Cannabis dispensaries in the Bay Area often recommend specific strains and doses of cannabis to customers for sleep and pain — despite a lack of scientific evidence for most of the recommendations, according to a new UCSF study.
Cannabis dispensary sales associates, or budtenders, in San Francisco and Alameda County most frequently recommend topicals for pain and edibles for sleep, often citing personal experience as their reason for their recommendation, the study found. Budtenders also strongly prefer indica strains for sleep.
But there is limited evidence that cannabis is beneficial for sleep disorders and recurring pain. While some studies show cannabis may help specific conditions like chemotherapy-induced nausea and pain related to multiple sclerosis, the vast majority of people using cannabis are not treating those issues, said study co-author Dr. Pam Ling, director of the UCSF Center for Tobacco Control Research and Education.
“People make many more assumptions than are supported by evidence about how helpful cannabis products will be,” Ling said. “People extrapolate from the limited studies to then say cannabis is good for all kinds of pain. And when we talked to budtenders, a lot of times they’ll make a recommendation, but it’s not necessarily based on evidence.”
The findings, published Monday in the journal Cannabis, highlight the need to further study the most commonly recommended cannabis products — topicals for pain and edibles for sleep — and the need to train budtenders on what’s known and not known about the health effects of cannabis, Ling said.
To conduct the study, researchers visited 35 of the 42 cannabis dispensaries in San Francisco and used a “secret shopper” approach, asking budtenders for recommendations on products, dosage and strains to alleviate pain and sleep problems. They sought to better understand how budtenders give medical advice to customers and their reasons for doing so. The visits were done in 2020, and research staff were young adults, including some undergraduate and graduate students.
Twenty-two of the dispensaries were in San Francisco, and 13 were in Alameda County.
For pain relief, budtenders most often recommended topicals (77%), followed by edibles (23%) and tinctures (20%).
For sleep problems, budtenders most often recommended edibles (60%), followed by tinctures (29%) and flower (20%).
Their most common reasoning for recommending topicals for pain was personal experience with the product (26%) and because the product does not get you high (19%).
Most budtenders (85%) didn’t provide a reason for recommending edibles for sleep. A smaller proportion cited reasons such as product effectiveness (9.5%), personal experience (9.5%) and good for beginners (9.5%).
Most budtenders seemed to rely on personal experience when giving advice on cannabinoid concentrations and ratios for products, the study found. Cannabinoids are chemicals derived from the cannabis plant; the most common ones are THC and CBD.
Several budtenders indicated CBD-only products were effective for pain, but one said CBD could be ineffective for some and steered shoppers to THC-only products. Budtenders also relied on personal experience for dosage advice, with some sharing personal stories of times they had a “bad high."
With respect to cannabis strains, most budtenders (86%) did not have specific recommendations for pain relief; those who did recommended indica. But the majority (57%) recommended indica for sleep.