What is the purpose of this study? The use of medicinal cannabis has grown significantly in Brazil. However, because many patients use these products through "compassionate use" (when traditional treatments haven't worked), there is still a lack of large-scale data on how these treatments perform in daily life. This study, called CANAREAL, aims to track patients across Brazil to understand if cannabis-based products are truly effective and safe for treating various conditions, such as chronic pain, anxiety, and depression.

How will the study work? This is an observational study, which means the researchers will not provide the medication or change the treatment prescribed by the patient's doctor. Instead, we will simply "follow" the patient's journey for 6 months.

What will participants be asked to do? Participants will complete online questionnaires at different stages of their treatment. These tools will measure:

Quality of Life: How the treatment affects daily well-being.

Clinical Evolution: Changes in pain levels, anxiety, and depression symptoms.

Safety: Whether the patient experiences any side effects (adverse events).

Why is this study important? Unlike controlled laboratory tests, this "Real-World Study" captures the reality of diverse patients with different backgrounds and health needs. The information gathered will help doctors, patients, and health authorities in Brazil better understand the benefits and risks of cannabinoid therapy, leading to safer and more informed medical decisions in the future.

Study Rationale and Context The CANAREAL study is designed as a prospective, longitudinal, observational investigation aimed at filling the gap between controlled clinical trials and the clinical reality of medicinal cannabis use in Brazil. Under current Brazilian regulations (RDC 327/2019 and RDC 660/2022), patients access cannabinoid-based products primarily through compassionate use. This study adopts a Real-World Evidence (RWE) approach to evaluate how these treatments perform across a heterogeneous population with various comorbidities and treatment regimens.

Study Design and Procedures Participants who have already been prescribed cannabis-based products by their physicians will be recruited. The study does not interfere with medical prescriptions, dosages, or product choices.

Data collection will be conducted at three specific time points over a 180-day (6-month) period:

Baseline (T0): Collection of demographic data, medical history, primary reason for cannabis use, and previous conventional treatments. Initial scores for pain, anxiety, depression, and quality of life will be recorded.

Intermediate Follow-up (T1 - 90 days): Assessment of clinical evolution and monitoring of any early adverse events.

Final Assessment (T2 - 180 days): Final evaluation of therapeutic efficacy and overall impact on the patient's quality of life.

Instruments and Measurements To ensure objective quantification of subjective symptoms, the following validated psychometric and clinical tools will be utilized:

Quality of Life: The WHOQOL-Bref (World Health Organization Quality of Life) and EUROQOL-5D scales.

Clinical Symptomatology: The Visual Analogue Scale (VAS) for pain intensity, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Safety Profile: The UKU Side Effect Rating Scale will be used to document the frequency, severity, and nature of adverse drug reactions (ADRs).

Data Management and Analysis Data will be collected via secure digital platforms (Google Forms/WhatsApp). Statistical analysis will include descriptive statistics for demographic characterization and inferential analysis (e.g., paired t-tests or non-parametric equivalents) to compare baseline scores against the 3-month and 6-month follow-ups. The study intends to identify patterns of efficacy based on the cannabinoid profile (CBD-dominant, THC-dominant, or balanced) and the specific medical conditions treated.

Ethical Compliance The study is conducted in accordance with the Declaration of Helsinki and submitted for approval by the Research Ethics Committee of the Federal University of Santa Catarina (CEP/UFSC). All participants must provide electronic Informed Consent (ICF) before data collection begins.

Inclusion Criteria:

• Patients aged 18 years or older.
• Residents of Brazil.
• Patients who have a valid medical prescription for cannabis-based products.
• Patients who are either starting a new treatment or are already using cannabinoid products under the ANVISA RDC 660/22 or RDC 327/19 regulations.
• Capability to understand and sign the Informed Consent Form (ICF).
• Access to a smartphone or computer with internet to complete the digital follow-up questionnaires.

Exclusion Criteria:

• Patients who do not agree to the terms of the Informed Consent Form (ICF).
• Patients who fail to complete the initial (Baseline/T0) sociodemographic and clinical questionnaires.
• Inability to communicate.

The study targets a diverse population of patients in Brazil who seek cannabinoid therapy for various medical conditions, primarily chronic pain, anxiety, and depression, through the pharmaceutical and clinical service flow of partner companies and clinics.

Individual participant data (IPD) collected during the study will be shared in a de-identified format.

Data access will be granted to researchers whose proposed use of the data has been formally approved by an independent review committee.

The sharing process strictly complies with the Brazilian General Data Protection Law (LGPD).

De-identified raw data concerning quality of life scores obtained through WHOQOL-Bref and EUROQOL-5D instruments. Clinical evolution scores for pain (Visual Analogue Scale - VAS), anxiety (Beck Anxiety Inventory - BAI), and depression (Beck Depression Inventory - BDI). Reported adverse events collected via the UKU Side Effect Rating Scale.

Data will be available starting 6 months after the publication of the final study results.

Data availability will end 36 months after publication.

Data will be shared through a secure file transfer or via the Zenodo repository using the de-identification standards already planned to ensure participant confidentiality.