Adults With Pain at Increased Risk For Cannabis Use Disorder

The increased risk for frequent nonmedical cannabis use among individuals with pain was elevated when comparing between surveys in the 2 time periods.

Adults with self-reported pain in the United States were at an increased risk for cannabis use disorder in recent years, according to results from an epidemiologic survey published in the American Journal of Psychiatry.

Deborah S. Hasin, PhD, of the New York State Psychiatric Institute, New York, and colleagues sampled data from 2001 to 2002 and 2012 to 2013 collected by the National Epidemiologic Survey on Alcohol and Related Conditions. Adults aged ≥18 years were sampled in a multistage design (N=79,402).

Cannabis use was defined as nonmedical (use without prescription or not as recommended) and cannabis use disorder (fitting The Diagnostic and Statistical Manual of Mental Disorders-IV definition for cannabis dependence or abuse). Any use was defined as once or twice, and heavy use as 3 times or greater per week.

The survey respondents reported the same level of pain in both surveys (19.3%; standard error [SE], 0.31 vs 20.0%; SE, 0.44). The overall use of any nonmedical cannabis increased from 4.1% (SE, 0.15) in the first survey to 9.5% (SE, 0.27) in the second survey. Increases in frequent nonmedical use (1.2%; SE, 0.08 vs 3.7%; SE, 0.15) and cannabis use disorder (1.5%; SE, 0.8 vs 2.9%; SE, 0.13) were reported over time.

Any nonmedical cannabis use was more common among individuals with pain (2001–2002, 5.15%; SE, 0.39; 2012–2013, 12.42%; SE, 0.61) than individuals with no pain (2001–2002, 3.74%; SE, 0.14; 2012–2013, 9.02%; SE, 0.26). The surveys did not find a significant difference in any nonmedical use of cannabis among those without pain; however, individuals who had pain had an increased risk of use (risk ratio [RR], 1.99; 95% CI, 0.69-3.29; P <.05).

The prevalence of cannabis use disorder was similarly increased in the more recent survey for individuals with pain (2001–2002, 1.77%; SE, 0.21; 2012–2013, 4.18%; SE, 0.39) and slightly elevated in those without pain (2001–2002, 1.35%; SE, 0.15; 2012–2013, 2.74%; SE, 0.14). The risk for cannabis use disorder has significantly increased among individuals with pain in the more recent survey (RR, 1.02; 95% CI, 0.18-1.86; P <.05). The increased risk for frequent nonmedical cannabis use among individuals with pain was elevated when comparing between surveys (RR, 1.35; 95% CI, 0.47-2.23; P <.05).

As study limitations, the researchers noted that pain was a single self-reported variable and not a medical diagnosis. However, the consistency of the proportion of individuals reporting pain indicates that the measurement may be reliable. This study did not include information about changing opinions and laws of cannabis use, which may impact both usage rates and self-reporting.

The investigators concluded that adults in the United States with pain have an increasing risk for adverse outcomes due to cannabis, thus warranting clinical and public health attention. They wrote, “Psychiatrists and other mental health professionals treating patients with moderate to severe pain should be informed about the potential risks of cannabis, including cannabis use disorder, provide information about these risks to their patients, and monitor patients for signs and symptoms of cannabis use disorder.”


Hasin D S, Shmulewitz D, Cerdá M, et al. U.S. adults with pain, a group increasingly vulnerable to nonmedical cannabis use and cannabis use disorder: 2001-2002 and 2012-2013. Am J Psychiatry 2020;177(7):611-618. doi:10.1176/appi.ajp.2019.19030284.