"Those pot heads" - perceived external stigma and self-stigma among cannabis users in Germany: prevalence and associations with socio-demographics, cannabis use patterns and psychological distress.

BACKGROUND

Cannabis users have been stigmatized in the course of the long-standing prohibition. A recent law change in Germany made cannabis possession and cultivation legal for recreational use, potentially impacting stigmatization. This article aims to quantify the experience of perceived and self-stigma related to cannabis use before the law change and to explore associations with sociodemographic-, cannabis use pattern- and psychological distress-related items.

METHODS

Participants were recruited in 2023 from ISO-certified online access panels. A subsample of n = 684 regular (at least monthly) cannabis users was selected through quota-sampling based on age, gender, education, and federal state to reflect the demographic composition of the German population aged 18-64. A standardized online-questionnaire covering sociodemographics, health-related variables, cannabis use (frequency, purpose) as well as experiences of external and self-stigmatization was employed. Descriptive data analyses were performed utilizing the stigma-related items as outcome variables.

RESULTS

External Stigmatization was perceived by 30.6%, while 22.1% reported self-stigma concerning their cannabis use. Higher education, high psychological distress, medical use, and cannabis use disorder (CUD) were significantly associated with both external stigmatization and self-stigma. Respondents speaking publicly about their cannabis use show higher shares of external and self-stigma. Having been in trouble with the police regarding cannabis was positively associated with both types of stigmatization.

CONCLUSION

German residents who use cannabis at least monthly perceived external stigmatization and self-stigma related to cannabis consumption at a relevant level. As medical users and those with CUD are particularly affected, healthcare providers should be sensitized to the issue of stigmatization.