A systematic review of 21 studies across five countries reveals that most physicians regularly field patient questions about medical cannabis and many express willingness to prescribe, yet the vast majority feel they lack sufficient knowledge about clinical benefits and adverse effects. This gap between demand and competence represents one of the most actionable barriers to safe, evidence-informed medical cannabis care.

As medical cannabis legalization expands worldwide, physicians are increasingly the gatekeepers who determine whether patients can access these therapies safely and legally. When a substantial majority of physicians report receiving frequent patient inquiries yet simultaneously acknowledge they lack sufficient clinical knowledge, the result is a bottleneck that affects patient care, safety, and trust. Understanding the specific contours of this knowledge gap is essential for designing targeted educational interventions, shaping policy, and ultimately ensuring that the growing availability of medical cannabis is met with proportionate clinical competence.

Medical cannabis occupies a challenging position in clinical practice. It is increasingly legal and culturally accepted, yet the evidence base supporting specific indications remains incomplete. Physicians, particularly general practitioners, find themselves navigating patient expectations that often outpace the available clinical evidence. This PRISMA-guided systematic review synthesized 21 articles drawn from five countries, encompassing both quantitative survey data and qualitative studies, to characterize how hospital physicians and GPs perceive medical cannabis. The mechanistic rationale for the review is straightforward: if physicians are the primary access point for patients, then their attitudes, knowledge, and confidence levels determine in large part how equitably and safely medical cannabis is prescribed.

The findings reveal a striking and consistent pattern. Between 49% and 95% of physicians reported frequent patient inquiries about medical cannabis. Willingness to prescribe ranged enormously, from 10% to 95%, depending on specialty, clinical setting, and the legal context of the country surveyed. Physicians who had already prescribed medical cannabis tended to report greater confidence in its benefits and fewer concerns about adverse effects, though this cross-sectional association cannot establish causality. The most pervasive barrier identified across nearly all included studies was insufficient knowledge of both therapeutic and adverse effects. The authors concluded that robust physician education programs and higher-quality clinical evidence are needed before medical cannabis prescribing can be reliably evidence-informed.

This review confirms what I see every day in clinical practice: the demand is real, and many physicians genuinely want to help their patients explore medical cannabis, but the gap between willingness and competence is enormous. The study gets right that this is fundamentally a knowledge problem rather than an attitudinal one. Most physicians are not ideologically opposed; they are practically uncertain. What the review cannot capture, though, is how much has changed since its 2019 search cutoff. The landscape of cannabinoid medicine has shifted rapidly, and some of the barriers documented here are likely smaller now in certain jurisdictions while persisting in others.

In my own practice, I invest substantial time in structured education during patient visits, explaining what the evidence supports, what remains uncertain, and what the realistic expectations should be. I find that when physicians have a clear framework for counseling, much of the discomfort dissolves. The real clinical challenge is not whether to discuss cannabis with patients, because they are going to ask regardless. The challenge is building the clinical literacy to do so responsibly.

For clinicians, this systematic review sits at the intersection of implementation science and clinical education. It does not tell us whether medical cannabis is effective for any specific condition; instead, it maps the physician-level barriers that intervene between legalization and responsible clinical use. The wide range in willingness-to-prescribe estimates (10% to 95%) should caution against interpreting any single survey as representative. What emerges clearly is that the field needs standardized, evidence-based educational curricula for physicians, not just legal permission to prescribe. The finding that prescribing experience correlates with more favorable attitudes may reflect self-selection bias as much as genuine learning, a distinction with important implications for how we design training programs.

From a pharmacological and safety standpoint, the knowledge gap documented here has direct clinical consequences. Physicians who are uncertain about adverse effects and drug interactions cannot provide safe counseling on cannabis alongside other medications, particularly for patients on anticoagulants, antiepileptics, or opioids where cannabinoid interactions are clinically relevant. One actionable takeaway for practicing clinicians: even before comprehensive training programs become available, familiarizing yourself with the basic pharmacology of THC and CBD, including their cytochrome P450 interactions, provides a foundation for safer patient conversations today.