Dispensary staff rely on personal experience and customer reports more than clinician input | Research

The takeaway

A nationwide survey of 434 dispensary workers found most based cannabis recommendations on customer medical conditions and other customers' experiences rather than clinician input, and few counseled about serious risks like cannabis use disorder or psychotic reactions.

Cannabis consumers, dispensary operators, health care providers, and policy makers designing dispensary regulations.

Only 40% of dispensary staff relied on clinician input for recommendations

What the researchers found

Most dispensary staff based recommendations on the customer's medical condition (74%), other customers' experiences (70%), the customer's prior experience (67%), and personal experience (63%). Only 40% relied on clinician input. Most advised about safe storage and common side effects, but few counseled about cannabis use disorder, withdrawal, motor vehicle collision risk, or psychotic reactions.

Why it matters

Most medical cannabis patients report getting advice from dispensaries rather than physicians. Understanding what dispensary staff actually recommend and what risks they discuss reveals critical gaps in patient safety education.

The numbers in context

434 responses; 351 unique dispensaries; 74% based recommendations on medical condition; 70% on other customers' experiences; 40% on clinician input; few counseled about CUD, withdrawal, driving risk, psychosis

How the study worked

Nationwide cross-sectional online survey of 434 dispensary workers (budtenders 40%, managers 32%, pharmacists 13%) from 351 unique dispensaries across the US, conducted from February to October 2020.

What this study cannot tell us

Self-reported practices may differ from actual behavior. Online survey may not capture all dispensary types. Response bias possible. Cross-sectional design.

How to read the evidence

First nationwide survey of dispensary practices with a solid sample size, though self-report and online methodology have limitations.

When this study was published

Published in 2021 using data from February-October 2020.

The bigger picture

The disconnect between dispensary recommendations (largely experience-based) and clinical evidence highlights a systemic gap in the medical cannabis landscape. Patients may be receiving advice that is more anecdotal than evidence-based.

Questions still open

Would requiring dispensary staff training improve risk counseling? How do patients process dispensary advice compared to clinician advice? Should dispensaries be held to clinical counseling standards?

Common questions

What do dispensary workers base their recommendations on?

Primarily the customer's medical condition (74%), other customers' experiences (70%), the customer's own prior experience (67%), and the dispensary worker's personal experience (63%). Only 40% used clinician input.

Do dispensary workers warn about risks?

Most advised about safe storage and common adverse effects, but few counseled about cannabis use disorder, withdrawal symptoms, driving impairment risk, or psychotic reactions.

Read the original research

Analysis of State Cannabis Laws and Dispensary Staff Recommendations to Adults Purchasing Medical Cannabis.

JAMA network open, 4(9), e2124511

View on PubMed ↗Publisher’s paper ↗

Citation

Merlin, Jessica S; Althouse, Andrew; Feldman, Robert; Arnsten, Julia H; Bulls, Hailey W; Liebschutz, Jane M; Nugent, Shannon M; Orris, Steven R; Rohac, Rebecca; Starrels, Joanna L; Morasco, Benjamin J; Kansagara, Devan. (2021). Analysis of State Cannabis Laws and Dispensary Staff Recommendations to Adults Purchasing Medical Cannabis.. JAMA network open, 4(9), e2124511. https://doi.org/10.1001/jamanetworkopen.2021.24511