Beyond symptom change: a qualitative descriptive study of reported quality of life experiences among adults prescribed medicinal cannabis for anxiety disorders.

The aim of this study was to explore the perceived impacts on QoL for people with diagnosed anxiety disorders over the first six to twelve months after commencement of medicinal cannabis treatment.

This longitudinal qualitative study highlights that people using medicinal cannabis for anxiety disorders perceived improvements in quality of life beyond symptom reduction, including sleep, relationships, and daily functioning. Findings emphasise the important role of pharmacists and other healthcare professionals in patient counselling, treatment monitoring, stigma reduction, and supporting safe, patient-centred anxiety management.

A longitudinal qualitative descriptive study design was employed. Consistent with qualitative descriptive methodology, the aim was to present participants’ experiences without extensive interpretation or theory development [ 45 , 46 ]. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [ 47 ]. Purposive sampling was used to recruit adults who self-reported initiating medicinal cannabis for treatment of an anxiety disorder [ 48 ]. Sampling aimed to achieve maximum variation in participant demographics and treatment experiences, including age, gender, concurrent treatments, cannabinoid formulations, and patterns of medicinal cannabis use [ 49 ]. This strategy was used to capture a diverse range of experiences and perspectives regarding medicinal cannabis treatment for anxiety disorders. Eligible participants were aged 18 years or older, had initiated treatment within the previous six months, and primarily used medicinal cannabis for anxiety disorders including generalised anxiety disorder, social anxiety disorder, panic disorder, or related anxiety disorders. Exclusion criteria included bipolar disorder, schizophrenia, and current illicit (non-prescribed) cannabis use. Snowball sampling was also used; however, all participants were required to meet inclusion criteria. Participants were recruited through clinicians, in-clinic advertisements, and clinical email networks across four Australian clinics, some of which provided telehealth services nationally. Eligible participants were contacted up to three times before being considered non-responders, as repeated contact may improve participation rates [ 50 ]. Despite recruitment efforts, participants were recruited only from WA and New South Wales. LR, a female PhD student with qualitative interviewing experience and no prior relationship with participants, provided study information where possible. Recruitment was guided by the concept of information power, whereby relevance and richness of data are prioritised over sample size alone, consistent with Braun and Clarke’s reflexive thematic analysis [ 51 , 52 ]. Given the focused study aim, specific sample, and longitudinal design with multiple data collection points, recruitment continued until the dataset provided sufficient depth, diversity, and richness of accounts to support nuanced thematic interpretation relevant to the research aim [ 51 , 52 ]. This resulted in a final sample of nine participants. Eligibility was determined using a pre-screening questionnaire administered via Qualtrics [ 53 ], which collected demographic, diagnostic, treatment, and prior medicinal cannabis use information (Supplementary Materials 1). Data were collected through participant diary entries and semi-structured interviews. Participants were invited to complete diary entries at three and six months following study commencement, either via Qualtrics or by telephone according to participant preference. Entries included prompts regarding completion date, medicinal cannabis products used, and perceived treatment experiences (Supplementary Materials 2). Semi-structured interviews were conducted by LR within 12 months of treatment commencement, either in person, by telephone, or via Zoom or Microsoft Teams according to participant preference. The interview guide was developed through literature review and internal expert discussion within the research team. It explored experiences prior to treatment, medicinal cannabis use, perceived changes in daily life and functioning, comparisons with other treatments, and future anxiety management plans (Supplementary Materials 3). A pilot interview was conducted to refine the interview guide and interview process. Written informed consent was obtained prior to participation, with