Weeding out the Stigma: Experiences Shared by Older Veterans

Abstract

Background: Cannabis use today is the highest it has been in three decades, approaching 36.5% prevalence for past year use (Schulenberg et al., 2017). From a 2014 nationwide sample of Veterans over 18, approximately 9% reported past year cannabis use (Davis et al., 2018). It also showed that in states where medical cannabis was legal, 41% of Veterans who used cannabis in the past year reported doing so for medical purposes. Modern research findings continue to point to medical cannabis as a potentially effective alternative to prescription medications (i.e., opioids and benzodiazepines) for treating a broad range of medical conditions. Aims: The goal of our larger study was to develop a deeper understanding of cannabis use in US older Veterans (60 years +) who are using cannabis as a substitute or complement for opioids and/or benzodiazepines. While research exists on the use levels of cannabis, to our knowledge, limited research on the perceived stigma of using cannabis among older Veterans exists. For the current study, we sought to develop an understanding of stigma associated with older Veterans using cannabis. Methodology: We surveyed 121 older Veterans who were enrolled in the Illinois Medical Cannabis Patient Program during fall 2020. We then used maximum variation sampling to select a subset of 32 Veterans who completed the initial online survey. From November 2020 to February 2021, two researchers conducted 30-minute audiotaped semi-structured interviews. Participants represented diversity regarding the age of cannabis initiation, type of cannabis user, military branch, type of healthcare provider, and race/ethnicity. Interview topics included (1) use of cannabis, opioids, and benzodiazepines, (2) interactions with medical providers, (3) stigma regarding cannabis use, and (4) educational materials for older Veterans. For the current study, we present findings from the third topic regarding stigma associated with using cannabis. The interviews were transcribed verbatim for data analysis purposes. Weekly meetings among two coders ensued to debrief on coding procedures, reflect on biases and interpretations, and reach consensus regarding coding discrepancies. The final codebook reached an 87% inter-rater reliability. Then, the two coders independently coded the transcripts and employed a rigorous thematic analysis approach using NVivo12 QSR. A narrative was woven together with exemplary quotes to illustrate major themes. Findings: We identified three stigma focused themes: (1) stereotypes regarding people who use cannabis, (2) hesitation of disclosing cannabis use with others, and (3) media portrayal (i.e., movies, television shows) of cannabis users. Implications: Stigma creates situations in which older Veterans are hesitant to disclose their use of cannabis with physicians and friends/family which can be dangerous and also socially isolating. Additionally, older Veterans may benefit from shared experiences about cannabis use for medical purposes, but this often does not occur. The empirically-based insights gained from this work have the potential to inform public health leaders, healthcare administrators, and public messaging regarding the use of medical cannabis. Additional research is needed to expand upon our findings with more generalizable methods and a representative sample of older Veterans.