Dispensary Budtender Guidance Versus Clinician Consensus: A Comparative Study of Medical Cannabis Advice

PURPOSE: Medical cannabis (MC) patients frequently rely on budtenders, dispensary staff without formal medical training, for therapeutic guidance. This study examined whether budtender guidance aligns with that of MC clinicians and identified factors influencing alignment. METHODS: A national sample of budtenders (n = 87) from multiple US states completed a survey in March to April 2025, which included 3 patient vignettes (chronic pain, pregnancy with insomnia, and posttraumatic stress disorder) and the Cannabis Knowledge Assessment Tool. Their responses were compared with consensus guidance from 7 MC clinicians. Alignment was rated on a 5-point scale, and statistical analyses included a 1-sample t test and multiple linear regression. FINDINGS: Budtender guidance significantly diverged from clinician consensus (M = 2.75 vs 5.0; P < 0.001). Clinicians recommended MC for chronic pain, advised against use during pregnancy, and recommended cautious low-Δ-9-tetrahydrocannabinol regimens for posttraumatic stress disorder. In contrast, many budtenders suggested higher Δ-9-tetrahydrocannabinol dosages or endorsed MC use in pregnancy. Regression analysis revealed that higher Cannabis Knowledge Assessment Tool scores (P = 0.005) and absence of illicit market experience (P = 0.029) predicted closer alignment with clinician guidance, whereas dispensary type and cannabis-related degrees were not significant predictors. IMPLICATIONS: These findings highlight variability in the quality of budtender guidance and the potential risks of relying on nonclinician sources for MC advice. Enhancing evidence-based cannabis education and establishing clearer policy frameworks may help ensure dispensary staff provide safer, clinically informed guidance to patients seeking cannabinoid therapy.