Supplementary Material for: The persistence of stigma and other challenges experienced by medical cannabis users: A thematic synthesis of qualitative studies

Background: The legislation, practices, and guidance shaping patient and professional access to medical cannabis (MC) for managing chronic pain and other conditions vary widely across jurisdictions. Despite promising evidence of effectiveness, challenges persist for those trying to access or prescribe MC. Little is known about how patients navigate these complex environments. We aimed to understand the evidence related to personal lived experiences associated with using MC for chronic pain and other conditions in negotiating these challenges. Summary: We used a framework by Thomas and Hardens for conducting a thematic synthesis of data gathered in a scoping review. Studies were included that used qualitative methods to capture lived experiences associated with using MC for chronic pain and other conditions. Our analysis identified themes relevant to patients and those caring for them. Forty-five studies met our criteria. Four interconnected themes were identified: 1) limited education and knowledge about medically appropriate use; 2) perceived stigma for patients and professionals; 3) persisting social consequences of stigma; and, 4) challenging pathways for patients seeking MC access. Key Messages: There has been remarkably little change in the association of stigma and medical cannabis in the literature over time and across jurisdictions and regulatory regimes. Future research comparing stigma experiences over time is needed to determine if these harms persist. Changing regulations to moderate stigma would foster patient-centered care.