Jessica S. Merlin, MD, PhD, MBA; Andrew Althouse, PhD; Robert Feldman, MS; Julia H. Arnsten, MD, MPH; Hailey W. Bulls, PhD; Jane M. Liebschutz, MD, MPH; Shannon M. Nugent, PhD; Steven R. Orris, BS; Rebecca Rohac, BS; Joanna L. Starrels, MD, MSCE; Benjamin J. Morasco, PhD; Devan Kansagara, MD, MCR

Published in JAMA

September 2021



IMPORTANCE Overthelastdecade,cannabishasbecomemoreaccessiblethroughtheproliferation 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.
OBJECTIVE Todescribethepracticesoffrontlinedispensaryworkerswhointeractwithcustomers 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.
DESIGN, SETTING, ANDPARTICIPANTS This nation widecross-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.
MAIN OUTCOMES AND MEASURES Participant responses to questions about formulating customer recommendations and talking to customers about risks.
RESULTS 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.
CONCLUSIONS AND RELEVANCE 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.

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Merlin, J. S., Althouse, A., Feldman, R., Arnsten, J. H., Bulls, H. W., Liebschutz, J. M., … & Kansagara, D. (2021). Analysis of state cannabis laws and dispensary staff recommendations to adults purchasing medical cannabis. JAMA network open, 4(9), e2124511-e2124511.