Table 4.
Themes requiring additional exploration.
| Subtheme | Subtheme description | Most representative quote | Counta |
|---|---|---|---|
| Cannabis use behaviors | |||
| Theme 18: Some veterans report taking a moderate quantity of dry cannabis or oil in the morning and/or night, in some cases cannabis alongside other substances, and experimenting with different strains of cannabis. | |||
| 18.1 Dosage and timing | Veterans report taking 2–3 g of dry cannabis or 0.5 mL of cannabis oil per day, am and/or pm. | “It’s usually after supper around 7:30 and the biggest dose I take on the THC is half a mL is what I take, and that’s enough to help me sleep through the night.” (F3, V9) | N = 2, n = 2 |
| 18.2 Polysubstance use | Veterans report using cannabis alongside alcohol or prescription medications for sleep and pain. | “Meanwhile, I was drinking and smoking marijuana the whole time.” (F2, V5) | N = 2, n = 2 |
| 18.3 Cannabis strains used | Veterans report using indicas and sativas. | “I went on my voc rehab in September and since then I’ve played around with different sativas and things. I’ve been playing around with different strains and whatnot as well to try and figure out what works better than others.” (F1, V4) | N = 1, n = 2 |
| Theme 19: Some veterans report using multiple forms of cannabis together, as well as using oils, smoking, nasal sprays, and creams. | |||
| 19.1 Multiple forms | Veterans report using multiple forms of cannabis concurrently. | “So it was basic medical marijuana. There was no fun stuff or anything like that, it was the drops and little vape pens and that was it. Oh, and tablets that had the pot inside it.” (F4, V11) | N = 2, n = 2 |
| 19.2 Oils | Veterans report using cannabis oils. | “My main go-to in the cannabis world is CBD oil.” (F3, V9) | N = 2, n = 2 |
| 19.3 Smoking | Veterans report smoking cannabis. | “I do smoke—I do smoke a fair bit of flower.” (F1, V4) | N = 1, n = 1 |
| 19.4 Nasal spray | Veterans report using cannabis nasal sprays. | “When I get migraines I’m able to manage it with—with a nasal spray meant for migraines, and with the THC it keeps it enough that I’m not going to be lying in my room with a pillow over my head for 8 hours.” (F1, V2) | N = 1, n = 1 |
| 19.5 Topical forms | Veterans report using topical cannabis products (e.g., creams). | “I and a lot of other veterans that I know get that go through Spartan Wellness is pain creams. … One is for muscles and one is for joints. … It really does help myself and many others.” (F3, V10) | N = 1, n = 1 |
| Reasons for cannabis use | |||
| Theme 20: Some veterans report the need for frequent dose adjustments of their opioid medications as a reason for switching to cannabis. | |||
| 20.1 Need for frequent dose adjustment of opioid medication | Veterans report that they had to frequently increase the dose of their opioid medication to manage their symptoms. | “The opioids are no longer working, so I go on higher and higher doses, and I was just becoming a BLOB on the couch.” (F1, V3) | N = 1, n = 2 |
| Theme 21: Some veterans report negative experiences with selective serotonin reuptake inhibitors (SSRIs) and nabilone as reasons for switching to cannabis. | |||
| 21.1 SSRIs | Veterans report negative experiences with or effects from using SSRIs to manage symptoms of depression. | “The SSRIs pretty much turned me into a sociopath. I had almost no emotional—I’m registering with almost anything it would have to be almost through the roof for me to even sort of acknowledge that there should be an emotion reacted with this, whereas with cannabis, you know, what if it’s a sad movie, I’ll cry just straight up. I mean, that’s the biggest thing I’ve noticed is that I’m actually able to feel my emotions.” (F1, V4) | N = 1, n = 1 |
| 21.2 Nabilone (synthetic THC) | Veterans report negative experiences with or effects from using nabilone. | “Initially I was on the synthetic THC. […] Nabilone, I think. I was so sick for years, couple of years, because of taking this medicine that was helping me, plus I was taking all kinds of other medicines and gabapentin. […] I had a long slew of medications and I was just desperate to … because I was so rough. I was suicidal, it was all bad. I was desperate for anything. He suggested [cannabis].” (F3, V10) | N = 1, n = 1 |
| Outcomes from cannabis use | |||
| Theme 22: Some female veterans report inconsistent effects from cannabis use, which was not reported in male participants. | |||
| 22.1 Inconsistent effects reported by females | Female veterans report inconsistent effects from using cannabis. | “So, yeah, for me it’s the only thing is barely finding a way to understand how it can help me better, because it’s very sporadic. Sometimes it helps, sometimes it doesn’t.” (F4, V12) | N = 2, n = 2 |
| Theme 23: One veteran reported cannabis interacting with other medications. | |||
