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Training and Practices of Cannabis Dispensary Staff

Article in Cannabis and Cannabinoid Research · December 2016

DOI: 10.1089/can.2016.0024

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Cannabis and Cannabinoid Research
Volume 1.1, 2016 Cannabis and
DOI: 10.1089/can.2016.0024 Cannabinoid Research

ORIGINAL RESEARCH Open Access

Training and Practices of Cannabis Dispensary Staff

Nancy A. Haug,1,2,* Dustin Kieschnick,1 James E. Sottile,3 Kimberly A. Babson,4
Ryan Vandrey,5 and Marcel O. Bonn-Miller4,6–8

Abstract
Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient de-
mand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms.
Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of can-
nabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed
the training and practices of cannabis dispensary staff.
Materials and Methods: Medical and nonmedical dispensary staff (n = 55) were recruited via e-mail and social
media to complete an online survey assessing their demographic characteristics, dispensary features, patient
characteristics, formal training, and cannabis recommendation practices.
Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting
medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In
terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia,
nightmares, and Tourette’s syndrome. They were more likely to recommend Indica and hybrid plants for post-
traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica
for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of can-
nabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol
(THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn’s disease, hepatitis C, and PTSD/trauma, while pa-
tients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for
arthritis and Alzheimer’s disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms.
Conclusions: Although many dispensary staff are making recommendations consistent with current evidence,
some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient’s
condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who
provide specific recommendations for patient medical conditions.
Keywords: cannabis; marijuana; dispensary; practices

Introduction with negative short- and long-term effects such as ad-

Approximately half of the United States has legalized diction, deficits in cognitive performance and motor
cannabis for medicinal purposes, with four states hav- coordination, and psychosis,1 a number of particularly
ing also legalized cannabis for nonmedical use. Epide- vulnerable groups of individuals are using cannabis to
miological research suggests that despite its association alleviate their medical conditions (e.g., anxiety, chronic
1
PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California.
2
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
3
Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California.
4
National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, California.
5
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
6
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California.
7
Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, Pennsylvania.
8
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

*Address correspondence to: Nancy A. Haug, PhD, Palo Alto University, 5150 El Camino Real, C-24, Los Altos, CA 94022, E-mail: nhaug@paloaltou.edu

ª Nancy A. Haug et al. 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons
License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly credited.

