As recreational use cannabis sales in Connecticut continue to near fruition and medical use continues to become more common, there is a growing need to ensure that pharmacists are ready for that changing landscape.
Nathan Tinker, the president and CEO of the Connecticut Pharmacist Association, recently oversaw the Cannabis Cognizant Summer Bootcamp, a daylong program designed to help pharmacists from across the country prepare for situations where the interactions between cannabis-based drugs and other prescriptions becomes an increasingly likely concern.
“With the imminent introduction of retail adult-use cannabis into the Connecticut market, we thought it would be useful to get pharmacists engaged and understanding of the opportunities, and the challenges that will bring to them and the profession,” Tinker said.
Tinker praised the state’s medical marijuana program, calling it one of the most successful in the country, but said the Bootcamp was a necessary response to the introduction of recreational-use cannabis.
“It is going to drastically impact both the way that the medical program works but also how retail pharmacists are going to have to engage with and counsel patients about marijuana in the marketplace,” he stated.
One of the Bootcamp speakers was Al Domeika, director of retail operations for Acreage Holdings, a multistate operator of cannabis cultivation and retailing facilities, who praised the event as another example of how the state historically has led the way in medical programs.
“Connecticut was the first state to implement pharmacists and pharmacy technicians to do the dispensing and selling of cannabis products,” he said. “Now we’re venturing into adult use, which is going to be a challenge for the medical shops as there is going to be a whole new population that is trying cannabis for the first time. So as far as pharmacist engagement, there will still be opportunities for pharmacists to be utilized in certain shops.”
According to Domeika, who has decades of experience as a pharmacist in addition to his work in the cannabis industry, the primary drug interactions that pharmacists need to be aware of are the result of Tetrahydrocannabinol (THC) and Cannabidiol (CBD) being metabolized by the same enzyme pathways as blood thinners like warfarin and Plavix. Some drugs taken for organ transplants, heart medications, blood pressure medications and diabetes treatments may also have some degree of interaction.
“There aren’t enough studies to see what the extent of that interaction is, but the science says that because these are metabolized by the same enzymes that potential interactions can occur,” Domeika continued. “All pharmacists should be aware that medical cannabis is being dispensed, although there’s no formal training, especially in retail establishments, we need to do our best to reach out to all health care professionals to try to get them up to speed on the pharmacology of cannabis.”
Tinker added that the nearly 100 registered attendees for the Bootcamp hailed from across backgrounds and specialties.
“We have a lot of hospital pharmacists, we have a lot of community pharmacists and we also have a lot of dispensary employees who want to learn more about the broad range of issues here,” he observed, adding that the event also focused on issues, including consumer safety and the distinctions between synthetic and analog marijuana products.
The Bootcamp also reviewed important distinctions between medical use and recreational use products, including different packaging rules and dosages. Sometimes different names for the same product will be used depending on whether it is prescribed or sold in a recreational context.
Domeika noted that while marijuana is legal in Connecticut, opinions among pharmacists are “pretty much split down the middle.” He emphasized that in his own view “there is still a stigma that we have to fight every day that marijuana itself is this illicit gateway drug, which has been proven not true many times over. But there are still people that just don’t want to deal with it.”
Tinker stressed that the pharmacist profession is ready to address this still-evolving issue.
“One thing I know about pharmacists,” Tinker said, “is whether they have personal feelings about something one way or the other, they’re going to have patients coming in the door, asking them questions. And they want to be able to be equipped with the information and knowledge to answer those questions regardless of their personal feelings.”
