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How to Avoid a Negative Dispensary Experience

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Recently, a friend told a disturbing story: On her first trip to a dispensary, his 80+ year old grandmother came home with a large bag. The budtender had encouraged her to buy every vape cartridge and tincture product in the store. Despite the many containers of tincture, and vaporizers that spilled from her bag, the patient had left the dispensary with very little product knowledge, or directions. Alarmed, her family struggled for answers. They turned to a family member who had attended FGCU’s first WEED course last semester. They asked if it was normal for grandma to purchase so many products on the first visit? He was shocked to see a new patient receiving so many products, and most of them not what the recommending doctor had suggested for the patient’s conditions.

I have heard my share of disparaging dispensary stories over the years. I learned just how valuable a kind, knowledgeable, and communicative budtender really is. Thankfully, the stories of blatant patient disregard and manipulation have been fairly isolated.

Hopefully, the majority of faces in the cannabis industry are here to help, and with a little awareness and preparation, you can make your dispensary visit the best possible. 

Read on for three facts to keep in mind when purchasing from your local dispensary. Hopefully, they will keep you and your loved ones from falling victim to a negative dispensary experience.


How did this happen? 
Why was a patient taken advantage of?
How could they prevent this from happening in the future? 

A dispensary is a retail store.

Patient be wary: while cannabis dispensaries promote themselves as medical centers and often offer rich opportunities for education, they are retail stores. Retail stores, by design, thrive on their ability to sell as much product as possible. 

In structure, dispensaries are no different than your local Target or Publix, and if you’ve ever found yourself working the frontlines of a busy retail store, you know how it works. A store purchases (or produces) a product, with an expectation of how much will be sold. If these items don’t sell, the product is marked down to encourage sales, and salespersons on the floor will be encouraged (and incentivized) to sell as much of the product as possible. 

This structure works well when you’re selling bags of chips and skinny jeans, but when applied to something like cannabis and human health, risks come into play, and unfortunately, all of the risks are to the patient. 

A quick search of dispensary job reviews on Indeed.com will yield multiple accounts of former dispensary workers being pressured to sell patients unnecessary products in the face of declining demand. 

The problem with this model is obvious: How can a budtender provide ethical care when their superior’s instruction directly conflicts with the patient’s needs? What if a CBD vape pen is on sale, but what the patient really needs is CBN tincture? Can you trust your budtender to proceed ethically? In cases like this, the patient is at the will of the budtender’s judgement, and when judgement is influenced by industry demands, patient satisfaction is put at risk. 

The solution? Be informed of your dispensary’s return policy, practice logic, and make sure you research all products you plan to buy before entering the store. Use your budtender as a reference, but have your own backup information on hand. Also, don’t be shocked by the fact that…

Your budtender has no certification.

The cannabis industry is young. Medical cannabis programs vary in structure and policy, but all have one thing in common: there is no governing body for, no nationally-recognized standards for, and, in almost all states, no state training or certification required of those who sell your medicine in a cannabis dispensary. That’s right—it is easier and less expensive to become certified to advise medical cannabis patients on a dispensary floor than it is to apply makeup at a beauty counter or cut someone’s hair.

While some impressive private education programs are available throughout the US and online, most are not regulated by a governing body. Many offer private certifications in cannabis education and budtending, but no national standard or testing is currently recognized or required in the US to sell medically-infused products as a dispensary worker. Background checks are often required, and each state writes its own policy on licensing mandates—but of those licensed to sell cannabis, most require no cannabis education either. 

Now, that’s not to say that there aren’t passionate, well-informed industry professionals out there eager to provide good patient care. There certainly are, and the dispensary is one of the best places to find them! However, many new patients mistakenly assume that the same certifications and education required of your nurse, doctor, or pharmacy are also held by your local dispensary workers. 

Like any retail store, most dispensaries require their employees to undergo some training on product knowledge and sales, but not all require budtenders to understand how and why these products work. This is why, prior to entering a dispensary, it is essential to remember that…

You need to know the ropes.

It never feels good to be taken advantage of, but it happens to the best of us. To avoid this experience, practice the same caution you would in any retail store. 

Do your research before speaking with a salesperson. 

Read up on what cannabinoids, terpenes, and strains may be of most benefit to your individual condition. 

Enter with the knowledge of what to ask is a good way to ensure your budtender has the resources he or she needs to help you. It will also help you recognize who has the education and experience best suited to assist your needs.

When you do choose to work with someone, choose an individual who can answer your questions with ease. 

And never feel pressured to leave the store with a product you’re unsure about. The dispensary will still be there tomorrow after you’ve had time to sleep on it.

How can a patient tell the difference between good and not-so-good service? 

