A systematic review of 21 studies finds that most physicians across specialties and countries feel they lack the knowledge to prescribe medical cannabis confidently, even as patient demand surges. The primary barrier is not principled opposition but self-reported knowledge deficits, reported by 64 to 90 percent of surveyed physicians, pointing toward medical education as the most tractable policy intervention.

Medical cannabis legalization has outpaced clinical training. Patients routinely arrive at appointments better informed about cannabis products than their prescribers, creating a knowledge asymmetry that undermines shared decision-making. Understanding whether physician hesitancy stems from genuine opposition or from addressable knowledge gaps determines the right policy response. If the barrier is education, the solution is investment in evidence-based training. If it is opposition, different strategies are needed. This review provides the most comprehensive pre-2019 map of where physicians actually stand and why, making it essential for anyone designing medical cannabis programs, continuing education curricula, or regulatory frameworks.

Medical cannabis is now legal in some form in dozens of countries, yet physician engagement with prescribing remains highly uneven. This systematic review searched PubMed, Scopus, EMBASE, and the Cochrane Library through February 2019, identifying 21 studies that examined how physicians across five countries think about, experience, and respond to medical cannabis. The review addressed a fundamental question for implementation science: what drives physician behavior when a new therapeutic option enters the regulatory landscape? The authors categorized findings around four domains: patient inquiries, prescribing willingness, knowledge and education, and attitudes and beliefs, enabling a structured comparison across disparate legal and specialty contexts.

The review found that between 49 and 95 percent of physicians reported receiving patient inquiries about medical cannabis, while willingness to prescribe ranged from 10 to 95 percent depending on the study setting. The most consistent barrier was self-reported inadequate knowledge, cited by 64 to 90 percent of physicians, with 78 percent reporting discomfort with dosing, frequency, and route of administration specifically. Physicians with prior prescribing experience reported greater confidence and more favorable views, though this cross-sectional association cannot distinguish learning from self-selection. Addiction medicine specialists stood out as notably more skeptical, with one study showing only 36 percent support for legalization compared to 60 percent among other specialists. The authors concluded that targeted continuing medical education, not persuasion, represents the most promising intervention, though they acknowledged that the underlying evidence base remains thin and no meta-analysis could be performed due to study heterogeneity.

The Knowledge Gap at the Heart of Medical Cannabis Prescribing

Imagine arriving at your doctor’s appointment knowing more about your intended medication than your physician does. For millions of patients seeking medical cannabis, that is not a hypothetical. It is the clinical reality documented in study after study, and it is the central tension this systematic review illuminates. Rønne and colleagues synthesized 21 studies from five countries and found something both unsurprising and important: the primary barrier to physician engagement with medical cannabis is not moral opposition or ideological resistance. It is a knowledge deficit so pervasive that 64 to 90 percent of physicians openly acknowledge it. That finding, by itself, is genuinely useful because it reframes the policy problem from persuasion to education, a distinction that matters enormously when designing interventions. What the review does particularly well is reveal how unevenly physician attitudes distribute across specialties and regulatory environments. Addiction medicine specialists are markedly more skeptical than primary care physicians or oncologists. Physicians in countries with structured licensing procedures, such as Israel, behave differently from those in more permissive regulatory settings. This granularity is valuable. It pushes back against the common but misleading idea that there is a single “physician attitude” toward cannabis waiting to be measured.

Where the review’s inference becomes less reliable is in its treatment of the association between prescribing experience and favorable attitudes. The finding that experienced prescribers report more confidence and more positive views is presented as though experience generates confidence. But the cross-sectional data cannot distinguish this from the simpler explanation that physicians who already view cannabis favorably are the ones who choose to prescribe it. This is like concluding that flying makes people less afraid of heights because frequent flyers report less fear, when in fact fearful people simply never become frequent flyers. The distinction has major policy implications: if experience drives confidence, then early exposure programs would be effective. If self-selection drives the association, education must come first. Compounding this interpretive challenge is the review’s decision not to perform formal quality appraisal of its included studies. Synthesizing these studies without quality grading is like averaging restaurant reviews without distinguishing between a food critic and someone who reviewed the parking lot. We do not know how much the most compelling-sounding findings depend on the weakest primary studies, and that uncertainty permeates every conclusion.

In my clinical practice, I see the knowledge gap this review describes every day, both in the patients who arrive with detailed questions their doctors could not answer and in the colleagues who quietly ask me for guidance because their training never covered this territory. To my patients, I would say: your doctor’s uncertainty is real and reflects genuine gaps in the training we have received, not indifference to your needs. To colleagues: this review confirms what most of us already sense, that our profession is undertrained on cannabis, and that structured, evidence-based education is the path forward. To policymakers: if you want physicians to engage responsibly with medical cannabis programs, you must invest in their education at the same time you change the law. Legalization without continuing medical education infrastructure creates a vacuum that anecdote and industry fill. When physician hesitancy about a treatment is rooted in knowledge gaps rather than values, the policy solution is education, not persuasion or coercion. But confirming that the knowledge gap is the real driver, rather than a socially acceptable proxy for opposition, requires qualitative research that this review’s primary studies rarely provided.

