During the height of cannabis prohibition, admitting consumption was very risky. Not only was the identity of “cannabis consumer” tied to stereotypes such as laziness, lack of success and ambition and “a motivational syndrome”, it could result in incarceration and the strict collateral sanctions associated with a drug charge. 1
Of course, this risk was more intense for some than for others. Those who were already under close watch by law enforcement because of structural racism, as well as those who were responsible for the well being of others had to be very careful about how they were perceived by those in control of the laws. This is not to say that cannabis use was not occuring during these times, or that prohibition somehow impacted the physical and psychological effects of cannabis. Cannabis has been used as a therapeutic tool across the globe for thousands of years. In fact, its history as a dangerous, illicit narcotic is dwarfed by its history as a medicine. But, during the height of prohibition, assigning negative identities to consumers was a tactic used by the government to discourage use.
In the mid 1990s something changed. The re-emergence of medical cannabis use, fueled by the HIV/AIDS crisis and championed by LGBTQ activists resulted in an exception to the “all use is abuse mantra.” If someone had a note from their doctor supporting their cannabis use as “medical”, they were exempted from the loser stereotype and instead put in the category of “severely ill.” And the truth was that many of the early medical cannabis patients were severely ill. Cancer, HIV, epilepsy and other serious conditions were the first accepted uses of cannabis in the United States. And states like California that left it up to a patient and their doctor to decide whether cannabis was appropriate for them were accused of using medical cannabis as a guise for full legalization. Many of the early medical cannabis states had strict lists of conditions for which cannabis could be legally used. And the process of adding additional conditions was often lengthy, difficult and mired in paternalism.
Public health paternalism and cannabis identity
Paternalism is the “thinking or behavior by people in authority that results in them making decisions for other people that, although they may be to those people’s advantage, prevent them from taking responsibility for their own lives”. In the United States, we have many examples of public health paternalism. Laws restricting birth control, abortion, drug use, as well as requirements to receive welfare, drug treatment and even pain medication are developed in a paternalistic nature. The decision by state governments to supersede the views of medical professionals and limit access to medical cannabis is a clear example of paternalism. The result is a muddying of the definition of medical cannabis use, as well as confusion among consumers themselves as to whether their use is medical. Last year, I partnered with The Cannigma to dive deeper into the process of developing a medical cannabis identity.
To investigate this concept, The Cannigma conducted a survey of cannabis consumers, including the question of whether they considered their use at all medical. We know from other research that over 50% of cannabis consumers consider their use both medical and recreational. Our goal was to find consumers who considered their use recreational only, and then to dive deeper into the formation of their identities as cannabis consumers.
Once these individuals were identified from the survey, I conducted in depth interviews to learn more about their consumption and the motivations behind it. At the same time, I wanted to look at a larger sample of consumers to evaluate the relationship between self identified medical cannabis use and state-sanctioned use (having a medical cannabis card from a state program) to see if cannabis identity varied between the two groups.
The hypotheses were that 1) those who do not consider themselves medical consumers would still report therapeutic benefits to their use and that there would be commonalities in how they developed their identities as cannabis consumers and 2) those who have state-sanctioned medical cannabis identities would consider that identity more important to them than those who self-identified. The reason being that qualifying as a medical consumer in your state, an identity born out of paternalism, would require the adoption of a cannabis identity to differentiate themselves from other consumers who still wear the badge of negative stereotypes.
This is indeed what we found. Among interviewees, two themes emerged that impacted the development of their identities as cannabis consumers. First, geography and early experiences shaped their identities. Whether cannabis was allowed where they lived, what it was allowed for and their early experiences as consumers played a role in later cannabis identity. This included whether they had access to educational information about cannabis.
Second, interviewees, although claiming to be only recreational consumers, all described therapeutic benefits from using the plant, from help with sleep, to staying away from alcohol to recovery from exercise. However, since these reasons were not considered qualifying conditions in their state, they did not view that use as medical in nature. 2
When looking at the quantitative data from the New Frontier Consumer Survey, it was confirmed that those who self-identify as medical consumers largely rejected the idea that cannabis was an important part of their identity (45.6%). However, when looking just at those who have a state-sanctioned medical card, 45.5% said that cannabis was an important part of their identity.
Paternalism is a mechanism of control disguised as protecting people from themselves. Finite lists of conditions for which cannabis can be used is paternalism because it purports that 1) political leaders know more about what is best for the patient than the patient and their doctor and 2) that those who desire to use cannabis for medical purposes somehow need to be protected from their own desires. The result is not only a patchwork of access where someone with a certain medical condition is allowed access in one state but not another. It also influences how consumers see themselves, their consumption and the motivations behind it.
- Acuff, S. F., Simon, N. W., & Murphy, J. G. (2023). Effort-related decision making and cannabis use among college students. Experimental and clinical psychopharmacology, 31(1), 228–237. https://doi.org/10.1037/pha0000544
- Amanda Reiman, Joshua S. Meisel, Rielle Capler, Darcey Paulding McCready (2023), Medical cannabis identity and public health paternalism, Public Health in Practice, Volume 5, 2023, 100372, ISSN 2666-5352, https://doi.org/10.1016/j.puhip.2023.100372.
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