Pennsylvanians can use marijuana for anxiety or epilepsy. They can use it to ease the side effects of chemotherapy or the symptoms of post-traumatic stress.

There are 23 different medical conditions that will qualify someone for a card allowing them to access medical marijuana.

There is one reason that is just off the table: pleasure. You can use weed because you need it but not because you want it.

The history of marijuana and the law has been comparable in Pennsylvania and neighboring Ohio. Medical cannabis was signed into law in Pennsylvania in April 2016; Ohio did it June 2016. Ohio stopped driver license suspensions for marijuana use at the same time; Pennsylvania took until 2018.

And both have had a push and pull over recreational use. Pennsylvania has teased it out. U.S. Sen. John Fetterman supported it strongly as lieutenant governor. He and then-Gov. Tom Wolf held a listening tour to get opinions from across the state. Wolf called for the legislature to legalize in 2020.

In Ohio, the first attempts to legalize happened in 2015, even before medical use was OK’d. It failed – and not by a little, either. Sixty-five percent of voters rejected the idea. That changed this month when 57% of Ohio voters said yes, making the Buckeye State the 24th state to permit recreational use.

It makes “When will Pennsylvania follow?” a natural question. But does it have to be? That’s hard to say definitively.

The Keystone State is now surrounded by places where an edible gummy or a joint is completely fine without having to prove you have glaucoma or multiple sclerosis. The only exception is West Virginia which also only allows medical use.

That doesn’t mean Pennsylvania should jump off the bridge because all the other kids are doing it. Peer pressure is no reason to write law.

But there are other reasons to consider it. Loss of tax revenue is one. That money could go toward support of drug and addiction programs. If residents can go to Ohio, Maryland, New York or New Jersey to get the product they want and give that money to those treasuries, is that better for Pennsylvania? For that matter, is it a potential negative for residents who might go to Steubenville to buy marijuana and then cross the border back into a place where it is illegal?

The Ohio vote creates more than one reason for Pennsylvania legislators to actively consider all of the moving pieces of marijuana and the law and figure out where to go from here.

While the state House has an interest in moving forward, the Senate is more reluctant. That is fine. Maybe legalization isn’t the right road for Pennsylvania, but open discussions by lawmakers are a different story.

Perhaps a middle ground might be decriminalization of possession, which would help residents who pick up product in states were it is legal. It could also protect the medical marijuana companies. It wouldn’t address the tax issue though.

Marijuana is a complicated issue, and the Ohio legalization is boxing Pennsylvania into a place where a decision is going to be needed sooner or later.