Cannabis use within broader mental health strategies: insights from sexual and gender diverse youth

Abstract

Background

Mental health and cannabis-related inequities persist between sexual and gender diverse (SGD) youth and their non-SGD counterparts. SGD youth are at heightened risk of cannabis-related harms, which may further exacerbate existing mental health inequities. To date, research has largely adopted a deficit-based perspective, emphasizing risks and vulnerabilities. Yet, these perspectives do not capture the full range of SGD youth mental health and their experiences with cannabis use. Little is known about the efforts of SGD youth to improve or maintain a positive mental health. The present qualitative descriptive study explored the strategies that SGD youth who use cannabis undertake to promote their mental health and examined how cannabis features within these efforts.

Methods

A peer researcher conducted semi-structured individual interviews with 15 SGD youth who used cannabis and self-reported mental health issues. Data underwent collaborative inductive thematic analysis.

Results

Participants promoted their mental health by (1) seeking a safe space to foster introspection and confront emotions; (2) constructing identities and accepting one’s authentic self; and (3) managing stress and cultivating positive experiences. To achieve these goals, participants engaged, in addition to cannabis use, with interpersonal relationships, support systems, and physical and mental breaks. Participants also identified negative experiences with cannabis, including over-reliance, decreased focus, fuzzy thinking, and anxiety, pointing to therapeutic relationships, social support, and other mechanisms as longer-term pathways to mental well-being.

Conclusions

SGD youth who use cannabis do not rely solely on cannabis to manage their mental health. Rather, cannabis is integrated into a broader array of strategies aimed at achieving mental health goals. This study provides a valuable perspective on the mental health of SGD youth from a positive, strengths-based perspective. Our findings reflect the complexity of cannabis use in this population; although cannabis use may be used to cope with mental health struggles, it may simultaneously coexist with broader health-promoting strategies. This complexity underscores the need for nuanced, non-stigmatizing approaches to cannabis use in this population. These findings have the potential to inform SGD-tailored harm reduction initiatives and mental health interventions that recognize the multifaceted role cannabis can play in SGD youth’s lives.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28940-7.

Background

Inequities in mental health and cannabis use persist between youth who identify as sexual and gender diverse (SGD) (i.e., lesbian, gay, bisexual, transgender, queer and other non-heterosexual and/or cisgender identities) and their non-SGD counterparts [1–4]. SGD youth face elevated rates of depression, anxiety, suicidal thoughts, and suicide attempts [1, 4], particularly among bisexual and transgender individuals [1]. Additionally, SGD youth have among the highest rates of cannabis use and problematic cannabis use [2, 3]. Boyd et al. [2] found that, when compared to heterosexual youth, lesbian, gay, bisexual and questioning youth are two to three times more likely to report lifetime use of cannabis. Furthermore, longitudinal data show that SGD youth initiate cannabis consumption at an earlier age and tend to increase its use more rapidly compared to their heterosexual/cisgender counterparts [5, 6]. As a result, SGD youth are at heightened risk of experiencing cannabis-related harms, including anxiety and depression, psychotic disorders [7–15], as well as cognitive harms, cannabis use disorder, and dependency [8–13, 16]. Consequently, cannabis-related harms may further compound the existing mental health inequities between SGD and non-SGD youth.

Traditionally, research on SGD individuals’ mental health and substance use has mainly focused on deficits and risk factors [17]. For instance, one dominant framework for understanding mental health and substance use among SGD communities is the minority stress theory [18–20]. This theory argues that experiencing social and psychological stressors related to sexual and/or gender minority status—such as in the form of homophobia, biphobia, transphobia—may lead to mental health difficulties and substance use to cope [19, 21]. This theory aligns with research suggesting that SGD individuals may use cannabis as a form of self-medication to find comfort and alleviate the effects of discrimination and violence [22, 23]. Minority stress and the self-medication explanation offer some insights to understand cannabis use inequities, highlighting their unjust and avoidable nature. Yet these explanations do not capture the full range of experiences of SGD youth with cannabis use. There is therefore a growing interest among researchers in tackling substance use, and cannabis use realities in a more nuanced and strength-based manner. The minority strengths model [24] is an emerging lens that complements minority stress theory by emphasizing the individual and collective strengths that foster well-being. Through processes such as social support, community identification and connectedness, these strengths foster identity pride, self-esteem, resilience, positive mental health, and health-promoting behaviours [24].

Applying this lens situates substance use among SGD youth within the developmental context of adolescence and emerging adulthood—a period characterized by experimentation, identity exploration, and meaning-making—while recognizing the influence of culture, as well as meanings and benefits SGD youth perceive from cannabis use [23, 25, 26]. Rather than viewing cannabis use solely as a marker of stress and dysfunction [26], this approach encourages a critical examination of both potential benefits and harms to develop a more non-pathologizing and comprehensive understanding of SGD youth experiences. Despite growing interest in strengths-based perspectives, research examining cannabis use through this lens remains limited. Such work is particularly timely in contexts that have legalized cannabis, such as Canada, as legalization reshapes access, social normalization, and stigma around cannabis use [27, 28]—thereby transforming the context in which SGD youth engage with cannabis.

