Dispensaries and Medical Marijuana Certifications and Indications: Unveiling the Geographic Connections in Pennsylvania, USA

Background Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics.Methods Using data from the Pennsylvania Department of Health, we geocoded MMJ dispensary locations and linked them to U.S. Census Bureau data. We created dispensary access measures from the population-weighted centroid of Zip Code Tabulation Areas (ZCTAs): distance to nearest dispensary and density of dispensaries within a 15-minute drive.We evaluated associations between dispensary access and the proportion of adults who received MMJ certification and the proportion of certifications for insufficient evidence conditions (amyotrophic lateral sclerosis, epilepsy, glaucoma, Huntington’s disease, opioid use disorder, and Parkinson’s disease) using negative binomial modeling, adjusting for community features. To evaluate associations between the proportion of the population that was non-White, Hispanic, or both (NW-H) and distance to nearest dispensary, we used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for median income.Results Distance and density of MMJ dispensaries was associated with the proportion of the ZCTA population certified and the proportion of certifications for limited evidence conditions. Compared to ZCTAs with no dispensary within 15 minutes, the proportion of adults certified increased by up to 31% and the proportion of certifications for limited evidence decreased by up to 22% for ZCTAs with two dispensaries. In 2021, the odds of being within five miles of a dispensary was higher in ZCTAs with the highest proportions of NW-H individuals (OR: 26.05, CI: 16.7 - 40.6), compared to ZCTAs with the lowest proportions.Conclusions Greater dispensary access was associated with the proportions of certified residents and certifications for insufficient evidence conditions. Whether these patterns are due to differences in accessibility or demand is unknown. Associations between community demographics and dispensary proximity may indicate MMJ access differences.### Competing Interest StatementThis study was funded by the Story of PA, Clinical Registrant through the Geisinger Academic Clinical Research Center### Funding StatementThis study was funded by the Story of PA, Clinical Registrant through the Geisinger Academic Clinical Research Center.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors