioid use disorder in Pennsylvania.

Multiple experts raised the most concern about statements promoting cannabis as a substitute to buprenorphine, a federally approved medication for opioid use disorder. Spotlight PA reached out to the companies that made that claim, asking them for a source for their statements. Spotlight PA also spoke to several additional experts about that specific issue, including researchers whose work was cited by at least one cannabis company official.

Additionally, to better understand the oversight that does exist, Spotlight PA also reviewed thousands of pages of documents provided by the Department of Health in response to open records requests.

All of those sources — a review of over 60 websites, an examination of peer-reviewed research, interviews with more than a dozen experts, and a review of thousands of pages of records from the Department of Health — informed the final story.

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