Most Dispensary Staff Do Not Discuss Risks of Cannabis with Medical Use Consumers, Study Finds

Dispensary staff routinely advise medical cannabis consumers about safe storage and common adverse events associated with cannabis use, but few staff counsel patients about cannabis use disorder or other risks, according to new research published in JAMA Network Open.

The researchers found that staff in states where cannabis access is highly medicalized (i.e., where medical cannabis is treated similarly to other prescription medications) were more likely to rely on employee training and clinician input to make product recommendations. But across the board, few workers reported consistently counseling patients about cannabis risks.

The researchers say that these findings provide new insight into dispensary staff practices, which may encourage clinicians to routinely and openly discuss cannabis use and its risks with their patients to ensure that medical cannabis users are receiving balanced, well-rounded, and evidence-based advice.

Most dispensary staff make recommendations from past customer experience

This new research, led by researchers at the University of Pittsburgh, surveyed over 400 consumer-facing dispensary workers in the United States, with the majority identifying themselves as either “budtenders” or dispensary managers. These survey participants were asked to consider how they serve customers seeking cannabis to treat medical conditions or symptoms, regardless of whether they were using a medical marijuana card or self-medicating with legal recreational cannabis. With this in mind, the participants were given a list of 18 statements and asked to check all that would routinely apply to how they advise medical cannabis consumers and what their basis would be for making product recommendations.

The most commonly reported bases for product recommendations were the customer’s medical condition (74 percent), the experiences of other customers (70 percent), the customer’s prior experience with cannabis (67 percent), and the staff member’s own personal experiences with cannabis use (63 percent). Fewer respondents identified employer training (61 percent) or clinician input (40 percent) as being the basis for their recommendations to medical cannabis consumers.

The researchers found that the majority of respondents would routinely advise consumers about the safe storage of cannabis and common adverse events, such as sleepiness. However, only around 5 percent of respondents reported always informing customers about the risk of developing cannabis use disorder, with another 13 percent saying they would frequently, but not always, inform customers of this risk. Overall, a minority of dispensary staff reported routinely counseling customers on the potential for withdrawal, increased motor vehicle collision risk, or psychotic reactions.

Medicalization of cannabis can affect product recommendations

The researchers also investigated whether dispensary practices might vary according to local state cannabis law. In particular, the researchers were interested in whether cannabis medicalization or the existence of a legal adult-use cannabis market within the state affected the extent to which dispensary staff relied on traditional sources of information (clinician input and employer training) versus customer or personal experience.

A state cannabis medicalization score was calculated for each state by assessing a number of key legal domains in the state’s cannabis policy – such as the presence of regulations governing manufacturing, testing, product labeling, the types of products permissible for sale, and any limits on the dose that can be issued by dispensaries – and condensing these into a single numerical value which could represent the state’s level of medicalization. The final medicalization scores per state varied from 23 (least medicalized) to 86 (most medicalized), with a mean of 46.

When combining this with the survey data on dispensary practices, the researchers found that dispensary staff in states with higher medicalization scores were more likely to use employer training and physician or clinician input as a basis for their clinical recommendations.

Higher medicalization scores were negatively associated with the likelihood of a staff member making recommendations based on their own personal experiences or on stock needing to be moved out of inventory. However, there was no association between medicalization and the likelihood of staff counseling consumers about cannabis risks.

Addressing the void in counseling over cannabis use

Previous studies have indicated that the majority of patients using cannabis for medical purposes rely on advice from dispensary staff regarding different cannabis products and use patterns, rather than getting input from a medical professional. This “void in clinician counseling of cannabis use,” as Calcaterra et al. describe it, arises from the continued federal prohibition of cannabis, which prevents doctors from prescribing cannabis and presents barriers for researchers looking to produce evidence-based recommendations regarding the drug’s use. As a result, cannabis dispensary workers often end up acting as proxy clinicians to medical cannabis patients.

Despite this, there has been relatively little exploration of dispensary staff practice before now. Recently, one Californian study confirmed that the vast majority of dispensaries comply with mandatory ID checks but beyond operational checks such as this, very little research has paid attention to the practices of dispensaries.

“Although most patients obtain their information on medical cannabis from cannabis dispensaries, the study by Merlin et al. suggests they may not be receiving balanced information and advice,” Theresa E. Matson of the Kaiser Permanente Washington Health Research Institute and colleagues wrote in an accompanying editorial commentary to the new JAMA Network Open study.

“This imbalance is an important gap in medical care that will widen as the prevalence of cannabis use continues to increase. Clinicians can meet this need by asking patients about their cannabis use and offering patients shared decision-making about the potential risks as well as the benefits of medical cannabis use.”

The study authors themselves also believe that patients could benefit from clinicians engaging in more open discussions about medicinal cannabis use.

“Despite customers’ potential reliance on dispensaries for health-related information about cannabis, it may not be reasonable to expect dispensaries, which are retail and not medical establishments, to bear primary responsibility for such counseling, much as alcohol retailers may not provide counseling about alcohol-related harms,” the researchers wrote.

“Clinicians may not be aware of dispensary staff practices, and engagement in discussions about the benefits and harms of cannabis use with their patients is warranted. For example, clinicians might alert patients that dispensary staff purchasing recommendations may be based on nonprofessional anecdotal experience and they should not expect counseling about harms.”