Table 2.

Participant Quotes Supporting Thematic Analysis

Theme/Subtheme	Representative Quotes
Theme 1: Evidence regarding medical cannabis
Subtheme 1: Lack of evidence	“So that’s when I say as a doctor, I am not comfortable prescribing marijuana regularly, as if we are going to be doing evidence-based medicine, we need more evidence and better data to give the patients.” (P01) “Everybody is so hyped on cannabis for everything that they are being encouraged now, by their friends, by their family, etc…There really is a scant bit of evidence that medical cannabis may have some role to play in certain types of chronic pain, perhaps neuropathic pain, MS pain, spasticity, but really not much evidence, compared to other treatments.” (P04) “The biggest issue is there’s very little quality published evidence. The evidence that is there are various trials of very small numbers, often very short trials, they can be as short as… 30 minutes…and there’s almost no randomized controlled trials.” (P06) “I think one of the biggest issues is there’s a lack of very high-quality, large-scale studies, which definitively show a benefit and that’s why I think a lot of people were reticent to adopt it and use it in their practice at this point.” (P12)
Subtheme 2: Need for more research	“Oh, yeah. I think that there’s enough evidence available to warrant further investigation.” (P03) “So fundamentally I think cannabis falls into, presently at least, falls into the area where there is a potential. And the reason that we should probably continue to investigate whether it is useful is because its risks are not that big. So, I see from a point of risk benefit ratio from that perspective, I think we should probably continue to look for opportunities to investigate.” (P13)
Theme 2: Medical cannabis as first-line therapy for chronic pain
	“I mean I would have to admit, when I prescribed it, I thought of it as third line, but I often thought of it as second to last line, mainly for practical issues.” (P01) “I’ve always considered them like last line of defense. Yeah, definitely like fourth or fifth… type options.” (P09) “I think cannabis just serves as an additional tool to help with pain control and try to minimize the overall burden, but we don’t feel any pressure to use it as the primary agent to accomplish that goal.” (P12)
Theme 3: Barriers to access
Subtheme 1: Lack of knowledge among physicians	“Yeah, I think I think that the vast majority, in my opinion of say, family doctors probably aren’t interested and it’s a lack of knowledge and the hassle factor, you know, fill out a form and talk to the patient and then have to troubleshoot.” (P04) “Many don’t have the necessary information that they should have, patients, and educating patients on cannabis I think it’s crucial, more so patients who have those two extremes and naturally if somebody is not wanting to try that, I think it’s futile.” (P13) “There is no universality of doses, the same thing goes with CBD oil, how much of that is bioavailable… What’s the concentration of CBD after ingested? I don’t know.” (P01)
Subtheme 2: Cost	“There’s the financial barrier, which for many patients is a real problem, because it’s not at this point covered by very many organizations. And so, it’s out of pocket for the majority of people, which if they’re low-income earners is often unreachable.” (P06) “But if you can’t afford said products, then that’s the biggest challenge that I often see people facing with regards to even embarking on a trial because it’s quite expensive.” (P11) “I would say cost. So, I think that the one limitation that we hear from our patients is that if their drug plan does not cover it, the costs, especially for some of these people, their, their opioids or other medications are covered by ODSP or covered by their workplace insurance, whereas medical cannabis for them is not.” (P12)
Subtheme 3: Stigma	“So, I think the number one barrier is getting over their own stigma and their own anxiety about bringing it up to a doctor.” (P06) “I think there are still a number of barriers that make it more challenging for patients to seek it out. I mean, there’s the societal judgment and the stigma that might be associated with it, which has been sort of ongoing for quite some time.” (P11) “I mean, yeah it’s [the] luck of the draw. You either find a doc[tor] who’s willing to do it, or you have a doc[tor] who throws their hands up and says, ‘I want nothing to do with that’.” (P10) “I think there are elderly people who feel a certain degree of shame or that it’s wrong. There has been a significant cultural shift. Younger people are even less bothered by it, but outside of smoked cannabis, I think the stigma [has] dramatically decreased.” (P08) “I think older populations definitely have a bit more of a negative stigma, primarily because of [the] way it was portrayed prior to legalization.” (P09)