Medical cannabis and stigma: A qualitative study with patients living with chronic pain

Abstract

Aims and Objectives: To explore the ways in which stigma is experienced, and what strategies are used to manage stigma among patients using medical cannabis to ease suffering from chronic pain.Background: Various jurisdictions have legalised medical cannabis in recent decades.Despite increasing prevalence and more liberal attitudes towards medical cannabis, it is possible that patients who use medical cannabis experience stigma.Design: A phenomenological qualitative study.Methods: Fifteen patients living with chronic pain and licensed by the Israeli Ministry of Health to use medical cannabis to treat pain symptoms for at least 1 year participated in semi-structured interviews. Transcribed data were analysed using thematic analysis to identify themes related to stigma. The manuscript is in correspondence to SRQR EQUATOR checklist.Results: Expressions of stigma were more related to 'felt' than 'enacted' stigma.Stigma related to decisions to delay onset of medical cannabis treatment and the ways in which participants managed medical cannabis use during their everyday lives.Participants dissociated themselves from recreational cannabis users, by presenting themselves as responsible normative individuals and engaging in a form of normalisation known as 'normification', emphasising their own discrete and controlled medical cannabis use and cannabis' benefits.Conclusions: Patients experienced 'felt' stigma which had consequences for their self-presentations and medical cannabis use. This suggests that medical cannabis is not normalised in Israel and interventions may be needed to handle stigma related to medical cannabis. Relevance to clinical practice:The findings emphasise the effects of 'felt' stigma on patients. Aiming to increase the effectiveness of medical cannabis treatment and reducing harms, we suggest that particular focus should be placed on managing stigmaThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Negative experiences of patients using medicinal cannabis: A systematic review of qualitative studies

“…Recent findings indicate that MC users are often perceived and criticised as predominantly seeking a hedonistic rather than a therapeutic effect. This may lead to social distancing and patients' tendency to conceal their use of MC (Hulaihel et al, 2022; Lewis & Sznitman, 2017; Roberts, 2020). Stigma has been shown to increase frequency of substance use (Rapier et al, 2019) and to decrease responsiveness to treatment (Crapanzano et al, 2019) in non‐MC populations.…”

Therapeutic use of cannabis in the US

“…Even in countries, such as Israel, where medical cannabis is legal and clinically available for medical use, patients report a feeling of stigma which may have subsequently delayed their use of cannabis for their symptoms. 52 Reported benefi ts of cannabis include use for pain, nausea, muscle spasm, infl ammatory conditions, seizure disorders, and gastrointestinal conditions. 53 The potential for adjunctive treatment with established medication regimens, or for a reduction in adverse reactions or burden from current medications, is of clinical consideration in otherwise diffi cult-to-treat chronic conditions such as infl ammatory bowel syndrome and fi bromyalgia.…”

“…As noted, the clinical benefits of cannabis are evident for many patient symptoms, particularly chronic pain, but evidence standards at this writing include observational, preclinical, case studies, patient report and survey, and other less rigorous evidence due in part to both the legal status and stigma associated in the US with cannabis. Even in countries, such as Israel, where medical cannabis is legal and clinically available for medical use, patients report a feeling of stigma which may have subsequently delayed their use of cannabis for their symptoms 52. Reported benefits of cannabis include use for pain, nausea, muscle spasm, inflammatory conditions, seizure disorders, and gastrointestinal conditions 53.…”

Symptom severity is a major determinant of cannabis‐based products use among people with multiple sclerosis

“…side effects and drug–drug interactions (Brown & Winterstein, 2019)), identifying patients most likely to use CBP, as well as their motivations to do so, may help healthcare providers initiate discussion with them on this issue, and provide proper guidelines and harm reduction counselling. Due to the sensitive nature of issues related to the use of (formerly) illicit substances, some patients may be reluctant to talk about their consumptions with their healthcare providers, especially physicians, or may underreport their use, by fear of stigmatisation (Hulaihel et al, 2022; Nayak et al, 2022; Troup et al, 2022). They may more openly talk about this with nurses, as the latter may have better listening skills, be less prone to top‐down decision making, and have more positive attitude toward CBP (and thus lower stigma) compared to physicians (HaGani et al, 2022; Melnikov et al, 2021; Ubel et al, 2017).…”