There certainly has been a lot of news about medical cannabis lately. And rightly so, with the first of Hawaii’s 16 dispensaries to open soon.

Cannabis’ reputation is continuing its shift from that of an illicit drug to a therapeutic one, evidenced by medical cannabis’ increasing use and support. States allowing medical cannabis total 28, and D.C., up from 18 in 2013. And, medical cannabis use will likely waft through another 10 states by 2020.

The federal government still classifies cannabis as a Schedule I controlled substance making it illegal. Thus, doctors cannot write a “prescription” but can certify/order it for qualifying medical conditions. Qualifying conditions vary by state: spasticity (e.g., from multiple sclerosis), chronic pain, and nausea and vomiting are common to all. Hawaii has approximately 10 qualifying conditions.

Hawaii’s Department of Health is responsible for overseeing both the Medical Marijuana Registry and Medical Marijuana Dispensary programs here.

Cannabis contains more than 60 unique compounds called cannabinoids. The two principal pharmacological compounds in cannabis are delta-9-tetrahydro- cannabinol (THC) and cannabidiol (CBD). Different strains of cannabis have different proportions of these two cannabinoids; in general terms, a strain with higher THC is more effective for certain conditions while a strain with higher CBD is more effective for other conditions.

Medical cannabis is supplied through licensed, registered dispensaries, not pharmacies. But, I would propose that pharmacists are the health care providers best equipped to care for medical cannabis patients (MCPts). In fact, medical cannabis laws in three states (Connecticut, Minnesota and New York) require a board-certified pharmacist to be onsite at the dispensary to dispense cannabis products.

The pharmacist sits down with the patient to discuss their disease state and therapy goals, then determines the appropriate dose, strain and formulation (capsule, tincture, cream, etc.).

Pharmacy organizations support this role; the American Pharmacists’ Association, National Community Pharmacist Association and the American Association of Colleges of Pharmacy agree on the need for pharmacist oversight at the dispensary level.

But, pharmacist oversight at dispensaries won’t be happening in Hawaii. So how will patients know which cannabis strain is most effective for their condition? They might not, and the dispensary may or may not be of assistance.

Additionally, medical cannabis doesn’t come in set dosages. How will our MCPts know how much to use? They might not. Our dispensaries might not know, either. Hawaii’s MCPts will have to experiment with different strains, doses and formulations to achieve desired effects without much input or oversight by trained health care professionals.

We need to move beyond the stigma of cannabis being just a means of “getting high,” accept its pharmacologic potential, and its legitimacy as a medication.

Pharmacists should treat medical cannabis as they would any newly released medication. When a new medication’s appearance on the market is imminent, we educate ourselves through journal articles, product information and other resources. We learn about the new medication’s adverse effects, drug interactions and contraindications. Medical cannabis is no different from any other medication in this regard.

Pharmacists shouldn’t be deterred about counseling MCPts; we can still get a good start on caring for MCPts in three ways.

First, we can educate ourselves — the American Association of Colleges of Pharmacy’s Medical Cannabis Toolkit FINAL 07-07-16.pdf is a good place to begin.

Second, we can find out if there will be a dispensary near the pharmacy where we work; if so, chances are some of our patients will be using medical cannabis.

And, third, once we begin to identify MCPts who patronize our pharmacies, we can then use our training, skills and that all-important patient-focused mindset to identify contraindications, and help minimize side effects and drug interactions.

Ideally, in the future, pharmacists will be onsite at Hawaii’s medical cannabis dispensaries and can fully care for MCPts.

Until then, we can become knowledgeable about medical cannabis and provide the best care for all our patients.

Anne Wheelock, of Honolulu, has been a community retail pharmacist in Hawaii since 1981.