A study in Georgia, which recently decriminalized recreational cannabis use, reveals significant gaps in primary health care physicians’ (PCPs) knowledge and practices regarding cannabis. A survey of 246 family physicians showed that only 35.6% were familiar with cannabis legislation. Most physicians recognized mental health risks (97%) and accident risks (92.4%) associated with cannabis use, but fewer than half acknowledged its medical benefits, such as for chronic pain management. Screening for cannabis use was notably low, with only 26.6% documenting cannabis use in patient records. Additionally, 88.1% never used structured criteria to diagnose cannabis use disorders. Qualitative interviews with 10 PCPs identified barriers to effective counseling, including time constraints, stigma, and lack of training. Physicians expressed concerns that limited knowledge could hinder their ability to provide evidence-based counseling, potentially increasing public health risks. The study concludes that PCPs in Georgia are not adequately prepared to address cannabis use, suggesting a need for targeted continuing medical education and systemic interventions to improve patient care.