Sales to apparently alcohol-intoxicated customers and online responsible vendor training in recreational cannabis stores in a randomized trial

Abstract

Background: In some U.S. states, laws prohibit sales of recreational marijuana to intoxicated customers to prevent associated harms. In alcohol markets, training in responsible sales practices is one intervention to help reduce such sales to intoxicated customers. Similar training may be beneficial in the recreational cannabis market.

Methods: An online responsible marijuana vendor (RMV) training was developed. Among its five modules, learning elements taught store personnel to recognize signs of alcohol impairment and intoxication, refuse sales, and understand the risks of driving under the influence of cannabis. A sample of n = 150 recreational cannabis stores in Colorado, Oregon, and Washington State, USA were enrolled in a randomized controlled trial, half of which were randomly assigned to use the RMV training. Stores were posttested using a pseudo-customer protocol in which confederate buyers feigned obvious signs of alcohol intoxication.

Results: Deterrence of sales to intoxicated customers does not seem to exist, regardless of whether the states' laws prohibit it. Only 16 of 146 stores (11.0%; 4 Oregon stores were eliminated that were not in business) refused sales. There was no difference in refusal rates between intervention (11.6% [3.9%]) and control stores (7.6% [3.1%], F = 0.71, p = 0.401 [1-tailed]) or between stores that used the RMV training (6.3% [4.0%]) or not (12.0% [5.7%], F = 0.91, p = 0.343 [2-tailed]). In 11 visits, store personnel commented on the buyers' behavior, or expressed concern/suspicion about buyers, but sold to them anyway.

Conclusions: Training in responsible sales practices alone did not appear to reduce sales to apparently alcohol-intoxicated customers. Legal deterrence from making these sales may be insufficient or nonexistent for store management to support adherence to this responsible sales practice. Regulatory and policy actions may be needed to increase perceived risk with such sales (i.e., clear policy and swift, severe, and certain penalties) to achieve training's benefits.

Trial registration: ClinicalTrials.gov NCT03073291.

Keywords: Alcohol intoxication; Cannabis; Commerce.

Conflict of interest statement

Conflicts of Interest:

Dr. Buller, Dr. Woodall, Mr. Grayson, Ms. Svendsen, and Ms. Liu receive a salary from Klein Buendel, Inc. Ms. Buller is an owner of Klein Buendel, Inc. Ms. Buller, Dr. Woodall, and Dr. Buller are members of Avid Will, LLC, which is licensed to market the Train To Tend® responsible marijuana vendor training; commercialization of the training was a condition of the funding through the Small Business Innovation Research Program at the National Institutes of Health. Dr. Cutter reports personal fees from Pythagoras Board membership, Brainstorm Cell Therapeutics, Teva Neuroscience, EMD Serono, Novartis, Pfizer, CSL Behring, Avexis Pharmaceuticals, Genzyme, Medimmune/Viela Bio, Receptos, Biolinerx, Sanofi-Aventis, Galmed, Opko, NHLBI, NICHD, Vivus, Genentech, Reata Pharmaceuticals, GW Pharmaceuticals, Roche, Orphazyme, Somahlution, Horizon Pharmaceuticlas, Reata Pharma, Merck/Pfizer, Klein-Buendel, Click therapeutics, Osmotica Pharmaceuticals, Medday, TG Therapeutics, Perception Neurosciences, Celgene, and Recursion Pharmaceuticals outside the submitted work. For Dr. Saltz, no conflicts of interest are declared.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Figure 1:

CONSORT flow diagram for pseudo alcohol-intoxicated customer assessments in randomized trial