additional verbal consent recorded at interview commencement. Interviews lasted approximately 60 min to allow sufficient time for participants to share their experiences. Interviews were audio-recorded, transcribed using MS Teams or OtterAI software with institutional ethics approval, reviewed against original recordings for accuracy, and de-identified prior to analysis. Transcripts were produced using a clean verbatim approach, and participants were offered the opportunity to review transcripts and select a pseudonym. No repeat interviews were conducted. Reflexive thematic analysis was conducted by LR following Braun and Clarke’s methodology [ 54 ] using NVivo 12 software [ 55 ]. Diary entries and interview transcripts were coded inductively, with codes developed through repeated reading of the data and iteratively refined into themes and subthemes. Consistent with COREQ recommendations, LR reflected on assumptions regarding medicinal cannabis and anxiety shaped by previous research involvement and personal experiences with mental health. LR acknowledged the potential for these perspectives to influence early coding decisions. To support reflexivity and ensure interpretations remained grounded in the data, transcripts were revisited multiple times throughout analysis. LR is an experienced qualitative researcher with a background in journalism, informing a reflexive approach to interviewing and analysis, including active bracketing of personal views and attentiveness to participants’ accounts. Factors such as gender, age, and background were also considered within reflexive practice. An initial codebook developed by LR was reviewed by members of the research team (KL, CC), who examined coding outputs independently. Coding discrepancies and interpretations were discussed within the research team and resolved through consensus. Several strategies were employed to enhance trustworthiness [ 56 , 57 ]. Confirmability was supported through LR’s reflexive journaling and maintenance of an audit trail documenting coding decisions and theme development. Credibility was enhanced through peer debriefing and ongoing discussion of interpretations within the research team. Transferability was supported through purposive sampling and detailed description of the study context and participant characteristics. Dependability was strengthened through consistent application and review of the coding framework across the analytic process. This study was approved by the University of Western Australia Human Research Ethics Committee (2023/ ET000618 ).

Nine participants (median age 36 years; six females, three males) were included. Table 1 presents participant characteristics and cannabinoid preparations used. Table 2 provides details on the themes and constituent subthemes. Table 1 Demographic characteristics and medicinal cannabis use information of participants Participant Gender Age Occupation Concurrent Psychological Treatment Primary Cannabinoid Product Frequency of use Formulation/route Dosage Bloom Female 45 Family counsellor No THC-dominant 3–4 times per week Oral oil 0.2 mL per dose; THC 20 mg/mL Candy Female 39 School officer No CBD-dominant (with THC for sleep) Daily Oral oil CBD oil 100 mg/mL (0.5 mL per dose); THC oil 26.3 mg/mL at night Fennic Male 32 Student Yes THC-dominant Daily Oral oil 0.3–0.5 mL per dose; THC 26.3 mg/mL Sophie Female 36 Stay-at-home mother/business owner No THC-dominant (CBD when needed) Daily Oral edible (gummy) Half a gummy per dose (THC-based; dose not specified) Jane Female 31 Marketing Yes Mixed THC/ CBD (with THC-dominant use when needed) 2–3 times per week Oral oil; inhaled dried flower (optional) Oil: THC 20 mg/mL, CBD 1 mg/mL; flower strength not specified MGJC Male 32 Unemployed No CBD-dominant + THC-dominant Daily Oral capsule; inhaled dried flower CBD capsule (dose not specified); THC flower ~ 30% Bob Male 74 Retired Yes CBD-dominant + THC-dominant Daily Oral oil; inhaled dried flower CBD oil (dose not specified); THC flower used at night Amber Female 31 Temporary work Yes THC-dominant Daily Inhaled dried flower  ~ 25% THC; ~ 2 g per day Jemima Female 62 Retired Yes Mixed THC CBD Daily Oral oil; oral edible (gummy) CBD oil 40 mg/mL (full spectrum); gummies 10 mg THC / 10 mg CBD Participants are identified using self-selected pseudonyms to maintain confidentiality. THC refers to tetrahydrocannabinol and CBD refers to cannabidiol. THC-dominant refers to products with a higher ratio of THC relative to CBD. mg refers to milligrams and mL refers