Dispensing Cannabis

Maria G. Tanzi, PharmD

Use of cannabis for medical reasons has increased in recent years, with many patients receiving information on appropriate use from personnel working at a medical cannabis dispensary.

Results of a new observational study published in JAMA Network Open in September 2021, however, suggest that patients may not be getting the information needed to fully evaluate the benefits and risks of this treatment modality. According to the research, frontline dispensary workers primarily provide information based on customers’ experiences, and few discuss key safety concerns with patients.

Survey results

A cross-sectional study was conducted from February 13, 2020, to October 2, 2020, in which frontline cannabis dispensary workers were surveyed to assess discussions occurring with customers purchasing cannabis for medical purposes. A total of 434 survey responses from 351 unique dispensaries in the United States were analyzed, with the largest number of surveys coming from New York, Oregon, and Florida. Most responders identified themselves as a budtender (i.e., people who give advice on cannabis use), or as a manager. Most respondents—50.5%—had worked in the cannabis industry for over 2 years.

Results showed that recommendations from dispensary workers to customers were made based on the customers’ medical condition (74%), the experiences of other customers (70%), the customer’s own prior experience with cannabis (67%), and the respondents’ personal experience with cannabis (63%). Most were not basing their recommendations on clinician input. When assessing safety, most dispensary workers educated their customers about safe storage of cannabis and some routine adverse effects from cannabis such as sleepiness. However, few reported discussing cannabis-related risks such as psychosis, potential for motor vehicle collisions, cannabis withdrawal syndrome, or cannabis use disorder.        

Pharmacists can take the lead with education

Only a few states require a pharmacist to dispense medical cannabis. Most budtenders and dispensary managers have little to no medical training. Pharmacists, on the other hand, are well-positioned to help educate patients on the scientific evidence supporting medical cannabis use and the potential safety concerns that go along with it.

Patients tend to avoid discussing their cannabis use with clinicians, as they fear providers will view this as illicit drug use. But pharmacists can create a trusting environment where patients feel comfortable discussing their use.

Counseling sessions can begin by asking patients what they know about the substance and why they are using it. Although the data are limited on the use of cannabis for medical reasons, there is some good evidence supporting its use in those with chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis spasticity symptoms, and moderate evidence supporting its use to improve sleep outcomes in those with select chronic conditions. Pharmacists can assess whether patients have tried other treatments to manage their specific condition, as there are generally more effective first-line options available. It is also important for pharmacists to differentiate between marijuana products when counseling patients, as traditional cannabis will contain varying levels of cannabinoids. Individual CBD oil products may also vary by product as most are not regulated by FDA.

A detailed discussion on the risks of cannabis use should cover topics such as cannabis use disorder/addiction, cannabis withdrawal, psychotic reactions, potential cannabis medication interactions, and other potential adverse effects. Patients should have a clear understanding of the potential risks of using cannabis and any evidence to support its benefits in their specific condition.

Health-system implications

In an accompanying commentary, the authors wrote that health systems should begin by routinely screening patients for cannabis use and that this information should be documented in the electronic medical record. They also suggest that continuing education is needed for clinicians focused on the potential risks and benefits of cannabis, along with patient decision aids to help with the shared decision-making process.