Abstract
BACKGROUND: Cannabis is increasingly part of the mental health landscape, yet clinical practice has not kept pace with patient use. Many individuals rely on cannabis for anxiety, trauma, and mood concerns, often without professional guidance. Persistent stigma, limited training, and the racialized legacy of prohibition create barriers that prevent open dialogue in therapy and undermine patient trust. MAIN BODY: This perspective highlights the disconnect between patient experiences and clinical engagement with cannabis. Drawing on historical context, clinical insight, and emerging evidence, it considers how systemic inequities and professional discomfort shape current practice. Black and Brown communities have borne disproportionate harms from cannabis criminalization, influencing how cannabis use is perceived and discussed within care settings. A harm reduction and person-centered approach provides a framework for clinicians to engage with patients in a more ethical and effective manner. This includes acknowledging cannabis use without judgment, exploring patients’ intentions and experiences, and supporting informed decisions about risks and benefits. Cultural humility and awareness of cannabis’s historical and therapeutic roles are essential to counteracting stigma and building safety in the therapeutic relationship. By moving beyond abstinence-only models, clinicians can foster transparency and trust while respecting patient autonomy. CONCLUSION: Clinicians need not endorse cannabis to engage meaningfully with patients. What is required is openness, informed practice, and recognition of the structural forces that shape patient behavior and disclosure. Approaching cannabis use as a valid subject of clinical conversation advances justice-oriented care and creates opportunities for more responsive and inclusive mental health practice.