"We were inundated with emails from people all over Canada from all different walks of life"

A few months before the pandemic began, Rob Whitley, an associate professor of psychiatry at McGill University, applied for funding from the Mental Health Commission of Canada.His goal was to produce three short documentaries over a two-year period focused on cannabis and mental health and how the plant can affect well-being and quality of life. Initially, the scope of the project was concentrated on Montreal but COVID-19 changed those plans.

Working alongside members of Recovery Advocacy Documentary Action Research (RADAR), a non-profit collective of academics and filmmakers who focus on mental health, Whitley and his team began recruiting Canadians from across the country, relying on both social and traditional media to get the word out.

For a moment, Whitley was unsure the project — which received $100,000 in federal support — was going to get off the ground. Then the messages started pouring in.

“We were inundated with emails from people all over Canada from all different walks of life,” he says.

“Teachers, former police officers, veterans, serving military, people working in higher education, clinicians, manual workers, one guy was a stuntman. So we were kind of surprised that suddenly people wanted to participate and we’re happy to share their story, which was a great thing for the project.”

More than a quarter of Canadians consumed cannabis in 2020 and about half said they consumed it for medical purposes. Those figures captured Whitley’s attention.

Part of his research is based on trying to understand how people recover from mental health issues. He wanted to gain insight into where cannabis fits in that equation.

“The stigmas and stereotypes surrounding cannabis users are obscuring the reality that many people from many walks of life are now using cannabis for beneficial health purposes,” he wrote in an op-ed for the Vancouver Sun last year, announcing the project.

And though his team heard back from Canadians across the country, the stigma that’s still attached to cannabis was immediately evident. Many of the respondents requested anonymity for fear of repercussions.

“I was told my testicles were going to atrophy. My kids were going to be all screwed up. I was going to get bronchitis and I was probably going to go mental and psychotic,” a medical consumer identified as Captain BD, says in the first documentary, Weeding Through The Myths: Cannabis 101. “And here I am 75 years later and so far none of those things have happened.”

Self- vs. external stigma

Whitley says that throughout the process of making the documentaries both self- and external stigma were recurring themes.

Self-stigma refers to an internalization of broader public stigma where individuals start to believe “in the negative stereotypes that have been prescribed to us.”

Self-stigma can manifest as self-sabotage, rumination and suicidal ideation, according to the National Alliance on Mental Illness.

“A lot of the people said that they had always been conditioned by their parents, schools or society to think that if you took cannabis, you were a stoner or loser or pothead. And many of the people in their interviews said that it was very tough for them to come to the realization that cannabis might actually be a helpful substance,” Whitley tells The GrowthOp from Montreal.

“And when they started taking it, they still had this internal self-stigma that they were a drug abuser, or they were doing something which was wrong and that was morally questionable. And many of them described this as a journey.”

Along that journey, many of the respondents also recounted external stigma, from their families, friends, workplaces and elsewhere.

Some Canadian veterans, for example, told Whitley they were times they wanted to consume medical cannabis to help them sleep but never would have done so, despite the fact that some forms of cannabis consumption are allowed in the Canadian Armed Forces.

“They felt they would have been judged by their superiors and would have been overlooked for promotion and put in a box and labelled in a certain way, which obviously wouldn’t happen if you were taking insulin for diabetes, or if you had a puffer for asthma,” Whitley says. “But if you’re taking cannabis, there is that judgment out there still.”

Another cannabis consumer featured in the series, identified only as ‘A’, said that they consume cannabis once in the morning and once in the evening and feel ‘high’ for about 30 minutes but found the greatest benefit in the residual effects and hours that followed.

“It’s just the relaxation, the weight that’s lifted off my shoulders, the what-if questions start to go away, I start ruminating less and just generally feel happier,” they said.

Kevin Lee, a cannabis educator and vice-president of business development at Vancouver-based ND Supplies, said that while cannabis is increasingly becoming more mainstream, “the real stigma lies in what people believe it does, or the effects that it has.”

“A lot of people who don’t understand the plant or care for the plant have spoken up about it and really helped shape the perception,” Lee says. “I think slowly but surely those walls are getting broken down, but at the end of the day, it’s hard to change people’s minds when it’s been ingrained into them. People are used to seeing cannabis negatively, and it’s going to take a long time for that to change.”

Cannabis, mental health and the unknown

Phil Tibbo, a professor of psychiatry and the Dr. Paul Janssen Chair in Psychotic Disorders at Dalhousie University, highlights that much remains unknown about the impact of cannabis on mental health and attributes this lack of clarity to prohibition.

“It’s difficult to do research on an illegal substance. And I think that’s actually prevented us from developing the knowledge base that we need to be informed,” he says in the second documentary, Medical Cannabis for Mental Health.

A 2018 study published in the Journal of Clinical Oncology found that, in a survey of more than 250 oncologists, only 30 percent of respondents felt informed to make cannabis recommendations to their patients. Four years later, there’s little evidence that much has changed.

A survey published last month in the Journal of the American Association of Nurse Practitioners found a “significant percentage of health care practitioners possess only limited knowledge about the use and efficacy of medical cannabis.”

Nearly 180 health care professionals, almost all of which hailed from California, Oregon, or Washington, states where medical cannabis has been legal for more than 20 years, participated in the survey.

In May 2020, Tibbo was a co-author on a position statement from the Canadian Psychiatric Association focused on the use of cannabinoids for mental health. The statement highlighted a lack of evidence.

“We actually still don’t have a whole lot of information, a whole lot of randomized controlled trials that have indicated any benefits with respect to the use of cannabinoids in mental illness, which, I think, surprises some people,” Tibbo says. “The number of randomized control trials is actually really quite low in this area. We’re saying there’s a lack of evidence, we’re not saying that it doesn’t have any evidence.”

Whitley also examined the relationship between cannabis and psychosis in the films.

“It’s my duty to present potential benefits and also potential harms of any modality of healing, so we did try to include in the documentaries the well-known knowledge that use of cannabis in adolescents and young people, especially under 20, heavy use of cannabis can, in a small minority of people, affect the developing brain, and has been linked in many studies to a higher risk of psychosis,” he says.

He adds, however, that the risk is localized in young people, and as the participants in the documentaries were adults, the issue was not as prominent as it may have been if the films had focused on a younger demographic.

The final entry in the series, Joint Forces, examines cannabis use among Canadian veterans.

About two weeks ago, the films were screened during an online event and put into the public domain. With hours of footage on the cutting room floor, Whitley says he and his team conducted more than 30 interviews, they will likely be revisiting the material in the future.

Throughout the process, they learned there are very few, if any, cannabis resources directed toward medical school teachers, doctors or other clinicians, like nurses, occupational therapists and researchers.

“Perhaps it’s time for somebody like me to create more educational resources about cannabis and certain target groups and then evaluate their impact and see if it can have a positive effect,” he says.

“Society is still conditioning people somewhat to think that cannabis is a gateway drug and cannabis is a problematic substance. We do need much more widespread education.”