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Comparing Cannabis Use for Pain to Use for Other Reasons in Primary Care Patients

May 1, 2024
Meg Brunner, MLIS
Ford MA, et al. Comparing cannabis use for pain to use for other reasons in primary care patients. Journal of the American Board of Family Medicine 2023;36:996-1007.
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What’s the Question?

People in the United States commonly report using cannabis to manage chronic pain. Though more research is needed on the benefits of cannabis for pain, studies do show a small but significant benefit compared to placebo.

However, cannabis use can also sometimes be harmful, and these harms likely vary by product characteristics (such as the ratio of THC to CBD), mode of use (e.g., smoking vs. ingesting), and frequency of use. Depending on how patients use cannabis for pain, they may be more or less likely to experience negative effects compared to people who use cannabis for other reasons.

How do use patterns differ between people who use cannabis for pain and people who use it for other reasons, what types of negative effects do they report, and is there anything we can learn from this information that we could use to help better support patients in pain?

This study aimed to find out, by comparing cannabis use patterns (mode and frequency), cannabis use disorder (CUD) symptoms, and perceived helpfulness of cannabis for patients who use it primarily for chronic pain compared to those who use it for other reasons.

How Was This Study Conducted?

This study, part of NIDA Clinical Trials Network protocol CTN-0077Ot, was conducted in Washington State, where both retail and medical cannabis is legal. Participants included 1,688 patients who completed a cannabis survey at Kaiser Permanente in 2019; 375 reported using cannabis for pain, 558 reported using it for other reasons. Group differences were broken down by participant characteristics, use patterns, and perceptions.

What Did Researchers Find Out?

Patients who used cannabis for pain were older and more likely to be women, retired/have a disability, and have a chronic non-cancerous pain diagnosis.

Those using cannabis for pain were also significantly more likely:

• to use applied and beverage cannabis products
• to use cannabis more often (including more times per day and more days per week)
• to also smoke tobacco cigarettes
• to perceive cannabis as very/extremely helpful

They were significantly less likely:

• to use cannabis for nonmedical reasons (i.e., to get high)
• to report symptoms of cannabis use disorder

What Are the Implications for the Workforce?

Primary care patients who use cannabis for pain use it more often, often use it in applied and ingested forms, and report more co-use of tobacco, all of which could impact safety and effectiveness. However, they also report fewer symptoms of cannabis use disorder.

To balance the harms and benefits of cannabis use for pain, clinicians may find it helpful to talk to their patients about cannabis using a shared patient-clinician decision-making approach. These conversations should include discussion about the patient’s reasons for use, as well as modes, frequency, and perceived helpfulness of that use. Clinicians should also carefully assess tobacco use among patients who use cannabis and provide tobacco cessation counseling and medications as indicated.