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Medical Decision-making Among Cannabis Dispensary Staff

Welcome to Cannabis Conclusions, a unique educational series from Higher Learning LV that is targeted at hemp and cannabis industry professionals. This series provides readers with the conclusion section from important modern peer-reviewed research studies.


A 2017 study entitled "Medical Decision-Making Processes and Online Behaviors Among Cannabis Dispensary Staff" that was published in the journal Substance Abuse: Research and Treatment investigated the "medical decision-making processes and patterns of information exchange among a sample of budtenders from two major metropolitan areas in California." The research also documented "perceived barriers to medical decision-making and budtender-patient interactions."

Most common conditions among medical cannabis patients

The scientific investigation involved 158 budtenders from the San Francisco Bay Area and Greater Los Angeles (featuring an average age of 32 and an age range of 21 to 58) and involved an online internet survey administered from June to September 2016. Inclusion criteria (eligibility characteristics) involves a minimum age of 18 and those who "had a medical cannabis card or referral letter from a physician and currently worked as a budtender, either part-time or full-time, at a cannabis dispensary in San Francisco or Los Angeles."


The study reported that 56 percent of the participant budtenders had received "formal training to become a budtender." Of the trained budtenders, 67 percent reported that their training "was through their dispensary and 65 percent took an online course."


Study Conclusions

"The 158 budtenders in this study indicated that the following conditions were the most common that patients want to treat with cannabis:

  • Anxiety (81 percent)

  • Chronic pain (80 percent)

  • Cancer (74 percent)

  • Sleep problems (70 percent)

  • Depression (64 percent)

"Budtenders reported that flowers and buds (83 percent), edibles (78 percent)), waxes (60 percent), oils (47 percent), and topicals (46 percent) were the most popular choices among patients at their dispensary.


"Most (92 percent) of the budtenders used Internet at least several times a day. The most common social networks were Facebook (82 percent), Instagram (72 percent), YouTube (56 percent), and Twitter (51 percent). About half of budtenders (49 percent) exchanged information about medical cannabis via e-mail in the past 30 days, while 39 percent used text messages and social media.

Most popular products among medical cannabis patients


"Several demographic and workplace differences were also found between trained and untrained budtenders, with trained budtenders having more established careers as cannabis professionals compared with their untrained counterparts. In contrast, untrained budtenders tended be ethnically diverse young adults who interact with patients in dispensaries with larger workforces and sales volume, suggesting that dispensary size and practices may influence the types of interactions patient experience with budtenders.


"With regard to decision-making about cannabis, most of the budtenders in our study (82 percent) favored a patient-centered philosophy whereby patient preferences are prioritized in medical decisions about marijuana, even if they do not follow product recommendations from the budtender.


"Most of the budtenders in our study (82 percent) favored a patient-centered philosophy whereby patient preferences are prioritized."

"However, trained and untrained budtenders did not consider medical decision-making to be equally important. Surprisingly, trained budtenders were less likely to consider medical decision-making as very important and prefer a patient-centered philosophy.


"Trained budtenders were also more likely to indicate lack of trust and legal issues among patients as barriers to decision-making, which may partially explain why some trained budtenders prefer to control their interaction by encouraging patients to follow their advice. In addition, trained budtenders may consider medical decision-making to be less important through experiences with training programs that de-emphasize aspects of patient-centered care that could hold dispensaries liable for providing unsolicited medical advice.

"For the online behaviors, trained budtenders had slightly less Internet usage overall, which may be indicative of differences in how certain budtenders broadly integrate online engagement and information exchange into their daily lives. Although these differences in overall Internet usage may have been influenced by age, trained budtenders were more likely to exchange health-related information with patients through five types of digital mediums.


"Similarly, trained budtenders were more likely to use Twitter, Pinterest, Tumblr, and Vine, which can all influence the rapid dissemination of cannabis-related information to patient populations across social networks, forums, microblogs, and e-commerce platforms. Together, the higher rates of information exchange and social media usage among trained budtenders suggest a pattern of online behavior that may help grow their social networks and connect more patients to information about retail products, including online cannabis marketplaces that allow users to personalize their preferences, geolocate products, and make purchases.


"Higher rates of information exchange among trained budtenders suggest online behavior that may help connect more patients to information about retail products."

"The growing popularity of such platforms, however, could represent an alarming trend of dispensary and workforce behaviors that occur outside of state regulations. In California, the newly passed adult-use law, Proposition 64, only sets guidelines for advertising recreational cannabis in community settings (eg, billboards, schools, youth centers) and on-site at brick and mortar dispensaries, but does not directly address online advertising and communications.


"Similarly, some dispensaries have started to partner with digital platforms such as HelloMD and PrestoDoctor to directly connect qualified patients to physicians, although California law makes no explicit distinctions about how physicians can advertise their recommendation services online.


"As some dispensaries and budtenders may use these digital platforms to transcend regulatory boundaries through the Internet, the findings from this study demonstrate the need for continued surveillance of the cannabis industry workforce and large online marketplaces that streamline retail purchases."


View the original study.

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