Similarly, some researchers have shifted from identifying risk factors for mental health problems toward examining the drivers of positive mental health. Within this orientation, mental health promotion is conceptualized as the abilities of individuals and communities to exert control over their mental well-being and adopt strategies to improve it, even in the context of structural barriers and adversity [29]. This perspective also emphasises the role of supportive environments and the importance of addressing social determinants that shape mental health outcomes [29, 30]. Thus, positive mental health extends beyond the mere absence of psychiatric diagnoses and is conceptualized as a resource for life and a state of psychological well-being [31, 32]. Research among youth has shown that positive mental health is influenced by positive relationships and mentors, social capital, self-efficacy and agency, personal growth, and sense of achievement [33–35].

Emerging literature highlights the critical role of SGD youth resilience and social support in fostering mental health-promoting behaviours (e.g., active coping, support seeking) and mental well-being [36–38]. However, limited research has examined the efforts of SGD youth to improve or sustain positive mental health, and even less is known about the ways in which cannabis use may intersect with these efforts. Developing this understanding is essential to contextualize substance use in a non-stigmatising manner that moves beyond the sole focus on potential harms. Moreover, examining SGD youth mental health from a strength-based perspective can inform the development of health-promoting interventions [39], thereby contributing to addressing the persistent inequities in mental health and substance use between SGD and heterosexual/cisgender youth.

Research objective

The aim of this study was to explore the strategies that SGD youth who use cannabis and self-report mental health difficulties employ to promote their mental well-being, and to examine how cannabis features within these efforts. Beyond exploring motivations for substance use, we sought to situate cannabis within the broader constellation of strategies through which SGD youth sustain and enhance their health. In doing so, this study foregrounds the agency and resilience of SGD youth and acknowledges their capacity to engage in intentional practices aimed at supporting their mental health.

Methods

Methodology

This study employed a qualitative descriptive approach [40, 41]. Qualitative description is a form of naturalistic inquiry that seeks to capture a comprehensive portrait of a phenomenon “in the everyday terms” of those experiencing it [40]. The phenomenon examined in this study was the mental health promotion strategies of SGD youth who consume cannabis.

Our goal was to stay close to the data and offer a coherent and meaningful depiction of participants’ experiences, allowing for a rich and nuanced understanding of the phenomenon [40]. Qualitative descriptive studies are also interpretive [41], requiring researchers to move from raw data toward a comprehensive portrait. This exercise ensures that the understandings derived from the analysis are grounded in participants’ experiences and that these experiences fit within the resulting portrait. The revealed meanings must be coherent and useful to engage in conversation with the existing literature and advance our understanding of the phenomenon [40]. In sum, our intention was not to test a priori theories or hypotheses. Instead, we aimed to produce a clear, data-grounded, and valuable portrait of the health promotion strategies of SGD youth at the intersection of cannabis use and mental health. This methodology was deemed appropriate for expanding the evidence base on mental health and cannabis use from a holistic perspective.

Research setting

This research was conducted in Canada, where recreational cannabis use has been legal since 2018 [42]. More specifically, this study took place in the province of Québec, which adopted one of the most restrictive cannabis regulatory frameworks in Canada. Compared with other provinces, Québec prohibits home cultivation, limits retail sales to government-run stores (the Société québécoise du cannabis—SQDC), restricts the availability of edible products, bans high-potency products, and prohibits cannabis use in all public spaces [43–45]. Québec also has the highest legal age for purchasing and possessing cannabis in Canada, set at 21 years [43, 46]. Despite these age restrictions, a recent portrait of cannabis use in Quebec found that 22% of youth between 15 and 20 years old report cannabis use [47]. In terms of mental health outcomes, a survey on the psychological health of adolescents and young adults in Quebec found that 42% of youth between 12 and 25 years have anxiety or depression symptoms [48].

