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Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use

Dickson, Betsy, MD; Mansfield, Chanel, MPH; Guiahi, Maryam, MD, MSc; Allshouse, Amanda, A., MS; Borgelt, Laura, M., PharmD; Sheeder, Jeanelle, PhD; Silver, Robert, M., MD; Metz, Torri, D., MD, MS

doi: 10.1097/AOG.0000000000002619
Contents: Obstetrics: Original Research
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OBJECTIVE: To characterize recommendations given to pregnant women by Colorado cannabis dispensaries regarding use of cannabis products for nausea during the first trimester of pregnancy.

METHODS: This was a statewide cross-sectional study in which advice about cannabis product use was requested using a mystery caller approach. The caller stated she was 8 weeks pregnant and experiencing morning sickness. Dispensaries were randomly selected from the Colorado Department of Revenue Enforcement Division website. The primary outcome was the proportion of marijuana dispensaries that recommended a cannabis product for use during pregnancy. We hypothesized that 50% of dispensaries would recommend use. A sample size of 400 was targeted to yield a two-sided 95% CI width of 10%. Secondary outcomes included the proportion endorsing cannabis use as safe during pregnancy, specific product recommendations, and encouraging discussion with a health care provider. Recommendations were compared by licensure type (medical, retail, or both) and location (rural vs urban).

RESULTS: Of the 400 dispensaries contacted, 37% were licensed for medical sale (n=148), 28% for retail (n=111), and 35% for both (n=141). The majority, 69% (277/400), recommended treatment of morning sickness with cannabis products (95% CI 64–74%). Frequency of recommendations differed by license type (medical 83.1%, retail 60.4%, both 61.7%, P<.001). Recommendations for use were similar for dispensary location (urban 71% vs nonurban 63%, P=.18). The majority (65%) based their recommendation for use in pregnancy on personal opinion and 36% stated cannabis use is safe in pregnancy. Ultimately, 81.5% of dispensaries recommended discussion with a health care provider; however, only 31.8% made this recommendation without prompting.

CONCLUSION: Nearly 70% of Colorado cannabis dispensaries contacted recommended cannabis products to treat nausea in the first trimester. Few dispensaries encouraged discussion with a health care provider without prompting. As cannabis legalization expands, policy and education efforts should involve dispensaries.

Nearly 70% of Colorado cannabis dispensaries contacted recommend cannabis products for treatment of morning sickness in the first trimester.

University of Colorado School of Medicine and the Colorado School of Public Health, Aurora, Colorado; the University of Utah Health, Salt Lake City, Utah; and Denver Health and Hospital Authority, Denver, Colorado.

Corresponding author: Torri D. Metz, MD, MS, 777 Bannock Street, MC 0660, Denver, CO 80204; email:

Dr. Metz is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under award number 5K12HD001271-18. This project was also supported by the Colorado Clinical and Translational Sciences Institute with the Development and Informatics Service Center under award number UL1 RR025780. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure Dr. Borgelt received grant funding from the Colorado Department of Public Health and Environment (CDPHE) for a study evaluating the use of cannabidiol for the treatment of refractory pediatric epilepsy. Additionally, she has served on seven different working groups for the Colorado Department of Revenue and CDPHE regarding use of cannabis and patient safety. The other authors did not report any potential conflicts of interest.

Presented as a poster at the Society for Maternal-Fetal Medicine's 38th Annual Pregnancy Meeting, January 29–February 3, 2018, Dallas, Texas.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.