This study aimed to evaluate the perceived knowledge, beliefs, and attitudes of Colombian psychiatrists regarding the use of MC. To our knowledge, this is the first study of these characteristics conducted outside Australia and focusing only on specialists in psychiatry. The survey showed that the majority of the sample of Colombian psychiatrists believe that MC should be available for different medical conditions and expressed a desire to be able to prescribe it. In addition, they were open to starting a dialogue with their patients on issues related to MC. However, there is a serious lack of knowledge of the legal status of cannabis in the country and the methods through which patients can gain access to government-regulated products. Clarity regarding the presentations of cannabis-based products—that is, whether the drug is available in oils, dried buds, creams, and/or capsules—is lacking. This situation opens the doors for optimizing education and training in MC in mental health workers. In different countries of the world, including Colombia, there are many myths and misleading advertising of MC that generates false expectations in patients, for example, that it cures cancer (Shi et al., 2019). Many patients consult their physicians with that expectation, and it is the medical community that should educate the general public regarding the real benefits and risks of MC. For this reason, we believe that doctors (including psychiatrists) in Colombia should optimize their knowledge related to MC to offer their patients a realistic and ethical vision of its use. Previous surveys have reported a strong desire among health workers to receive continuing medical education on MC given the global expansion of its use (Kondrad & Reid, 2013).

Regarding indications for MC use in psychiatry, the condition with the highest approval was insomnia (35%). Since the remaining responses were neutral or disapproving, this indicates that most of the physicians surveyed would have concerns about using cannabinoids for insomnia, although there is currently moderate evidence supporting the use of MC in insomnia secondary to chronic neuropathic pain, fibromyalgia, and multiple sclerosis (National Academy of Sciences, 2017). Anxiety received the second-highest approval rate of 29%, a relatively low figure given the growing, but limited, evidence supporting the use of CBD for social anxiety disorder (Bergamaschi et al., 2011). The condition that generated the greatest disapproval was schizophrenia; this finding is completely reasonable since most psychiatrists associate cannabis use with a risk of psychosis, which is a real risk with nonmedical or recreational use, which tends to involve high doses of THC, especially among young people (Moore et al., 2007). However, recent studies have shown that CBD acts as an excellent adjunctive antipsychotic for the treatment of patients with refractory schizophrenia (Leweke et al., 2012; McGuire et al., 2018) and psychosis associated with Parkinson’s disease (Zuardi et al., 2009).

An interesting finding of the survey was that the majority of the psychiatrists agreed with the use of MC for nonpsychiatric medical conditions, with cancer-related chronic pain receiving the highest approval with 87.6%, a figure much higher than the highest approval rate for a psychiatric symptom, which was for insomnia (35.2%). When comparing the approval of MC use in psychiatric versus nonpsychiatric symptoms, we found a statistically significant difference (p = 0.003). This could indicate that psychiatrists feel more comfortable with the use of MC and perceive it as safer and more effective for specialties other than their own, such as pain medicine and palliative care. This finding was similar to that of other surveys of perceptions and knowledge regarding MC among medical psychiatrists and nonpsychiatrists; in these surveys, cannabinoids were better accepted for the treatment of nonpsychiatric medical diseases, and they had much lower approval for conditions such as insomnia, PTSD, anxiety, and depression (Jacobs et al., 2019; Karanges et al., 2018).

Regarding perceived safety and adverse effects, most psychiatrists were neutral about or disagreed with whether cannabis was more harmful than other medications. In fact, it was viewed as much safer than opioids. This perception is interesting and suggests that the old negative and even harmful connotations of cannabis in the field of mental health (Rey, 2002) could be changing with new and emerging safety and efficacy research (Hoch et al., 2019) and that, therefore, although psychiatrists are not inclined to use it for mental disorders at present, they are beginning to consider it a safe treatment compared to other psychotropic drugs and medications with potential risk of dependence, such as opioids and/or benzodiazepines.

There were several limitations of this study. The first is that the majority of the psychiatrists surveyed were located in Cundinamarca, particularly in Bogotá, the capital, where most of the psychiatrists in the country are concentrated. This could generate a selection bias, since it is likely that many of the respondents probably had similar academic background regarding MC. Another limitation is the sample size, which, although significant, represents only 12% of the professionals, taking into account that in Colombia, there are approximately 1.8 to 2.5 psychiatrists per 100,000 inhabitants, that is, about 1200 psychiatrists (The World Bank, 2020; Universidad de Antioquia, 2021). In future studies, surveys could be conducted in which indications for THC and CBD are considered separately. The percentage of women and young people (under 44 years) who responded to our survey was disproportionate, which is consistent with the general profile of people who respond to medical surveys (Cull et al., 2005) but may not necessarily represent the collective thought of the psychiatrists. The study also did not record information related to the work sector of psychiatrists, whether public or private. Finally, our findings cannot be generalized to other countries in Latin America, the USA, or Canada, among others, because access to MC and the available products and legal frameworks differ among countries. It is important to clarify that this research is merely descriptive and is not intended to promote sales of any pharmaceutical company.