Understanding Perceived Stigma of Patients Undergoing Medical Cannabis Treatment

Cannabis-based medical products are becoming increasingly prescribed all around the world. In fact, cannabis as a wider product is becoming more freely available in many countries, including Canada, the USA and Uruguay – with similar reforms expected to be increasingly implemented in Europe. Many countries in Europe currently permit the prescription of medical cannabis to some extent. In the UK, a legal change in November 2018 made it legal for specialist clinicians to prescribe cannabis-based products to patients with a range of medical conditions.

Despite this ongoing trend, evidence suggests that stigma around cannabis use – even for medicinal purposes – continues to be perpetuated. It is well documented that this stigma can impact the utilisation of healthcare services and negatively impact treatment. Furthermore, facing stigma can also leave patients experiencing stress, anxiety, and other mental health struggles relating to their treatment. An increasing number of studies are being carried out to better understand the therapeutic potential of cannabis medicines. 

In countries with significant experience with medical cannabis therapies, stigma has been shown to be a factor in both prescribing practices and patient perception. Yet, there remains a paucity of knowledge on the prevalence and subsequent effects on stigma on current and prospective medical cannabis patients in the UK. To address this, researchers, including those from Sapphire Medical Clinics, recently published a questionnaire study which sought to bridge this gap in knowledge. 

Existing Evidence on Stigma of Medical Cannabis Patients

A 2013 Canadian study aimed to understand, in more detail, medical cannabis users’ perceptions of and responses to the stigma attached to using cannabis-based products. The researchers found that, while patients have often been found to face stigma because of their condition, medical cannabis is one of the few treatments where patients are directly stigmatised due to their access of medicine. They also noted that the stigmatisation of their treatment could have potential negative effects on their physical and mental wellbeing, as well as the impact on healthcare interventions.

Overall, the existing evidence shows that stigma can come from healthcare officials and law enforcement, as well as friends and close relatives. Some patients describe how they had incorrectly been labelled as ‘addicts’ and accused of accessing cannabis medicines for reasons other than their legitimate health conditions. One study, which assessed medical cannabis patients in California, USA, found that perceived stigmatisation often led to delays in seeking treatment or attempts to bypass their normal medical team.

Design and Methods of Current Study

For the current study, 2,319 patients actively treated with medical cannabis products for any indication at Sapphire Medical Clinics were invited to take part in a cross-sectional questionnaire. The questionnaire was developed by a multidisciplinary group of clinicians and academics from the fields of psychology, neuroscience, and clinical medicine and was informed by the existing literature. 

The data collected was reported as either descriptive statistics or the raw responses from participants. Results were presented as a mean ± standard deviation median (interquartile range ) depending on whether the data was parametric or non-parametric. 

A total of 631 patients responded to the survey, with 450 providing complete responses (19.4% of the total patients invited to take part). 

Findings of the Questionnaire

The data collected showed that an overall majority (84.4%; n = 380) of patients believed that those who received medical cannabis treatment are subject to stigma. Nonetheless, participants remained comfortable speaking about their prescription. In fact, 81.3% (n = 366) of participants reported feeling very comfortable or comfortable telling friends, 76.9% (n = 346) telling family, and 61.3% (n = 276) telling medical professionals.

These figures presented a statistically significant difference in comfort with telling family, friends, and medical professionals. Participants largely reported that they found friends (n = 372; 82.7%) and family (n = 339; 75.3%) to be very approving or somewhat approving of the medical cannabis treatment. In contrast, participants felt that only 37.8% (n = 170) of healthcare professionals and 32.9% (n = 148) of society, in general, were very approving or somewhat approving of their treatment.

Stigma from Society in General

Participants were also asked about their perceived stigmatisation from the police or criminal justice system, and other government agencies. It was reported that 40.2% (n = 181) of participants were concerned about how they might be perceived by healthcare professionals, while 57.1% (n = 257) and 55.3% (n 249) were concerned about police or criminal justice system, and other government agencies, respectively. 

These results show a clear indication of perceived stigma by those treated with cannabis-based medicines. The majority of this perceived stigma comes from society in general, as opposed to family and friends, with a particular emphasis on government agencies, despite medical cannabis being legal since 2018. 

Discussion and Conclusions

The authors of this study note that these findings support the existing literature on this topic. As noted earlier, previous studies of other jurisdictions show that medical cannabis patients report feeling stigmatised, despite having legal access to medical cannabis. Many of the past studies, however, focus on jurisdictions where the medical cannabis sector exists alongside legal recreational markets. In these studies, it has been observed that “the co-existence of route to access CBMPs alongside recreational cannabis is a factor that increases stigmatisation.”

Nonetheless, the authors of the current study note that their data reflect a similar pattern of perceived stigma, despite the absence of a legal recreational cannabis market. Furthermore, when comparing this data to that from studies conducted in California, where medical cannabis has been legal since 1995, there remain significant concerns from patients who are wary of discussing or seeking out medical cannabis treatment. These findings highlight the need for additional strategies to improve education and awareness to address stigma, rather than relying on changing attitudes over time. 

Finally, the researchers conclude, a reduction in perceived stigma would likely lead to an increase in appropriate access to medical cannabis in the UK and around the world. They note that this would also likely increase the safety of medical cannabis products “with patients being empowered to share their full medication history with healthcare professionals.”