| 23.1 Interactions with other medications | Veterans report having negative experiences with cannabis interacting with other medications. | “So I put in a vape and I started out like 6% THC and stuff like that, and I got up to 13% THC, and at the same time a medical condition, non-military-related one, I had new medication. Well there is a conflict between the CBD or the THC and this new medication. I ended up in hospital. So, like, this was me trying to figure out my doses.” (F2, V8) | N = 1, n = 1 |
| Facilitators of cannabis use | |||
| Theme 24: Some veterans report obtaining medicinal cannabis through online cannabis dispensaries. | |||
| 24.1 Online dispensaries | Veterans report ordering/receiving medical cannabis from private dispensaries. | “Like, I buy my stuff through Shoppers Drug Mart, which is absolutely a godsend because they’re really, really helpful. They’re kind and they will take a lot of time, especially some things when I need it because I’m just trying to navigate through this.” (F4, V11) | N = 1, n = 2 |
| Theme 25: Some veterans report receiving cannabis-related information from cannabis companies and social media platforms. | |||
| 25.1 Cannabis companies | Veterans report that their primary source of information on cannabis comes from cannabis companies. | “I wish that I had met with the people from Spectrum initially, because they’re very knowledgeable. Like, the nurse practitioner I talked to, she’s so knowledgeable, she also knows my condition, which a lot of people are very uneducated about it. Most people are. So I really appreciate that. And just having that wealth of knowledge from them is really great, and I can phone them anytime and they will answer everything and anything.” (F3, V10) | N = 1, n = 1 |
| 25.2 Social media | Veterans report that their primary source of information on cannabis comes from social media. | “I’d like to have maybe like once a month or once a week somebody sends me a notification, ‘Did you try this?’ Like, I’m on some other cannabis pages on Facebook and they talk a lot about different things.” (F4, V11) | N = 1, n = 1 |
| Stigma around cannabis use | |||
| Theme 26: Some veterans report an absence of stigma around cannabis use among fellow veterans. | |||
| 26.1 Absence of stigma among fellow veterans | Veterans report not experiencing any stigma around cannabis use from their fellow veterans. | “Yeah, I don’t think there is any negative impact, either. Like, with the friends it’s the same. A lot of them—of my friends are retired people and they’re doing it for fun or some other people are doing it for pain. So it’s something that everybody is talking about, it’s like having a beer nowadays, really. Which is a good thing, in a way.” (F4, V11) | N = 1, n = 1 |
| Theme 27: Some veterans report experiencing self-stigma (i.e., the internalization of systemic and public stigma around cannabis use) when purchasing cannabis from private medical cannabis clinics that they perceive as shady. | |||
| 27.1 Experience of self-stigma when buying cannabis from private medical cannabis clinics | Veterans report experiencing self-stigma when purchasing cannabis from private medical cannabis clinics they perceive as shady. | “I don’t like—with CannaConnect is to me it feels like it’s a shady drug deal behind, like, illegal drug deal or something because, you know, you have a doctor you’ve never met through video screen doesn’t know your history, I mean, and they’re just willing to write your prescription. It seems so, you know—it just kind of for me it plays on that stigma.” (F1, V2) | N = 1, n = 1 |
| Questions and concerns about cannabis use | |||
| Theme 28: Some veterans report having questions about how to transition from other medications to cannabis, the effects of various ratios of THC to CBD, as well as the timing of cannabis consumption. | |||
| 28.1 Transitioning from other medications to cannabis | Veterans have questions around how to transition from other medications to cannabis. | “With a treatment plan, weaning off of these, you know, terrible, terrible narcotics. I wanna see some more stuff like that. Safe transitioning centers like they’re doing for heroin in Vancouver. I mean, if there can—they can get that approved for a narcotic like heroin as a transitionary thing, I don’t see how we can have dispensaries and no treatment centers with THC CBD.” (F2, V7) | N = 1, n = 3 |
| 28.2 Amount of THC vs. CBD | Veterans have questions about the effects/consequences of different ratios of THC to CBD with respect to symptom management. | “Something I’m curious about is the THC/CBD relationship between the two and that you need to have a little bit of THC with the CBD—is that true or not? Or, like, do they need to be a bit of THC with the CBD to make it work?” (F4, V11) | N = 1, n = 3 |
| 28.3 Timing of consumption | Veterans have questions about when the best time to take cannabis is. | “I still would like to have one of you guys [health professional] tell me what to do. Take this in the morning, take this at bedtime. Like, I’d like to have just some clear direction.” (F4, V11) | N = 1, n = 1 |
aN = number of focus groups in which subtheme was endorsed; n = number of veterans who endorsed subthemes.