Study Protocol: Cannabis in the Closet? Older Persons

Cannabis in the Closet? Older Persons’ Perceptions of Stigma and their Influence on Use and Access to Medicinal Cannabis Sherry Dahlke1* Kathleen F. Hunter2, Madeline Toubiana3, Maya R. Kalogirou4, Melissa Scheuerman5, Jeffrey I. Butler6 1 Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9. 2 Faculty of Nursing, University of Alberta, 5-293 Edmonton Clinic Health Academy 11405 - 87 Ave NW, Edmonton AB. T6G 1C9. 3 Department of Strategy, Entrepreneurship and Management, University of Alberta, 3-21D Business Building, 11203 Saskatchewan Drive NW, Edmonton AB, T6G 2R6. 4 Faculty of Nursing, MacEwan University, Edmonton, AB, Canada, 11405-87th Avenue, Edmonton, T6G 1C9, AB, Canada. 5 Medical Cannabis Manager, Alberta Craft Cannabis Inc., 5705 99 Street NW, Edmonton, AB, T6E 3N8. 6 School of Nursing, York University Centre for Aging Research and Education, Faculty of Health, York University; Faculty of Nursing, University of Alberta. HNES suite B05, 4700 Keele Street, Toronto, ON, M3J 1P3. ABSTRACT Background: Cannabis has been used for medicinal purposes for millennia. Stigma associated with cannabis use may influence older persons access to cannabis, information seeking about cannabis, and/or use of cannabis. Scant research has sought to examine the impact of older persons’ perceptions of stigma on the ways they learn about and use medicinal cannabis, with important implications for their health. Methods/Design: In this qualitative descriptive study, we will seek older persons’ information needs and challenges accessing cannabis from older persons and professionals who work in the cannabis industry. Using open ended questions, we will survey and interview older persons who use cannabis or are considering using it about their perceptions of stigma, information seeking, choice of cannabis product, and preferred vendor. Professionals who work with cannabis will be interviewed for their experiences with older persons seeking information about and access to cannabis. Discussion: Findings will identify what information related to medicinal cannabis use older Canadians most urgently need, shed light on any stigma they fear and/or experience when searching for such information, and inform the development of information products and knowledge mobilization strategies tailored to older Canadians’ knowledge needs. Keywords: social stigma, cannabis, older people * Correspondence regarding this article should be directed to Sherry Dahlke, Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9. Email: . Social Science Protocols, March 2022, 1-11. http://dx.doi.org/10.7565/ssp.v5.6760 1 1. Background 1.1 Study objectives and significance Research related to cannabis has typically focused on younger people. Although the cannabis literature defines older persons as people aged 50 or older, the World Health Organization defines them as age 60 and older (WHO, 2015). Older cannabis users are a diverse group with diverse needs, who may also hold divergent views of the stigma associated with cannabis use. Our aim in this project is to understand older persons’ fears and experiences of stigma related to cannabis and how it affects their information seeking and access to cannabis for medicinal reasons. Cannabis has both benefits and risks for older Canadians, dependent on the proportion of cannabidiol (CBD) and tetrahydrocannabinol (THC) present in the products they consume (Atakan, 2012). Older persons are more likely than younger individuals to seek cannabis for health reasons (Choi et al., 2017; Hakkarainen et al., 2019; Lum et al., 2019), but are at greater risk of experiencing negative side effects or severe health consequences (Hall, 2018; Minerbi et al., 2019). To prevent negative side effects older persons must understand how to consistently portion and dose their CBD and/or THC products each time they consume them. There is also a knowledge need associated with accessing accurate information about the form of cannabis consumed – oil, edible, vaporization, inhalant – that would be most effective for their health condition and how to safely administer it. Consuming the wrong form or dose can occur due to unclear labelling of cannabis products purchased in retail stores or through a licensed distributor, or to procuring it from an illicit seller (Wolf et al., 2020), whether directly (such as self-purchased) or indirectly (such as receiving it as a gift) (Baumbusch & Sloan Yip, 2021; Kamrul et al., 2019). Further, those who obtain cannabis from a retail store may misconstrue it as a medical grade product because of the name of the store, when in fact, it may not be (Baumbusch & Sloan Yip, 2021; Lum et al., 2019). Older users of cannabis may have perceptions of stigma surrounding cannabis to the extent that they do not engage with information seeking and may purposefully conceal their cannabis use (Kamrul et al., 2019). Stigma may cause older persons to conceal their interest or usage, or to decline discussing their cannabis use with healthcare providers. This reluctance may prevent older persons from receiving accurate information, thereby increasing the possibility of medication errors (e.g., drug interactions with other medications). As such, a significant need exists for research into this constellation of factors related to cannabis use: social stigma, older users, and cannabis use for medicinal reasons. 1.2 Cannabis: Use, stigma, and older users Cannabis is one of the most widely used illicit drugs worldwide. In Canada, most people have used it recreationally before turning 30 (Adlaf et al., 2005; Erickson et al., 2013). Yet, cannabis has been used for thousands of years to treat rheumatism, pain, sleep, inflammation, nausea, anxiety, and many other conditions (Zuardi, 2006). Some recent evidence suggests that cannabis may also be helpful in treating pain, nausea, arthritis, anxiety, sleep issues, and depression (Bachhuber et al., 2019; Briscoe & Casarett, 2018; Kamrul et al., 2019; Lum et al., 2019; Stockings et al., 2018). Cannabis has been legal in Canada for health reasons since 2001, and for recreational use since 2018 (Cox, 2018; Statistics Canada, 2018), which means that older Canadians have lived most of their lives with cannabis viewed as an illicit drug. Although “a sense of moral outrage [of illicit drug use] has relatively little basis in the pharmacological” (Roberts & Chen, 2013, p.118] properties of the drug, cannabis may well evoke that history of stigma for older users or potential users. Consequently, older Canadians may be reluctant to discuss cannabis with their healthcare provider as a means of managing their health problems. Social Science Protocols, March 2022, 1-11. 2 http://dx.doi.org/10.7565/ssp.v5.6760 It is well known that fear of stigmatization can drive behaviour and actions underground, and lead people to conceal or avoid st (...truncated)