Medical Cannabis Certifications for Severe Chronic and Intractable Pain: Discerning Geographic Patterns Across Pennsylvania, USA

IntroductionChronic pain is the most common qualifying condition found in states with medical cannabis (MC). We conducted a study assessing the geographic distribution of MC certifications for severe chronic or intractable pain in Pennsylvania (PA) between 2018 to 2024, identifying relationships between median household income and ethnic background with the percentage of adults with a MC certification for pain. MethodsUsing data from the PA Department of Health (PDOH) from 2018 to 2024 (N = 44,645 to 165,740 certifications for pain / year), we mapped Zip codes associated with MC certifications for pain to counties and Zip code tabulation areas (ZCTAs). The difference between the highest and lowest counties was determined. A linear regression evaluated correlations between community variables and the percentage of adults in geographical areas with a MC certification for pain in 2024. ResultsThere was an almost a four-fold difference in the percent of adults with a MC certification for pain in the highest (Perry = 2.3%) versus lowest (Tioga = 0.6%) counties in 2024. Bradford and Tioga County had a significantly (p < 0.05) lower percentage certified relative to the county-wide average. There was a significantly higher proportion of certifications for pain in counties with larger population densities of adults (1.76 +/- 0.12%) than counties with smaller population densities (1.38% +/- 0.14%) of adults (t(65) = 4.66, p < 0.001, d = 1.14). At the county level, higher median household income was associated with a greater percentage of adults with MC (r(65) = +0.34, p < 0.01). At the ZCTA level, the proportion of non-White individuals, including Hispanics, showed a modest, but significant, inverse association with MC certification (r(1,722) = -0.07, p < 0.01). ConclusionsThis study identified four-fold county level disparities in MC certifications for pain. The association between median household income and MC pain certifications may indicate differences in accessibility of MC based on financial status. Further research may be warranted pending any changes to the legal status or demand for MC.