244
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 245
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pain, epilepsy, cancer, HIV/AIDS, post-traumatic stress medical (23%). The dispensaries were located in Colo-
disorder [PTSD]).2,3 Indeed, more than 1,000 medical rado (41%), California (20%), Arizona (16%), Oregon
cannabis dispensaries, cooperatives, and delivery ser- (2%), District of Columbia (5%), and the Northeast
vices are operating in California,4 and *500 exist in (10%; Connecticut, Rhode Island, Massachusetts, Maine).
Colorado, to meet patient demand. The locations of the dispensaries were self-reported as fol-
Although each state has created its own legislation to lows: rural (16%), suburban (13%), small city (<300,000;
govern the cultivation and distribution of cannabis to 35%), and large city (>300,000; 36%).
individuals, there is currently little to no guidance or
oversight of associated patient care. Indeed, with the Measures
exception of a few states that have mandated cannabis- An online survey was constructed by the study investi-
specific physician continuing medical education (e.g., gators to evaluate the training, knowledge, attitudes,
New York), the majority of states do not require any and practices of dispensary staff. Questions included
training for either those providing ‘‘recommendations’’ demographics (i.e., age, race/ethnicity, sexual orienta-
for patient cannabis use (i.e., physicians) or those actu- tion, marital status, education, annual income, dispen-
ally dispensing cannabis to consumers (i.e., dispensaries sary earnings, and hours worked), dispensary features
and/or ‘‘bud tenders’’). This is troubling, as cannabis (i.e., geographical location, zip code, type of dispensa-
comprises more than 400 chemical compounds and is ry), and a checklist of primary responsibilities. A di-
associated with widely variable effects among humans.5 chotomous (yes/no) item assessed formal dispensary
To provide a specific example, empirical literature has training, and if endorsed, the item branched to a check-
shown that delta-9-tetrahydrocannabinol (THC), the list of types of training (e.g., medical, scientific, busi-
primary psychoactive compound in the cannabis plant, ness, customer service) with a textbox for ‘‘other.’’
can be anxiogenic, while cannabidiol (CBD), a second- Additional items assessed the number of patients
ary cannabinoid, has anxiolytic effects.6 Next, the liter- served, the percentage of patients who are repeat pa-
ature would suggest that the provision of cannabis, trons, and a categorical response choice for how often
comprising high levels of THC, to individuals with repeat customers visit the dispensary. The typical
anxiety may be contraindicated. amount of cannabis purchased per visit was assessed
Although it is important to note that rigorous re- by having the participant fill in an amount in grams,
search on the use of cannabis as a therapeutic remains ounces, or dollars. A dichotomous (yes/no) item
in its relative infancy, issues of inconsistent and non- assessed whether advice, guidance, or counsel is pro-
empirically supported practices by physicians plague vided to patients, and if endorsed, the item branched
the cannabis and substance use field more broadly.7 to a checklist of types of advice (e.g., benefits of can-
So, to offer initial information regarding current prac- nabis and side effects) with a textbox for ‘‘other.’’
tices by those providing cannabis recommendations to Items assessing the medical/psychological symptoms
patients, the present study aimed to document the or conditions reported by patients were indexed on a
training and practices of a sample of dispensary staff 3-point Likert scale ranging from ‘‘rarely’’ to ‘‘frequent-
(i.e., ‘‘bud tenders’’). Given its descriptive nature, no ly.’’ Respondents also checked off which cannabinoid
specific hypotheses were forwarded; however, infor- concentrations (i.e., high THC, high CBD, 1:1 ratio of
mation garnered from this study is meant to inform THC/CBD) or cannabis plant strain recommendations
targeted implementation science efforts aimed at (i.e., sativa, indica, hybrid) they made for each of the
streamlining provider practices and highlighting the symptoms or conditions listed. Attitudes toward work
need for structured education in this emerging industry (e.g., satisfaction, feeling valued, stigma, burnout) were
that has developed outside traditional mechanisms of assessed on a 5-point Likert scale ranging from ‘‘very
medical drug development. satisfied’’ to ‘‘very dissatisfied’’ or ‘‘always’’ to ‘‘never.’’