Recruitment strategies and participants

In 2021, our team conducted a photovoice study [49] on the perspectives and experiences of SGD youth at the intersection of mental health challenges and cannabis use. Participants for this study were recruited through community organizations, social media and snowball technique. A year later, for the present study, individuals who had participated in the photovoice study (n = 46) were re-contacted through participant registries and invited by email to participate in a new follow-up interview, using convenience sampling aiming for maximum variation in terms of gender, sexual orientation, and cannabis use profiles. Interested individuals completed a short sociodemographic form. Sexual orientation and gender identity were assessed using a fixed list of options with a write-in “other” field, allowing participants to self-identify beyond predefined categories. For the photovoice study and the current study, we recruited people aged between 15 and 24 years old, following UN youth definition [50]. Other eligibility criteria included: residing in Quebec; reporting current cannabis use (at least occasionally); self-identifying as SGD; and self-reporting mental health issues (diagnosed or not). We intentionally included participants regardless of whether they had received a formal diagnosis. SGD individuals face multiple barriers to accessing mental healthcare, including discrimination, financial constraints, long wait times, and a lack of affirming services [49, 51]. As a result, a formal diagnosis is not a reliable indicator of mental health need within this population. Restricting eligibility to those with a formal diagnosis would have systematically excluded individuals experiencing significant, yet undiagnosed, mental health difficulties and introduced a bias toward those with greater access to healthcare. We recruited a diverse group of youth, varying in demographic profiles, gender identity, and cannabis use profiles. Recruitment was conducted by an SGD peer researcher (author KW). In the context of this study, the peer researcher was a SGD youth with lived experience relevant to the study topic who received training in qualitative research and public health. The peer researcher had previously established rapport with participants during the photovoice study and was well-positioned to facilitate recruitment and engagement. They participated in all stages of the study, including the drafting of this manuscript.

A total of 15 SGD youth (mean age = 22 years) agreed to participate. Regarding gender identity and gender modality, six participants identified as cisgender women, one participant as a cisgender man, one participant as non-binary, two as trans women, one as a trans man, and four as trans nonbinary. In terms of sexual orientation, most participants identified as queer, followed by bisexual and pansexual. In terms of cannabis use, a third of participants used every day, slightly more than a quarter several days a week, and two-fifths either once a week or occasionally (i.e., every two or more weeks). Nine participants reported having received a mental health diagnosis, with anxiety being the most frequent one (see Table 1).

Table 1.

Participants’ demographic characteristics

	n = 15
Mean age (range)	22 (16–25)
Gender	n (%)
Trans women	2 (13.3)
Trans men	1 (6.7)
Trans non-binary	4 (26.7)
Cisgender women	6 (40)
Cisgender men	1 (6.7)
Non-binary	1 (6.7)
Sexuality	n (%)
Bisexual	4 (26.7)
Queer	9 (60)
Pansexual	2 (13.3)
Frequency of cannabis consumption	n (%)
Every day	5 (33.3)
A few times a week	4 (26.7)
Once a week	3 (20)
Occasionally	3 (20)
Self-reported mental health issue(s) a	n (%)
Anxiety	7 (46.7)
Depression	1 (6.7)
Post-traumatic stress disorder	1 (6.7)
Premenstrual Dysphoric Disorder	2 (13.3)
Personality disorder	1 (6.7)
No formal diagnosis	6 (40)

^a Numbers do not add up to the total because participants could self-report to more than one mental health diagnosis

Data collection

Once participants provided their verbal consent, the peer researcher conducted online semi-structured individual interviews between September 2022 and January 2023. During the interview, participants were invited to discuss their cannabis use and the changes they perceived since participating in the photovoice study. These questions covered topics such as use frequency, habits, perception of use control, harm reduction behaviours, use motives, cannabis effects, and perceptions of cannabis use. Participants were also asked to share their perspectives on their mental well-being, especially regarding strategies to cope with their mental health struggles and the mental health effects of cannabis. The peer researcher conducted the interviews as purposeful conversations using the interview guide flexibly as a reference. The interview guide (see Additional file 1) was developed specifically for the present follow-up study and covers multiple topics; the present paper focuses on findings pertaining to mental health promotion strategies, which emerged as the most salient themes relative to our research objective. Interview duration ranged from 45 to 90 min. All interviews were audio recorded and transcribed verbatim. Participants were given an honorarium of CAD$40 for their time and contribution to the study.

Data analysis

Interview transcripts underwent collaborative inductive thematic analysis, following the approach outlined by Braun and Clarke [52]. Initially, three members of the research team familiarized themselves with the data with multiple readings of transcripts. Then, we inductively developed initial codes, which were later organized into a codebook. The codebook enabled the interview transcripts to be fractured into data related to cannabis use (e.g., consumption habits, motives, relationship with cannabis, socialization, harm reduction), mental health (e.g., social support, stigma, coping, service access), and sexuality/gender (e.g., socialization, cannabis and queerness interplay). Then, codes were extracted and collated into preliminary categories related to the research question. Codes and supporting quotes were then read and re-read to construct themes iteratively, capturing emerging meanings, patterns, recurring ideas, and shared realities among participants. During this phase, bi-weekly meetings between the coders were held to debrief and collaboratively develop the analysis. Saturation was determined by consensus between coders. In the event of disagreements, coders engaged in discussion until consensus was reached. Unresolved disagreements were brought to the broader research team and the peer researcher for deliberation. The resulting themes were then presented as thematic maps to the research team and the peer researcher, who provided feedback and critical final comments. The analysis was performed using NVivo.

