A 2025 survey of more than 600 outpatients at a Thai hospital near the Cambodian border found that over 60% could not identify approved medical uses or side effects of cannabis, despite Thailand having decriminalized it in 2022. The findings highlight a significant gap between policy liberalization and the public education needed to support safe, informed cannabis use in community settings.

Thailand’s 2022 cannabis decriminalization was the first of its kind in Asia, creating an unprecedented public health experiment in a region where cannabis had deep cultural roots but limited formal medical infrastructure. When patients cannot identify what cannabis treats or what side effects to watch for, clinicians face a compounded challenge: they must educate before they can treat. The finding that even village health volunteers, who serve as the primary community health bridge in rural Thailand, share these knowledge gaps makes the problem structural rather than merely individual. For clinicians anywhere in the world working in newly legalized environments, this study offers a mirror.

Thailand removed cannabis from its narcotics list in June 2022, making it the first Asian nation to broadly decriminalize the plant. This policy shift created immediate demand for public understanding of safe use, approved indications, and potential adverse effects. In a border region near Cambodia, where cannabis had long been used in traditional cooking and folk medicine, the stakes were particularly high: cross-border trafficking, unregulated product quality, and cultural normalization of cannabis without medical context converged in a single community. Researchers at a 30-bed community hospital sought to measure what patients actually knew about cannabis in this rapidly changing landscape.

Between March and August 2024, the team surveyed 618 outpatients (69% female, ages 18 to 86) using systematic interval-based sampling and structured face-to-face interviews. Only 14.24% of respondents reported any prior cannabis use. More strikingly, over 60% answered “do not know” when asked about both therapeutic benefits and side effects of cannabis. Knowledge differed by age group and education level, consistent with general health literacy patterns, but the finding that village health volunteers showed low awareness was particularly notable given their role as frontline health communicators. The authors acknowledge that their single-site, convenience-based design limits generalizability, and that social desirability bias may have suppressed reported use rates. They call for targeted education programs, regulatory clarity, and culturally sensitive communication strategies, though these recommendations extend beyond what the descriptive data alone can support.

This study captures something I see every single day in clinic, just in a different country. When a society legalizes cannabis faster than it educates its people, the gap does not fill itself. What this Thai border hospital measured, the sheer prevalence of “I don’t know” answers, resonates deeply with what I observe among patients in the United States who have had legal access for years. The finding about village health volunteers is the most clinically actionable part: if the people tasked with translating health policy into community understanding do not themselves understand the subject, the entire information chain is broken from the start.

In my practice, I invest substantial time in structured education before any cannabis recommendation. That is not optional; it is the intervention. I walk patients through what cannabis can and cannot do, what side effects to expect, how to recognize adverse reactions, and when to stop. This study reinforces that clinicians everywhere need to treat education as a core clinical activity rather than assuming patients arrive with baseline understanding. The policy may say “legal,” but the patient often hears “safe,” and those are very different things.

This study sits in the early descriptive phase of a research arc that every newly legalized jurisdiction will eventually trace. Before interventional studies can test education programs or clinical counseling approaches, researchers must document the baseline: what do patients actually know, and where are the largest gaps? The Thai-Cambodian border setting introduces unique confounders, including culturally embedded traditional use that predates formal legalization, cross-border product variability, and a healthcare infrastructure built around a 30-bed community hospital rather than an academic medical center. These factors make the findings highly context-specific, but they also make the study valuable as a model for similar assessments in other low-resource or border settings undergoing cannabis policy transitions.

From a pharmacological standpoint, the inability of most respondents to identify side effects is a concrete safety concern. Patients who do not know that cannabis can cause tachycardia, cognitive impairment, or drug interactions with common medications like anticoagulants and sedatives cannot meaningfully participate in shared decision-making about its use. Clinicians in legalized settings should consider implementing standardized knowledge assessments, even brief ones, at the point of care. The single most actionable recommendation from this study is not about cannabis at all: it is about systematically training community health workers before expecting them to serve as effective cannabis educators.