STATE COLLEGE – The inside of the dispensary is like the lobby of a hotel. Plush lounge chairs, a Keurig coffeemaker and an electric glass fireplace decorate the front room. The television displays colloquial names of various strains like llera - Skywalker Sauce with 75 percent THC.

On a typical weekday, a steady stream of customers comes into Nature’s Medicines marijuana dispensary. Clients, some from Harrisburg, Pittsburgh and as far as the New Jersey border are escorted by name into the back room and leave with their next doses of relief from severe and maybe debilitating conditions.

Nature’s Medicines opened its doors in June 2018. It is one of 45 dispensaries that have begun selling medical marijuana in the state since legalization in April 2016 and the beginning of the medical marijuana program in February 2018. According to the pa.gov “Getting Medical Marijuana” guide, 21 health conditions qualify to be treated with medical marijuana, ranging from cancer remission therapy to autism.

Those with these severe conditions must register for the program and receive certification from an approved practitioner to use medical marijuana. Afterward, patients register for an ID card to purchase marijuana products from dispensaries. The cost of the card is $50.

While medical marijuana has become more accessible to those suffering from serious ailments, cannabidiol, a less psychoactive element in the cannabis plants, has become a popular remedy for those with anxiety or the occasional achy knee, according to recent stories in the Atlantic, the Chicago Sun-Times and other news outlets.

Cannabidiol (CBD) is a primary cannabinoid in cannabis that, unlike its psychoactive counterpart tetrahydrocannabinol (THC), is said to have health benefits without “the high.” It is fully legal in Pennsylvania and can be used without doctor’s approval.

Unlike medical marijuana, cannabidiol products can be purchased in retail stores and online. It is sold in various forms -- gummies, creams, and e-liquids for vaporizer pens and most popularly as oils. However, its health claims are not fully supported by human clinical testing.

Research surrounding CBD has been limited to animal subjects. A study performed on rats in 2016 concluded that transdermal topical application of CBD had potential to relieve arthritis pain-related behaviors and inflammation.

In 2015, the Drug Enforcement Administration eased its regulation of CBD, permitting the U.S. Food and Drug Administration to start more in-depth clinical trials on the Schedule I controlled substance.

In a recent opinion piece for the New York Times, psychiatrist Richard Friedman wrote that “the explosive popularity of CBD is way ahead of any evidence to support its efficacy.” Friedman questioned the effectiveness of the component in treating serious conditions like Parkinson’s disease.

To gain entry, customers must present their medical marijuana or caregiver card and valid Pennsylvania driver's license or ID to a receptionist.

Last June, the FDA approved Epidiolex, the first cannabidiol oral solution, for two severe epileptic conditions.

In a statement on the FDA website, Scott Gottlieb, the FDA commissioner, said that the department is aware of the rising popularity of cannabis and cannabis-derived components, including cannabidiol.

“We treat products containing cannabis or cannabis-derived compounds as we do any other FDA-regulated products — meaning they’re subject to the same authorities and requirements as FDA-regulated products containing any other substance,” he said.

The lack of CBD research casts doubt on pharmaceutical claims by some retailers who might not produce or sell pure products. The FDA monitors and notifies online retailers who make fraudulent claims for their products.

In 2017, four purchase websites received warning letters. That’s Natural!, an online company based in Colorado, had a testimonial on its website stating that “Scientific research by doctors have shown it actually kills cancer cells…”

Assistant Professor Alan Budney from the Geisel School of Medicine at Dartmouth said he is skeptical about medical marijuana and CBD products and concerned that the regulation of cannabis is too loose.

“I kind of think that medical marijuana was a huge mistake because what is happening in the public’s eye is that it’s good for everything. A problematic question is when do you use the term medical marijuana,” he said via phone call.

The cannabis plant can reproduce hundreds of strains. CBD to THC ratios differ among type and strain, resulting in different effects like sleepiness or feeling euphoric, according to leafly.com, a website that provides resources and information about cannabis for medical and recreational marijuana users.

Budney said that the data surrounding the chemical components in marijuana is problematic because of this variability. Therefore, users are not always well-informed of the potency of what they purchase.

“I don’t think they should allow them to make medical claims on it,” Budney said. “Instead of getting help with other things, they’re [people] going to be purchasing products that don’t work.”

Unlike CBD purchase websites, medical marijuana products that come from certified dispensaries go through a process of testing.

Manager Nia Rodriguez of Nature’s Medicines said that the dispensary sources its products from seven different companies like Prime Wellness. All of them have to perform lab testing to ensure purity and cannabinoid percentage accuracy.

“All of our companies grow [cannabis] in the state and follow Pennsylvania regulations. When we receive it, we don’t even get a chance to see the product. Everything comes pre-bought and pre-packed,” she said.

The dispensary sells patches, topical creams, edibles, vaporizer cartridges, capsules, concentrates, and the flower itself, among other products. Prices range from $12 for one gram of the Terrapin Hash Haze flower, to $192 for 20 extra-strength capsules. Patients are able to make their own choices, with advice from dispensary employees on what might work best for them.

Nature's Medicines opened in June 2018 in State College. Clients come from around the state to purchase medical marijuana products.

“We talk to every single person, at least once, but never just once,” Rodriguez said. “Everyone needs to see the pharmacist who sits down with them. Every patient, we explain to them about every medicine and what they need. The pharmacist is a drug counselor who matches a patient’s ailments to strains that work best for the patient. He gives them advice, but does not prescribe.”

Rodriguez, who uses medical marijuana to treat back pain from two scoliosis corrective surgeries and arthritis in her spine, said that CBD does not work for her. She said that customers take the same gamble with the quality of CBD products as they would with anything sold over the counter.

“Everyone is different. Some people swear by it and others don’t. For me, medical marijuana is the only reason I can work in the winter,” she said. “CBD is essentially non-euphoric. It levels you out and brings down the high.”

Employee Natalie Healy is a caregiver for her 13-year-old son, Christopher, who has severe autism and is non-verbal. When he began puberty, Healy said he started to injure himself and his aggression increased.

“For a while, I felt like I was the only one dealing with a child so severe,” she said.

Since her son began medical marijuana treatment, Healy said she noticed that strains that were high in CBD made her son’s aggression worse.

“A higher dose of THC seemed to work better. We’re trying to find the right balance, but I’ve seen an improvement. His teachers at school say that he’s academically more focused,” she said.

According to Rodriguez, customers pay out of pocket to cover medical marijuana. It is not currently covered by health insurance companies.

“No one will spend $250 on something that doesn’t work,” Rodriguez said.

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Dejanae Gibson is a Penn State junior majoring in print and digital journalism.