Positionality statement

The research team brought diverse positionalities in terms of sexual and gender identities, race and ethnicity, career stage (trainees and professors), and lived experiences with cannabis use and mental health, and included both queer researchers and allies. We shared a commitment to health equity, understanding inequities affecting SGD communities as socially produced rather than as individual deficits. Accordingly, we approached cannabis use not as inherently problematic, but as a complex social practice shaped by developmental, relational, and structural contexts. We viewed SGD youth as possessing significant individual and community strengths, considering their lived experiences and expertise as valuable resources for informing health promotion and harm reduction. These commitments shaped our interpretation of the findings and our emphasis on understanding cannabis use within the broader context of SGD youth’s lives.

Strategies to ensure trustworthiness

To foster trust and honesty among participants, participants were given the option to skip questions or withdraw from the study at any point without consequences. The strong rapport established between the participants and the peer researcher further facilitated an open environment for truthful responses. The rigour of our analysis was enhanced by the alignment between our research objectives and the chosen methodology and methods, as well as through frequent debriefing meetings during the analysis. Additionally, the peer researcher recorded field notes during and after interviews, capturing contextual observations that informed debriefing discussions. Finally, using a qualitative analysis software ensured a data-oriented audit trail. Together, these strategies reinforced the credibility, transferability, confirmability, and dependability of the study [53].

Results

Our analysis revealed that participants adopted active approaches to promote their mental well-being. Specifically, we identified three key strategies: (1) Seeking a safe space for introspection and emotional confrontation; (2) Constructing identities and accepting one’s authentic self; and (3) Managing stress and cultivating positive experiences. The following section discusses how cannabis use features with other practices to jointly support participants’ mental health.

Seeking a safe space for introspection and emotional confrontation

Participants described an inward process through which they sought a safe space to acknowledge and confront their emotions, fostering self-reflection and introspection. A safe space was defined as a supportive mental or interpersonal environment where participants felt secure and free of judgment. In such spaces, participants could relax and reduce the psychological inhibitions and mental blockages that hindered the full experience of certain thoughts or feelings. Participants valued softening such inhibitions because it allowed them to confront challenging and uncomfortable emotions, creating an environment conducive to self-exploration and introspection.

Cannabis use aligned with this pursuit, as participants felt it freed them from apprehensions about destabilizing thoughts or emotions. Cannabis use emerged as a tool for confronting fears and delving into their emotions, as illustrated by the following participant: “[Cannabis] does help me relax, but it also helps me think about things that I’m usually scared to think about. (…) Cannabis allows me to confront things personally in my own mental space.” (22 years, cisgender woman, queer).

Evident in this participant’s experience is how cannabis, beyond relaxation, facilitated a mental state which helped her face and manage complex thoughts, feelings, and situations. By creating this safe space, participants felt they were more able to manage and regain control over their mental health, thereby improving their overall well-being. The following quote illustrates this notion:

I really see weed more (…) as a drug that confronts me, it’s good for me sometimes (…) to be confronted with my anxiety and to overcome it (…) I can chill out and smoke weed and when it confronts me, well, I can overcome these anxieties and it feels good. (25 years, trans woman, pansexual).

Confronting emotions was valuable to participants because it paved the way for introspection. Participants appreciated and actively sought resources for self-exploration because it allowed personal growth and a better understanding of themselves. To illustrate this, a participant described how cannabis provided her with resources in terms of introspection and reflection, which she identified as particularly valuable as a person experiencing mental health challenges:

[Cannabis] provides a safe space for someone with mental health [difficulties], it provides resources, it provides a sounding board, it provides a reflection, and it allows you to introspect and come to your own conclusion. A lot of these things I was able to do with consuming cannabis. (22 years, cisgender woman, queer)

However, some participants commented that excessive cannabis consumption impaired their capacity to reflect and think, resulting in what they described as “brain fog”—characterized by mental blockage, poor focus, fuzzy thinking and feeling stuck in one’s thoughts:

That like overreliance on [cannabis] and the frequency at which I was consuming it definitely tipped the line towards not helpful anymore (…) It’s not a pleasant feeling to feel like I’m trying to swim in my own mind (…) Just like being that high or suffering from the after effects and feeling I’m like walking through mud instead of just walking on the pavement. (23 years, cisgender woman, queer)

The previous experience illustrates that relaying solely on cannabis and its excess consumption may diverge from participants’ quest for introspection and emotional confrontation. Thus, cannabis was not the sole element that facilitated the creation of a safe space. Access to a mental health professional and interpersonal relationships also enabled emotional confrontation and engagement in introspection. For instance, participants who had access to a mental health professional valued the support and safety provided by these care providers, which is reflected in the following participant experience: “But knowing that there was someone [psychologist] taking care of me, it allowed me to have like an extra life net all the time. (…) we set up anchors” (25 years, trans woman, pansexual). Mental health care also supported the confrontation of emotions, self-exploration and self-understanding, as illustrated by these experiences:

