No Oversight or Training, How the Budtender Became a Pharmacist

With the patchwork of policies, timelines, and legislation covering the medical cannabis sector in the US, the training of the budtender varies from one location to the next.  The customer service provided in a longstanding California medical cannabis dispensary may be entirely different from that at a newly minted storefront in Florida. 

Across the industry, there are no overarching regulations on training for cannabis customer service staff, who are often responsible for dishing out medical advice to their patients. 

The Role of Budtender Today

In the recreational market, a budtender position is similar to that of a bartender, hence the name. At a medical cannabis dispensary, the position is much different.  On the medical side, its a job which has evolved into one more akin to a conventional pharmacist than one focused on customer experience. 

A pharmacist manages medicines supplied to patients and informs patients about those medicines, including methods of ingestion, and possible adverse reactions. They are there to answer questions and ensure that the drugs are both legal and suitable for the patient to take. 

Walk into any dispensaries serving medical patients, and a budtender most likely has the same roles and responsibilities. Public-facing medical dispensary staff recommend strains, advise on dosage, provide safety-warnings, and liberally dispense medical advice to their customers. 

Not all patients who use cannabis get their information from an informed physician. They tend to piece together their guidance from friends, budtenders, and retailers. Nicholas C Peiper, et al. explained in a recent piece published in the Journal of Substance Abuse, “In the context of arriving at informed decisions about cannabis, interactions at dispensaries therefore represent key opportunities for patients to consult dispensary staff, like budtenders, about product choices and the therapeutic potential of cannabis.”

The Current State of Training for Budtenders

It’s not clear how many, if any, states currently require medical training for these default-cannabis-pharmacists. California’s current cannabis legislation seems to suggest an annual “refresher” course for cannabis employees; however, the nature of this training is not clear. 

In Canada, the federal government has indicated it is in the process of creating a course for retail cannabis staff called “Responsible Service Training.” Although, it seems more akin to safety training for bartenders and servers than for staff dispensing medical knowledge. 

Many endeavoring offline and online businesses have popped up over the last few years, promoting budtender certification courses. These courses range in price, from a few hundred dollars to a few thousand. The majority of which are not accredited and do not have a standardized curriculum. From one certificate to the next, there is no consistency nor oversight of the course contents.

As one review explained, “The main tangible takeaway is a certificate, handed out to those who pass the 20-question, multiple-choice exam given at the end of the day’s activities. Whether the certification actually means anything is a separate question.” Pharmacists, at conventional pharmacies, require on average eight years of professional training before entering into the job market.

Realities for the Dispensary Staff: Training and Practices

To date, there are several industry surveys and regional investigations which explore the training and knowledge for those staff working behind the counter. The available data demonstrates the lack of education of these positions and a need for change.

In 2016, Cannabis and Cannabinoid Research published the results of a small countrywide survey about the training and practices of dispensary staff in the handful of legalized states at the time. Nancy A. Haug and her research team collected online surveys from 55 current dispensary staff, whose responses covered demographics, formal training, and cannabis recommendation practices, among other topics. Although 94 percent of respondents “reported that they provide advice, guidance, or counsel to patients,” only 55 percent had received any formal training.

Most alarmingly, the formal training was largely geared towards non-medical training like customer service, business, and others. A total of 20 percent checked the “other” box, which covered safety and regulatory compliance or a budtender certification. Only 20 percent of those surveyed reported medical training.

In another survey of medical cannabis dispensary staff, this time focused on two municipalities in California; there was a notably higher percentage of budtenders with formal training. Of the 158 respondents, 56 percent had received formal training. Most indicated it was on-the-job training or a certificate from an outside source.

This same survey also studied dispensary staff opinions of medical decision making versus patient-centered care. Medical decision making is a hypothesis-driven approach, based on the extensive accumulation of data and knowledge. Its an approach common in conventional medicine, but hard to apply within cannabis because of the lack of clinical study and large trial design. 

According to this regional survey, medical decision making was not popular among trained dispensary staff. Trained budtenders preferred a patient-centric approach. From the intel gathered from this survey, the common theme among Cali budtenders is to dispense advice based on opinion and experience instead of scientific data and clinical study.

A small survey of Oregan dispensary staff supported the idea that budtenders rely on patient-provided information to shape medical advice. Respondents indicated they relied on a patient’s reported medical condition and symptoms to advise on the strain. They also often asked about a patient’s experience and personal preference. Their top three sources of information included the internet, medical literature, and the patients themselves. Over 90 percent reported on the job training, although this category was ill-defined.

A final survey is worth highlighting, for the sake of demonstrating the lack of regulatory oversight on the medical advice dosed by budtenders. In “Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use,” researchers spoke with 400 dispensaries about cannabis use for morning sickness. 

The results speak for themselves: “The majority [of survey respondents] (65%) based their recommendation for use in pregnancy on personal opinion and 36% stated cannabis use is safe in pregnancy.” Out the majority which recommended cannabis during pregnancy, only about 30 percent advised the patient to speak with a physician without prompting. 

The State of Budtender Training

Over the years, the medical cannabis sector has organically evolved outside of the structure of conventional medicine. Its evolution has come with many benefits to the patients, but it’s also increasingly apparent there are some safety issues. The lack of budtender training and the lack of oversight of said training is one of the most notable.

While a pharmacist must attend eight years of professional schooling, a budtender need only demonstrate product knowledge. This product knowledge may come from an uncertified training course, or as one survey discovered, the internet. The cannabis sector is rife with misinformation, thanks to its long-standing Schedule I status. There is a genuine possibility that medical dispensary staff are providing inaccurate and possibly dangerous advice to patients. 

To improve the level of service to their clientele, prevent unwanted adverse reactions to the product, and protect themselves, some degree of medical training may be necessary in the future. Training and regulatory oversight will help move medical cannabis from the fringes of medicine and improve legitimacy.

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