to millilitres. Participant-reported brand names were excluded from the table. Products were classified according to their active cannabinoid content, formulation, and dose (where reported) to improve clarity and comparability. Where precise dosing information was unavailable, this is indicated as “dose not specified” Table 2 Overview of themes and subthemes Theme Subthemes Theme One: Reclaiming Agency Over Anxiety Symptoms Reduced emotional reactivity and perceived control of anxiety symptoms Improved motivation, mental clarity and engagement with coping strategies Theme Two: Improved Quality of Life Across Sleep, Relationships, Physical and Spiritual Wellbeing Restorative Sleep Improved Relationships Greater Physical Wellbeing and Connection to Spirituality Theme Three: Social, Legal and Safety Concerns Inhibit Disclosure and Confine Patients to their Homes Stigma of Disclosure Fear of Legal Implications Theme Four: Lack of Knowledge and Concerns of Side Effects Barrier to Accessing Medicinal Cannabis Treatment Limited awareness of medicinal cannabis treatment options Stigma as a barrier to treatment initiation Theme Five: Future Use Reflects Balancing Desire for Symptom Relief and Desire to Reduce Long-Term Use Satisfaction of current treatment Desire to reduce or discontinue medication as part of broader anxiety management Demographic characteristics and medicinal cannabis use information of participants Participants are identified using self-selected pseudonyms to maintain confidentiality. THC refers to tetrahydrocannabinol and CBD refers to cannabidiol. THC-dominant refers to products with a higher ratio of THC relative to CBD. mg refers to milligrams and mL refers to millilitres. Participant-reported brand names were excluded from the table. Products were classified according to their active cannabinoid content, formulation, and dose (where reported) to improve clarity and comparability. Where precise dosing information was unavailable, this is indicated as “dose not specified” Overview of themes and subthemes Reduced emotional reactivity and perceived control of anxiety symptoms Improved motivation, mental clarity and engagement with coping strategies Restorative Sleep Improved Relationships Greater Physical Wellbeing and Connection to Spirituality Stigma of Disclosure Fear of Legal Implications Limited awareness of medicinal cannabis treatment options Stigma as a barrier to treatment initiation Satisfaction of current treatment Desire to reduce or discontinue medication as part of broader anxiety management All participants described a shift in their relationship with anxiety following initiation of medicinal cannabis, characterised by greater emotional regulation, reduced reactivity, and increased perceived control. Prior to treatment, anxiety was described as overwhelming and difficult to manage, affecting daily functioning, relationships, and employment. Bob (aged 74, interview) recalled: “I was a real mess [pause] I didn’t know what to do [pause] I couldn’t do any of it, it was hard to go out or do anything.” “I was a real mess [pause] I didn’t know what to do [pause] I couldn’t do any of it, it was hard to go out or do anything.” Participants also described heightened emotional reactivity prior to treatment. Candy (aged 39, interview) stated: “It was just always stressful […] kids would do something, and I would just fly off the handle.” “It was just always stressful […] kids would do something, and I would just fly off the handle.” Following treatment initiation, participants commonly described anxiety as remaining present but becoming more manageable. In her three-month diary entry, Jemima (aged 62) described feeling “more relaxed” and “less reactive.” While Jane (aged 31, six-month diary entry) wrote that although her mental health “is not perfect,” she was “functioning much better than ever anticipated.” Fennic (aged 32, interview) explained: “It’s not like a miracle. It's not like it gets rid of it completely. It's still there and I still very much feel it. It's just that I think I have more of an emotional and mental control over it.” “It’s not like a miracle. It's not like it gets rid of it completely. It's still there and I still very much feel it. It's just that I think I have more of an emotional and mental control over it.” Some participants described being better able to engage with psychological coping strategies alongside medicinal cannabis treatment. Fennic (aged 32, three-month diary entry) described using breathing exercises to prevent