Nurses say education should take priority in medical marijuana

Patient and community education are two pillars that the rest of the cannabis industry is built.

Educating patients in medical states and creating intelligent consumers in adult-use markets are imperative to the long-term success and growth of the industry. At the same time, community education helps to quell resistance and opposition.

Most people who are opposed to cannabis hold those opinions based on rhetoric and ignorance. Rarely is someone educated on the medicinal benefits of cannabis still adamant in their opposition, at least for a medical market. Adult-use, however, still faces significant opposition at times – and while education may not always lead someone to support adult-use, it does empower others as it removes bias and destigmatizes perception. As with tobacco, alcohol, fast food, or a litany of other products, adult-use cannabis will always face scrutiny and opposition, but destigmatizing cannabis and its use is an integral part of moving forward.

With that in mind, Greenway recently spoke to two members of the medical marijuana industry in Missouri about the importance of patient education.

April Hatch, MSN, RN, is the co-founder of Cannabis Care Team, a company dedicated to cannabis medicine and education. CCT offers patient services, partners with dispensaries and physicians, and hosts community education events under the same umbrella.

Dedee Culley, RN, owns 2 Leaf Nurses, an educational consultancy that works with patients, the community, and licensed facilities.

Both companies have been actively engaged with Missouri’s patient community and have been a vital part of staff education for many businesses in the state.

Greenway posed a series of questions to Culley and Hatch, seeking their insight into the educational efforts in Missouri’s cannabis industry.

Patient education was a part of the application process originally. How have you seen facilities integrate education into their operations so far?

“Most of the dispensaries are offering a private area to complete patient consultations in, have printed education, education online, but most of the education takes place when the patient is at the counter determining what products to select,” Hatch explained. “Some are also hosting patient educational events, which is a great opportunity to bring new patients to the dispensary. Some of these are more cannabis-community-focused, and some are more geared to the medical patients,” Hatch said.

For her part, Culley says that while many operators are going above and beyond, there are more who could do better. “Sadly, I see many operations meeting only minimal state requirements,” Culley said. “From a financial aspect, they tend to see the cost of having a healthcare professional available to patients as an expense only, so they don’t hire or partner with these individuals. The truth is that these professionals not only serve the patients but, so far, the statistics that we have shown that these patients tend to return time and time to that facility and spend more money over time.

Hatch echoed that sentiment saying, “There is a wide spectrum of knowledge among dispensary staff so, unfortunately, we have seen patients leave the same dispensary with two very different experiences. One patient may feel confident in their choices and understand how to use the product, and another may leave even more hesitant about cannabis than they were before they walked in.”

That inconsistency is something that has created issues among patients throughout the state. Over the last few years, we have seen misinformation and inaccuracies spread like wildfire across social media. Still, now we are seeing inaccurate information being presented by dispensary staff, which causes significant issues and leads to increased hesitancy. Patients have experienced problems ranging from inappropriate details on state regulation to staff members not understanding home cultivation; some facilities have even struggled to maintain internal policy from one patient to the next.

“Not only do the staff members need training on the endocannabinoid system (ECS), cannabinoids, and terpenes – but also how to talk to patients, statements to avoid, and how to give the patient appropriate expectations. I frequently say that the patients dispensaries are working with have already been failed by traditional healthcare, so we have to be careful not to fail them. That requires compassion, good listening skills, engagement, and evidence-based education. Our personal experience with cannabis should not be what we utilize as guidance for the patient,” Hatch said.

Hatch’s last point has drawn the attention of regulators at times, cautioning dispensaries and ancillary businesses against providing medical advice that doesn’t come from a state-licensed healthcare professional.

“(It’s challenging when) dispensary staff may not be using the right words or verbiage when discussing something that we can’t make any claims about. We do hear a lot of staff comparing their own medical condition to the patients, and this can be helpful for some, but often takes the focus off why the patient is there,” Hatch continued.

Learning to communicate effectively is an integral part of the patient experience for staff at retail facilities; both Hatch and Culley stressed this when speaking to Greenway.

“Those that I work with directly are learning to listen to the cues patients give about their conditions and when to recommend me,” Culley explained. “Others are learning from other patients what their results have been and making those ‘non-medical’ recommendations as well as providing both written and verbal education on how to use cannabis safely,” Culley said.

“Our clients (the dispensary owners, management, and staff) have practiced how to talk to patients about the ECS, different symptoms, how to talk about the advantages of different products. So we see our clients providing evidence-based education that allows the patient to feel confident in the dispensary and the industry as a whole,” Hatch continued, “However, we are also very proud that our clients are talking to patients about how to utilize different cannabinoids and delivery methods to promote the best health outcome possible. It’s not all about the THC, and it often takes a combination of short and long-acting methods of delivery to see results.”

Confidence makes a huge difference in whether a patient chooses to return to a facility or seek out an alternative provider. It also makes a more significant impact beyond a single potential customer. Patients who have negative experiences flock to social media and community resources seeking accuracy and help. An uneducated patient who has a negative experience can result in dismal sentiment toward not just the retail facility but also the products the patient purchased.

“We have seen so many patients purchase products that they do not understand how to use for maximum benefit, so it is important the patient has an understanding of what type of products and delivery methods they may need to best address their symptoms before walking out the door,” Hatch said. “This is new to most Missourians, and that first trip can be very overwhelming, so the better they can be prepared, the better.”

