Negotiating the divide: Science, politics, and institutional boundaries in Swiss cannabis regulation

Aim: Cannabis policy developments worldwide typically follow separate tracks for medical and non-medical use, even in jurisdictions pursuing both forms of legalization. As these parallel regulatory frameworks evolve, understanding how stakeholders negotiate and maintain boundaries between these domains become crucial for effective policy development. Using Swiss cannabis policies as a case study, this study examines how stakeholders engage in boundary work related to medical and non-medical cannabis regulation. Methods: Thematic content analysis was conducted on qualitative interview data from 18 stakeholders involved in Swiss cannabis policy. Results: Two distinct forms of boundary work emerged. Conceptual boundary work involved using discursive methods to legitimize medical cannabis as scientific while positioning non-medical cannabis in the social/political domain. Structural boundary work manifested through institutional mechanisms, particularly health insurance reimbursement and pharmacy distribution. Insurance reimbursement served as a key structural element distinguishing medical from non-medical cannabis. However, using pharmacies as distribution points in non-medical cannabis regulatory pilot projects was identified as problematic, potentially undermining intended boundaries between domains. Conclusions: The study reveals that stakeholders engage in boundary work as a strategic tool to navigate the complexity of maintaining boundaries between medical and non-medical cannabis systems. Relying on scientific discourse to legitimize medical cannabis while keeping non-medical cannabis in the social/political sphere may create artificial distinctions that do not reflect the complex reality of cannabis use. Policymakers aiming to reduce blurred boundaries should carefully consider how policy elements may undermine intended separations between domains.