Participants’ narratives included a predominant discourse of stigma associated with CTP use. Experiences of stigma arose in interactions with family members and close friends, as well as from others in society. The multiple dimensions of stigma associated with using CTP use identified in the data afforded a view of participants’ experiences whereby most contributed to more than one dimension. In order to achieve the benefits of cannabis use, participants had to negotiate social censorship, disapproval, threats, and isolation. Ways participants coped with and minimized their experiences of stigma associated with CTP use are also described.
Dimensions of stigma associated with CTP
Three dimensions of stigma were identified that related to negative views of cannabis as a recreational drug, illegal activity surrounding cannabis use, and layered vulnerabilities related to poverty and particular illnesses and disabilities. Each dimension is described in the following sections.
Medicine in a joint
Unlike other medications the participants used, CTP was more difficult to conceal particularly when consumed through smoking. The distinctive and often times strong smell, appearance, and behaviours associated with smoking a joint invoke negative images for some, such as the “pothead,” and have been reinforced by the media and public opinion. We use the word “joint” deliberately to highlight the stigma participants’ experienced. Dominant views of cannabis, as a recreational drug used for pleasure, to just “get high” and to escape the realities of life were perceived to make it difficult for the medicinal value of cannabis to be recognized and defended in an objective way. As a consequence, participants reported being labelled as “potheads” by their families, healthcare providers and society at large. Some were falsely accused of using CTP not for medicinal purposes but “just to have some fun” (woman, aged 45, digestive disorder). These labels positioned CTP users as irresponsible, non-contributing, and on the margins of society, unbecoming attributions participants refuted. One man (aged 45, fibromyalgia) resented “being perceived as something less than acceptable” and felt that he was unfairly judged by others specifically because of his use of CTP:
Nobody turns around and says you’re a junkie if you have terminal cancer and are on heroin. But it doesn’t matter why you’re on marijuana, [if] you’re on marijuana, “You’re a pothead and get the hell away from me.
In this example, the man reveals a comparison point whereby harder drugs such as heroin can be packaged as therapeutic and legitimate in the context of buffering the symptoms that accompany advanced disease when there is little hope of survival. Yet, cannabis is not understood as affording the same relief – rather, its use brings into question both the legitimacy of the illness and the role of smoked cannabis as a medicine. Constructions of cannabis as an addictive substance were also perceived to contribute to condemnations of its use as a medicinal drug of choice, and thereby stigmatized users. Users of CTP reported being labelled “drug addicts” and that others, including physicians, continually reminded users that cannabis was a “bad medicine” that could lead to addiction. Even when participants were prescribed other potentially addictive medications (e.g., oxycotin, sleeping pills), it was their use of cannabis that was scrutinized and criticized. Healthcare providers went as far as to offer participants counselling to “get help” with their assumed marijuana addiction.
External stigma was also reflected in the lack of trust expressed by family members as well as health professionals as a result of participants’ use of CTP. Participants reported not being believed by others when they described the medical benefits they experienced from cannabis and their requests for cannabis led to a questioning of the severity of their reported symptoms. Participants recounted that others thought they were “making things up,” “faking things” or “manipulating symptoms” to get safe access to cannabis. There was an underlying sense that participants were viewed as being unreliable, dangerous, unsavoury, and “abusing the system” when in fact, they believed they were attempting to resolve the health problems they experienced in a responsible way.
Perceptions that cannabis use “changed” people and interfered with their ability to think clearly and act responsibly also contributed to the stigmatization that CTP users experienced. Participants reported to be reluctant to tell their employers or coworkers of their CTP use, fearing that they would lose their professional status, and they and their work performance would be negatively judged.
In summary, there was consensus that the stigma associated with cannabis use negatively impacted participants’ social, professional and family ties as well as their relationships with healthcare providers. These reactions forced participants to self-regulate and withdraw from some of their social networks and resulted in social isolation, estrangement from family and friends, and for some, relocation to another city. The reactions also acted as a barrier to receiving the health care many participants needed.