Materials and Methods Procedure

Participants The study was approved by the Palo Alto University
Participants included 55 self-identified dispensary staff Institutional Review Board (FWA00010885; Protocol#
members who provided informed consent to complete 15-001-S). A Federal Certificate of Confidentiality was
an online survey. Dispensary types included medical obtained from the National Institutes of Health to protect
(59%), nonmedical (18%), and both medical and non- participant confidentiality. Dispensaries were identified
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 246
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via website finders (i.e., leafly.com, weedmaps.com) and a ness (26%; n = 14), medical (20%; n = 11), other (20%;
contact list from the Americans for Safe Access. From n = 11), and scientific (13%; n = 7). Other training con-
September 2015 through May 2016, dispensary staff sisted of ‘‘bud tender’’ certification, or courses on can-
were invited via e-mail (n = 550, with 10% returned as nabis (e.g., Cannabis 101), or safety and regulatory
undeliverable and 20% providing an automated e-mail compliance (e.g., SellSmart, METRC).
response) and/or telephone (n = 117) to complete an The dispensary staff described their primary job re-
anonymous survey. A direct link to the survey was also sponsibilities as follows: customer service (91%; n = 39),
posted on a cannabis advocacy organization Facebook stocking inventory (79%; n = 34), ordering supplies or
page (i.e., National Organization for the Reform of Mar- dealing with vendors/growers (67%; n = 29), counseling
ijuana Laws) and a Reddit subreddit geared toward dis- patients (63%; n = 27), record-keeping (63%; n = 27),
pensary staff. Of those who accessed the survey or budgeting/finances/accounting (46%; n = 20), and
clicked on the survey link, 87% provided informed con- other responsibilities (25%; n = 14) such as human re-
sent to continue. On completion of the survey, 33 partic- sources, delivery, marketing, packaging products, and
ipants were placed in a lottery drawing for a $25 creating signage.
Amazon.com gift card. To increase rates of participation
in a later wave of recruitment, each participant was com- Dispensary patients
pensated with a $10 Amazon.com gift card (n = 22). The number of patients served by the dispensaries
Survey data were analyzed cross-sectionally using ranged from 15 to 5,000 patients per week, with a me-
IBM SPSS Statistics, version 23. Descriptive statistics dian of 425 patients (M = 778.4, SD = 1001.5, n = 50).
provided a profile of dispensary staff characteristics. On average, M = 69% (SD = 21%) of patients were de-
One-sample t-tests for proportions were calculated to scribed as repeat or frequent patrons. Repeat patrons
compare cannabinoid and strain recommendations visited the dispensary daily (26%; n = 13), 2 to 3 times
for each patient symptom or condition. Since the sur- per week (40%; n = 20), once a week (22%; n = 11), or
vey allowed for participants to skip items, the reported 2 to 3 times per month (12%; n = 6). The average
numbers for each item may differ. amount of cannabis purchased per visit was reported
as M = 10.4 g (SD = 9.4 g, n = 31) or M = $83.00
Results (SD = $32.00, Range = $25.00–$150.00, n = 18).
Participant characteristics Dispensary staff members were queried on the
The mean age of participants was 31.9 years (standard symptoms or conditions frequently reported by their
deviation [SD] = 9.8 years), with a range of 22–63 years. patients (see Fig. 1 for a summary). The most frequent
Majority were Caucasian (86%) and 9% identified as symptoms included chronic pain (93%; n = 41), insom-
having Hispanic or Latino ethnicity. The sexual orien- nia (80%; n = 35), and anxiety (80%; n = 35). Approxi-
tation of participants was heterosexual (67%), bisexual mately two-thirds of the sample (62%; n = 26) reported
(22%), homosexual (7%), and asexual (4%). The sample that they always or often check in or follow-up about
was 55% female, 33% reported being married or partnered, their patients’ health status.
and 60% had a college degree or higher. Most (84%)
reported working at the dispensary full-time (>30 h) at Dispensary staff recommendations
an average of $15.00/h (SD = $4.60; Range = $8.00– Dispensary staff were queried regarding the specific
$25.00/h). The average duration of employment at the recommendations they make to patients and on what
current dispensary ranged from 1 month to 7 years with information those recommendations are based. A ma-
a median of 1 year (M = 21.6 months, SD = 20.0 months). jority (94%; n = 47) reported that they provide advice,
Twenty percent of the sample reported working at another guidance, or counsel to patients. The type of advice
dispensary before their current position. included information on particular cannabis strains
(88%; n = 44), suggested administration methods (88%;
Dispensary staff training and responsibilities n = 44), potential cannabis side effects (80%; n = 40), ben-
Dispensary staff were asked whether they received any efits of cannabis for specific symptoms (74%; n = 37), and
formal training for their current position and the type other recommendations (22%; n = 11) such as natural
of training received. In our sample, 55% (n = 30) of staff remedies, travel/shipping legal advice, dosing guidelines,
members reported some formal training. The types of and ailment or disease-specific information. Those who
training included customer service (35%; n = 19), busi- did not provide advice or counsel indicated that it was
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 247
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FIG. 1. The percentage of dispensary staff who reported frequently seeing patients with the following symp-
toms or conditions. ALS, amyotrophic lateral sclerosis; GI, gastrointestinal; PTSD, post-traumatic stress disorder.

