Abstract
Over the last decade, cannabis has become more accessible through the proliferation of dispensaries in states that have legalized its use. Most patients using cannabis for medical purposes report getting advice from dispensaries, yet there has been little exploration of frontline dispensary staff practices. To describe the practices of frontline dispensary workers who interact with customers purchasing cannabis for medical purposes and assess whether dispensary practices are associated with medicalization of state cannabis laws (degree to which they resemble regulation of prescription or over-the-counter drugs) and statewide adult use. This nationwide cross-sectional survey study was conducted from February 13, 2020, to October 2, 2020, using an online survey tool. Potential respondents were eligible if they reported working in a dispensary that sells tetrahydrocannabinol-containing products and interacting with customers about cannabis purchases. Participant responses to questions about formulating customer recommendations and talking to customers about risks. The 434 survey responses from 351 unique dispensaries were most often completed by individuals who identified as budtenders (40%), managers (32%), and pharmacists (13%). Most respondents reported basing customer recommendations on the customer's medical condition (74%), the experiences of other customers (70%), the customer's prior experience with cannabis (67%), and the respondent's personal experience (63%); fewer respondents relied on clinician input (40%), cost (45%), or inventory (12%). Most respondents routinely advised customers about safe storage and common adverse effects, but few counseled customers about cannabis use disorder, withdrawal, motor vehicle collision risk, or psychotic reactions. A higher state medicalization score was significantly associated with using employer training (odds ratio, 1.41; 95% CI, 1.18-1.67) and physician or clinician input (odds ratio, 1.23; 95% CI, 1.05-1.43) as a basis for recommendation. Medicalization score was not associated with counseling about cannabis risks. This survey study provides insight into how frontline dispensary staff base cannabis recommendations and counsel about risks. The findings may have utility for clinicians to counsel patients who purchase cannabis, customers who want to be prepared for a dispensary visit, and policy makers whose decisions affect cannabis laws.
Highlights
Cannabis access has substantially increased over the past decade in the US,[1,2,3,4] with the proliferation of dispensaries in states that have legalized cannabis use
Most respondents reported basing customer recommendations on the customer’s medical condition (74%), the experiences of other customers (70%), the customer’s prior experience with cannabis (67%), and the respondent’s personal experience (63%); fewer respondents relied on clinician input (40%), cost (45%), or inventory (12%)
A higher state medicalization score was significantly associated with using employer training and physician or clinician input as a basis for recommendation
Summary
Cannabis access has substantially increased over the past decade in the US,[1,2,3,4] with the proliferation of dispensaries in states that have legalized cannabis use. In this context, clinicians may encounter increasing numbers of patients with questions about using cannabis for medical purposes. Clinicians may encounter increasing numbers of patients with questions about using cannabis for medical purposes It is not known what proportion of cannabis used is obtained from dispensaries; a 2020 study[1] suggests that individuals obtain cannabis from dispensaries as well as from alternative sources (eg, illicit markets, home growth). The health care clinician’s role is relegated to assessing whether the patient has a state-sanctioned qualifying condition, resulting in a phenomenon the authors describe as “cannabis dispensary workers as proxy clinicians.” There has been little exploration of frontline dispensary staff practices
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