Ask plenty of questions and prepare yourself with basic working knowledge of cannabis and your body. 

Listen to the answers and proceed accordingly. 

Your budtender may be able to talk about the cannabinoids and terpenes present in a vape cartridge, but can they tell you how those terpenes were derived and what they do?

An educator may be able to talk about the ratios of THC to CBD in a product, but can they explain the Entourage Effect? 

Most importantly, does the person working with you have an obvious interest in helping you feel better? 

By assuring you are informed about your condition, which products work for you, and have made your choice for routes of administration, you can be assured your trip to the dispensary will be rewarding instead of overwhelming.

Medical Minute

Medical Minute with Nurse Jordan

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In this column, our readers have the opportunity to ask our staff nurse anything they want to know about using cannabis plant medicine. She will provide quick and concise answers to big questions. In this month’s column, we researched Parkinson’s disease and how those suffering might be able to use cannabis for relief from their symptoms. Due to the abundance of cannabinoid receptors in the brain, the endocannabinoid system might turn out to be a direct delivery system for the relief of some symptoms experienced by patients who have Parkinson’s, according to a study published in Innovations in Clinical Neuroscience in January 2019.1

Parkinson’s disease affects the body’s movements by attacking the nervous system. The disease begins gradually and progresses over time. Sometimes, it begins with a simple hand tremor, others might experience less expression in the face, or speech might slow or soften.2 Pharmaceuticals have been the way patients have sought symptomatic relief until now. Thanks to the advancing laws surrounding medical and recreational cannabis, patients have more options than ever. 

What are the best methods of consumption for Parkinson’s patients? 

In states that have medical marijuana or recreational cannabis laws enacted, different products are available at dispensaries. One of the main symptoms caused by the disease is tremors. Some patients have had success with taking cannabis in an oil taken orally. Cannabis oil may contain THC and CBD and is often sold in blunt-tipped syringes or in bottles with a dropper, making self-administration of the cannabis plant medicine easy for the patient. 

In a study done by the British Association for Psychopharmacology, patients who received 300 mg of CBD a day showed a significant improvement of symptoms compared to those given a placebo.4 In another study done by the Movement Disorder Society, doses as low as 1.5 mg CBD: 2.5 mg THC up to 300 mg of CBD were given daily.5 Symptom relief was noted in patients with higher doses. Although there are still no set dosing parameters and more research is needed, do not let that get you discouraged. 

An open-label study of smoked marijuana decreased tremor and slowness in 22 people with PD.6 Improvement in patients’ sleep and pain scores were also observed. Some patients may prefer using an oil or tincture, others may feel more comfortable smoking. You may find a combination of delivery methods is what works best for you. Keep a journal and document your journey so if it works, you can duplicate what you did. 

What states list Parkinson’s as a qualifying condition?

A qualifying condition is a disease/disorder/symptom that a state has approved for a patient to use medical cannabis. Permission is received from a recommending physician and paperwork is filed with the state registry. According to the National Organization for the Reform of Marijuana Laws (NORML), there are 17 states in the U.S as of early 2020 that list Parkinson’s disease as an approved diagnosis.3 In addition to listing Parkinson’s disease, patients may also receive approval for persistent muscle spasms/spasticity.

Parkinson’s Disease

Connecticut
Florida
Georgia
Illinois
Iowa
Louisiana
Maine
Massachusetts
Michigan
Missouri
New Hampshire
New Mexico
New York
Ohio
Pennsylvania
Puerto Rico
Vermont
West Virginia
Virgin Islands

Persistent Muscle Spasms/Spasticity 

Arizona
California
Colorado
Delaware
Maryland
Michigan
Minnesota
Montana
Nevada
Oregon
Rhode Island
Utah
Washington

Treating Physician Decision

Arkansas (if approved by the Dept. of Health) Kansas
Oklahoma
Washington D.C
Wisconsin


What else should patients with Parkinson’s know? 

If you have not yet taken the time to view a video of a Parkinson’s patient using cannabis, then I highly suggest you take the time to do so now. As people often say, “seeing is believing.” One of the best videos available to see how quickly the effects of the cannabis plant medicine take place can be found on YouTube. By typing in “Ride with Larry” in the search bar of YouTube, you will find videos of a former police officer turned cannabis user. His tremors begin to calm within a matter of minutes after using cannabis oil. 

Researching at home can feel daunting. Some reports can be conflicting. If you want to try cannabis for your symptoms, it is important that you speak with your doctor, and don’t forget to document your journey.


Do you have questions for nurse Jordan?

Please submit any questions to [email protected]
Your question may be published in an upcoming issue.


