Doctors and Cannabis Industry sharing wisdom and advice – Education is key for all
Are you a nurse or doctor? If yes- thank you for all that you are doing to move the industry forward while recommending cannabis to your patients. It delights us when we hear positive wellness stories and learn more about how cannabis is improving lives.
If you’re not a trained medical professional and work in a dispensary- thank you for being really clear with patients. When they ask for your suggestion and insight about the ways cannabis may assist them, please say things like “I’m not a Doctor.” “Please check with your medical team.” Of course you may still share information, and let’s make sure it’s anecdotal or general, staying away from making claims and medical assurances.
Several recent articles are bringing “medtending’ onto our radar.
It is illegal to provide medical advice, unless you are a doctor. There can be huge fines for crossing this line.
The Denver Post recently reported that they “found that employees at 69 percent of stores (in CO) recommended treating pregnancy-related nausea with cannabis.” This contradicts what several studies, health experts, and even industry advocates have said about discouraging cannabis use with pregnancy.
Maureen McNamara was quoted by Spencer J. Ward in his recent article in Rooster, about the same topic. “Medtending walks a fine line between selling weed and playing doctor.”
Josh Ingold, with The Denver Post, reported that they “found that employees at 69 percent of stores (in CO) recommended treating pregnancy-related nausea with cannabis.” This contradicts what several studies, health experts, and even industry advocates have said about discouraging cannabis use with pregnancy.
Here is Josh Ingold’s article:
Should women suffering from morning sickness during pregnancy use marijuana to control their nausea?
Colorado health experts, regulatory officials and even industry advocates have consistently answered no, and they’ve backed that message up with studies, public service announcements and warning labels on cannabis packaging.
But a new study by doctors at Denver Health and the University of Colorado School of Medicine reports that, when asked for advice on mixing pot and pregnancy, employees at an overwhelming majority of marijuana stores in Colorado will say that it’s OK. And fewer than a third of those stores will recommend that a pregnant woman consult with a doctor about cannabis use — unless they are prompted to.
“It was surprising and concerning to us because there are data that suggest exposure to cannabis can be harmful to a developing fetus,” said Dr. Torri Metz, the study’s lead researcher.
One of those data points came out last month, when separate researchers at CU found that marijuana use during pregnancy was associated with low birth weights.
Dr. Larry Wolk, a pediatrician and executive director of the Colorado Department of Public Health and Environment, said the new findings are concerning — especially considering how much work has gone into discouraging marijuana use during pregnancy.
But, he said, other survey data do not yet show an alarming increase in the number of women using marijuana during pregnancy. Between 2014 and 2016, the percentage of women who said they used marijuana while pregnant or breast-feeding did not increase significantly, according to the latest numbers available from the Colorado Pregnancy Risk Assessment Monitoring System.
In 2016, about 8 percent of women surveyed used marijuana during pregnancy — similar to the percentage of women who smoked cigarettes while pregnant and slightly less than half the percentage of women who said they drank alcohol. Women who said their pregnancy was unintentional were more likely to have used marijuana — suggesting that, for at least some women, their marijuana use may have come during a time when they were unaware they were pregnant.
Those numbers lead Wolk to argue that there isn’t an epidemic of marijuana use during pregnancy, which only makes the new study more concerning.
“If this is the information they are giving out, that could erode and we could see an increase,” he said.
The results of the new study come with a caveat: They were obtained with a little bit of subterfuge.
To carry out the study, researchers called 400 Colorado marijuana stores, both medical and recreational, and told the employee who answered that they were eight weeks pregnant and suffering from nausea.
“Are there any products that are recommended for morning sickness?” the researcher would ask, sticking to a script.
The researchers then recorded the answers. (They did not visit the stores in person, nor did they buy any marijuana products.)
They found that employees at 69 percent of stores recommended treating pregnancy-related nausea with cannabis. Only 32 percent of stores recommended consulting a doctor — although that percentage grew to 82 percent if the caller directly asked whether she should consult a doctor.
Metz said the study set-up was “as close as we can get in a study to replicating the real world.” And she said she is confident that the answers researchers received over the phone are the same as what a store employee would tell a customer in person.
The specifics of the advice that researchers heard, though, were all over the place. Some employees recommended using a product high in THC, the psychoactive component of marijuana. Others recommended a product containing only CBD, which does not get users high.
Some expressed caution about recommending marijuana without consult from a doctor, while others specifically noted the packaging labels warning against using cannabis while pregnant — and then recommended it anyway. Sometimes, the employees lacked a basic understanding of biology.
“Edibles would not hurt the child,” one was quoted in the study as saying. “They would be going through your digestional tract.”
To Wolk, this shows the real problem.
“I think people have to be careful of the kind of information they’re asking of a budtender because these are not health care people,” he said.
Wolk said the state will next month launch a new public-education campaign focused on marijuana and pregnancy. The campaign will specifically focus on reaching people who are already consuming marijuana, as a recent state study found that marijuana consumers are much less likely to believe that using marijuana once or twice during pregnancy could be harmful.