I think I’ve been in therapy enough to know how to understand my own emotions. (20 years, trans non-binary, bisexual)

I think the therapist was good (…) I think the method that she was using, which was mainly just like talk therapy, a little bit of CBT [cognitive behavioural therapy], stuff like that was helpful to some extent. (…) And she has been so informative in like how my body reacts to stressors and like trauma and stuff like that and like that has been so enlightening. (23 years, trans non-binary, queer)

Interpersonal relationships and a sense of community also contributed to safe spaced for introspection and emotional confrontation. These relationships enabled participants to manage their emotions and foster self-exploration, which is illustrated by the following participant: “I got more friends and more community, I definitely started to like, have more regulated emotion and was able to like, be a bit more introspective” (24 years, trans woman, queer).

In sum, participants found safe spaces in cannabis use, therapeutic relationships, and interpersonal connections. They actively constructed and sought a mental and social safe space because it allowed them to overcome difficult emotions and thoughts. These safe spaces enabled participants to engage in introspective reflection, which improved their self-understanding, promoted personal growth, and ultimately promoted their mental well-being.

Constructing identities and accepting one’s authentic self

Participants promoted their mental health by actively constructing their personal and social identities. The process of identity construction facilitated their acceptance of their authentic selves and fostered a sense of belonging within supportive communities. Participants viewed identity construction as a process of recognizing, embracing, and fully acknowledging their strengths and weaknesses without judgment or the need for external validation. To achieve this, participants cultivated positive and compassionate attitudes toward their thoughts, feelings, and behaviours. Evident in participants’ experiences is how identity construction formed the foundations for healthy self-esteem, contributing significantly to their mental and emotional well-being.

The acknowledgement of a non-heterosexual and/or non-cisgender identity during adolescence and early adulthood was a pivotal aspect of participants’ identity construction journey. For some, cannabis use not only facilitated the acknowledgement of their gender identity and sexual orientation but also their acceptance. This acceptance, in turn, enhanced their mental well-being. The interplay between cannabis use, SGD identity construction and acceptance was particularly evident in this participant experience:

[Cannabis] definitely helped me, like be aware of [my] gender and sexual identity, even to accept them and that they are an important part of who I am (…) And so I guess it was a lot of self-acceptance. And I’m happy to say I haven’t had any negative experiences regarding my gender and sexual identity because of cannabis. (23 years, cisgender woman, queer)

Beyond individual acceptance, cannabis use also emerged as a key coping strategy for dealing with stigma—both social and internalized—related to sexual orientation and gender identity. The following account illustrates how, beyond identity acceptance, cannabis use enabled a non-binary participant to feel more comfortable with their gender identity and gender expression, which ultimately decreased their anxiety:

I think [cannabis] definitely helped me be more chill about my gender. Like if I am high, like I will be more comfortable in my clothes. Because I am less anxious and more in the present [moment]. I won’t mind wearing like tighter clothes or stuff like that. (20 years, trans non-binary, bisexual)

Evident in the previous quotes, is how cannabis use served as a strategy to cope with feelings of shame related to SGD identities and the anxiety that such stressors may cause. Nonetheless, for some, cannabis use prevented their identity construction and gender exploration:

So maybe if anything, it’s like [cannabis] hindered my self-discovery because I was using it to (…) create a new reality where I didn’t have to think about what was going on in my head or who I was. (24 years, trans woman, queer)

This account illustrates that, for some participants, the use of cannabis was not inherently tied to the process of gender identity affirmation. Rather, beyond cannabis use, participants emphasized the central importance of belonging to an SGD community and cultivating chosen family networks as foundational to foster self-acceptance and developing personal and social identities. Establishing connections within supportive social circles provided participants with the energy and encouragement needed to develop a stronger sense of self-assurance. Shared experiences within these communities created a sense of belonging and acceptance. For instance, a trans participant shared how pivotal access to a community and a deep connection with others were to fostering acceptance, self-esteem, and the construction of her identity: “So one of the main resources for me has been community and connection and like a new sense of chosen family for me has been a huge resource of self-esteem (…) I feel like I am learning how to love myself because I see myself in them” (24 years, trans woman, queer). This experience demonstrates how a chosen family within the SGD community offers a valuable resource of support, self-esteem, and pride in one’s identity.