acute anxiety attacks, while Bob (aged 74, interview) described using cognitive reframing during periods of panic: “That it’ll pass you know… the panic attacks or anxiety it’ll pass, and I’ll be alright sort of thing.” “That it’ll pass you know… the panic attacks or anxiety it’ll pass, and I’ll be alright sort of thing.” Participants also described greater motivation, mental clarity, and engagement in daily activities following treatment initiation. Several participants linked these changes to reduced anxiety-related mental burden and greater “headspace.” Jemima (aged 62, interview) stated: “There’s so much I need to get done and the difference is now I actually have the motivation and the headspace to do it.” “There’s so much I need to get done and the difference is now I actually have the motivation and the headspace to do it.” Beyond anxiety symptom changes, participants described perceived improvements across sleep, relationships, physical wellbeing, and spirituality. Prior to treatment, participants described disrupted sleep characterised by difficulty falling asleep, waking during the night, and waking with heightened anxiety. Following treatment initiation, eight participants described improved sleep quality, including deeper and more restorative sleep. Bob (aged 74, interview) described sleep disruption due to panic attacks prior to treatment. Following treatment, he stated: “Sleep is better and when I wake up, I get up better in the morning.” “Sleep is better and when I wake up, I get up better in the morning.” Participants commonly linked improved sleep with greater energy, emotional regulation, and improved anxiety management. Jemima (aged 62, interview) explained: “When you have a good night’s sleep, you are a different person really.” “When you have a good night’s sleep, you are a different person really.” One exception was identified, with MGJC (aged 32, interview) reporting no improvement in sleep due to concurrent medications. Participants described improved anxiety management as positively affecting interpersonal relationships and social engagement. Jemima (aged 62, three-month diary entry) stated: “I am able to engage with friends and family more calmly.” “I am able to engage with friends and family more calmly.” Amber (aged 31, interview) similarly described improved emotional regulation during social interactions: “It actually helps me not only tolerate other people around me, but me be a more tolerable person.” “It actually helps me not only tolerate other people around me, but me be a more tolerable person.” Participants who were parents commonly described greater patience with their children. Sophie (aged 36, interview) explained: “I still can get cranky with them, but the reaction is tempered to the realms of what they deserve.” “I still can get cranky with them, but the reaction is tempered to the realms of what they deserve.” Participants also described perceived improvements in physical wellbeing, which they associated with greater “mental space” and reduced psychological burden. Candy (aged 39, interview) described returning to the gym after treatment initiation, while Jemima (aged 62, interview) stated: “I just feel really well-oiled like I’ve been to the mechanics or something.” “I just feel really well-oiled like I’ve been to the mechanics or something.” Some participants also described greater feelings of meaning, connection, and spirituality. Sophie (aged 36, interview) described feeling “more spiritually guided… just happier,” and characterised treatment as giving her “a new lease on life.” Despite perceived benefits, participants described ongoing stigma and legal concerns associated with medicinal cannabis treatment. Many described reluctance to disclose treatment due to fears of judgement and negative stereotypes associated with recreational cannabis use. Bob (aged 74, interview) stated: “Because it’s an ‘illicit drug’… they think you're just a druggie sort of thing, you know. But that's not the way it is with me.” “Because it’s an ‘illicit drug’… they think you're just a druggie sort of thing, you know. But that's not the way it is with me.” Participants commonly distinguished prescribed medicinal cannabis from recreational cannabis use, emphasising therapeutic intent and responsible use. Jane (aged 31, interview) reflected on peers’ surprise regarding her treatment: “I’ve interpreted that as oh, she's not like a stoner. She's still doing life.” “I’ve interpreted that as oh, she's not like a stoner. She's still doing life.” Stigma was