Cannabis has now been legalised for medicinal purposes in a number of countries and jurisdictions around the world. While federal law in the USA still prohibits the use, sale, and manufacture of cannabis products for any use – at the time of writing – 37 states now permit medical cannabis use for a wide number of conditions, including cancer. Furthermore, various other jurisdictions around the world – including the UK – also allow the prescription of medical cannabis for symptoms related to cancer, such as chemotherapy-induced nausea and vomiting.
Despite the legality of such prescriptions, evidence suggests that medical cannabis patients continue to face stigma related to their medicine. Findings suggest that medical cannabis-related stigma often influences decision-making regarding the plant, but few studies have explored this phenomenon in oncology. In the one study that has focused on this subject, stigma was identified as a significant barrier to medical cannabis use by cancer survivors. Other related studies that were focused outside of oncology have revealed that stigma is often assumed, as opposed to directly experienced, by medical cannabis patients.
In order to better understand how medical cannabis-related stigma affects cancer survivors, the authors of a recent study published in the Journal of Cancer Survivorship aimed to understand the experiences of 24 adults with cancer histories who had used medical cannabis.
Design and Methods of the Study
Researchers selected seven geographically and culturally diverse states across the USA (Arizona, California, Florida, Illinois, Massachusetts, Oregon, New York) and the District of Columbia (D.C.). that permit medical cannabis. A total of 24 individuals were recruited for the study through state-sanctioned medical cannabis dispensaries. Participants were aged 21 years or older, were certified to use medical cannabis and had a physician-verified cancer history.
The researchers conducted semi-structured telephone interviews with each of the 24 participants. Interviews included prespecified inquiries pertaining to medical cannabis-related stigma:
- “Have you experienced stigma around [medical cannabis]?”
- “If yes, from where/whom?”
- “How, if at all, has stigma affected your decisions around using [medical cannabis]?”
Qualitative research methods were then employed to analyse the transcripts.
Results of the Study
Of the participating patients, 12 (50%) had stage IV or metastatic disease, eight (33%) had early-stage diagnoses, and four (17%) were in remission. All participants used medical cannabis for the management of symptoms, including pain (n = 19), nausea/poor appetite (n = 14), anxiety/depression (n = 13), and poor sleep (n = 10).
Experiences of Medical Cannabis-Related Stigma
The researchers noted that patients referred to stigma experiences and practices frequently throughout the interview, without being prompted by the interviewer. Participants noted the phenomenon in two arenas: the medical (which is defined by the researchers as organised provision of healthcare to individuals or a community) and the personal/professional (which is defined as private life, relationships, and career). Almost all participants perceived some level of medical cannabis-related stigma in one of these arenas, however, stigma in medical settings was considerably more pervasive.
Sub-themes of medical domain stigma included the seemingly “taboo” nature of medical cannabis in clinical settings – as one participant remarked: “it’s all hush hush [in the doctor’s office]” – and unwillingness on the part of healthcare providers to discuss medical cannabis treatment. One participant even stated that a medical professional had labelled them a “substance abuser” without further exploration of their medical cannabis use and another experienced “giggling” at a medical conference after revealing their medical cannabis use. Notably, no participant denied the presence of social judgement or stigma in the medical setting.
Many patients also reported perceived stigma in personal aspects of their lives, including mixed responses from friends and family, with some being supportive of, and others opposing, their decision to use medical cannabis. Some participants explained that disapproving friends and family members saw cannabis as a “gateway drug” and any use of cannabis – even medicinal use – as a “substance use disorder”. However, a quarter of participants – all from the Eastern USA – explicitly reported the absence of stigma in their personal and professional lives. A few noted that perceptions of medical cannabis were shifting and the door to medical cannabis acceptance was “creaking open”. Nonetheless, stigma was perceived across the cancer trajectory, “including among those undergoing and those in the surveillance stage of cancer treatment.”
Internalised Medical Cannabis-Related Stigma
Internalised stigma was recognised as a persistent theme in both medical and professional/personal domains. For example, one participant noted: “[My family] probably thinks … I’m a junkie.” Another participant assumed their medical team’s response to their medical cannabis use would be negative “I didn’t want to hear [from providers], ‘well that’s foolish or you can’t plan [medical cannabis] to work.’” Another stated: “[Healthcare professionals] have a kind of moral opposition to [medical cannabis use]. I’m reading into it. I’m not quite sure if that’s really the case.”
Some participants reported responding to medical cannabis stigma – whether experienced or internalised – through partial secrecy. For example, while all participants discussed medical cannabis use in the medical setting to some extent, most discussed medical cannabis “only generally, without disclosing full details” such as mode of consumption or types of medical cannabis products used.
Many participants revealed that they were open about their medical cannabis use with a select few in their social circle but withheld information from those they feared may stigmatise their medical cannabis use. In contrast, a few participants reported that they were unphased by facing potential stigma; one noted: “Yeah [I felt stigma], but I don’t care because I’m going to get well.”
Conclusions
The findings presented by this study demonstrate that medical cannabis-related stigma was perceived by cancer patients in both medical and personal settings, though it appeared to be more prevalent in medical domains. The authors note that these findings extend earlier investigations that suggested ongoing widespread medical cannabis-related stigma, “as well as to possible early shifts in culture around medical cannabis.” Furthermore, the apparent regional differences in medical cannabis-related stigma could suggest that “local variations in legal/cultural/informational milieus might underlie these differences.”
Finally, the researchers recommend that, in order to fully understand the experiences of affected populations, “a more comprehensive study should include individuals with cancer acquiring cannabis from medical cannabis dispensaries, adult-use dispensaries as well as informal sources.”
