Abstract
INTRODUCTION: Chronic pain is the most common qualifying condition found in states with legal (certified) access to medical cannabis (MC). We assessed the geographic distribution of MC certifications for severe chronic or intractable pain in Pennsylvania (PA) between 2018 and 2024, identifying relationships between community variables with the percentage of adults with an MC certification for pain. METHODS: Using 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), geographic areas that approximate a standardized representation of zip codes for statistical purposes. 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 an MC certification for pain in 2024. RESULTS: There was almost a four-fold difference in the percent of adults with an 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 (r(65) = +0.335, p < 0.01), lower median age (r(65) = -0.241, p = 0.0499), and higher rural-urban continuum code (r(65) = +0.644, p < 0.001) were associated with a greater percentage of adults with an MC certification for pain using simple linear regression. Using a multiple regression model, only rural-urban continuum code was significantly associated with the percent of adults with an MC certification for pain (p < 0.001). At the ZCTA level, the proportion of non-white individuals, including Hispanics, showed a significant inverse association with the percent of adults with an MC certification for pain (r(1,722) = -0.07, p < 0.01). CONCLUSIONS: This 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.