also described in interactions with some health professionals and influenced disclosure decisions involving family, peers, and clinicians. Participants additionally described anxiety relating to roadside drug testing and driving legislation in WA and NSW. Concerns included losing independence, employment, or the ability to respond to emergencies despite efforts to avoid driving while impaired. Bob (aged 74, interview) described feeling confined by driving restrictions: “I just feel a bit confined… that gets me really anxious and panicky.” “I just feel a bit confined… that gets me really anxious and panicky.” Participants commonly expressed frustration that legislation did not distinguish between impairment and the presence of THC in the body. Jane (aged 31, interview) stated that being able to declare her prescription during roadside testing would substantially reduce her anxiety. Participants described limited knowledge of medicinal cannabis as a barrier to treatment access. Candy (aged 39, interview) stated she had been unaware of cannabidiol (CBD) oil and would have sought treatment earlier had she known more about it. Concerns regarding side effects also contributed to initial hesitancy, particularly fears of cognitive impairment. Fennic (aged 32, interview) described uncertainty regarding potential long-term cognitive effects. Following treatment initiation, participants commonly reported minimal side effects and several expressed wishing they had commenced treatment earlier. Bloom (aged 45, interview) described feeling “more sleepy,” while Candy (aged 39, interview) described occasionally feeling “a little high” when taking excessive THC, although she described this as “very minimal.” Bob (aged 74, interview) stated: “I can function normally, the memory’s good… it doesn’t impact me in that way.” “I can function normally, the memory’s good… it doesn’t impact me in that way.” Stigma was also described as a barrier to treatment access. Bob (aged 74, interview) expressed concerns regarding being labelled a “druggie,” while Bloom (aged 45, interview) contrasted medicinal cannabis with alcohol, describing cannabis use as more socially “frowned upon.” Participants additionally described positive experiences among family members or friends as encouraging consideration of medicinal cannabis treatment. All participants expressed satisfaction with medicinal cannabis treatment and willingness to continue use in the short term. However, longer-term intentions varied, with several participants describing a desire to reduce or discontinue treatment to avoid medication reliance and strengthen self-management strategies. Amber (aged 31, interview) described reducing her dose alongside psychological support: “To be more mentally strong, so that I don’t find that I need it anymore.” “To be more mentally strong, so that I don’t find that I need it anymore.” Only one participant expressed concerns regarding potential long-term cognitive effects related to a family history of Alzheimer’s disease. Other participants were comfortable continuing medicinal cannabis alongside psychological therapies, commonly framing treatment as one component of broader anxiety management. Jane (aged 31, interview) explained: “I think it’s always going to be part of the kind of mix… whether it’s the primary kind of treating medication or not, that doesn’t really matter.” “I think it’s always going to be part of the kind of mix… whether it’s the primary kind of treating medication or not, that doesn’t really matter.” Overall, participants described willingness to continue medicinal cannabis long term if required for ongoing anxiety management.

This longitudinal qualitative descriptive study explored perceived QoL impacts among people with anxiety disorders during the first six to 12 months of medicinal cannabis treatment. Participants described perceived improvements in emotional regulation, sleep, relationships, daily functioning, and engagement in meaningful activities, while framing medicinal cannabis as a management tool rather than a cure for anxiety. However, these perceived benefits coexisted with ongoing stigma and driving-related legal concerns. Findings highlight the importance of considering QoL alongside symptom management and the role of pharmacists and other healthcare professionals in supporting patients through counselling, treatment monitoring, and stigma reduction. Further longitudinal research is needed to better understand long-term QoL outcomes and inform clinical practice and policy.

