As more states permit the use of medical marijuana, the role of pharmacists in the dispensary setting is set to grow and evolve.
As of February 2022, 37 states permit the use of medical cannabis products.1 These products are used to treat a variety of medical conditions, including cancer, epilepsy, glaucoma, and chronic pain.
Cannabis, however, is still illegal on the federal level, so each state can determine if and how medical cannabis is available. For example, in New York state, dispensaries must have a licensed pharmacist on-site to counsel patients on the treatments available to them.2 On a recent episode of Inside the Practice, Jeff Lombardo, PharmD, a Drug Topics® editorial advisory board member and a research assistant professor at University at Buffalo School of Pharmacy and Pharmaceutical Sciences, joined us to discuss the ins and outs of working in cannabis pharmacy in New York.
Drug Topics®: Do pharmacists need a more comprehensive education to inform them about the medical benefits of cannabis and the endocannabinoid system?
Jeff Lombardo, PharmD: Pharmacists can draw on their pharmacology training. If you look at the endocannabinoid system, it’s a system. And if you look at the way that cannabinoids work...I equate it to the way that some blood pressure medications [work], with binding affinities with cannabi- noid receptors—CB1, CB2; [it’s] very similar to β-blockers.
If you think about it in that context, I think you’ll want more information on how cannabinoids work. There are some good journals out there; Cannabis and Cannabinoid Research is one of the better ones, somewhat evidence-based and has some really good articles. Another thing that pharmacists can do is...look at some of the research for various indications. Read through the abstracts, read through the design. That gives a better understanding of how cannabinoids may be beneficial in certain patient populations. If you focus on the pharmacology, that’s a good place to start.
Is the sentiment toward medical cannabis is changing? Might that impact the role of pharmacists at dispensaries?
Lombardo: I think sentiment is changing, thought is changing. I go back to the pharmacology question: defining how the compounds are working in the body. You have this endocannabinoid system [that] we’re just learning about. I think education and good solid research, conferences, seminars to talk about it [are] a good thing.
CBD [cannabidiol] falls under the Farm Bill, but still, federally, it’s Schedule I. A lot of the academic institutions face this problem....We have funding from NIH [National Institutes of Health], and we don’t want to jeopardize that funding. But when some of those regulations change a little bit... you can do some of the prospective, randomized controlled trials and really answer the question in a way, scientifically, that evidence-based practitioners want to know.
If cannabis goes recreational—which it is in New York state—there [will be changes]. I don’t know what’s going to happen...Maybe cannabinoids move into the pharmacy. You’ve heard about Epidiolex; it’s an islet CBD, [and] it’s
a specialty pharmacy drug. It’s in the pharmacy. If other companies go through the same [approval] pathway, you’ll see those medications moved from a dispensary to a pharmacy. They’ll be covered by insurance, and they’ll be much more economical. That’s a funny question, as far as pricing...But it could be covered on a patient’s [insurance] benefits. That’s where I think you might see the change. Maybe not tomorrow, but maybe in a couple of years.