Similarly, therapeutic relationships also played a role in supporting participants’ identity construction. Accounts of several participants demonstrated that finding a therapist who understands and empathizes with their challenges related to their identity provided solace and had a profound impact on improving their mental well-being, ultimately facilitating the process of self-acceptance. This was particularly evident in the narrative of the following participant when describing her relationship with her therapist with whom she shared an identity as a trans woman:

I’m being followed by a psychosocial counsellor, and she’s a trans woman of, like, 40 [years]. (…) [We have] done a lot of work on myself, like my relationship to drugs, to nightlife, to my trans-identity. Everything’s changed because, my relationship to myself has changed a lot. (25 years, trans woman, pansexual).

In sum, participants utilized a combination of cannabis use, a sense of community, and therapeutic relationships to feel comfortable exploring and ultimately embracing their authentic selves in terms of sexual orientation, gender identity and gender expression. These support systems played a vital role in building confidence and a sense of self, ultimately improving participants mental well-being.

Managing stress and cultivating positive experiences

Participants’ conception of mental well-being was intricately connected to an outward quest for relaxation, pleasure, detachment, and dissociation. They recognized achieving balance between daily life challenges and coping resources as a crucial element that fostered their mental well-being.

Specifically, participants emphasized the importance of taking physical and mental breaks for reflection and recovery. They associated certain activities as escape routes from daily stressors. These escape routes were described as allowing them to find enjoyment and pleasure. This pursuit of pleasure and fulfilment suggests that participants viewed joy and positive experiences as critical for promoting and maintaining their mental well-being.

Participants frequently cited cannabis use as a tool for managing and temporarily escaping their mental health challenges, including anxiety, panic attacks, paranoia and even issues related to eating disorders: “When I smoke pot, it’s like if my eating disorder doesn’t exist anymore, like I know it’s there, but it’s like I can shut up about it, like I don’t care” (17 years, cisgender woman, pansexual). This illustrates how cannabis use was employed to provide temporary relief by silencing mental health struggles when participants needed it most.

Evident in some participant narratives is how they perceived cannabis use as a tool for relaxation, stress reduction, and anxiety management. Conversely, some participants reported symptoms of anxiety following cannabis use: “I get really anxious when I take cannabis. So that’s also why I think it’s one of the reasons why I’m more careful” (22 years, trans man, queer). Hence, cannabis use experience was not uniform and for some it even aggravated anxiety symptoms: “I was also using it to manage my anxiety, over time it just made it worse” (23 years, cisgender woman, queer).

Cannabis use also provided participants a deliberate break in their day, allowing them to distance themselves from everyday stressors, responsibilities, and realities. For some, this pause enhanced their overall well-being, as a participant noted: “[Cannabis] it’s just a way to fully disassociate from all of my responsibilities and allow myself to relax” (22 years, cisgender woman, queer). This account highlights the need for temporary relief from life’s challenges, a theme that echoed in many interviews.

Similarly, another participant commented: “Relaxing is important for my mental health and now, relaxing is associated with cannabis, and well, technically, cannabis helps my mental health now. But I tell myself that I could relax without it and it would surely be better” (22 years, cisgender man, queer). These reflections, along with other participants’ descriptions of their quest towards mental well-being, underscores their awareness of the importance of developing alternatives and long-term coping practices beyond cannabis use. These complementary practices included seeking help from professionals, developing plans to address stressors, and adopting other coping mechanisms beyond cannabis use.

Some participants highlighted the role of mental health professionals, such as therapists and social workers, in providing long-term guidance on stress management. Through therapeutic alliance and support, participants detailed how they learned alternative or complementary techniques like meditation, deep breathing, and the importance of physical activity, which they described as effective ways to cope with stress. Describing this notion, one participant shared:

Now that I have this help [psychologist], I can see that there are other ways to get better that are even better for me [than cannabis] because they’re long-term methods. (…) My psychologist gave me other tips. For example, I could go and do some sport, go for a walk instead of just turning around and saying, “Oh, I’m not feeling well, I’ll go and smoke a joint.” (22 years, trans man, queer).

Evident in this participant’s account is not only the value added to the therapeutic support he received but also the realization of complementary mechanisms that may reduce the need to consume cannabis. Physical activity and hobbies (e.g., sports, meditation, crafts) were particularly valuable because they provided relief and diverted attention away from anxiety or other mental health struggles, ultimately fostering positive experiences. The importance of such activities in creating positive activities was particularly evident in the narrative of one participant. This participant emphasized the importance of such activities as follow:

I think just like activities, gatherings like, maybe a little like jogging team or a queer basketball team (…) things that are getting us moving and active or like different habits or different things we can occupy ourselves with, where we can get dopamine and [a sense of] community and have a sense of release and relief. (24 years, trans woman, queer)

In short, participants recognized that mental well-being is closely tied to achieving a sense of balance, peace, positivity, and tranquillity in their lives. They actively sought strategies to cope with stress, anxiety, and the challenges of daily life by taking pauses and detaching from such stressors. These notions reflect a holistic understanding of mental well-being embraced by participants, in which cannabis features among multiple strategies.