This study explored QoL experiences among people living with anxiety disorders during the year following initiation of medicinal cannabis treatment. Participants described perceived improvements across QoL domains including emotional regulation, sleep, relationships and daily functioning. Medicinal cannabis was framed not as a “cure” for anxiety, but as a management tool supporting greater agency, emotional regulation, and engagement in everyday life. These perceived benefits coexisted with ongoing stigma and roadside drug testing. Participants’ accounts align with previous quantitative and qualitative studies reporting improvements in QoL and anxiety symptoms [ 33 , 35 , 36 , 58 ] alongside ongoing experiences of stigma following treatment initiation [ 35 , 39 ]. To date, no published studies have qualitatively examined longitudinal QoL experiences among people with anxiety disorders following initiation of medicinal cannabis; this study addresses that gap. Findings from this study suggest medicinal cannabis was perceived less as a cure for anxiety and more as a tool for symptom management. Across the study, anxiety was described as remaining present but less intense and overwhelming, particularly during acute episodes where participants reported greater self-regulation and perceived control. This is consistent with previous research reporting reductions in anxiety symptoms following medicinal cannabis treatment [ 59 – 62 ]. However, unlike previous literature primarily focused on symptom reduction, this study identified broader QoL and recovery-orientated benefits, including greater self-efficacy, agency, and capacity to engage in daily life alongside ongoing symptoms. Medicinal cannabis was perceived to facilitate engagement with coping strategies, including breathing exercises and cognitive reframing, that had previously felt inaccessible. This aligns with contemporary recovery-orientated approaches in mental health, which emphasise meaningful functioning and self-management alongside ongoing symptoms [ 12 , 63 , 64 ], with medicinal cannabis positioned as one component of a broader therapeutic “toolbox.” Participants who engaged in psychological interventions alongside medicinal cannabis treatment described complementary but distinct roles, with medicinal cannabis perceived to reduce emotional overwhelm and facilitate engagement with therapeutic coping strategies. While studies suggest the combination of treatments is beneficial for post-traumatic stress disorder [ 64 , 65 ], evidence remains limited for general anxiety disorder. Our findings provide preliminary insights into how medicinal cannabis may be used alongside psychological therapies as part of broader anxiety management. This study found participants described a desire to eventually reduce or discontinue medicinal cannabis use, reflecting preferences for autonomy and reduced medication reliance rather than dissatisfaction with treatment itself. Similar concerns regarding long-term medication use and dependence have been reported in previous literature [ 65 – 67 ]. However, participants remained willing to continue treatment if needed, suggesting perceived benefits outweighed preferences to discontinue. Reported adverse effects were typically mild and not perceived to interfere substantially with daily functioning, despite previous literature identifying potential risks including worsening anxiety symptoms and cognitive decline [ 68 – 70 ]. Findings from this study suggest improvements in anxiety symptoms may support broader engagement with everyday life across social, occupational, relational, and physical domains. Sleep was among the most consistently valued changes, with improved sleep quality commonly associated with greater energy, emotional regulation, and daily functioning. These findings are consistent with broader literature [ 35 , 36 , 58 ]. Furthermore, poor sleep quality and disturbances are linked to impairments in cognitive, emotional, and interpersonal functioning, contributing to the onset and maintenance of anxiety disorders [ 71 , 72 ], and highlighting the importance of addressing sleep in anxiety management [ 73 , 74 ]. Anxiety disorders are commonly associated with social withdrawal and interpersonal difficulties [ 10 , 75 , 76 ]. Findings from this study described improved interpersonal relationships, greater emotional availability, and increased willingness to participate in social activities. While previous questionnaire-based studies have identified improvements in relationship-related QoL domains [ 36 , 58 ], this study provides insight into how participants interpreted these changes within everyday life contexts. Findings from this study suggest improvements in anxiety management extended beyond symptom relief to occupational and physical domains, including greater engagement with work, concentration, motivation, exercise, and daily routines. Our results are consistent with questionnaire-based studies reporting improvements in physical health-related quality of life following medicinal cannabis treatment [ 36 , 58 ]. Participants in this study attributed increased physical activity and functioning to reduced psychological burden and greater capacity to engage in previously unattainable routines. Despite perceived therapeutic benefits, stigma and driving-related legal concerns remained persistent sources of anxiety. In this study, participants frequently distinguished prescribed medicinal cannabis from