Since time immemorial, humankind has relied on the therapeutic use of medicinal plants based on knowledge acquired through experience and belief systems. These practices persist to the present day, and cannabis, a plant long used by our ancestors, is a case in point. The recent resurgence of interest in cannabis, driven in part by its legalization in several countries, has attracted a great deal of attention. ¹ Widely known as marijuana, cannabis is the most widely consumed illicit drug worldwide. In recent years, there has been a marked increase in the number of countries that have legalized the use of cannabis for medicinal purposes. Examples include the Netherlands (2003), Italy (2007), Colombia (2015), Australia (2016), and Puerto Rico (2017), as well as 29 states in the United States. ^{2, 3} The primary motivation behind legalization has been to facilitate the substance’s therapeutic and recreational use. ^{2, 4}

In the Netherlands, the utilization of cannabis has been confined to circumstances where conventional treatment has not yielded the anticipated response, a measure implemented to mitigate adverse effects. ³ In certain American countries, the legalization of marijuana for alternative medical purposes has been the subject of substantial controversy, as evidenced by the cases of Mexico, Colombia, and Argentina, where two generic drugs approved by the U.S. Food and Drug Administration are employed. ^{1, 5, 6}

In Peru, the use of cannabis as a therapeutic alternative is a controversial issue. In 2017, the Peruvian government officially sanctioned the use of medical cannabis; however, the corresponding regulation was not approved until two years later. Acceptance of the use of medical cannabis as a treatment has been very variable, especially in the last 10 years. ² In 2019, Law N° 30681 was approved, which regulates the medicinal and therapeutic use of cannabis and its derivatives, and establishes the General Directorate of Medicines, Inputs and Drugs (DIGEMID) as the competent authority to authorize the production, importation, commercialization and taxation of cannabis-related products. ⁷ The legalization of cannabis has raised concerns from a public health perspective, as its highly potent psychostimulant components are susceptible to abuse, leading to a number of problematic outcomes. ^{8, 9} As a result, the public perception of cannabis remains controversial, especially among more conservative demographics who associate the plant with recreational use and the potential for adverse effects.

A lack of accurate information about the use and benefits of medical cannabis has been noted among medical and non-medical personnel in Peru, and people often obtain information from non-scientific sources. ^{9– 11} The lack of clear regulations on the medical use of cannabis raises doubts about its safety and efficacy. The proposal to legalize domestic cultivation of cannabis in the country has raised doubts about the ability to control THC and CBD levels in plants. Although THC and CBD have therapeutic benefits, particularly in alleviating the side effects of chemotherapy and chronic pain, the medical use of cannabis remains controversial. The lack of scientific evidence supporting its efficacy for certain diseases and the associated risks, such as addiction and potential mental disorders, contribute to the controversy. Without proper regulation, the safety and efficacy of cannabis-derived medicines may be called into question. It is crucial to establish clear guidelines to ensure that medical professionals and alternative medicine seekers have access to reliable information when using cannabis for treatment. ²

Research has demonstrated the potential benefits of THC and CBD on health. ¹² However, the WHO does not currently recommend the medical use of CBD as an ingredient in pharmaceutical products due to insufficient studies demonstrating its safety. ¹² The WHO states that CBD provides benefits in its natural state. Consequently, evaluating perceptions concerning cannabis utilization is instrumental in identifying salient concerns and knowledge gaps. This comprehensive assessment will facilitate the development of more efficacious public health policies and educational initiatives, thereby enhancing the informed and responsible utilization of medical cannabis, and ensuring its enhanced accessibility and safety. ¹³

The majority of studies concentrate on the medical knowledge of cannabis as a therapeutic alternative. ^{11, 14– 18} In the Peruvian context, this is also the case, as it is medical personnel who should possess sufficient knowledge to prescribe it. However, only a limited number of studies have focused on the perceptions of non-medical individuals, such as adolescents and young adults. However, insights from these individuals regarding their perceptions, knowledge, and experiences with cannabis use are crucial for comprehending behavioral patterns, acceptance levels, and emerging trends in cannabis consumption. ^{19, 20}

