Mistrust Limits Possibilities for Patient-Provider Discussions Regarding Cannabis Use During Pregnancy

Recent changes in cannabis policy and use among pregnant people have prompted recommendations that health care providers discuss cannabis use with pregnant patients. We explored pregnant people's perceptions of their interactions with health care providers regarding cannabis use during pregnancy.

We conducted in-depth interviews with 34 individuals who were either pregnant or had been pregnant within the past 2 years and who used cannabis before or during their pregnancy. The interviews explored people's experiences with and perspectives on communication with health care providers about cannabis use during pregnancy.

Most participants reported an absence of provider-initiated inquiries about cannabis use and few disclosed their cannabis use to a provider. Participants expressed distrust in providers as sources of accurate cannabis information, as they understood providers as grouping cannabis with alcohol and other drugs, which they saw as conflicting with their perception of a lack of conclusive scientific evidence about health effects of cannabis use during pregnancy. They worried about providers judging and reporting them to child welfare if providers learned about their cannabis use. Participants described using cannabis for medical reasons, but only rarely recalled experiencing providers talking with them about risks and benefits of cannabis versus other treatments.

Although many pregnant people use cannabis as a medicine to manage pregnancy symptoms or health conditions, they perceive providers as viewing and treating cannabis as a harmful recreational drug. This disconnect, along with their fears of provider judgment and of providers reporting them to child welfare, appears to be limiting effective, person-focused discussions regarding risks and benefits of different approaches to treating the symptoms and health conditions for which pregnant people use cannabis.