Paper under discussion:

Perceptions of cannabis as a stigmatized medicine: a qualitative descriptive study

Joan L. Bottorff, Laura J.L. Bissell, Lynda G. Balneaves, John L. Oliffe, N. Rielle Capler and Jane Buxton (2013) Harm Reduction Journal 10:2.

In the December Qualitative Methods Journal Club (QMJC) we discussed the above titled paper on the use of cannabis for therapeutic purposes (CTP). We were fortunate to be joined by Dr Amir Englund and Dr Tom Freeman, both active researchers in the cannabis field. While discussing the published paper, our conversation covered issues regarding the use of cannabis as medicine, the routes of cannabis administration and the legislation surrounding cannabis. We also raised the following issues about the published paper:

It is clear from the title of the paper, that the article reports a qualitative study.

The goal of the study is stated upfront, at the end of the first paragraph. This helps the reader familiarise themselves with the purpose of the study. The authors include a strong rationale for conducting the study – not just to describe users’ perceptions and responses to stigma related to CTP, but to use these experiences to develop strategies for reducing stigma and supporting CTP users. Club members speculated that it would be impossible to gather these detailed insights in other ways, showing the benefit of the naturalistic approach to enquiry.

The introduction provides the background in relation to cannabis for therapeutic purposes and positions the situation regarding the use and criminalisation of cannabis in Canada, where the study was conducted. As non-Canadian readers, this context and scene setting was considered both helpful and necessary. The inclusion of literature and theory on stigma, including how stigma can have negative health effects provides a theoretical underpinning to the study.

The methods section starts with a simple overview overall study design and approach, including why the authors justify chose naturalistic inquiry. QJC members particularly liked how the authors provide important information and context to help non-Canadian audiences in the section on study setting. We discussed how the section on recruitment and sampling also provided the reader with a good level of detail on how study participants were sampled and their key demographics (including the health condition they used CTP for). However, members questioned why the sections on data collection and data analysis were comparatively shorter.

We found the results engaging and very easy to read. They were helpfully broken down into 2 key areas. In line the study goal, the first area focuses on 3 dimensions of stigma associated with CTP, and the second reports findings on how users coped with stigma associated with CTP use. The results are supported by verbatim quotations from the interviews to highlight the descriptive themes. The QJC members liked that the authors provide information on the age and medical condition of the participants as contextual information to assist the reader.

The discussion considers the implications of the findings. It suggests that people in the study were stigmatised not only for their use of cannabis, but for the illness for which they were using cannabis for. It draws on existing literature to show the reader how participants in the study managed their experience of stigma because of CTP use. The discussion also includes a summary of the study limitations – notably about the self-selecting nature of the sample, and proposes areas for future research.

The conclusion reminds the reader of the aim of the paper and summarises the key findings in line with this. In line with the journal focus, the paper ends with the implications for harm reduction.

You may also like….

Englund, A., Freeman, T.P., Murray, R.M. & McGuire, P. (2017) Can we make Cannabis Safer? The Lancet Psychiatry, 4(8):643-648.
Potter, G.R. & Chatwin, C. (2012) The Problem with “Skunk” Drugs and Alcohol Today, 12(4): 232-241.
Room, R. (2005) Stigma, social inequality and alcohol and drug use. Drug & Alcohol Review, 24: 143 – 155.


The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.

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