REFERENCES:

1. Mohanty, D. & Lippmann, S. Innovations in Clinical Neuroscience, 16 (1-2). 2019.

2.  Mayo Clinic. Parkinson’s Disease. www.mayoclinic.org

3. NORML. Medical Marijuana. Information for each state. norml.org

4.  Chagas, M.H.N., et al. Journal of Psychopharmacology Sep. 18, 2014. doi: 10.1177/0269881114550355

5. Kluger, B. et al. Movement Disorder, 30(3). 2015. doi: 10.1002/mds.26142

6. Lotan, I. et al. Clinical Neuropharmacology, 37(2). 2014. doi: 10.1097/WNF.0000000000000016

7. Medical Marijuana and Parkinson’s Part 3 of 3. November 21, 2016. Ride with Larry. www.youtube.com

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Medical Minute with Nurse Jordan

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In this issue, we are learning all about Multiple Sclerosis (MS) and diseases that mimic its symptoms. The cause of MS is unknown. It is a disease that affects the central nervous system,1 which controls the majority of functions for the mind and body. Read on as we explore some commonly asked questions about using cannabis for MS.

What states have approved MS as a qualifying condition?

Qualifying conditions to receive your medical marijuana card vary from state to state. It is important to make sure your state has approved the condition you have. In the case of MS, some states specifically approve MS2 as a diagnosis and several states use the term “persistent muscle spasms or spasticity.” Since that is a primary symptom of MS, approval would most likely be provided.

Multiple Sclerosis

Alaska
Arkansas
Connecticut
Florida
Hawaii
Illinois
Louisiana
Maine
Massachusetts
Missouri
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Ohio
Pennsylvania
Utah
Vermont
West Virginia

Persistent Muscle Spasms

Arizona
California
Colorado
Delaware
Maryland
Michigan
Minnesota
Montana
Nevada
Oregon
Rhode Island
Utah
Washington

Treating Physician Decision

Oklahoma
Washington D.C.


What are the best methods of consumption for MS patients? 

In my professional opinion, after working with several MS patients performing cannabis massage, I can say that one of the best methods of consumption for MS patients is high quality topicals, like the organic ones we designed for our patients.3 Because this condition can have a detrimental effect on the muscles, self application or application done by a licensed therapist can be a total game changer. The relief that is felt often takes place within minutes of application. Re-application can be done as needed. 

Studies are showing that cannabis may be effective for the pain and spasticity felt by MS patients.4 Another method of consumption that can assist with the discomfort being felt is by using a cannabis oil or tincture. The difference in an oil and tincture is how the plant is extracted: either by using alcohol as a solvent or by using an oil. Either method is great for internal absorption. Thanks to the body’s ECS,5 we have receptors throughout the body waiting to be activated by cannabinoids. THC and CBD bind to the body’s receptors and assist in relieving the spasms and pain felt by MS. 

If you are on other medications and you want to try using cannabis, speak with your doctor. Be honest in your desire to understand the plant and check to see if there are any contraindications of your medications. Safety first.

Are there any MS support groups or organizations offering guidance or more resources?

A quick google search for “multiple sclerosis local support groups” will provide you with any groups near you. The National MS Society6 offers guidance for patients. You can find this information by visiting their website – www.nationalmssociety.org click on the tab that says treatment, then where it says “Complementary and Alternative Medicines.” You will see several alternative treatments listed and Marijuana (Cannabis) is the second. They provide comprehensive information about cannabis plant medicine as a whole.7 

With no surprise, “there’s an app for that.” If you are a tech savvy person and you and/or your caregiver prefer that route, there is an interactive application from Healthline called MS Buddy:Multiple Sclerosis.8 It can be found in the app store on any smartphone. This is another great resource for patients. Members can communicate with fellow patients for inspiration and advice. It is important to note, this is not a medical app. This is a platform designed for support, not medical answers. Those types of questions should still be asked of your primary care physician.


Do you have questions for nurse Jordan?

Please submit any questions to [email protected]
Your question may be published in an upcoming issue.


REFERENCES:

1. “Definition of MS” https://www.nationalmssociety.org/What-is-MS/Definition-of-MS
2. NORML, National Organization for the Reform of Marijuana Laws, State Info. https://norml.org/states
3. Primal Healing, cannabis topicals.
http://www.primalhealing.com
4. Nielsen S. Et al. Current Neurology and Neuroscience Reports.  2018 Feb 13,18 (2):8.  doi: 10.1007/s11910-018-0814-x
5. Pacher, P. Et al. Pharmacol Rev. 2006 Sep; 58(3): 389–462. doi: 10.1124/pr.58.3.2
6. Frequently Asked Questions. National MS Society. https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuana/Marijuana-FAQs
7. Cameron, M. & Rice, J. National MS Society. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Professionals/Cannabis-and-Multiple-Sclerosis.pdf
8. MS Buddy: Multiple Sclerosis. Social support health chat. Application for smartphones.