Medicine on the wrong side of the law
Cannabis as a stigmatized medicine was also confounded with the fact that it is an illegal substance. Users of CTP, therefore, explained they were faced with not only being labelled as “potheads” but also criminals. They reported being viewed with suspicion and marginalized for their illegal activities associated with using CTP. One woman (aged 45, digestive disorder) indicated that she was initially hesitant to begin using CTP because of the stigma associated with cannabis as an illegal substance:
"When I first came to the compassion club it was an emotional thing for me, I cried when l left. I was like, “Oh my God, this is where my life has thrown me? I’ve lost my career. I’m in the ditch vomiting. Now this is what I have come to”. I was like, “It’s illegal! It’s illegal!” I want to be an upstanding citizen; I don’t want to be a criminal. But then, as I was realizing a little clearer what was really going on, I realized it was the biggest gift and my complete ally and then my whole concept just shifted."
Having a federal license or community-based dispensary membership card provided recognition of their need for medical cannabis and thus distinguished users of CTP from illegal recreational users. However, for some holding a license or membership card did not negate the stigma they experienced as CTP users because they felt “branded” as being involved in an apparently illegal activity, and described additional scrutiny and differential treatment that negatively impacted their lives. For example, a 55-year-old woman thought her fears would be relieved upon receiving her license from Health Canada, but instead felt much regret over the process and believed she was in a worse situation:
I thought I’d feel different but I don’t… I don’t feel as safe now because I’ve identified myself as a pot smoker where before I was anonymous and I think I was in a better position… If I had to do it over again I wouldn’t even tell my doctor, it wasn’t worth it.
Similarly, a 27-year-old man with cancer believed that since receiving his Health Canada licence, he was “discriminated upon constantly” by police who would often detain him until they verified the legitimacy of his license:
It’s all fun and games the first 10 times you do it but after, you know, you get pretty annoyed. I mean if I just had to flip them a card and walk away then that would be a little different but they’ve got to run your name. They’ve never heard of the program, they want to have it explained to them or if they have heard [of the MMAD], you know, I’ve literally had cops make me wait while they bring a couple of other cops over to look at the licence.
The inclination that those producing their own CTP might be dealers was also a site for stigma. Despite being “legal,” those that cultivated their own cannabis with licences were often harassed by local police, landlords and subsidised housing investigators. Several had been subjected to what they believed were unwarranted raids on their property and would often lose their cannabis plants in the process either due to confiscation by the police or by their own hand to conceal their gardens. One 36-year-old woman living with AIDS was repeatedly harassed by the police who were supposed to be checking the security of her residence. They wanted to see her garden and questioned the validity of her federal licence. Legal producers also had difficulty finding and keeping their housing due to landlords’ concerns about the legitimacy and impact on other tenants of their cultivation of cannabis. One participant, a man living with AIDS in a subsidised housing residence, complained that he was constantly investigated by the housing officials. He often dismantled his garden to avoid confrontation and to keep his lease despite the loss of his home-grown medicine.
Because of the current criminal sanctions associated with cannabis, participants believed their CTP use also raised suspicions and judgements about their ability to parent. Several participants feared losing custody of, or access to, their children as a result of being caught with CTP. One user of CTP (aged 34, AIDS) resented this, stating people “shouldn’t have to fear [their] kid being taken away because of [their] choice in medicine.” Being a parent, therefore, led participants to take steps to conceal their use of CTP.
Using cannabis in the context of layered vulnerabilities
For many participants, the stigmatization they experienced in using cannabis was entangled with other stigmatized vulnerabilities, such as living with a marginalized disorder (e.g., HIV/AIDS, fibromyalgia, mental illness, history of drug addiction), transitioning gender identity, being homosexual, or living in poverty. A 34-year-old man who held a federal licence, talked about the multiple stigmas he lived with which made his cannabis use less acceptable than that of others who did not have AIDS or a history of drug addiction:
It doesn’t matter how many federal licences [I have]… I’ve got the stigma of AIDS, I’ve got the stigma of an ex-junkie, okay, so I’ve got a lot of dirt in my closet that can be thrown up, right. But if one of [my brother’s] friends who don’t have this dirt, if one of those friends suddenly started smoking cannabis and he got a federal licence like me, I think it would be a little more accepted.
