So I looked up PA's medical marijuana program (appears more inclusive for potential patients), and it looks like they have quite the range of dosage forms that NY doesn't have, especially actual dried plant. I have no idea how familiar you are with marijuana so I apologize if the detail I'm going into is unnecessary (dried plant is what one would normally think of when you hear marijuana, but with the advent of different extraction processes that produce different oil, waxy, buttery, and harder [think malleable jolly rancher] 'shatter' substances that can be smoked or vaporized, the actual 'buds' of the plant that Cheech and Chong smoked are now commonly referred to as flower. After a cursory review of PA's site, I didn't see anything that specifically outlawed smoking it (actually combusting the plant material), but instead said 'for administration by vaporization or nebulization,' (oil would be used in a nebulizer similar to those used by patients with different respiratory disorders, whereas vaporization uses a 'vaporizer' which heats the plant or oil [depending on the vaporizer some can only accommodate one, while others have special chambers to vaporize both] to a point where THC, CBD, and other cannabinoids and beneficial terpenes are literally turned into vapor [think boiling], but without being so hot as to ignite the plant itself and produce noxious smoke). Inhalation is generally considered the fastest and most concentrated way to consume marijuana (edibles are a different story that I admittedly don't fully understand; 'pot brownies' are known to get people uncomfortably high with bad paranoia if taking to much or if you aren't used to marijuana), although smoking is the worst for your lungs as you can imagine, and vaporization is still not fully researched... since it doesn't contain the combustion products it's considered safer, but the heated vapor can irritate your throat and lungs after prolonged use (it is possible to combine a vaporizer with a water pipe [bong] or other apparatuses so as to cool the vapor and help remove any oily/tar like residue from the vapor). From what I understand, in NY, the oil is pre-filled into single use cartridges built into vaporizers that is unique to each dispensary so there isn't the ability to utilize additional paraphenrnalia or specialized high end vaporizers. Tinctures (in the pharmaceutical compounding sense) use ethanol to extract the active components into a concentrated liquid. Tinctures, pills, 'liquid' (it doesn't specify anything about it, so it's too vague for me to know what the exact dosage form is) and oil should all be able to be taken orally. And of course the topicals you would just apply to the affected areas (this could be difficult if you have a restricted range of motion or areas of pain in your back where you can't reach. Theoretically you could have someone apply it for you with gloves on (I'm not sure if caregivers are allowed to 'administer' any of the products to you [example: pharmacists are not legally allowed to take a pill out of a patient's bottle and put it in their mouth if they have physical difficulty, but nurses and doctors can]). Bottom line, if you want the healthiest option, avoid inhaling. This stance is controversial as many people believe vaporizing is healthy, however, inhaling trace amounts of oil can theoretically cause a specific type of pneumonia and/or cause damage to the anatomy of the lungs depending on how long you've used it. There is not enough research out there yet to give a very good picture of the long term effects of vaporizing. It is one of the most popular methods of delivery out there right now, so it is up to you. Again, since it doesn't actually combust the plant, it's not like smoking it or a cigarette with the additional noxious fumes from the burning plant material, and there are ways to filter/cool down the vapor.

Your best bet is to discuss the options available to you with your doctor, along with the specific reasons/symptoms you're using medical marijuana along with your goals for treatment with it. He or she should be much more knowledgeable on the topic than I, although as I said before, this is relatively new, and long term studies on health impact and adverse effects simply don't exist as federal funding is a gray area since it's still considered a DEA schedule I narcotic (street drug with no medicinal value and high abuse potential).

The other major important factor to consider is the strain of medical marijuana you get, along with the percentages of THC and CBD. THC is the psychoactive component, but also is attributed as being a pain killer and relieving spasticity. In NY, three oil preparations must be available at each dispensary (though the exact concentrations are not regulated and vary from one to another), 1. High THC, Low CBD; 2. High CBD, Low THC; and 3. 50% THC, 50% CBD. Since plant material is available in PA, many different strains with different concentrations of each could possibly be available; you'd have to ask your doctor and the dispensaries. High THC can cause anxiety and paranoia in some people, whereas CBD is good for anxiety. Marijuana comes from Cannabis indica, Cannabis sativa, and varieties of hybrids of the two. Indicas are generally known for a relaxed 'high', with sedation and strong appetite stimulation. Sativas are known for a more 'heady high' while being mood elevating and giving the user energy (marijuana users who use during the day typically are using sativas or sativa dominant hybrids). Once you figure out your goals of treatment and symptoms you want to relieve, you can work with your doctor, dispenser, and even research different strains (and learn about marijuana) on websites like leafly dot com.

Any THC containing product will still have the same rules as recreational marijuana including that you cannot and should not operate a motor vehicle, or heavy machinery while under the influence or while you suspect you may still have some affect from it. Common sense things.

Medical marijuana has provided many patients with amazing results and relief and resulted in a much greater quality of life. The pain-killing, anti-anxiety, anti-depressant, stress-relieving, anti-inflammatory, sedating and sleep inducing, and appetite stimulating effects can be quite drastic (in an obviously very positive way) in patients with serious health conditions where other treatments have failed.

I hope this provided some initial information for you to at least know what to research and talk to your doctor about! Good luck with your treatment and I hope it works well for you! If you would, please let me know what you end up trying... I have yet to get my card here in NY as the actual product is too expensive for me. I am very interested in how it works out for SFN!