In this context, the following research question was posed: What is the perception of the use of cannabis as a therapeutic alternative among the inhabitants of the Peruvian city of Trujillo? The study was justified by the controversy of opinions generated by its legalization in Peru. Notwithstanding the prevailing stigma associated with its addictive potential and the prevailing cultural barriers that limit its medical application, the study seeks to underscore the significance of cannabis in the health field as a therapeutic option. ²¹ The objective of the study was to evaluate the knowledge and perception of cannabis as a therapeutic alternative in the population of Trujillo. This analysis is congruent with Sustainable Development Goal 3 (Health and Well-being), as it facilitates a more profound comprehension of how the population perceives cannabis use. The findings of this study can serve as a foundation for the development of more effective public health policies and programs, with the aim of promoting the physical and mental well-being of the Trujillo community.

The sociodemographic characteristics of the surveyed population indicate that most of the subjects are young (59.6%), with a high level of education, usually university level. In terms of sex, the population is predominantly female (56.2%), and in terms of marital status, most of the subjects are single (81.2%).

As shown in Table 2, the survey results indicate a lack of general knowledge about the use of cannabis as a therapeutic alternative. While some respondents expressed being aware of its benefits and therapeutic applications, the majority showed a lack of knowledge about its presentations, recommended doses and harmful effects. Regarding the perception of Peruvian and foreign legislation, a minority of those surveyed said they were unaware of the subject. Approximately, a little more than half of the respondents expressed the belief that cannabis consumption can generate addiction and have psychoactive effects. Finally, a minority of respondents believed that medical cannabis could be therapeutically useful for children, while the majority did not consider it appropriate for this group.

As demonstrated in Table 3, the majority of respondents expressed the opinion that only specialized physicians should prescribe medical cannabis and that it is safe if used responsibly. However, opinions were divided on its overall safety and potential health risks. The majority of respondents expressed their belief that pharmacists should possess a comprehensive understanding of medical cannabis, acknowledging the potential for abuse. There was a general consensus on the need to better inform the public and support for legalization with scientific backing. However, opinions were divided on whether the use of medical cannabis can lead to the use of other drugs and whether it is a viable therapeutic alternative.

The research results indicate that sociodemographic characteristics have the potential to influence perceptions and acceptance of cannabis for medical use (see Table 1). The majority of participants were young and, consistent with other research, younger generations are more open to discussing and adopting alternative treatments such as medical cannabis. They are more open to new ideas and trends, which may lead to greater acceptance of the therapeutic use of cannabis, which was previously surrounded by taboos and misconceptions in previous generations. ^{11, 26} This inclination toward novel approaches may be attributed to the greater accessibility of knowledge through social networks, characteristic of both young people and adults. In terms of educational level, most participants had attained a university level, suggesting that they may possess a broader understanding of the subject, which could lead to a greater openness to accepting controversial issues, such as the use of medical cannabis. ²⁰ The majority of the participants possessed a university education, indicating a more extensive understanding of the subject matter and a higher propensity for acceptance of medical cannabis. However, it should be noted that this is not a definitive factor. ^{18, 27} Similarly, a lack of accurate information influences the perception of cannabis use. In this sense, the absence of educational campaigns focused on the therapeutic use of cannabis contributes to this misinformation, reflecting the urgent need to address this knowledge gap among both the general population and healthcare professionals. ¹⁷ The accessibility of the media and social networks, which often present contradictory or non-scientifically based information, which can generate confusion among the population and unequal perceptions about the therapeutic use of cannabis. Added to this is the fact that part of the population accepts it while others question it due to the lack of scientifically validated information. ²⁸