In this example, the man’s history of addiction prevails and the remnants of his past drug use (i.e., HIV/AIDS) locate CTP as little more than a new addiction. These vulnerabilities created challenges in accessing CTP. Requests for CTP were often questioned or not taken seriously on the basis of already suspect diagnosis and practices, and frequently resulted in long delays in accessing CTP. Other individuals who had struggled for years to get diagnosed or be referred to specialists had difficulty generating enough energy to lobby or negotiate access to CTP when healthcare providers had already labelled them “problem” patients or held judgemental attitudes about their illnesses.
Coping with stigma associated with CTP use
Choosing to continue their use of CTP because of the significant benefits experienced in relation to managing their health problems, participants engaged in a variety of coping strategies to respond to the stigma associated with CTP use. Strategies identified in this data were: keeping use of CTP undercover, convincing others of the benefits of CTP, being responsible in their use of CTP and actively defending their right to choose their own medication.
Covert use: keeping CTP use undercover
Some participants believed that with the overwhelming condemnation attributed to cannabis and the current criminal sanctions associated with cannabis in Canada, there was little they could do except be covert in their CTP use. As such, they guarded and hid their use of cannabis from others. When one 55-year-old woman was asked if she had any advice for other CTP users, she stated: “Keep your mouth shut, grow it, use it, don’t tell anybody, don’t even tell your family, don’t tell your friends, keep it to yourself and save your own life.” Individuals went to great length to cover up their CTP use, including lighting incense to mask the smell, smoking away from their home, changing their clothes after smoking cannabis, and being vigilant about who was around when they smoked.
By using CTP covertly, participants also protected themselves through self-imposed social isolation. Some isolated themselves in order to avoid criticism and feeling “guilty” about their use. Others smoked in private to avoid children seeing them smoke cannabis. One woman who isolated herself from her family explained:
I have a very difficult time convincing my family why I have to use it and it’s just got to the point where I don’t even bother talking to my family because of the fact that they just keep dissing me because I use it.. They’re old school, a drug’s a drug, that’s their mentality.
Expert use: convincing others of the benefits of CTP use
Several participants believed that the harsh judgemental attitudes they had experienced were the result of “misinformation” from the media and a general lack of knowledge of CTP. As such, several participants believed that the only way to address this was to educate and discuss the therapeutic properties of cannabis “to open other people’s eyes.” One man (aged 42, daily user, AIDS) argued that if the perception of cannabis was to change to being a therapeutic agent rather than a recreational drug, much would be improved:
It’s that stigma attached to pot, that lovely word pot has such a bad condemnation to it. Meanwhile people can pop sleeping pills left, right and center and nobody thinks anything of it. So it’s a perception. When we can change that perception of what this is and what the approach is [cannabis as therapy], the battle is half won. [It would help for] people to talk about the issue, get proper information out there, and if you can stack the seats with informed people and reach out to a community where you need to reach out to, then you can start the process.
The work of informing friends and family was often a long (but important) process of education on the part of participants. A 36-year-old woman’s experience with her mother typified this experience:
"She [participant’s mother] goes, “I think you have a problem, I think you have an addiction.” Now I looked at her and said “I’m not taking really any pain killers at all, okay, nothing, I’ve taken myself off prednisone, taken myself off the [mesalamine], not taking [acetaminophen/codeine], and you’re telling me, Mother, I’m possibly addicted to cannabis?” We had a slight fight about it [laughing] and then, of course, she changed her mind because I had to educate her, as well as many others, and now she doesn’t like to admit to that little story because now she is a full on cannabis granny, raging granny. I mean she is so supportive. Now she looks at me and she is very, very proud. She doesn’t feel I have an addiction problem in any way.
