Consulting people who use cannabis to plan a regulatory trial on non-medical cannabis sales in pharmacies.

Background Switzerland has taken a different path to cannabis regulation than other countries. A 2021 law allows regulatory experiments on the production and sale of cannabis for non-medical purposes. The research team planned a randomised controlled trial (RCT) to test how selling cannabis in pharmacies affects users' health and consumption habits. The study intervention also included counselling on risk reduction, such as smoking cessation. The research team aimed to incorporate the perspectives of people who use cannabis into the study design, despite challenges related to stigma and legal constraints.Methods When planning the RCT, the research team mandated an external researcher to form an advisory group with regular users of non-medical cannabis. This researcher used convenience sampling (including snowball sampling) to recruit people who use cannabis, considering age, self-reported gender and cannabis use frequency. She conducted an individual interview, followed by iterative group discussions. She summarised the results into reports and sent them to the research group, who considered the results during study planning and formulated topics to be discussed in the next advisory group meeting.Results In a two- and half-year long process (November 2021 to March 2024), eight people who use cannabis provided iterative feedback that informed the development of the study intervention. Based on their feedback, the research team expanded the product selection to include cannabis resin alongside cannabis flowers. The group's feedback also led the research team to make several changes to the sales process in pharmacies. While the members of the advisory group expressed that much of their feedback had been considered, they noted that some key aspects - such as product pricing - had not been implemented. Legal and political constraints limited the research team's ability to implement advisory group feedback.Conclusions This experience showed that gathering user input is feasible, even in highly regulated, stigmatized contexts. Including the perspectives of people who use cannabis in the trial set-up allowed the research team to adapt the study intervention. Where they could not adapt the study intervention, it helped them prepare for possible reactions from future study participants and disseminate their findings to other stakeholders. Future research should test the feasibility and benefits of such activities throughout all research stages.Cannabis In Switzerland Switzerland has taken a different path to cannabis policy than other countries. In 2021, the country adopted a law allowing researchers to test how cannabis could be produced and sold for non-medical (so-called ‘recreational’) use. The intent was to test different models before deciding on a law for legal cannabis sales. In Switzerland, where the production and sale of cannabis is still illegal, people who use cannabis face stigma and researchers running such trials have to follow strict laws.About Our Study The research team aimed to test how selling non-medical cannabis in pharmacies would change the health and use habits of people who use cannabis. While planning this study, they wanted to gather the perspectives of people who use cannabis to improve the trial. The intention was to adapt the trial as much as possible to the needs of people who use cannabis while complying with the law.What The Research Team Did •They invited people who use cannabis from the city of Bern to form an advisory group who met regularly. •An external researcher interviewed each person and held five group discussions. •She summarised their feedback into reports. She made sure to protect their identities by anonymising their statements. •The research team used this feedback to make changes to the study. For example, they added cannabis resin (hashish) as a purchase option in pharmacies, alongside cannabis flowers. However, in some cases they had to follow the law, even if it went against what participants wanted.Challenges And What They Learned The research team learned that it is possible to involve people who use cannabis in research, even though cannabis is still illegal and strict rules apply. They found the feedback from people who use cannabis valuable. Although they could not meet all the advisory group’s needs, they were able to make many changes to the study.