recreational cannabis use, framing treatment in terms of legitimacy, therapeutic intent, and responsible use while also describing concerns regarding judgement and social perceptions of treatment. Similar findings have been reported among people prescribed medicinal cannabis for chronic pain and other conditions [ 35 , 39 , 77 , 78 ]. Roadside drug testing emerged as a significant source of ongoing anxiety within this study. Concerns regarding licence loss, employment and caregiving consequences, and restrictions on independence despite efforts to avoid driving while impaired were found. These findings have also been reported for patients prescribed medicinal cannabis for endometriosis [ 79 ]. Emerging evidence suggests THC-related driving impairment is complex and influenced by factors including timing, dose, route of administration, and individual variability, with impairment not reliably inferred from product strength alone [ 80 – 82 ]. However, current Australian roadside drug testing approaches, including under the Road Traffic Act 1974, primarily detect the presence of THC rather than impairment itself [ 42 , 43 ]. Consequently, patients prescribed THC-based medicinal cannabis may still face criminal penalties despite not driving while impaired, contributing to psychological distress and practical consequences reflected in participants’ accounts. Findings from this study support growing calls for impairment-based legislative approaches; however, no ‘gold standard’ measure of cannabis-related driving impairment currently exists. Ongoing research by the Victorian state government aims to better understand impairment thresholds and inform more nuanced policy responses [ 83 ]. These findings highlight the need for evidence-informed policy that maintains road safety while minimising unintended social and legal harms for patients prescribed medicinal cannabis. Findings from this study have implications for pharmacists and other healthcare professionals involved in anxiety management. As accessible healthcare professionals, pharmacists are often involved in counselling regarding medicinal cannabis administration, adverse effects, drug interactions, safe use, and treatment monitoring [ 84 , 85 ]. Consistent with broader literature emphasising QoL alongside symptom management [ 12 , 33 , 63 , 64 ], findings also highlight ongoing stigma surrounding medicinal cannabis treatment, suggesting pharmacists may help reduce stigma through evidence-informed counselling and patient education [ 84 ]. Future research could examine QoL outcomes across broader demographic, cultural, and clinical contexts and explore how experiences evolve over longer periods of medicinal cannabis treatment. Further work is also needed to develop and validate approaches to assessing driving impairment following prescribed medicinal cannabis treatment to support road safety and inform policy. A key strength of this study was the longitudinal design, which addressed a gap in the literature by qualitatively examining quality of life experiences among people with anxiety over a period of 12 months after treatment commencement. While existing research has largely relied on quantitative registry data [ 33 , 35 , 36 , 58 ], this study provides in-depth, lived-experience accounts of perceived QoL changes. The use of both diary entries and semi-structured interviews enabled contextualised insight into participants’ day-to-day experiences and allowed for reflection on change over time. This study has several limitations. As a qualitative descriptive study using reflexive thematic analysis, the findings were not intended to objectively verify participants’ accounts or establish causal relationships, but rather to provide in-depth insights into how participants made sense of their experience with medicinal cannabis treatment over time. While several strategies were employed to enhance trustworthiness, limitations remain. Credibility may have been influenced by expectancy effects, placebo-related influences, recall bias, evolving understandings of treatment, and social desirability bias, particularly given ongoing stigma surrounding cannabis use. No objective quality of life measures were collected within this qualitative component, and participants willing to participate may have held more favourable views towards medicinal cannabis treatment. To mitigate these limitations, we engaged with several clinics across Australia and offered participants multiple ways of being interviewed (both online and in person) to maximise opportunities for participation. To reduce social desirability bias, participants were offered anonymised diary entries in addition to interviews. Although confirmability was strengthened through reflexive journalling, peer debriefing, and maintenance of an audit trail, it was not possible to disentangle treatment-related changes from contextual factors such as life events or concurrent psychological therapies. Transferability may also be limited as the study involved a small purposively sampled cohort within the Australian regulatory context, where state-based legal frameworks may uniquely shape experiences of anxiety, stigma, and QoL. Although maximum variation purposive sampling was used, the sample lacked cultural and linguistic diversity, with no culturally and linguistically diverse participants included. This limits insight into how cultural beliefs, stigma, and social attitudes towards cannabis may shape experiences [ 86 ].

