One of our key findings was that older adults’ past experiences with cannabis as an illicit substance and the enduring stigma associated with it contribute to many believing they may be judged for consuming cannabis, even if it is for medicinal purposes. To manage stigma, participants concealed, re-framed, and re-focused their consumption, as well as proselytized to others about the benefits of medicinal cannabis. Most participants demonstrated or hinted at stigma regardless of whether they were a long-time cannabis consumer or had started consuming as an older person. Although there was variation in descriptions of stigma among participants, those who had consumed cannabis throughout their lives and those who had consumed as a youth were more likely to express the desire to conceal their consumption. Participants’ concealment to mitigate stigma parallels prior research related to mental health and chronic diseases (Corrigan & Rao, 2012; Link & Phelan, 2001, 2014; Quinn et al., 2017; Thoits, 2011). Armentor (2017), for example, reported that fibromyalgia patients concealed their symptoms and cannabis consumption from healthcare providers, family, friends, and employers for fear of stigmatization. Similar to our findings about the various forms of concealment (social avoidance, secrecy, and selective disclosure), Hathaway (2004a) and Reid (2020b) documented precautions users take to avoid broadcasting their cannabis consumption in public such as only consuming at home with familiar people; using eye drops to mask reddened eyes; and disguising odors by changing clothes after smoking, using scented products, substituting smoking with edibles, or eating mints or using mouthwash.

Another key finding was that many participants were reluctant to disclose their medicinal cannabis consumption to their healthcare professionals and those who did often encountered stigmatizing attitudes. This finding parallels previous research. Skliamis et al. (2022), for example, compared cannabis consumers’ perceptions of stigma in European countries and found that healthcare providers often held stigmatizing views about cannabis and cannabis consumers.

Our study adds to the debate regarding the intersection of medicalization and normalization, and how recreational legalization affects that debate, by exploring the post-recreational legalization landscape in Canada. Some of our participants discussed that medicinal cannabis was becoming more normalized since the legalization of recreational cannabis, and that retirement made their use more acceptable. Yet, there were still certain people who believed they had to conceal their consumption, even though it was medicinal, and others believed it had to be concealed from children and often from healthcare professionals. Normalization can be understood as a social process through which changes in thinking and behaviors are incorporated into mainstream society and also occurs in healthcare settings (May et al., 2009).

Much of the research on normalization and cannabis consumption has focused on youth and adults (Krediet et al., 2020; Mostaghim & Hathaway, 2013; Reid, 2020b; Sandberg, 2013). Reid (2020b) argues that cannabis stigma persists, and true normalization will not occur until those who do not consume cannabis no longer view those who do as deviating from normal society. However, scholars such as Sandberg have suggested that the normalization of cannabis has occurred in the “margins of mainstream society” (Sandberg, 2013, p. 65) with social stigma still occurring on both macro levels (i.e., cultural norms) and micro levels (i.e., individual experience; Reid, 2020b). This helps to explain why some of our participants were more comfortable proselytizing to others about the benefits of medicinal cannabis use and others concealed, re-framed, or re-focused their consumption.

Legalization seems to have helped legitimize cannabis consumption and reduce the perceived risks for older adults in the United States (Han et al., 2021). Baumbusch and Yip (2022) suggested that the normalization process in Canada has influenced older adults’ perceptions, making medicinal cannabis more acceptable than recreational consumption. Our participants were quick to differentiate themselves from recreational consumers, stressing that they were consuming medicinally and often under the supervision of health professionals, associating recreation use with more stigmatizations. Other scholars have also suggested that medicinal cannabis is less stigmatized than recreational cannabis (Reid, 2020b). Our study adds to this emerging body of literature by showing how older adults’ past experiences with cannabis as an illegal substance are enduring and contribute to their perceptions of stigma and varying levels of comfort with disclosure.

That many of our participants were only willing to disclose their cannabis consumption with those they felt were “safe” speaks to the continued stigmatization of cannabis, despite legalization. Moreover, the hesitancy of some participants to disclose their consumption of medicinal cannabis with their healthcare professional indicates that stigmatizing views of cannabis remain pervasive in mainstream medicine, due in part to the lack of clinical trials to determine its efficacy (Reid, 2020b). A cultural shift among healthcare professionals toward willingness to discuss possible cannabis consumption for health conditions and how it might interact with older adults’ medications is thus necessary. If older patients are unable to discuss these concerns with their healthcare providers, they may seek advice from less reputable sources that are unaware of their health conditions and prescription medications. Clearly, it is problematic that several of our participants described “self-medicating” because they were unable to discuss medicinal cannabis consumption with a healthcare provider.

Participants who engaged in re-framing or re-focusing their cannabis consumption for medical purposes did so by stressing its legality, differentiating their use from recreational cannabis as well as the type of products they consumed, as has been found in prior research (Newhart & Dolphin, 2018). This is an important distinction because most of the studies of stigma have tended to focus on the ways that consumers cognitively manage or manipulate stigma perceptions. In contrast, our finding of re-focusing stresses the importance of paying attention to the material dimensions and the way they can entrench stigma while also alleviating it for some groups. This can be understood as a social distancing mechanism achieved by altering the materiality of the products to avoid being considered recreational cannabis consumers, who were perceived as more deserving of stigma (Ashforth & Kreiner, 1999; Baumbusch & Yip, 2022; Canales, 2000; de Meis & House, 2002; Garcia et al., 2005; Meisenback, 2010).

By claiming that medical consumption of cannabis was entirely different from recreational use, participants endeavored to distinguish themselves from stereotypical recreational cannabis consumers (Bos et al., 2013; Meisenbakc, 2010) and enacted a “stigma hierarchy” (Toubiana & Ruebottom, 2022) that elevates medicinal users, while framing recreational consumers as meriting stigma. Most participants consumed CBD oil describing it as a medicinal treatment that was odorless and easy to conceal. Cannabis researchers confirm that CBD oils are the most common treatment for medical symptoms in the older adult population (Yang et al., 2021). This approach can be linked to some prior literature. Athey et al. (2017), for instance, have underscored the heterogeneity of how medical cannabis consumers define their use as medical. Accordingly, Athey, Boyd, and Cohen maintain that the boundary between recreational and medicinal use is blurred as many consumers pursue cannabis for both therapeutic and recreational effects. The authors stress that motivations for using cannabis are context-specific (pg. 226) and that usage and the meaning associated with it are variable. Thus, rather than viewing recreational and medical marijuana use as dichotomous, it should be conceptualized as “existing on a continuum” (Athey et al., 2017, p. 227).