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ObjectiveTo explore values and preferences towards medical cannabis among people living with chronic pain.DesignMixed-methods systematic review.Data sourcesWe searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020.Study selectionPairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain.Review methodsWe analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence.ResultsOf 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient’s use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration.ConclusionsOur findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients’ values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.

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Despite the increasing rates of substance use by women, they continue to be underreported in substance use services. Factors related to women's relationships, family responsibilities, and stigma may provide insight into some of the barriers encountered by women. This study compared men and women on general and women-predominant barriers. In addition, this study investigated whether these barriers differed among individuals who use opioids compared to those who use other substances only. In total, 100 self-identifying men and women were recruited from a substance use service in Ontario. Participants completed a questionnaire package which measured demographic information, substance use, mental health and barriers. Although men and women encountered similar general barriers, women experienced significantly more womenpredominant barriers. In addition, women reported higher levels of perceived stigmatization compared to men. Barriers did not differ among individuals who used opioids compared to other substances.

Negative affect levels (NA) are associated with psychosocial stress and poor behaviors among individuals of Latinx and African heritage (Black) backgrounds. Little is known for potentially modifiable associates of these psychiatric disorders. However, there is a significant association between NA levels, psychosocial stress, and cigarette smoking - as an increase consequence of stress-related smoking. According to Díaz-García et al. (2020), modifiable research for NA indicates health care providers related psychosocial stressors clinical interventions, behaviors, family and work stress to reduce NA levels and improve outcomes for diverse patients. This study aims to establish research as the first NA examination for 95 adult participants diagnosed with psychosocial stress disorders. Additionally, the study will identify adult cigarette smoking among individuals of African heritage (Black) and Latinx background to identify behaviors of adults diagnosed with NA.