Objectives <p>This study examines the perceptions and lived experiences of cannabis business operators in Bangkok as they navigated Thailand’s rapid transition from decriminalization in 2022 to a subsequent medical-only regulatory reversal.</p> Methods <p>Using a qualitative design, the researchers conducted semi-structured in-depth interviews with 13 key informants in Bangkok between 2024 and 2025. Participants included retail shop operators (<i>n</i> = 8), farm operators (<i>n</i> = 3), and policy advocates (<i>n</i> = 2). Data were analyzed using the six-phase Thematic Analysis framework supported by ATLAS.ti Version 21.</p> Results <p>Five primary themes emerged: (1) Navigating Regulatory Unpredictability and Legal Uncertainty; (2) Structural Inequity and Enforcement Disparities; (3) Market Segmentation and Economic Drivers; (4) Adaptation and Survival Strategies; and (5) Socio-Cultural Perceptions and Public Health. Analysis revealed that while international tourists comprise approximately 60% of the market, domestic customers (40%) are primarily motivated by therapeutic needs. Furthermore, the study synthesized six domains for evidence-based policy, including regulatory formalization, equity promotion, and sustainable cannabis tourism development.</p> Conclusions <p>The findings highlight that regulatory instability and the absence of a comprehensive Cannabis and Hemp Act place a disproportionate burden on small Thai operators, creating structural inequities. Additionally, in the absence of formal public health infrastructure, operators have emerged as informal harm reduction actors through proactive customer education and safety guidance. These results offer actionable insights for other jurisdictions navigating similar cannabis policy transitions.</p>