Article Text

Download PDFPDF
Association of cannabis use with patient-reported pain measures among adults with chronic pain in US states with medical cannabis programs
  1. Mark C Bicket1,2,3,
  2. Elizabeth M Stone4,5 and
  3. Emma Beth McGinty6
  1. 1Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  4. 4Center for Health Services Research, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA
  5. 5Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  6. 6Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Mark C Bicket, Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA; mbicket{at}


Introduction Most Americans live in a state that has legalized cannabis as a medical treatment for pain, but it is unclear how chronic pain intensity relates to cannabis use. Our objective was to examine the association between patient-reported pain measures and cannabis among adults with chronic pain.

Methods This cross-sectional study of a representative sample of adults reporting chronic non-cancer pain in 36 states and DC with active medical cannabis programs from March to April 2022 assessed cannabis use for chronic pain, categorized as active (within 30 days), past (>31 days), or never use (referent). Measures were pain intensity (primary) and interference, Widespread Pain Index, and number of chronic pain diagnoses.

Results Among 1628 participants (57% female, 69% white), 352 (22%) actively used cannabis to treat chronic pain, 137 (8%) reported past cannabis use, and 1139 (70%) never used cannabis. In adjusted models, active cannabis use was associated with higher scores for pain intensity (score difference 1.03, 95% CI 0.05 to 2.02) and pain interference (score difference 1.82, 95% CI 0.99 to 2.65) compared with never use. Persons who actively used cannabis had higher Widespread Pain Index scores (score difference 0.56, 95% CI 0.26 to 0.86) and more chronic pain diagnoses (difference 0.45, 95% CI 0.06 to 0.83).

Conclusion People with chronic non-cancer pain who used cannabis for pain reported non-clinically meaningful worse pain measures and greater burden of chronic pain conditions than their counterparts who never used cannabis. Alternatively, those with worse pain and greater burden of pain appear more likely to use cannabis.

  • Pain Management

Data availability statement

No data are available. Data will not be shared per the data use agreement with NORC, which only allows access by the study team.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available. Data will not be shared per the data use agreement with NORC, which only allows access by the study team.

View Full Text


  • Twitter @MarkBicket

  • Contributors All authors conceived the study, designed the study protocol and methods, interpreted the data, and critically revised the manuscript for important intellectual content. EMS performed the data analysis. MCB wrote the first draft of the manuscript. EBM is the guarantor.

  • Funding This study is supported by the National Institute on Drug Abuse (NIDA; grant number R01DA49789).

  • Disclaimer The funder did not contribute to the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests MCB reports current grants from PCORI, CDC, NIH, Michigan Department of Health and Human Services and past grants from the Arnold Foundation. The other authors report no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.