The Colombian Medical Cannabis Paradox: A Scoping Review of Structural Barriers and Health Inequity

<b>Background:</b> Law 1787 of 2016 established Colombia's medical cannabis framework, intended as a public policy to improve health equity by guaranteeing access and promoting inclusive development. This scoping review analyzes this policy's implementation as a social determinant of health, mapping the literature on the gap between its legislative promise and its real-world impact. <b>Methods:</b> A scoping review was conducted following PRISMA-ScR guidelines across six electronic databases, selecting peer-reviewed articles (2016-2025) that analyzed the regulatory, socioeconomic, and healthcare factors acting as structural determinants in Colombia. <b>Results:</b> From 122 initial records, 10 studies were included. The analysis reveals a systemic paradox: the policy's implementation created structural barriers that undermine its equity goals. Findings highlight three gaps: (1) Inequitable Access: High costs and lack of medical knowledge create socioeconomic, rather than clinical, barriers for patients. (2) Socioeconomic Marginalization: The market model favors corporate capture, systematically excluding small-scale rural producers. (3) Policy-Driven Inequity: The regulatory framework's complexity reinforces these inequities. <b>Conclusions:</b> Colombia's medical cannabis policy implementation functions as a social determinant that produces health inequity. To align with public health objectives, policy reform must dismantle these identified structural barriers.