Adults With Pain More Likely to Misuse Nonmedical Cannabis Than Those Without Pain

U.S. adults living with pain have a greater risk of adverse cannabis use outcomes, nonmedical cannabis use, and cannabis use disorder, according to a new study.

Lead study author Deborah Hasin, PhD, said in a press release that in spite of evidence linking cannabis use to unwanted outcomes—including motor vehicle accidents and psychiatric symptoms—”many people view cannabis use as harmless, and non-medical use of cannabis on a daily or near-daily basis has increased.” Dr. Hasin, a professor of epidemiology in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons, further said, “In our study, we hoped to identify factors—such as pain—that may increase the risk of cannabis use disorder.”

The researchers, whose study appeared in The American Journal of Psychiatry, examined data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) spanning 2001-2002 (n=43,093) and the NESARC-III spanning 2012-2013. They compared risk differences of past-year nonmedical cannabis use, nonmedical use at least three times a week, and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV cannabis use disorder between patients with and without moderate to severe pain. Evaluations were conducted to observe changes in risk differences over time.

During both time periods, patients with pain were more likely than those without pain to report any nonmedical cannabis use (2001-2002: 5.15% vs. 3.74%; 2012-2013: 12.42% vs. 9.02%). In the earlier survey, there were no significant pain-based differences in the prevalence of frequent nonmedical cannabis use, but in the later survey, the prevalence was significantly higher in the pain group than the non-pain group (5.03% vs. 3.45%). Patients with pain were more likely than those without pain to have cannabis use disorder at both timepoints (2001-20012: 1.77% vs. 1.35%; 2012-2013: 4.18% vs. 2.74%).

“Although meta-analyses of cannabis for treating pain show only mixed efficacy, particularly for plant marijuana, 66% of adults now view marijuana as beneficial for pain management. Given that about 20% of the adult population experienced moderate to severe pain, this puts a large group of U.S. adults at risk for frequent non-medical use and cannabis use disorder. Greater balance is needed in media reporting of marijuana issues, including messages that convey credible information about the nature and magnitude of health risks from non-medical cannabis use, including among the large group of US adults with pain,” Dr. Hasin said. “Psychiatrists and other mental health professionals treating patients with pain should monitor their patients for signs and symptoms of cannabis use disorder.”