There are veterans whose hands won't stop shaking. There are people who feel as if their legs are breaking with each step. There are children with uncontrollable seizures.

Those are just some of the people who could be helped by using medicinal marijuana.

Pennsylvania's medical marijuana physician registry now lists 109 approved practitioners scattered across the state's 67 counties. Five of the initially approved physicians listed Butler County as their place of business.

Dr. Bryan Doner is one of those physicians, despite the fact that he spends much of his time practicing as medical director of ACMH's Wound and Hyperbaric Department.

Board certified in emergency medicine, Doner said he plans to maintain his practice at ACMH near Kittanning, but he saw needs in Butler and other places in Western Pennsylvania, so he started a company called Compassionate Certification Centers. Doner said he plans to debut two centers, in Butler and Pittsburgh, in December with plans for another to come later.

“We've tried to do standardized health care from the medical marijuana standpoint,” Doner said. “We're getting involved in our patients' medical marijuana care plan.”

Doner said Butler's center should be operational by Dec. 8 at its 127 E. Cunningham St. location, which will be open for patients immediately. He said certified physicians already help patients register for the medication so they can begin treatment once dispensaries are operational, which the state expects will happen in 2018.

He said there will be too many patients and too few physicians, and some patients could find that the necessary physician isn't covered by their insurance and will have to look elsewhere.

“We did this to fill the gap,” he said.

Its place in health care

Doner said medical marijuana has a place in health care, and he agrees with the 17 conditions listed as prerequisites for the medication, including the inclusion of autism, which other states accept. But Doner said chronic pain attracts his eye when looking at the list.

“That is the most common (thing) that we see,” he said.

Chronic pain is one that lasts more than several months or longer than what is perceived as the normal healing process, according to the National Center for Complementary and Integrative Health's website. Based on the 2012 National Health Interview Survey, the center concluded that chronic pain is a common problem in the U.S.

“Chronic pain becomes more common as people grow older, at least in part because health problems that can cause pain, such as osteoarthritis, become more common with advancing age,” the site said. “The annual economic cost of chronic pain in the United States, including both treatment and lost productivity, has been estimated at nearly $635 billion.”

Doner said medical marijuana has the power to help people who have nowhere else to turn — people who have explored every option and still suffer.

“It offers patients hope, maybe in areas that medicine hasn't worked in the past,” Doner said.

Watching the process

Doner registered for the program through the Department of Health's website, completed a four-hour course on the program and submitted a completion certificate to the department, before being added to the registry. He said he hopes to help other physicians through the process too.

Pennsylvania's systematic approach to the program's implementation has given the doctors an opportunity to transition their patients smoothly into the program if they so choose, Doner said.

“I'm very encouraged by the way Pennsylvania has rolled out their process,” he added.

But not all the doctors on the registry are fully committed to the program, at least not yet.

Dr. Dillon Stein of Butler Health System attended a class that automatically signed him up for the registry, but Stein's attendance was for the hospital's educational purposes, according to Jana Panther, BHS' director of marketing.

She said Butler Health System plans to turn away patients interested in the program.

“At this time, we are not actively taking any patients for evaluation,” Panther said.

She said BHS is waiting for the program to solidify more in the medical community before deciding whether to take action.

Kent Hartley, a Butler native and co-founder of Cresco Yeltrah, a company that has received state permission to grow, process and dispense medical marijuana, said some are merely watching the clock.

“There's quite a few people in Western Pennsylvania who have been waiting for this for a long time,” Hartley said. “They know what this product can do.”

No handbook on usage

Hartley said there are still some unknowns within the medical marijuana program that may prevent some from participating, but his company's dynamic could help. Cresco Yeltrah is a grower-processor — which produces the forms of medical marijuana that are legally acceptable in Pennsylvania — and a dispensary, which distributes the medicine to the patients.

Pennsylvanians will have access to medical marijuana through pills, oils and topical forms like gels or creams. But smoking is prohibited, and dry leaves and plants themselves are not considered acceptable treatments.

Hartley said those involved in production of medical marijuana have had time to work out acceptable forms of the product. However, because of restrictions on marijuana, physicians know little about dosage, which would factor in things like age, weight and condition.

“There's really no handbook for the state,” he said. “The doctors are really not familiar with the dosage.”

Hartley said the dual-role that his company serves will help it collect a wider range of data that could be used to develop dosage protocols.

“We plan on helping the state and the doctors from that perspective with the data we've accumulated over the years,” Hartley said.

Hartley said medical marijuana may provide a way to stunt the growing opioid epidemic by offering an alternative to pain control that is safer, and he has heard good things from local doctors in favor of the idea.

“Most of these guys are on board,” Hartley said. “They understand that this could help with this crisis.”

He said the industry still has areas it needs to address, but it is growing into a strong force that has its place in today's society, and the state, growers and dispensaries are working to make medical marijuana as clinical as any other form of treatment.

“The response from a lot people within this industry is really positive right now,” he said. “I think you'd really be surprised.”