not part of their role at the dispensary (i.e., driver or de- to recommend indica for insomnia, anxiety, and night-
livery service). None of the dispensary staff members in- mares than both sativa and hybrid plants. They were
dicated that they provide advice regarding medications more likely to recommend indica and hybrid plants
or drugs other than cannabis to their patients. for PTSD or trauma, and muscle spasms compared to
Dispensary staff reported making recommendations sativa. In contrast, staff were less likely to recommend
for specific strains or formulas of cannabis based on the indica for depression than sativa or hybrid plants.
following: the particular condition or ailment (89%; Finally, dispensary staff recommended hybrid strains
n = 39), the experience of other patients (83%; n = 35), more often for ALS than sativa.
patient preference or needs (79%; n = 33), their own ex- In terms of specific cannabinoid recommendations,
perience (71%; n = 30), information obtained from sci- dispensary staff were more likely to recommend a 1:1
entific articles (68%; n = 28), dispensary owner or other ratio of THC:CBD for anxiety, PTSD or trauma, and
staff recommendations (52%; n = 22), information Crohn’s disease compared to high THC. They were
obtained on websites (48%; n = 20), new variety or un- more likely to recommend high CBD and a 1:1 ratio
usual/rare breed (47%; n = 20), and what needs to get for ALS, epilepsy, and muscle spasms compared to
moved out of inventory (21%; n = 9). high THC. Dispensary staff were more likely to rec-
The survey assessed which plant strains (i.e., sativa, ommend high CBD than high THC for arthritis and
indica, hybrid) and which cannabinoid concentrations Alzheimer’s disease. They were also more likely to rec-
(i.e., high THC, high CBD, 1:1 ratio of THC/CBD) ommend a 1:1 ratio for hepatitis C compared to high
were recommended for particular symptoms or condi- THC or high CBD. Staff were more likely to recom-
tions. Several patient conditions were associated with mend high THC for appetite than high CBD (Table 2).
specific plant strain recommendations by dispensary
staff (Table 1). Indeed, dispensary staff were more Dispensary staff attitudes
likely to recommend indica for chronic pain and Tour- Dispensary staff members were asked to rate satisfac-
ette’s syndrome than sativa. They were also more likely tion with their current position on a scale ranging
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 248
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Table 1. Dispensary Staff Plant Strain Recommendations for Patient Symptoms or Conditionsa

Symptom or condition S, % I, % H, % Significance

ALS or Lou Gehrig’s disease 11 21 36 t(27) = 2.07, p = 0.048 (S vs. H)

Alzheimer’s disease 14 18 18 ns
Anxiety 13 60 23 t(29) = 3.61, p = 0.001 (S vs. I)
t(29) = 2.43, p = 0.021 (I vs. H)
Appetite 53 33 33 ns
Arthritis 25 36 32 ns
Cachexia (wasting syndrome) 32 36 32 ns
Cancer 36 36 46 ns
Chronic pain 23 57 30 t(29) = 2.25, p = 0.032 (S vs. I)
Crohn’s disease/GI 21 43 25 ns
Depression 63 16 47 t(29) = 3.41, p = 0.002 (S vs. I)
t(29) = 2.32, p = 0.027 (I vs. H)
Drug addiction 27 36 39 ns
Epilepsy 14 18 18 ns
Glaucoma 32 25 32 ns
Headaches or migraines 27 23 37 ns
Hepatitis C 18 21 25 ns
HIV/AIDS 27 36 32 ns
Insomnia 3 80 20 t(29) = 8.66, p = 0.000 (S vs. I)
t(29) = 4.11, p = 0.000 (I vs. H)
Multiple sclerosis 18 29 36 ns
Muscle spasms 7 40 33 t(29) = 3.01, p = 0.005 (S vs. I)
t(29) = 2.47, p = 0.020 (S vs. H)
Nausea 27 33 47 ns
Neuropathy 17 43 40 ns
Nightmares 13 70 20 t(29) = 4.39, p = 0.000 (S vs. I)
t(29) = 3.40, p = 0.002 (I vs. H)
PTSD or trauma 11 46 36 t(27) = 2.77, p = 0.010 (S vs. I)
t(27) = 2.07, p = 0.058 (S vs. H)
Tourette’s syndrome 11 39 25 t(27) = 2.28, p = 0.031 (S vs. I)
a
Percentages do not add up to 100% because participants selected each symptom/condition for which they recommended a given strain, inde-
pendently. Thus, symptoms/conditions for which percentages added up to above 100% indicate that some participants recommended multiple
strains for a given condition. Conversely, symptoms/conditions for which percentages added up to less than 100% indicate that some participants
did not recommend any strain for a given condition.
GI, gastrointestinal; H, hybrid; I, indica; ns, not significant; PTSD, post-traumatic stress disorder; S, sativa.