Kristi Kelly, the executive director of the Colorado-based Marijuana Industry Group, said the study also provides an opportunity for the industry and the medical community to work together. Store employees should be reminded not to provide medical advice, she said. But doctors, she said, should remember that patients curious about marijuana are going to try to seek out information from many different sources.
“It makes sense that we would work closely with the medical and scientific community to figure out the most effective way to provide education content to customers,” she said.
Representative quotes from cannabis dispensary employees in response to phone script questions
I’m calling because I’m eight weeks pregnant and nauseated. Are there any products that are recommended for morning sickness?
• “Let me call my daughter. She just had a baby. Call me back in 5 minutes.”
• “On the package it says do not consume while pregnant — ‘there may be health risks associated with this product if you are pregnant, breast-feeding, or planning on becoming pregnant.’ You are welcome to come to the shop to see if we can find something, but I think most of the labels are going to be like that.”
• “Have you talked to your doctor? I do not want to recommend anything, you know. I know what would help with nausea, but I do not think I could legally recommend anything for someone that is pregnant, but I could recommend something for nausea do they still let you purchase while you are pregnant?”
• “I cannot give medical advice; look it up and then call me, and I’ll see if I have the product, but we do have CBD and weed in stock.”
Why is the product recommended or not recommended?
• “All the products say it is not recommended for pregnant women use; they just do not know what it could do to the fetus. There is not enough studies out there. It is a drug, so probably not the best thing for you when you are pregnant.”
• “Technically, with you being pregnant, I do not think you are supposed to be consuming that, but if I were to suggest something, I suggest something high in THC.”
• “Legally cannot provide a recommendation.”
• “Need a doctor’s recommendation first.”
• “Edibles would not hurt the child; they would be going through your (digestive) tract.”
• “They have been doing studies. As long as you are not heavily, harshly smoking. Like the smoke, I think that is the only way it could physically damage the baby because you are inhaling smoke.”
Recommendations on frequency
• “In the context of edibles, start with a low dose and see how it works out for you because those types of things would not cross the blood-brain barrier, so even if you have got the CBDs and the other good parts of the plants would get in your baby’s blood system, but the psychotropic properties, the THC molecule, would not get near your baby, so basically would not be getting your baby stoned.”
• “Before your first trimester. Second trimester you do not want to overconsume. When I was pregnant and started to feel a little nausea coming on, I did not smoke more than two times a day.”
• “I am not sure. I do not really know. I am not really too familiar with this because I do not want to give you the wrong information and find out it can be harmful to your baby, so I do not want to tell you the wrong thing. Just one of my co-workers, she was pregnant and she was using flower and vaping.”
Responses regarding speaking with a health care provider
• “I think that would be a smart choice. Try for someone that is liberal or pro-cannabis. The others are not fully educated on the benefits of cannabis and will tell you to stay away, but always check with a medical professional.”
• “I do think you should talk to your doctor at your discretion about it. I know there are some doctors that might be really uncomfortable with that. I do think that it is a medical professional’s responsibility to be open to talking with their patient.”
• “The doctor will probably just tell you that ‘marijuana is bad for kids’ and will just try pushing pills on you. Maybe you have a progressive doctor that will not lie to you. All the studies done back in the day were just propaganda.”
• “Google it first. Then if you feel apprehensive about it, you could ask.”
• “Most of them out here tell them not to smoke weed. Even the cancer doctors. It is so messed up. I do not know how the baby doctors work, if they are chill or not. Just do not go stoned when you talk to them.”
• “No, because they will test you when the baby is born and can get child protective services involved. That is just the unfortunate, honest truth.”
• “In the state of Colorado, you are protected, so it is not something you have to bring to their attention. They are not gonna call CPS like they would have 10 years ago if you have MJ in your system.”
Is cannabis safe to take during pregnancy?
• “Different people opinions, kind of like alcohol. I used to be a bartender, and it is legal to serve someone who is pregnant because it is up to them, so, you know. I am not here to tell you you should or should not use. Does that make sense? I do know a lot of people that do use cannabis during their pregnancy, though, and for what they have found, there has not been side effects that they can see.”
• “I know a lot of doctors are recommending marijuana nowadays.”
• “We have a girl that comes in and she is probably six months pregnant and she smokes bud, but she does not smoke it as much as she did, but she still does. She said her doctor said it was OK. She said the doctor said that, but I am not a doctor. I know aspirin is OK for babies, and that is pretty much what you are getting is an aspirin that is probably better.”
Source: Denver Health study
Cannabis Trainers™ offers compliance training programs for dispensary staff.
We coach people in our Sell-SMaRT™ Responsible Vendor training not to give medical advice.
From Spencer J. Ward’s Rooster article, “It’s imperative that employees selling cannabis do so with integrity and professionalism and never cross the line on offering medical advice,” Maureen McNamara explains. “There is a big difference between saying ‘This will stop your migraine’ and saying ‘Personally, this was effective for me in stopping a migraine. And, everybody is different. This may be a contribution to you and please check with your doctor.’”
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