Cannabis has long been one of the most commonly used drugs in the world, with people using various forms of the Cannabis Sativa plant for both medicinal and recreational purposes. According to the most recent United States (US) National Survey on Drug Use and Health, the annual percentage of cannabis use rose from 11% to 17.5% between 2002 and 2019, equating to more than 48.2 million people over the age of 12. These figures demonstrate that, for the first time in modern history, the number of cannabis users in the US has surpassed the number of tobacco consumers.
In recent years, both medical and recreational cannabis has become increasingly available. Legislative changes have introduced legal markets for cannabis and use of the drug has become increasingly acceptable in society. For example, cannabis-based medicines can now be prescribed in the UK for a wide range of conditions, including chronic pain, anxiety, post-traumatic stress disorder, and insomnia, in patients who meet relevant eligibility criteria.
Cannabis Use and Stigma
Many cannabis users may be unwilling to disclose their cannabis use to healthcare providers. This may be due to perceived bias, stigma, or a fear of consequences. Furthermore, in many instances, caregivers lack the knowledge and training to navigate conversations regarding cannabis use. Previous studies have highlighted that reluctance to disclose cannabis use may negatively impact patient care.
Stigma is defined as the negative beliefs held toward an individual or group due to specific characteristics or attributes – such as cannabis use. Cannabis use can be stigmatised as deviant behaviour, due to the widely illicit nature of the products that are used recreationally. While continued legislative reform to increase access to medical cannabis has contributed to society’s growing acceptance of the plant, stigma may persist.
The authors of a recent study aimed to determine how perceived stigma affects consumers’ willingness to disclose cannabis use in a healthcare setting.
Design and Methods of the Study
The researchers of this study used a web-based survey of cannabis users in the US. The electronic survey was distributed using newsletters, email, and social media. A total of 249 respondents who completed the survey between July and December 2022 were included in the final analysis.
In addition to demographics, the questionnaire collected route, dose, frequency and reasons for cannabis use. Furthermore, participants were asked to report if they had disclosed their cannabis use to healthcare professionals. Finally perceived, anticipated, internalised, enacted, and total stigma scores were measured using adapted versions of the Substance Use Stigma Mechanisms Scale (SU-SMS) and Substance Abuse Self-Stigma Scale (SASSS).
Primary outcomes were stigma scores and frequency of cannabis use disclosure. Secondary outcomes included cannabis use disclosure and demographic data, including the legal status of cannabis in the reported state of residence, as well as cannabis use characteristics.
Findings of the Study
Of the 249 participants, most reported residence within a state where cannabis is fully legalised for medicinal and recreational purposes (61%; n = 152), with California (15.3%; n = 38) and Colorado (11.2%; n = 28) being among the most common.
How did people consume cannabis in America?
The most common primary consumption routes reported were smoking (42.6%; n = 106), followed by vaping (20.9%; n = 52), and edibles (14%; n = 35). Most participants (71%; n = 176) reported cannabis use on most (21 or more) days of the month. Furthermore, one-third of participants (33.1%; n = 82) reported using cannabis more than three times daily, and almost half (48.4%; n =120) had been using cannabis for over 10 years. The 10 most reported reasons for cannabis use included anxiety (n = 161), pain (n = 157), sleep (n = 141), depression (n = 109), recreation/leisure (n = 88), arthritis (n = 73), post-traumatic stress disorder (n = 68), muscle spasm (n = 62), headache/migraine (n = 61), neuropathy (n = 49).
Do people tell their doctor about using cannabis?
Most respondents (77.5%; n = 193) indicated that they “sometimes” or “always” made their cannabis use known to their healthcare provider, with the patient’s comfort level with their provider being the primary reason influencing disclosure. In most circumstances, the respondent reported leading discussions around cannabis use (57.1%), as opposed to being influenced by direct inquiries from their healthcare provider (11.4%). Responses also indicated that 27.8% of the time, discussions around cannabis use were never initiated by either person.
Is cannabis use stigmatised?
Among the four stigma domains, anticipated stigma scores were the highest; the most significant concerns were that healthcare providers would treat patients differently in the future based on their cannabis use history, not listen to their concerns, or look down on them.
Enacted stigma scores were the second highest with respondents reporting that healthcare providers had treated them differently based on knowledge of their cannabis use. Perceived stigma was the third most experienced and participants most strongly indicated feelings that healthcare workers without a cannabis use history could never really understand them. Finally, internalised stigma was the least reported stigmatisation experience.
Conclusions
No statistically significant associations were detected between the frequency of cannabis use disclosure and internalised, enacted, or perceived stigma categories when measured individually. However, higher anticipated stigma scores were strongly correlated with participants indicating they never disclosed their history of cannabis use. A higher overall stigma score was also strongly correlated with never, or only sometimes, disclosing cannabis use.
Comfort level with healthcare providers was reported as being the most important influencer in the desire to disclose cannabis use, which may infer persistent discomfort for some patients. The authors note that these findings “align with prior research indicating poor communication between patients and primary care providers regarding cannabis use.” They also acknowledge a lack of awareness among providers, both in the current study and in previous studies.
The authors recommend that the current findings be used to inform the development and validation of a new cannabis-specific stigma scale and that cannabis screening is conducted in an unbiased manner, with special consideration paid to the role of anticipated stigma in influencing cannabis use disclosure.
At Curaleaf Clinic a key aim of our work is to help educate and inform healthcare professionals and the public alike to help improve knowledge on the role of medical cannabis to enable people to have open and honest conversations, leading to improved, patient-centred outcomes.
