"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.