Dispensing Medical Advice: San Francisco Bay Area Budtender Recommendations for Pain and Sleep Relief

Evidence regarding the efficacy of various forms of cannabis and cannabinoid concentrations is limited, and cannabis industry regulatory infrastructure is still in development. Meanwhile, most US states have legalized medical or adult use cannabis. This study aimed to understand what advice cannabis budtenders in the San Francisco Bay Area were providing to customers for pain and sleep trouble - two of the conditions most cited as reasons for using cannabis medicinally.

We visited 35 of 42 cannabis dispensaries in Alameda and San Francisco Counties in California, and using a "secret shopper" approach, asked the budtenders for recommendations on products, dosage, and strains to best alleviate pain and sleep trouble.

For pain relief, budtenders showed a strong preference for topicals (77.1%), while edibles were most indicated for sleep trouble (60.0%). Reasons provided included budtender personal experience and product effectiveness. Cannabidiol (CBD) was endorsed most often for pain relief in high CBD:THC ratios (28.6%), 1:1 ratios (28.6%), and CBD alone (22.9%). For sleep relief, tetrahydrocannabidiol (THC) alone was most recommended (34.3%). When asked about cannabis strains for pain, 85.7% of budtenders did not express a preference, but for sleep, 57.1% of budtenders selected indica.

This study illustrates that budtenders in the Bay Area have specific ideas about cannabis uses, including types, concentrations, and strains, despite a lack of evidence for most recommendations. Future research should prioritize study of topical preparations of cannabis for pain, edibles for sleep, and tinctures for both, which budtenders regularly recommended to customers.