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May 1, 2026
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In late March 2026, the Pennsylvania Supreme Court decided D.M. v. 23rd Judicial District, Berks County (2026 WL 827710), a case raising important questions about standing doctrine and the tension between medical marijuana patients’ protections and judicial discretion. Here, the 23rd Judicial District (Berks County Court) itself was the defendant and sued for its policies regarding medical marijuana use in treatment court programs.

Key takeaways:

• The decision gives defendants another way to challenge standing where the claimed injury is an indirect economic effect of a policy or government action.
• For cannabis businesses, the opinion suggests that economic harm tied to patient choices may be too remote to support standing on its own.
• Future challenges to treatment court medical marijuana policies may need to be brought by affected patients rather than industry groups.
• The ruling leaves unresolved whether Berks County’s case-by-case policy complies with the Medical Marijuana Act and Gass.
• The dissent may give future challengers useful language for pushing back on an overly rigid chain-of-events standing analysis.

The background: treatment courts and medical marijuana

Berks County operates several treatment court programs for defendants struggling with substance abuse and mental health issues. Participants are typically subject to drug testing and prohibited from using opioid-based and other addictive medications.

This prohibition originally extended to medical marijuana, but the Pennsylvania Supreme Court’s 2020 decision in Gass v. 52nd Judicial District, Lebanon County held that a blanket prohibition for all probationers violated Pennsylvania’s Medical Marijuana Act. The Act provides that patients shall not be “subject to arrest, prosecution or penalty in any manner, or denied any right or privilege… solely for lawful use of medical marijuana.”

Following the Gass decision, the Berks County Courts amended its policy. Rather than an outright ban, the revised policy states that medical marijuana use will be addressed “on a case-by-case basis,” requiring applicants to provide a letter from their treating physician detailing the diagnosis and medical necessity for use.

The challenge: a coalition takes on the courts

The Pennsylvania Cannabis Coalition (Coalition), representing approximately 75% of Pennsylvania’s licensed medical marijuana dispensaries, filed suit. Alongside D.M., a United States Air Force veteran, the Coalition filed a petition arguing that the amended policy still violates the Act because it allows treatment courts to reject applicants based solely upon their lawful use of medical marijuana.

The Coalition’s argument was economic. When patients stop purchasing medical marijuana to gain entry to treatment court programs, member dispensaries lose sales, and at least two individuals had already ceased purchases as a direct result of the policy.

The standing question

The case never reached the substantive question. Instead, it turned on standing, whether the Coalition had sufficient interest to bring the challenge.

Pennsylvania’s standing doctrine requires a plaintiff to demonstrate a “substantial, direct, and immediate” interest in the outcome of the litigation. For associations like the Coalition, this means establishing that at least one member has suffered, or will suffer, an immediate or threatened injury as a result of the challenged action.

The majority, authored by Justice Mundy, concluded that the Coalition’s claimed financial harm was too remote and attenuated to satisfy the immediacy requirement. The Court traced an extensive chain of events required before any dispensary would be affected: a customer must be charged, referred to treatment court, apply, meet eligibility requirements, be accepted, and then have the court exercise its discretion to deny continued medical marijuana use.

The majority also applied a “zone of interests” analysis, finding the Act’s immunity provision was designed to ensure safe treatment options for patients, not to guarantee revenue streams for cannabis businesses.

A sharp dissent

Justice Donohue, joined by Justices Wecht and McCaffery, penned a forceful dissent accusing the majority of “eras[ing] over fifty years of standing jurisprudence.” The dissent argued that the Coalition satisfied all three prongs of the standing test.

On the substantiality issue, the dissent noted that the Coalition’s pecuniary interest clearly exceeded that of the average citizen, and that Pennsylvania law imposes no minimum dollar threshold for establishing substantial interest.

On directness, the dissent relied heavily on Pennsylvania State Education Association v. Public School Employees’ Retirement Board, where the Court found that a labor organization had standing to challenge a regulation that directly applied to school districts but indirectly affected union members’ bargaining positions. The same “downstream consequences” logic, the dissent argued, should apply here.

The dissent reserved its sharpest criticism for the majority’s analysis of immediacy. Justice Donohue characterized the majority’s step-by-step recitation of every event between the policy and the harm as “troubling,” arguing that “if we were to conduct this type of inquiry in other standing cases, we would rarely find a party to have an immediate interest.” The dissent contended that the harm was merely “one step removed” from the policy’s express target, treatment court participants, and that this should be sufficient.

Conclusion

D.M. v. 23rd Judicial District reminds us that sometimes the most interesting legal battles are fought outside the courthouse door. The Coalition’s concerns may be legitimate, but the Supreme Court has determined they do not translate into the kind of immediate, direct interest required to hear the case on its merits. The substantive question, whether Berks County’s case-by-case approach complies with the Act, awaits another plaintiff.

A copy of the opinion can be found here.