Beyond access: A comparative phenomenological study of medical cannabis patients in three legal contexts

Background Medical cannabis (MC) patients in the United States navigate a fragmented legal landscape, with state laws ranging from prohibition to full legalization. These legal differences influence not only access but also how patients understand and enact their use, engage with healthcare systems, and manage stigma. This study explored how legal context shapes the lived experiences of MC patients. Methods Using interpretive phenomenological analysis, semi-structured interviews were conducted with 41 adult MC patients across three legal categories: highly restricted, medical-only, and fully legal states. Participants were recruited following a national survey. Interviews were analyzed inductively, first within individual cases and then comparatively across groups. Thematic development was supported by team consensus, reflexive memoing, and an independent audit. Results Participants in all legal contexts framed MC use as therapeutic and non-recreational, but their experiences differed. Those in restricted states described concealment and legal risk; those in medical-only states encountered bureaucratic barriers and mixed provider support; and those in fully legal states expressed autonomy but faced social misrecognition. Across groups, patients reported stigma, inconsistent clinical guidance, and a need to self-manage treatment. Conclusions Legal status shaped not only MC access but also the narratives, behaviors, and identities patients constructed around their use. Findings suggest that policy reform must extend beyond legalization to address provider education, clinical integration, and the recognition of patient expertise. Future research should examine how these dynamics evolve as cannabis policies continue to change.