“The dispensary staff we have trained have been taught to try not to let the new patient leave until they can verbalize understanding of how they want to dose or consume the product,” Hatch said.

“The feedback (we’ve received) has been 100% positive, with so much gratitude as well as increased confidence in knowledge going to a dispensary,” Culley said.

What kind of questions are you facing? 

Culley explains that often, staff and patients are asking similar questions, “They want to know about specific conditions and the Endocannabinoid Deficiency Syndrome that so many people suffer with and have no idea. (Patient) questions are generally focused on their specific medical conditions and how they can safely use cannabis.”

“Those types of questions and recommendations really DO require healthcare professionals that can talk with patients about their condition – which is usually multiple conditions that require great attention to detail, coaching, and time,” Culley told Greenway.

Hatch said that some of the most common questions CCT has encountered with staff are similarly difficult to explain in blanket statements. “We also get a lot of questions about drug interactions and how to find physicians who are not opposed to cannabis. I wish we could give a solid ‘yes’ or ‘no’ to the drug interaction questions, but the research just isn’t there,” she said. “It’s best for patients to determine the risks vs. benefits along with their prescribing physician,” Hatch said, “Regarding cannabis-supportive physicians, there are some, but nowhere near what it needs to be. Instead, we try to provide education on how to talk to doctors about cannabis or what questions to ask when looking to find a new one.”

Usage and dosage are two of the most common types of questions from new cannabis patients. And for those who have consumed or used cannabis products in the past but are new to a legal market, those questions are often equally important.

“How can I utilize cannabis if I do not want to smoke or get high is a common question we hear before the patient visits a dispensary, but how do I use this (product) is the most common question we get from patients after they leave the dispensary,” Hatch explained.

As with any field, education does not come without challenges and difficulties.

What challenges have you faced in patient education?

“The greatest challenge has been the facilities’ resistance to paying or partnering with a cannabis nurse or other healthcare professional,” Culley said. “They have so much overhead and have invested so much and are still trying to recover those monies, that they do not see the value yet,” she continued, “Patients, on the other hand, when they know there is a healthcare professional available, are not shy about seeking us out. They want to know what they need for their personal needs, and they want to know they are safe.”

“The staff at the facilities I work with have been nothing but amazing!  They want to learn, and they want to do the best for patients, so they freely ask questions and recommend patients.  Those facilities that do not engage a healthcare professional are simply doing what they can with the education they have received. If that is just meeting the state minimum requirements, it’s really not enough,” Culley said.

Hatch says that the most challenging part is often based around misinformation, ”Everyone has their own opinion on cannabis, and there is so much information available online – so patients can easily get confused. When patients are confused it often leads to a bad experience.”

Aside from overcoming stigma and opening doors, it’s the importance of standardizing information and creating uniform, educated responses that makes public education so important. Reaching communities as a whole and separating fact from fiction is a necessary part of a medical program. But that can be difficult when marijuana and cannabis are often regarded as second-class citizens to pharmaceuticals or even recreational chemicals like alcohol and tobacco.

What does community education look like and mean to you?

For Culley, the importance of community education is as much about understanding the community itself as it is about the plant. “Community is an area where people all live in close proximity to one another. They share the same geographical area – town, city, county – but may have very different interests and lifestyles and beliefs. To educate in a community, you must be willing to look at that and adapt the learning to meet them where they are. I love working with communities and bringing awareness to what is available and how to be safe and successful.”

“As a nurse with an MSN in public health, community education is what I’ve been doing for the last 10 years so I could go on and on, but first and foremost, community education happens in a neutral and comfortable setting outside of the dispensary and this needs to be the focus of the industry post-covid,” Hatch said.

Education as the focus of the industry is a place where some licensees and ancillary businesses have been exceedingly successful, but it’s also a place where many struggle. The most common efforts at education are the recycling of descriptions of terpenes and the occasional statement about onset. While that may suffice in other states, many of the patients in Missouri aren’t even aware of how to properly read a label.

What are two areas that you believe the industry as a whole should be focusing on related to patient education, community education, or both?

“I am going to be completely biased,” Hatch stated, “One – dispensaries should be utilizing professionals who have experience working with chronically ill patients-aka nurses, for several different reasons, but the one that we remind others of is that nurses are the most trusted profession since 2002. Firefighters were thankfully given that title in 2001,” Hatch continued, “We understand the value of all healthcare professionals, but we think nurses are the best.”

“Two – If we really want to see patients have the best chance to heal, we have to start talking about cannabinoids other than THC. There (are very few) dispensary groups in Missouri providing a 1:1 CBD:THC cultivar, obviously, dispensaries can’t sell what’s not grown here, but we’re so pleased to see that all of the dispensaries we have trained have CBD and/or CBG product options or work with a local CBD shop to help the patients get what they need,” Hatch explained.

“The industry here in Missouri, specifically, should be focusing on the medical PATIENT and their safety and success with cannabis,” Culley said. “This is an amazing and wonderful plant we have finally been able to make available to them, yet many patients don’t understand the plant, how to use it, how to adjust with medications and an entire list of other educational opportunities.”

Culley continued, “As we focus on the medical patients of our state, they will draw others in, and we will have greater opportunities to educate the communities and stop the stigma we all so desperately want. The industry must stop focusing solely on the retail component and profits, or we will be no better off than the healthcare system so many are tired of being in. We have the opportunity to really do better with, and for, the people than ever before,” she concluded.

More from Dedee Culley and April Hatch at Greenway