Responsible use: doing everything “right”
In an effort to reinforce the differences between recreational and therapeutic uses of cannabis, some participants cast aspersions on recreational users while exulting themselves as being a responsible user and “clean on other fronts” (aged 43, daily user, Fibromyalgia). For example, when asked how her therapeutic use compared to recreational users, one woman (aged 36, licensed user, HIV-AIDS) asserted, “They act stupid some of them…because they flaunt it, they’ll smoke it anywhere.” In contrast and as a “responsible” CTP user, she took precautions and always smoked with discretion: “I don’t flaunt it, like sit there with my arm out the window.” She identified recreational users as “pimps, pushers and, people in the criminal world” and stated they were “different” from her. A 36-year-old man (daily user, chronic back pain) believed therapeutic use was fundamentally different because “recreational people are the people who use it and giggle and laugh and joke around and then that’s it.” Participants perceived their use of CTP as “necessary” while recreational use was often strictly “social” in nature. A third participant (aged 36, daily user, HIV/AIDS) who indicated she never used cannabis recreationally stated: “I think the recreational is more for relaxation not for pain, what it’s supposed to be for, it’s more for them to party with. For us, it’s more of a life thing.” As a result of the necessity of their use of CTP, participants were very particular in how they procured their cannabis, how much they used, and when so as not to be confused with recreational drug addicts.
Leading by example was what one participant (aged 42, daily user, HIV/AIDS) believed he could do to change society’s perceptions of him and his CTP use. And while he was fully aware that he would not be able to change opinions overnight, he remained hopeful and believed that once others saw him as a responsible user, their attitudes towards him and CTP would start to change:
I can only do what I can do for myself and present myself and approach my life in the way that shows that I am not a drug addict. I am not a detriment to society. I’m actually trying to be a part of society but I am kind of running into a lot of roadblocks. I know how the world works. It happens slowly, very slowly and usually it’s one or two or three people who start and take it somewhere and then other people build on it. That’s all you can do.
Participants also attempted to control the stigma surrounding their use of CTP by being open and honest about their use. Applying for a federally-issued licence for CTP use and production, and notifying law enforcement of their CTP production were ways some participants attempted to manage their image as a responsible cannabis user.
Activist use: CTP as a human rights issue
Notwithstanding the stigma experienced for using an illegal substance therapeutically, participants continued to staunchly defend their right to choose their own medication. And despite “swimming [in a] pool with sharks” and illegally accessing CTP, many participants were committed to using CTP and helping others gain access regardless of the potential risks, including arrest and/or imprisonment. Several participants became activists in their own right and argued that neither the government nor the medical community had the right to deny them access to their “medication”, or to persecute them for using it. Doing what he felt was “logically and ethically correct in [his] heart”, one 34-year-old man living with AIDS dared the government to take away his CTP:
Screw them, I’m a free man, you know? Furthermore, I’m [now] like a 60 or 70 year old man. I’m living out my final years. Do you really think I’m going to listen to some federal regulation for Christ’s sake? I mean this is insane.
Similarly, other participants believed it was the duty and “moral ethical obligation” of Health Canada to explore the therapeutic uses of cannabis and to “open up access in order to maximize the benefits of medical cannabis in society as a whole”. Some were hopeful that through their activism, the laws surrounding CTP would eventually change and they would be able to use their medication freely and openly without fear of prosecution (woman aged 36, daily user, AIDS):
"I will get the message across, because I know it’s coming. Yeah, freedom is a right. I hope this all goes through finally [and] that we shouldn’t have to go to jail for what we believe in, for helping sick people. I don’t believe it’s a crime and I believe it’s a waste of taxpayer’s money, and the government should stay out of it. This should be a medical, a medical thing and that’s it."