Discussion

The present study explored the strategies SGD youth who use cannabis employ to promote their mental health, examining how cannabis features within these efforts. Our analysis revealed that participants valued the pursuit of mentally and socially safe spaces, allowing the confrontation of emotions and introspection. They also actively constructed their identities, which ultimately fostered a sense of self-acceptance. Finally, participants identified coping strategies to manage stress and to cultivate positive experiences. Overall, our results demonstrate that SGD youth who use cannabis do not solely rely on this substance to take care of their mental health. Instead, cannabis is one of the various strategies they employ to achieve mental well-being through the creation of safe spaces, the process of identity construction, and the use of coping mechanisms. Our findings resonate with the minority strengths model, which proposes that personal and collective strengths—including social support, community identification, and identity pride—operate as pathways to positive mental health among SGD individuals [24]. Similarly, our results extend previous research that has largely framed cannabis use among SGD youth with mental health challenges mainly through a self-medication lens [22, 23], by showing that cannabis is embedded within broader, intentional mental health promotion strategies.

In addition to the use of cannabis, our study underscores the importance of therapeutic and interpersonal relationships and sense of community, and the mental health support SGD youth gain from such resources—a finding that echoes previous research [34, 37]. Hence, our results provide evidence that beyond healthcare services, participants’ agency and support networks were key in their quest for introspection, identity development and coping. This is a meaningful result as youth navigate their transition into adulthood, a journey that, for those who identify as SGD, is compounded by the parallel process of sexual and gender identity development. As such, the health-promoting strategies identified—including cannabis use—were resources participants drew upon to maintain their mental well-being and support their development as adolescents and emerging adults. Consistent with this, we identified that despite social stressors and discrimination, participants were resilient and thrived — a finding consistent with previous research [17, 32, 54], including London-Nadeau et al. [26] who concluded that cannabis use features among the strategies to face adversity and foster SGD pride. Our study recognized the agency among SGD youth and acknowledged participants’ capacity to make decisions to cope with their mental health, which may include the use of cannabis.

We recognize the existing literature showing that cannabis use potentially entails short-term (e.g., impaired driving, overdoses/bad trips) and long-term (e.g. respiratory harm, cannabis use disorder, depression, anxiety, psychosis, decreased memory and attention) harms and risks [11, 55–57]. In fact, some participants reported experiencing negative experiences secondary to excessive cannabis use, notably decreased focus, fuzzy thinking, anxiety, feelings of over-reliance, and, in some cases, a sense that cannabis hindered rather than supported self-discovery. At the same time, our findings suggest that understanding cannabis use among SGD youth requires moving beyond a binary framing of cannabis as either beneficial or harmful. Rather than challenging minority stress [18–20] or self-medication explanations [22, 23], our findings extend these perspectives by situating cannabis use within the broader repertoire of strategies that SGD youth employ to support their mental well-being. While some participants described using cannabis to cope with distress, many also recognized its limitations, viewing its dissociation and numbing effects as temporary relief. Instead, they emphasized therapeutic relationships, social support, physical activity and hobbies as more long-term and sustainable pathways to mental well-being. As such, our results reflect that even when cannabis use addresses coping motives, it may simultaneously coexist with broader mental health promotion and strength-based strategies. This more nuanced perspective contributes to a non-pathologizing and more holistic understanding of cannabis use among SGD youth. Thus, our work further advances the evidence on the complex relationship between cannabis use and mental health, particularly among SGD youth [24, 26, 58, 59]. Specifically, our work shows even within SGD youth who face mental health difficulties, cannabis use is embedded in intentional, multi-dimensional mental health promotion practices rather than solely serving as a coping mechanism. By recognizing cannabis as one component of a broader landscape of well-being practices, our findings may inform SGD-tailored harm reduction and mental health interventions that move beyond risk-focused paradigms toward more contextualized and strengths-based approaches.

A holistic vision of mental health and cannabis use resonates with our analysis. Participants recognized that mental health is about personal growth, identity development, and actively cultivating positive experiences and emotions. Our results corroborate existing evidence on the role of physical activity, hobbies, and leisure in preventing mental health struggles [60, 61]. However, our study also sheds light on how cannabis complements such efforts, particularly for SGD youth who experience mental health challenges. Our research also points to the aspects that SGD youth value when taking care of their mental health, namely the need for SGD youth to find safe spaces and take breaks to allow reflection, identity construction, distraction, and recovery from daily stressors. These holistic perspectives allow a more health-promoting conceptualization of mental health as a state of psychological well-being that becomes a resource of life and fulfilment [31, 32, 62], as well as a more nuanced, non-stigmatizing vision of cannabis use. These perspectives also point to the need to expand mental health and substance use research beyond the study of risk factors of mental health problems and instead complement this knowledge with more positive and strength-based understandings [17, 63]. Such insights could guide mental health and substance use directions regarding promotion, prevention and intervention [39].