The burden of mental health disorders is well documented, with anxiety identified as one of the most disabling mental disorders and among the top 25 causes of disease burden worldwide [ 1 – 5 ]. Anxiety disorders are widespread, with lifetime prevalence ranging from 13.6 to 28.8% in high-income countries [ 6 ]. QoL encompasses physical, psychological, and social domains of health, influenced by an individual’s experiences, beliefs, expectations, and perceptions [ 7 , 8 ]. Anxiety disorders are associated with substantial impairments in QoL and psychosocial functioning [ 9 – 12 ]. QoL impairments associated with anxiety disorders include reduced self-esteem, poorer physical health, impaired daily functioning, and socioeconomic disadvantage [ 7 , 10 , 11 , 13 – 17 ], with comorbid mental and physical health conditions often compounding these impacts [ 2 , 15 ]. Anxiety management commonly involves psychotropic medications, such as benzodiazepines or antidepressants, and cognitive behavioural therapies [ 18 ]. Although psychotropic medications are effective in reducing anxiety symptoms [ 19 – 21 ], adverse effects including sexual dysfunction (reported in 30–50% of patients treated with selective serotonin reuptake inhibitors), weight gain, dependence, and withdrawal reactions may negatively affect QoL and contribute to treatment discontinuation [ 22 – 25 ]. Cognitive behavioural therapy is also effective, with 49.5% of patients responding post-treatment and 53.6% at follow-up, typically around six months (range one to 84 months) [ 26 – 28 ]. However, uptake of psychological therapies like cognitive behavioural therapy remains limited by barriers including stigma, low perceived need, doubts about effectiveness, cost, and long waiting periods associated with workforce shortages [ 29 – 31 ]. Consequently, as a result of these limitations some individuals may seek alternative treatments, such as medicinal cannabis [ 32 ]. Previous quantitative research has reported improvements in QoL following medicinal cannabis treatment for anxiety [ 33 – 37 ]. Arkell et al. reported sustained improvements across physical and mental health domains of the SF-36 Health Survey, a health-related QoL measure [ 36 ]. Mean score changes ranged from 6.60 points (95% CI 4.57–8.63) to 18.31 points (95% CI 15.86–20.77) across up to 15 follow-up assessments conducted at average intervals of 44.6 days [ 36 ]. Other studies have similarly reported statistically significant and clinically meaningful QoL improvements following medicinal cannabis treatment, including among people with anxiety [ 33 , 38 ]. Qualitative studies have also reported perceived anxiety symptom relief alongside experiences of stigma associated with treatment [ 35 , 39 ]. In Australia, legal and regulatory frameworks may further affect treatment engagement, particularly roadside drug testing laws under which individuals prescribed delta-9-tetrahydrocannabinol (THC) products may still face legal penalties regardless of impairment while driving [ 40 – 43 ]. Penalties may include fines, license disqualification, or imprisonment under the Road Traffic Act 1974 Western Australia (WA) [ 42 , 43 ]. Previous medicinal cannabis research has predominantly focused on post-traumatic stress disorder, with comparatively limited investigation of generalised anxiety disorder and QoL outcomes [ 34 , 44 ]. As such, gaps remain in our understanding of how medicinal cannabis use affects quality of life across different anxiety subtypes. To date, no published studies have qualitatively examined longitudinal QoL experiences among people with anxiety disorders following initiation of medicinal cannabis, limiting understanding of how perceived benefits and challenges evolve over time.

Below is the link to the electronic supplementary material. Supplementary file1 (DOCX 24 kb) Supplementary file2 (DOCX 389 kb) Supplementary file3 (DOCX 17 kb) Supplementary file1 (DOCX 24 kb) Supplementary file2 (DOCX 389 kb) Supplementary file3 (DOCX 17 kb)