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Medical Minute

Medical Minute with Nurse Jordan

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In this column, our readers have the opportunity to ask our staff nurse anything they want to know about using cannabis plant medicine. She will provide quick and concise answers to big questions. In this issue, we dive into pain of all kinds and why people are turning to cannabis as an alternative treatment or in conjunction with their current therapy. 


Pain is often broken down into two categories, acute and chronic. Acute pain tends to last a short period of time, up to 3 months, and is sharp and severe. Whereas chronic pain can last forever and can be an intense hurt or a constant dull ache. According to a study1 done in early 2019, chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients. 

Currently there are 50 million2 Americans suffering for various reasons. Many suffer in silence, taking countless pharmaceuticals only to feel new compounding symptoms from the use of too many OTC (over-the-counter) or prescription pills. Read on as we explore some commonly asked questions about making the switch to using cannabis for various types of pain. 

inhaled cannabis reduces self-reported headache severity by 47.3% and migraine severity by 49.6%

What are the most common reasons people use cannabis for pain? 

Pain can come from a variety of things including the common headache. A recent study released in November 2019 by Washington State University showed, “inhaled cannabis reduces self-reported headache severity by 47.3% and migraine severity by 49.6%.”3 This is fantastic news for chronic migraine and headache sufferers. Another common cause of pain is neuropathy, and science is showing great use for cannabis with this type of pain as well. A 2018 study4 by the University of California showed that using cannabis via vaporization or oral delivery was an effective treatment for pain caused by neuropathy. 

Another common reason for using cannabis is the daily pain caused by arthritis. One in four adults report they experience pain from arthritis.5 The question of whether or not cannabis is effective for arthritis pain is so common, the organization that represents the voice and needs of those suffering, The Arthritis Foundation, now has a dedicated tab6 on their website offering guidance.

What products or methods of application/consumption are recommended for general pain? 

In my personal opinion, one of the best ways to receive cannabinoid therapy is through our largest organ – the skin, via the use of topicals. We have been offering cannabis massage using topicals in Colorado for six years at Primal Therapeutics, and we have helped thousands of patients feel relief. Using topicals focuses on the health aspect and not the high sometimes associated with using cannabis plant medicine. Infused topicals can be an effective treatment for several types of pain. 

Other methods of consumption include smokeables such as using a vapor device or consuming the flower or bud in a joint, bong, or cannabis pipe, or consuming various forms of hash, now commonly called concentrates, for the very high concentration of THC they possess. A great consumption method can be ingestibles. These products can be purchased in almost all medical cannabis dispensaries in legal states and come as tinctures, capsules, and edibles. CBD manufacturers make these products as well. 

Pharmaceuticals, specifically those used for pain come with high addiction rates and countless side effects, including death.7 Cannabis has never caused a death, ever. This means experimenting with the plant in its various forms can cause little detriment. However, on occasion there can be a contraindication for using CBD with certain pharmaceuticals, so it is best to check with your doctor to see if you are on one of those medications. 

Can I receive the benefit of pain relief from cannabis without the high? 

Absolutely. As mentioned above, topicals are a great option for wanting to receive all the benefits of plant medicine without a psychoactive experience. Another way to use the plant for pain is to work with various cannabinoids. Not all cannabinoids make you feel high. Science has shown us that THC is the part that makes us feel “high.” To avoid that feeling, there are other great ways to use cannabis plant medicine. Tinctures, edibles, or capsules that are high in CBD with little or no THC may provide exactly the relief you seek. 

Experimenting with cannabis plant medicine may provide relief to those suffering. It is important to remember, pain is a general term, and it’s difficult to measure. Everyone has a different pain tolerance and what may cause great distress to one, may feel like a minor ache to another. Judgement should not be felt by those in pain. The feeling is difficult for many to express and communicate to those they love. Be patient with yourself and anyone you know who suffers from pain. 


Do you have questions for nurse Jordan? 

Please submit any questions to [email protected]

Your question may be published in an upcoming issue.


REFERENCES
1. Health Affairs. February 2019.
2. Center for Disease Control. 2016.
3. Journal of Pain. November 2019.
4. University of California. February 2018.
5. https://www.cdc.gov/chronicdisease/resources
publicationsfactsheets/arthritis.htm
6. https://www.arthritis.org/living-with-arthritis/painmanagement/chronic-pain/arthritis-foundationcbd-guidance-for-adults.php
7. Division of Drug Risk Evaluation, Food and Drug Administration. 2007 

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