iRace, Medical Marijuana

Exploring Stigma as a Barrier to Medical Marijuana Treatment

By: Colleen Beichner, iRACE FSUIntern
In the United States, policy around marijuana use continues to fluctuate, with federal laws classifying it as a schedule I drug, alongside heroin, and individual states legalizing it entirely for recreational purposes (DEA, 2020). As we begin to understand more about the therapeutic benefits of marijuana use, there continues to be stigma surrounding usage (Brady et al, 2020). Stigma is an unconscious process of feeling uncomfortable or opposed to an idea, practice, group, or in this case, a substance, without thorough evidence or in spite of evidence (Link & Phelan, 2001; Goffman, 1963). This stigma is further complicated by the identities of each user, as not all users are treated the same (Roberts, 2020). It is important to address this stigma as a complex issue that is different across populations and across time periods (Roberts, 2020; Ryan & Sharts-Hopko, 2017).
Stigmas that patients often experience can include stigma from identity (perceptions based on race, gender, disability, and class based on stereotypes), legitimacy of treatment, and community discomfort around treatment (Satterlund et al, 2015). Identity based stigma may often come from providers who had preconceived ideas about who may use marijuana or qualify for treatment (Ryan & Sharts-Hopko, 2017). An example of this may be highlighted with women, as women are often not viewed as a demographic interested in consuming marijuana (Ryan & Sharts-Hopko, 2017; Gunn et al, 2015). Additionally, younger adults and minorities may be perceived as more susceptible to abusing substances or not qualifying for treatment (Ryan & Sharts-Hopko, 2017; Williams, 2016). Patients which certain disabilities may not be viewed as qualifying for care due to social perceptions. Examples of stigma around disabilities includes instances of patients who are obese, have a history of drug addiction, and those with HIV/AIDS being discriminated against for this treatment. Other forms of stigma can manifest through perceptions by providers about whether marijuana is a legitimate treatment or not (Satterlund et al, 2015). Often, general healthcare providers may not be aware of research, guidelines, or laws surrounding marijuana as a treatment in their states (Brady et al, 2020; Roberts, 2020). Providers may fear legal repercussions as well, since state laws on medical marijuana are continuously changing (Roberts, 2020).
 Patients may also find that friends and family may not support their search for this form of treatment (Brady et al, 2020). Patients often fear being labeled a “stoner” or “pothead”, often denoting laziness, lack of intelligence, and lack of impulse control (Satterlund et al, 2020). Close personal relationships are a key component to seeking care and maintaining treatment, and stigma can complicate this. When patients find that those close to them may not approve, often many avoid treatment or hide treatment to avoid conflict with those around them (Brady et al, 2020). When patients experience this stigma, there are often several consequences to their wellbeing. Many patients experience stress, anxiety, and subsequent depression after these experiences (Satterlund et al, 2015). These instances of stigma can not only pose a barrier to recover but result in new forms of harm to patients. Stress in particular can become chronic and can result in further harm to mental and physical health as well as further exacerbating existing conditions (Satterlund et al, 2015). Not only can this stigma create harm, but it can also discourage the patient and future patients from exploring medical marijuana as a treatment. Depression in particular can lead to avoiding future checkups and avoiding treatments generally (Brady et al, 2020). 
With this background in mind, it is important to note how stigma plays a role and continues to create harm when it comes to utilizing marijuana as a medical treatment (Brady et al, 2020; Satterlund et al, 2015). The stigmatization of marijuana reflects a larger issue of policy and lack of training for healthcare professionals (Brady et al, 2020; Roberts, 2020; Satterlund et al, 2015). Many patients experience this stigma and find discomfort around discussing medical marijuana use with their physicians (Brady et al, 2020; Satterlund et al, 2015). Those who experience discomfort around discussing medical marijuana often find it helpful to personally research the topic first. If possible, patients may also bring their research to their providers in order to become involved in their own care. Some providers may respond by highlighting how new marijuana is as a treatment, that it is considered experimental, that marijuana has addictive potential, or that it does not have therapeutic effects (Brady et al, 2020). In the case of providers becoming resistant or unwilling to review research with their patients, many report trying to find alternative providers, preferably those specializing in medical marijuana, though this is not always a possibility . Despite these barriers, patients find it helpful to discuss medical marijuana with a physician or healthcare provider in order to monitor their usage and develop a plan that works for them. By developing and monitoring usage, some patients report a decrease in symptoms, a reduction in side effects, and overall greater wellbeing (Brady et al, 2020). In addition, by acknowledging larger systems, the therapeutic benefits of marijuana, and the history behind this drug, we can connect these benefits to all people by challenging the stigmas associated with both these identities and marijuana as a form of treatment (Brady et al, 2020; Fornili, 2018). Keeping these goals in mind during this process can help overcome stigma for the patient, their medical providers, and others around them (Brady et al, 2020; Roberts, 2020, Fornili, 2018).

Brady, J. P., Bruce, D., Foster, E., & Shattell, M. (2020). Self-efficacy in researching and obtaining medical cannabis by patients with chronic conditions. Health Education & Behavior, 47(5), 740-748.

DEA. (2022) Drug scheduling. United States Drug Enforcement Administration.

Fornili, Katherine-Smith. (2018). Racialized Mass Incarceration and The War on Drugs: A Critical Race Theory Appraisal. Journal Of Addictions Nursing, 29(1), 65–72. https://Doi.Org/10.1097/JAN.0000000000000215

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Shuster

Gunn, A. J., & Canada, K. E. (2015). Intra-group stigma: Examining peer relationships among women in recovery for addictions. Drugs: Education, Prevention & Policy, 22(3), 281-292.

Link, B.G. & Phelan, J.C. 2001. Conceptualizing stigma. Annual Review of Sociology 27: 363–385.

Roberts, J. (2020). Medical cannabis in adult mental health settings: Reconstructing one of the most maligned medications in the United States. Clinical Social Work Journal, 48(4), 412-420.

Ryan, J., & Sharts-Hopko, N. (2017). The experiences of medical marijuana patients: A scoping review of the qualitative literature. Journal of Neuroscience Nursing, 49(3), 185-190.

Satterlund, T. D., Lee, J. P., & Moore, R. S. (2015). Stigma among California’s medical marijuana patients. Journal of Psychoactive Drugs, 47(1), 10-17.

Williams, I. L. (2016). The intersection of structurally traumatized communities and substance use treatment: Dominant discourses and hidden themes. Journal of Ethnicity in Substance Abuse, 15(2), 95-126.