With regard to the utilization of medical cannabis (see Table 2), it was noted that 50.3% of respondents indicated a deficiency in knowledge concerning the benefits of medical cannabis, while 69.7% indicated a lack of knowledge about the risks associated with its use in terms of harmful effects. This observation suggests a general lack of knowledge about the benefits of medical cannabis among respondents, which may be related to the limited scientific evidence supporting its use. ²⁹ As Black et al. note, the paucity of scientific evidence supporting the efficacy of medical cannabis for depressive disorders reinforces the notion that the benefits of medical cannabis are not widely understood and have not been demonstrated in all cases. ³⁰ This suggests that, due to the lack of conclusive evidence, both the general population and healthcare professionals may have difficulty understanding or communicating the potential benefits of cannabis in the medical setting.

The research reveals a considerable gap in knowledge about cannabis legalization, with less than a quarter of respondents informed about it, suggesting a lack of access to information or a lack of interest in the topic. In contrast, studies in countries such as the United States show that the social and legal environment influences attitudes towards cannabis use, with greater acceptance in contexts of legalization, according to Yu et al. ³¹ Regarding the perception that cannabis can cause addiction, the results are divided: 51.2% of respondents expressed the opinion that cannabis use can cause addiction, a perception supported by Hoch et al. who indicate that a large proportion of the world’s population suffers from cannabis use disorders. ³² Furthermore, Compton et al. suggest that around 30% of users are likely to become dependent. ³³ However, this represents only a fraction of the world’s population, suggesting that not all users develop dependence or related disorders.

As demonstrated in Table 3, there is a clear division of opinion regarding the therapeutic use of cannabis. According to Sznitman, ³⁴ many of these concerns stem from the lack of solid scientific evidence, which significantly influences public acceptance of cannabis as a therapeutic option. The results of this study reflect this division, with 46.4% of participants in favor of its use for therapeutic purposes, compared to 53.6% who disagree. This division corresponds with the need for evidence-based legalization, with 90.6% of participants stressing the importance of scientific support. However, Montero et al. ³⁵ have pointed out that current support for medicinal cannabinoids remains limited and is based on preliminary or inconclusive data. Furthermore, the preponderance of respondents expressed strong support for the establishment of regulated frameworks, with an overwhelming majority agreeing that cannabis prescribing should be reserved exclusively for specialized physicians (86.7%) and that pharmacists should be required to provide comprehensive information on its use (90.3%). ³⁶ These results underscore the prevailing societal inclination toward safety and professional standards, a sentiment that persists even among those who are receptive to its legalization.

The results are important since they facilitate updating knowledge about cannabis in the population of Trujillo., in addition to contributing to the achievement of the Sustainable Development Goals. A comprehensive understanding of behaviors and knowledge concerning cannabis use is instrumental in formulating health policies that promote its safe and responsible use. These policies aim to identify and mitigate the stigmas and prejudices associated with its use, thereby fostering a more equitable and inclusive society. However, the study is not without limitations. Firstly, non-probabilistic sampling was employed, which precludes the extension of the results to the total population of Trujillo. Secondly, while the study assessed perceptions of medical cannabis, it did not analyze other contextual factors, such as cultural or socioeconomic influences, which could provide a more comprehensive perspective. Finally, the reliance on survey responses may introduce response biases or limitations in the accuracy of the results.

Valeria Gómez-Amaya: Conceptualization, formal analysis, investigation, visualization, writing – original draft preparation.

Amy Casanova-Coral: Conceptualization, data collection, investigation and methodology.

Josué Campaña-Silva: Conceptualization, data collection, investigation and methodology.

Jossuny Cubas-Namó: Conceptualization, data collection and investigation.

Jesús Namay-Rebaza: Conceptualization, data collection and investigation.

Genesis Camacho-Narvayes: Conceptualization, data collection and investigation.

Walter Rojas-Villacorta: Writing – review & editing, Supervision, Validation, Writing and funding acquisition.