This review sits at an important juncture in the research arc on medical cannabis implementation. It consolidates the pre-2019 evidence on physician-level barriers and identifies a clear pattern: knowledge deficits, regulatory complexity, and specialty culture are the primary determinants of prescribing behavior. However, because all included primary studies are cross-sectional surveys, the review cannot tell us whether addressing these barriers would actually change behavior. The field still lacks longitudinal studies tracking how physician attitudes evolve as education and experience accumulate, and the post-2019 landscape, which has seen substantial legalization expansion, remains entirely unaddressed.

From a pharmacological and safety standpoint, the review’s finding that 78 percent of physicians report discomfort with dosing, frequency, and route of administration is particularly concerning. Cannabis products vary enormously in cannabinoid ratios, bioavailability, and onset kinetics, and drug interactions with common medications including warfarin, benzodiazepines, and immunosuppressants are clinically meaningful yet poorly covered in standard medical curricula. Clinicians encountering patients who use or request medical cannabis should, at minimum, screen for potential drug interactions and document the specific products being used. The most actionable recommendation from this evidence is to seek structured continuing education on cannabinoid pharmacology from evidence-based sources before advising patients on medical cannabis, rather than relying on anecdotal clinical impressions or industry-produced materials.

This is a PRISMA-guided systematic literature review performing narrative synthesis of 21 primary studies, predominantly cross-sectional surveys. It occupies a mid-tier position in the evidence hierarchy: stronger than individual surveys because of its systematic scope, but weaker than meta-analyses because heterogeneity precluded quantitative pooling. Critically, the authors did not perform formal quality appraisal of included studies, meaning findings from methodologically weaker studies receive the same narrative weight as those from stronger ones. All conclusions should be treated as descriptive patterns rather than precise estimates or causal claims.

This review’s findings are broadly consistent with earlier, smaller surveys that identified physician knowledge deficits as the primary barrier to medical cannabis prescribing. Studies by Kondrad and Reid (2013) and Carlini and colleagues (2017) in US settings documented similar patterns of high patient demand alongside physician uncertainty, and the present review’s cross-national scope confirms that these patterns extend beyond the United States. The finding that addiction medicine specialists are more skeptical aligns with prior work on specialty-level variation in attitudes toward harm reduction interventions more broadly.

However, the review’s pre-2019 search cutoff means it does not capture the substantial body of work published since, including studies from additional countries and those examining the effects of emerging educational interventions. More recent surveys from the UK and European settings suggest that similar knowledge gaps persist even as legalization expands, reinforcing rather than contradicting the present findings. The review extends the prior literature by providing the first systematic multinational synthesis, but its descriptive nature means it cannot adjudicate between competing explanations for the observed patterns.

The most consequential analytic choice was the decision not to perform formal quality appraisal of included studies. Had the authors applied a validated quality scoring tool such as the Newcastle-Ottawa Scale for surveys, studies with very low response rates or small convenience samples could have been down-weighted or excluded. This might have narrowed the enormous reported ranges (for example, 10 to 95 percent willingness to prescribe) and produced a more focused, if less comprehensive, picture of physician attitudes.

Additionally, a structured subgroup analysis by regulatory context, rather than purely narrative comparison, could have more rigorously tested whether legal frameworks independently moderate physician behavior. The absence of this analytic step means the review’s claims about regulatory influence, while plausible, rest on informal pattern recognition rather than systematic comparison.

The most likely overinterpretation is treating the association between prescribing experience and favorable attitudes as evidence that exposure to cannabis prescribing changes physician minds. The cross-sectional data cannot distinguish this learning effect from simple self-selection, in which physicians who already view cannabis favorably choose to prescribe it. This distinction matters enormously: if self-selection drives the association, then mandating early exposure or clinical rotations would not produce the attitude shift that proponents expect.

A second common misreading is averaging the willingness-to-prescribe range (10 to 95 percent) into a single estimate. These figures reflect profoundly different regulatory, cultural, and specialty contexts and cannot be meaningfully averaged. The variation itself is the finding, not a number in between.

This systematic review contributes a valuable multinational map of physician attitudes toward medical cannabis through early 2019, identifying knowledge deficits as the most consistent and potentially actionable barrier. It does not establish that education interventions would change prescribing behavior, nor does it address the post-2019 landscape. For practice now, its clearest implication is that clinicians should actively seek structured, evidence-based education on cannabinoid pharmacology rather than waiting for training systems to catch up with legalization.

Why does my doctor seem hesitant to recommend medical cannabis?

This review found that 64 to 90 percent of physicians report feeling they lack adequate knowledge about medical cannabis, including its clinical effects, side effects, and proper dosing. Your doctor’s hesitation likely reflects genuine uncertainty rather than personal opposition. Medical training has not historically included substantial content on cannabinoid medicine, and many physicians are still building their understanding of this area.

Does this study prove that medical cannabis works?

No. This review examined physician attitudes and knowledge, not clinical outcomes. While some physicians in the included studies reported observing benefits in their patients, anecdotal clinical impressions are not the same as evidence from controlled trials. The effectiveness of medical cannabis for specific conditions requires separate, rigorous clinical research.

Should I bring up medical cannabis with my doctor even if they seem unfamiliar with it?

Yes. Open communication with your physician is always valuable. The most productive approach is to discuss the specific symptom or condition you hope to address, ask what the current evidence shows for that indication, and work together to weigh potential benefits against known risks. If your physician is not well versed in cannabinoid medicine, they may be able to refer you to a clinician with specialized expertise.

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