from very dissatisfied (1) to very satisfied (5). The mean ditions, and that these recommendations are based on a
score for satisfaction was 4.27 (SD = 0.95, n = 41), indi- number of sources, both empirically and nonempirically
cating a high level of satisfaction with their work. based. Despite the vast number of staff members offer-
Other attitudes toward dispensary work were ing recommendations to patients, only 20% of our sam-
assessed on a scale ranging from never (1) to always ple reported prior medical and/or scientific training.
(5). Items included the following: feeling valued or ap- In terms of plant strain recommendations, very little
preciated because of work (M = 3.81, SD = 1.13, n = 42), work has documented patient preference or the specific
feeling stigmatized or looked down upon by others for efficacy of certain cannabis strains as a function of clin-
their work (M = 2.57; SD = 1.06, n = 42), and experienc- ical condition. Staff recommendation of indica strains
ing burnout or fatigue as a result of work (M = 2.83, for chronic pain in the current study was consistent
SD = 1.10, n = 42). with individual patient preference observed in other
work.10 The recommendation of indica primarily for
Discussion insomnia and nightmares is consistent with one patient
While a number of studies have examined the charac- survey,11 but differs from another empirical study that
teristics of patients seeking cannabis recommendations highlighted patient preference for sativa strains for
from a physician,3,8 and those obtaining cannabis from sleep difficulties.12 While observations related to strain
a dispensary,2,9 the present study serves as the first ex- recommendations are interesting, due to extensive hy-
amination of characteristics and practices of dispensary bridization and variations in growing conditions, the
staff. Findings indicate that the vast majority of staff differences between cannabis strains do not seem to
provide specific counseling to patients regarding can- play as large a role in determining subjective effects
nabis that may be most helpful for their individual con- as cannabinoid concentrations.13 This has led some to
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 249
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Table 2. Dispensary Staff Cannabinoid Recommendations for Patient Symptoms or Conditionsa

High THC High CBD 1:1 Ratio

Symptom or condition (THC), % (CBD), % THC/CBD (1:1), % Significance

ALS or Lou Gehrig’s disease 18 57 57 t(27) = 2.67, p = 0.013 (THC vs. CBD, THC vs. 1:1)
Alzheimer’s disease 21 61 50 t(27) = 2.61, p = 0.015 (THC vs. CBD)
Anxiety 13 30 40 t(29) = 2.19, p = 0.037 (THC vs. 1:1)
Appetite 63 10 7 t(29) = 4.93, p = 0.000 (THC vs. 1:1)
t(29) = 4.33, p = 0.000 (THC vs. CBD)
Arthritis 32 71 53 t(27) = 2.20, p = 0.036 (THC vs. CBD)
Cachexia (wasting syndrome) 54 32 43 ns
Cancer 50 57 68 ns
Chronic pain 33 53 57 ns
Crohn’s disease/GI 25 47 61 t(27) = 2.23, p = 0.034 (THC vs. 1:1)
Depression 33 26 53 ns
Drug addiction 36 42 50 ns
Epilepsy 7 61 54 t(27) = 4.59, p = 0.000 (THC vs. CBD)
t(27) = 3.99, p = 0.000 (THC vs. 1:1)
Glaucoma 39 36 50 ns
Headaches or migraines 33 37 63 ns
Hepatitis C 18 29 64 t(27) = 3.12, p = 0.004 (THC vs. 1:1)
t(27) = 2.07, p = 0.049 (CBD vs. 1:1)
HIV/AIDS 36 36 68 ns
Insomnia 33 33 40 ns
Multiple sclerosis 32 46 57 ns
Muscle spasms 10 53 53 t(29) = 3.53, p = 0.001 (THC vs. CBD, THC vs. 1:1)
Nausea 50 23 53 ns
Neuropathy 20 47 47 ns
Nightmares 20 43 37 ns
PTSD or trauma 21 28 57 t(27) = 2.36, p = 0.026 (THC vs. 1:1)
Tourette’s syndrome 18 43 43 ns
a
Percentages do not add up to 100% because participants selected each symptom/condition for which they recommended a given cannabinoid
concentration, independently. Thus, symptoms/conditions for which percentages added up to above 100% indicate that some participants recom-
mended multiple cannabinoid concentrations for a given condition. Conversely, symptoms/conditions for which percentages added up to less than
100% indicate that some participants did not recommend any cannabinoid concentration for a given condition.
CBD, cannabidiol; THC, tetrahydrocannabinol.

