Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA.
BMC Prim Care. 2023 Jul 14;24(1):145. doi: 10.1186/s12875-023-02095-5.
Legal cannabis is available in more than half of the United States. Health care professionals (HCPs) rarely give recommendations on dosing or safety of cannabis due to limits imposed by policy and lack of knowledge. Customer-facing cannabis dispensary staff, including clinicians (pharmacists, nurses, physician's assistants), communicate these recommendations in the absence of HCP recommendations. Little is known about how dispensary staff approach individuals with complex medical and psychiatric comorbidities. Using responses from a national survey, we describe how cannabis dispensary staff counsel customers with medical and psychiatric comorbidities on cannabis use and examine whether state-specific cannabis policy is associated with advice given to customers.
National, cross-sectional online survey study from February 13, 2020 to October 2, 2020 of dispensary staff at dispensaries that sell delta-9-tetrahydrocannabinol containing products. Measures include responses to survey questions about how they approach customers with medical and psychiatric comorbidities; state medicalization score (scale 0-100; higher score indicates more similarity to regulation of traditional pharmacies); legalized adult-use cannabis (yes/no). We conducted multiple mixed effects multivariable logistic regression analyses to understand relationships between state medicalization and dispensary employees' perspectives.
Of 434 eligible respondents, most were budtenders (40%) or managers (32%), and a minority were clinicians (18%). State medicalization score was not associated with responses to most survey questions. It was associated with increased odds of encouraging customers with medical comorbidities to inform their traditional HCP of cannabis use (Odds ratio [OR]=1.2, 95% confidence interval [CI] 1.0-1.4, p=0.03) and reduced odds of recommending cannabis for individuals with cannabis use disorder (CUD) (OR=0.8, 95% CI 0.7-1.0, p=0.04). Working in a state with legalized adult-use cannabis was associated with recommending traditional health care instead of cannabis in those with serious mental illness (OR 2.2, 95% CI 1.1-4.7, p=0.04). Less than half of respondents believed they had encountered CUD (49%), and over a quarter did not believe cannabis is addictive (26%).
When managing cannabis dosing and safety in customers with medical and psychiatric comorbidity, dispensary staff preferred involving individuals' traditional HCPs. Dispensary staff were skeptical of cannabis being addictive. While state regulations of dispensaries may impact the products individuals have access to, they were not associated with recommendations that dispensary staff gave to customers. Alternative explanations for dispensary recommendations may include regional or store-level variation not captured in this analysis.
合法的大麻在美国一半以上的州都可以买到。由于政策限制和知识匮乏，医疗保健专业人员（HCPs）很少对大麻的剂量或安全性提出建议。面向客户的大麻药房工作人员，包括临床医生（药剂师、护士、医生助理），在没有 HCP 建议的情况下传达这些建议。关于大麻药房工作人员如何为患有复杂的医疗和精神共病的个人提供服务，知之甚少。本研究使用来自全国性调查的回复，描述了大麻药房工作人员如何为患有医疗和精神共病的顾客提供大麻使用建议，并研究了州特定的大麻政策是否与向顾客提供的建议有关。
这是一项从 2020 年 2 月 13 日至 2020 年 10 月 2 日在销售含 δ-9-四氢大麻酚产品的大麻药房进行的全国性、横断面在线调查研究。研究方法包括对如何为患有医疗和精神共病的顾客提供服务的调查问题的回复；州医疗化评分（0-100 分；分数越高，与传统药房的监管越相似）；是否已将成人使用大麻合法化（是/否）。我们进行了多项混合效应多变量逻辑回归分析，以了解州医疗化与大麻药房员工观点之间的关系。
在 434 名符合条件的受访者中，大多数是花商（40%）或经理（32%），少数是临床医生（18%）。州医疗化评分与大多数调查问题的回复无关。它与鼓励患有医疗合并症的顾客告知其传统 HCP 使用大麻的可能性增加有关（优势比[OR]=1.2，95%置信区间[CI] 1.0-1.4，p=0.03），与推荐大麻用于患有大麻使用障碍（CUD）的可能性降低有关（OR=0.8，95%CI 0.7-1.0，p=0.04）。在成年人使用大麻合法化的州工作，与推荐传统医疗保健而不是大麻治疗严重精神疾病患者有关（OR 2.2，95%CI 1.1-4.7，p=0.04）。不到一半的受访者认为他们遇到过 CUD（49%），超过四分之一的人不认为大麻会上瘾（26%）。
在管理患有医疗和精神共病的患者的大麻剂量和安全性时，大麻药房工作人员更倾向于让患者的传统 HCP 参与其中。大麻药房工作人员对大麻上瘾持怀疑态度。虽然大麻药房的州监管可能会影响个人可获得的产品，但它们与大麻药房工作人员向患者提供的建议无关。替代解释可能包括本分析中未捕获的区域或商店层面的差异。
