Study Finds Nearly 3 in 10 Individuals With Chronic Pain Use Cannabis

As more states begin to legalize or relax restrictions on cannabis, it has become more widely used for the treatment of chronic pain. A new study sought to identify whether cannabis can serve as a substitute for prescription opioids or other pain treatments.

“Evidence is mixed about whether medical cannabis serves as a substitute for prescription opioids or other pain treatments,” the study authors wrote. “Accurate estimates of cannabis use or its substitution in place of pain treatments among adults with chronic noncancer pain are, to our knowledge, not available.

In this cross-sectional study published by JAMA Network Open, the authors identified and surveyed individuals through the National Opinion Research Center (NORC) AmeriSpeak panel who were 18 years or older with chronic pain who lived in the 36 states with active medical cannabis programs from March to April 2022. A screener survey was conducted that identified people with pain unrelated to cancer on most days or every day in the past 6 months.

Cannabis use was self-reported (ever, past 12 months, past 30 days), as was pharmacologic treatments (prescription opioids, prescription nonopioid analgesics, and OTC analgesics), common nonpharmacologic treatments (physical therapy, meditation, cognitive behavioral therapy), and the substitution of cannabis for any of these treatments.

Of the 1724 individuals identified as having chronic pain, 1661 (96.3%) completed the full survey (948 [57.1%] female; mean [SD] age, 52.3 [16.9] years); 31.0% (95% CI, 28.2%-34.1%). Of adults with chronic pain who reported having ever used cannabis to manage their pain, 25.9% (95% CI, 23.2%-28.8%) indicated using cannabis to manage their chronic pain in the past 12 months, and 23.2% (95% CI, 20.6%-26.0%) reported using cannabis in the past 30 days.

Most individuals who reported using cannabis to manage chronic pain also reported having used either at least 1 other pharmacologic (94.7%; 95% CI, 91.3%-96.8%) or nonpharmacologic pain treatment (70.6%; 95% CI, 64.8%-75.7%).

More than 50% of participants who used cannabis to manage their chronic pain also reported that the use of cannabis led them to decrease the use of a prescription opioid, prescription nonopioid, and OTC pain medications. Fewer than 1% reported that the use of cannabis led them to increase their use of these medications.

Additionally, 38.7% said that their use of cannabis led to decreased use of physical therapy (5.9% reported increased use), 19.1% said it led to decreased use of meditation (23.7% reported it increased use), and 26.0% said it led to decreased used of cognitive behavioral therapy (17.1% reported it increased use).

Across the 36 states with medical cannabis programs, this study found that nearly 3 in 10 individuals use cannabis to manage their pain. Most individuals who used cannabis to manage their chronic pain reported using it in place of other pain medications, including opioids.

“The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain,” the study authors wrote. “Our results suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain.”

Reference

Bicket M, Stone E, McGinty E. Use of cannabis and other pain treatments among adults with chronic pain in US states with medical cannabis programs. JAMA Netw Open. 2023;6(1):e2249797. doi:10.1001/jamanetworkopen.2022.49797