You need medical marijuana? If you’re in one of 30 states, you may qualify for it. But if you also need advice on how to use it, you may as well grab a Magic 8-ball.

Most people, even in legal U.S. states, are not able to have important conversations with their doctors about weed. It just doesn’t happen. So often, they do the next best thing: they ask for advice from their budtenders.

While generally well-informed, budtenders are nowhere close to being doctors. Yet in giving routine advice, they blur the line between providing education and practicing medicine.

At its core, medtending is the overall practice of giving medical advice to customers in retail and MMJ store settings. To the extent it occurs today, it’s dangerous and can garner all kinds of legal problems for the people involved. Experts agree, if it continues the way it is now, there could be serious implications for the industry as a whole.

Think about this: does a pharmacy technician at Walgreens tell you which drug to use to relieve symptoms? They do not, for two very important reasons. Unlike marijuana, the medications they dispense could kill, so the risk for error is high and potentially catastrophic. Equally important, however, the people behind the counter in white lab coats are not licensed medical professionals in the way prescribing doctors are.

What it means to give medical advice is not black and white, this or that. In Colorado, the legal term of art is “the practice of medicine,” and is a multi-pronged rule. Budtenders most likely run afoul of the provision defining the “practice of medicine” as suggesting or recommending any sort of treatment or healing for the intended relief or cure of a person’s condition, injury or disease.

Jennifer Shepherd, one of the first onsite nurses at a Las Vegas dispensary, says, “Clients do seek medical advice. However, I am only able to provide them with information from evidence-based scientific standards provided by the American Cannabis Nurses’ Association and data collected from testing labs."

Clients do ask for dosage guidelines, but even something as simple as that has to come from a physician. “Clients are certainly frustrated with the lack of answers they’re able to obtain (from me),” she adds. 

In Colorado, the penalties for the unauthorized practice of medicine are severe. First offenses are class 2 misdemeanors and second and subsequent offenses are class 6 felonies. That means jail time is not out of the question if a budtender is making a bad habit of this.

By some measure, the problem is significant. Dr. Rav Ivker, Boulder physician and author of “Cannabis for Chronic Pain,” explains, “As a result of physicians’ lack of knowledge and experience in using cannabis to treat medical conditions, patients obtain the bulk of their information regarding specific cannabis products, dosage, side-effects, and anticipated results from the budtenders at dispensaries. Most of these young people are not well-informed and often give inaccurate advice.”

There is an inherent tension between budtenders who want to educate their patients and regulators who expect them not to play doctor. Although not a direct regulation of budtenders, the Marijuana Enforcement Division (MED) has made it clear they don’t want the industry playing Doogie Howser. Retail and medical marijuana rules both prohibit health and benefit claims from being on the labels and marketing layers of marijuana products. 

Label claims like “Indica strains are best for pain management” are the type the MED is trying to prevent — the kind of thing budtenders are saying every day.

Still, nothing from the MED directly regulates this gray area of budtender/patient interaction. One has to wonder if the issue is on most dispensaries’ radars. Maureen McNamara, founder of Cannabis Trainers, isn’t sounding the alarms yet. While coaching this behavior is part of her training program, she believes most budtenders, and all those she trains, have a grasp on the issue.

“It’s imperative that employees selling cannabis do so with integrity and professionalism and never cross the line on offering medical advice," 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.’”  

And what happens when she tests budtenders on this situation? They pass every time.

People remain in this situation for the same reason marijuana businesses can’t access banks and medical pot can’t be studied en masse: the federal government. An organization that also inhibits doctors from prescribing it.

Dr. Rav Ivker clarifies, “Physicians who are authorized by the state to do medical marijuana evaluations are only allowed to certify that a patient has a qualifying diagnosis to obtain a license to purchase medical marijuana. These are not prescriptions.

“The vast majority of these physicians are not knowledgeable enough to make well informed recommendations for specific cannabis products to treat specific medical conditions,” he adds. “The primary reason I wrote the book, "Cannabis for Chronic Pain," was to better inform the public, the medical community, and cannabis industry workers on the healing power of cannabis medicine.”

The MED regulates this kind of behavior on packaging, yet it neglects the pervasive, even daily context in which it’s actually happening in dispensaries. Of course, budtenders need to able to help their customers. The crux of the matter is how they help them responsibly and without creating risks for everyone involved.

Lenny Frieling, a Boulder attorney who specializes in marijuana law, says, “The big picture is, thou shalt not diagnose or make claims about the health benefits of marijuana. Safe language would include: ‘I can’t address you as a doctor, but I can share my experience and what I know about medical marijuana’ and ‘Are you seeing or have you seen a physician? I would seriously consider it.’”

Frieling’s assessment of the overall situation is equally nuanced. “Although any additional regulation and requirements are both suspect and cumulative, it is an issue that must be addressed.” In other words, the problem shouldn’t be ignored, but neither should the solution be rushed at the expense of overregulation.  

Prudence requires training budtenders and providing them with steps to navigate these hazy waters. Some suggest a certification similar to what massage therapists or pharmacy technicians receive. Others see that as excessive and would prefer the term "medicine" not be affiliated with "marijuana" at all. Yet as long as marijuana law remains at the state-level domain, anything like a golden rule won't be in federal play, let alone a set of guidelines to address the growing area of concern.

The only thing that is certain is education must be part of the solution. Doctors need to play a greater role in this dynamic, and that starts with improving their understanding of the plant.

“We are supposed to be the most advanced country in the world,” says Nurse Jen. “Why is it taking so long to incorporate this knowledge into the medical community?”

[cover photo belterz via iStock // originally published April 25, 2018]