Our findings should be interpreted within the legal and social landscape of cannabis legalization in Canada. Post-legalization research suggests a reduction in cannabis-related stigma and a normalization of its use among Canadian youth and young adults [27, 64]. For our study, the normalization of cannabis use may have reduced the compounding burden of being SGD and using cannabis, potentially facilitating its integration into broader health-promoting practices and identity narratives. Consequently, the transferability of these findings to jurisdictions where cannabis remains illegal or heavily criminalized may be limited, as legal frameworks fundamentally shape access to cannabis, its social meanings, experiences of stigma, and the ways individuals incorporate cannabis into their everyday lives.

Strengths and limitations

One notable strength of this study is the inclusion of a diverse array of experiences and perspectives. Participants varied in their cannabis use profiles and gender identities. For instance, we capture experiences from trans and non-binary individuals—a population often underrepresented in SGD research. Another strength of our study was the inclusion of a peer researcher throughout the research process. The peer researcher is a youth who identifies as SGD, was trained in qualitative methodologies, and had previously established rapport with participants through the photovoice study. Beyond leading participant recruitment and conducting the interviews, the peer researcher participated in the presentation and discussion of preliminary themes and thematic maps, contributing an insider perspective that enhanced the credibility and trustworthiness of our interpretations.

Despite these strengths, this study has limitations. First, we were not able to include perspectives from Two-Spirit individuals. Second, the transferability of our results to the general SGD population might be limited since all participants self-reported mental health issues—a criterion motivated by our research program aimed at understanding the intersection of mental health challenges and cannabis use. As such, our findings primarily reflect the experiences of SGD youth navigating cannabis use alongside mental health difficulties and may not capture how cannabis functions among SGD youth who do not perceive themselves as facing mental health challenges. Future research should examine cannabis use and mental health promotion among SGD youth without self-reported mental health concerns, as their experiences may differ. Third, the age range of our sample (15–24 years) spans adolescence and emerging adulthood, and cannabis use patterns, motivations, and impacts may differ between these developmental periods. Although examining age-related variations was out of the scope of the present study, future research should examine this question. Finally, member checking was not conducted, which may limit the extent to which interpretations reflect participants’ own understandings of their experiences.

Conclusions

SGD youth who use cannabis do not rely solely on this substance for managing their mental health. Instead, cannabis is integrated into a broader array of strategies aimed at achieving mental health goals, such as creating safe spaces, constructing personal and social identities, and employing coping mechanisms. This study moved beyond the focus on the potential risks of cannabis use on mental health, offering a nuanced understanding of SGD youth experiences from a positive and asset-based perspective. Our findings reflect the complexity of cannabis use among SGD youth: even when cannabis use is motivated by coping with minority stress or mental health struggles, it may simultaneously coexist with and support broader health-promoting strategies. This tension underscores the need for nuanced, non-stigmatizing approaches to cannabis use in this population. This study also recognized the agency and resilience among SGD youth, acknowledging their capacity to make decisions to improve their mental health. Our results also have the potential to inform the development of SGD-tailored harm reduction initiatives and mental health interventions that recognize the complex role cannabis use plays in SGD youth’s lives. Such approaches move beyond a sole focus on risk to embrace more contextualized, strength-based, and non-pathologizing understandings of cannabis use.

Abbreviations

SGD

Sexual and gender diverse

Authors' contributions

D.O-P.: Conceptualization, Data curation, Formal analysis, Writing – original draft. E.C.L-M.: Data curation, Formal analysis, Writing – original draft. A.I.: Data curation, Formal analysis, Writing – review & editing. K.W.: Data curation, Project administration, Writing – review & editing. R.K.: Writing – review & editing. O.F.: Conceptualization, Funding acquisition, Supervision, Writing – review & editing.

Funding

This work was supported by grants from the Mental Health Commission of Canada and the Canadian Institutes for Health Research under Grant PJT-175082 to O.F. D.O-P. is supported by the Canada Graduate Scholarship Doctoral Award from the Canadian Institutes of Health Research. R.K. and O.F. are supported by research scholar awards from the Fonds de Recherche du Québec.

Data availability

The data underlying this article (e.g., interview transcripts) cannot be shared publicly due to participant privacy. Data may be made available upon reasonable request to the corresponding author, subject to ethical and privacy considerations.

Declarations

Ethics approval and consent to participate

The study was granted ethics approval from the Comité d’éthique de la recherche en sciences de la santé de l’Université de Montréal (CERSES-20-156-P) and was conducted in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2) and the Declaration of Helsinki. All participants provided verbal informed consent prior to enrollment in the study.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.