argue that distinctions among cannabis chemovars la- pathic pain,16,20 as well as sleep disturbances.15 Based
beled as ‘‘Sativa’’ or ‘‘Indica’’ are relatively meaningless on the above literature, it appears that a meaningful
unless accompanied by detailed accurate assays of can- number of dispensary staff are providing recommenda-
nabinoid and terpenoid content.14 tions for cannabinoids that have either not been shown
Dispensary staff recommendations of cannabinoid to be effective for a given condition (e.g., 33% recom-
concentrations (e.g., THC, CBD) for particular patient mending THC for depression, 10% recommending
symptoms and conditions were also frequently incon- CBD for appetite, 78% recommending either high THC
gruent with the existing empirical literature. For in- or high CBD for multiple sclerosis), or could actually
stance, the existing empirical literature would suggest worsen a patient’s condition (e.g., 13% recommending
that cannabis high in CBD could be particularly helpful THC for anxiety, 7% recommending THC for epilepsy).
for individuals with anxiety disorders, while cannabis Aside from the present study’s contribution to the
high in THC could actually lead to acute and long- literature in terms of describing the characteristics of
term anxiety reactions.6,15,16 Early pre-clinical work cannabis dispensary staff, findings highlight the impor-
has also highlighted CBD as a potential antide- tance of consistent, evidence-based training of those pro-
pressant,15 anticonvulsant,16,17 and therapeutic for viding specific recommendations of cannabis strains or
PTSD.15 On the other end of the spectrum, the litera- cannabinoid concentrations for a given patient condition
ture would suggest that THC may be an antiemetic, (e.g., physicians, dispensary staff). Indeed, while one
and particularly beneficial for appetite stimulation might expect the most qualified individuals to provide
and pain.18 Finally, a number of reviews have docu- specific recommendations of cannabis product to be
mented that a combination of THC and CBD (e.g., trained physicians who are aware of a patient’s medical
nabiximols) can have therapeutic value for individuals history and other prescription medications that could
with spasticity due to multiple sclerosis,16,19 neuro- interact with certain cannabinoids,21–23 it is dispensary
Haug, et al.; Cannabis and Cannabinoid Research 2016, 1.1 250
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staff who are the most likely to provide cannabis advice. Laws (NORML), for their assistance in the recruitment
As each state is currently responsible for drafting and of dispensary staff.
monitoring its own cannabis legislation, it is imperative
for states to mandate some form of educational certifica- Author Disclosure Statement
tion for any individual providing cannabis advice to pa- Drs. Bonn-Miller and Vandrey serve as consultants for
tients, not just physicians. Furthermore, given the CW Botanicals, Insys Therapeutics, and Zynerba Phar-
quickly evolving literature in this field, it seems necessary maceuticals. Dr. Bonn-Miller also consults for Tilray (a
for individuals to receive regular updates via continuing division of Privateer Holdings). Dr. Babson served as a
medical education. Given the increasing availability and consultant for Insys Therapeutics. None of the above
preferences for myriad methods of cannabis consump- entities was involved with the design, implementation,
tion (e.g., edibles, extracts, dabs)2,24 and corresponding analysis, or dissemination of the present study. The
risks,25,26 patient and provider education programs expressed views do not necessarily represent those of
should strive to include trainings in safe and effective the Department of Veterans Affairs.
use of cannabis as a function of preparation.
The present study data, although novel, are not with- References
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