With research suggesting that many patients with cancer are using cannabis for medical purposes - and oncology teams tending to offer little guidance about its use - patients are often turning for advice to staff at cannabis dispensaries. A new study by researchers at Dana-Farber Cancer Institute suggests that despite a commitment by many dispensary workers to educate themselves about medical cannabis, dispensaries often prioritize sales skills over cannabis knowledge, and the level of on-the-job training at dispensaries is notably uneven.

The study, published online by the journal JCO Oncology Practice, is based on in-depth interviews with 26 workers at cannabis dispensaries in 13 states. If the results are confirmed by a larger, quantitative study, they obligate the medical community to ensure patients have reliable sources of guidance about medical cannabis, study authors say.

"Our study opens the door to discussing that we as clinicians may not be able to completely defer responsibility for advising patients to the dispensaries," says the study's first author, Ilana Braun, MD, of Dana-Farber and Brigham and Women's Hospital. "We need to figure out ways to address this issue."

In a previous study by Braun and her colleagues, 80% of oncologists surveyed said they discussed medical cannabis with patients, but only 30% felt qualified to offer recommendations for its use. In the absence of clinical guidance, dispensary personnel often become the default source of information on medical cannabis, research suggests. In a 2020 paper based on interviews with patients with cancer, Braun's team found that nearly all respondents were getting most of their advice on medical cannabis from non-medical sources, chiefly dispensary personnel, on topics ranging from dosages to properties of different strains.

"If patients are being deferred to the dispensaries, we wanted to know who works there, how they're trained, and what they tell patients with cancer," Braun comments.

For the new study, investigators conducted phone interviews with 26 employees in managerial and client-facing positions at dispensaries in 13 states. The responses revealed a strong dedication to their field on the part of many workers but a highly inconsistent level of cannabis therapeutics training among dispensary staff.

"The dispensary personnel we interviewed are really passionate about what they're doing and are trying really hard to give good advice. They're working hard in their off hours, paying for their own coursework, and doing whatever they can to learn," Braun says. They reported, however, that dispensaries often make hiring decisions based more on sales skills than expertise in cannabis therapeutics. Many said workplace training in cannabis therapeutics was unstandardized and weak.

"We're hearing from patients that they want this information from their oncology team," study co-author Manan Nayak, PhD, of Dana-Farber says. "Right now, the system is set up so that everyone - oncologists and dispensary personnel - is working in silos. It falls to the patient to find out where to go, get information from dispensary personnel, try different products, and maybe report back to their oncologist. The onus is often on the patient to communicate with the dispensary. There needs to be a way to close the loop between the dispensary and the clinical team."

The senior author of the study is William Pirl, MD, MPH, of Dana-Farber and Brigham and Women's. Co-authors are Jane Roberts, PhD, of Dana-Farber; Peter Chai, MD, of Dana-Farber, Brigham and Women's, and the Fenway Institute; James Tulsky, MD, of Dana-Farber and Brigham and Women's; and Donald Abrams, MD, of Zuckerberg San Francisco General Hospital.

Related Links
Dana-Farber Cancer Institute
The Flowers and Fruits of Earth

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