Individuals with pain at increased risk for cannabis use disorder

Adults with pain are at increased risk for adverse cannabis use outcomes, including cannabis use disorder, according to study findings published in American Journal of Psychiatry.

“U.S. adults have become increasingly likely to perceive cannabis use as harmless, and nonmedical use of cannabis, including daily or near-daily use, has increased among U.S. adults since the early 2000s,” Deborah S. Hasin, PhD, of the department of psychiatry at Columbia University Medical Center in New York, and colleagues wrote. “The prevalence of adults cannabis use disorder has also increased, including among hospital inpatients, Veterans Health Administration patients and in one general population study (although not in another).”

The researchers noted that because the prevalence of cannabis use disorder has increased, it is an important public health issue to identify characteristics that increase the risk for frequent nonmedical cannabis use and cannabis use disorder. Prior research has revealed a link between substance use disorders and pain, making it one such potential characteristic.

To examine differences in the prevalence over time of nonmedical cannabis use and cannabis use disorder among U.S. adults with and without pain, Hasin and colleagues used logistic regression to analyze data from 43,093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions between 2001 and 2002. They also analyzed data from 36,309 participants from the third version of this survey, which was administered between 2012 and 2013. They estimated risk differences of past-year nonmedical cannabis use, frequent (three times or more per week) nonmedical use and DSM-IV cannabis use disorder for groups with and without moderate to severe pain. They tested these risk differences for change over time.

The researchers found that those with pain were more likely to report any nonmedical cannabis use, with 5.15% reporting use between 2001 and 2002 vs. 3.74% for those without pain. Further, 12.42% of those with pain reported use between 2012 and 2013 vs. 9.02% of those without pain. The researchers noted that the latter risk difference was significantly greater than the former. They also found that frequent nonmedical cannabis use prevalence did not differ according to pain status in the 2001 to 2002 survey; however, it was significantly more prevalent in those with than without pain in the 2012 to 2013 survey for a prevalence of 5.03% vs. 3.45%, respectively. Those with pain were more likely to report cannabis use disorder than those without for a prevalence of 1.77% vs. 1.35%, respectively, in the 2001 to 2002 survey, and 4.18% vs. 2.74% in the 2012 to 2013 survey, which also marked a significantly greater risk difference in the later survey compared with the earlier survey.

“The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk,” they wrote. “Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder.” – by Joe Gramigna

Disclosures: Hasin reports funding from the Campbell Alliance for the validation and use of a measure of opioid addiction among patients with chronic pain. Please see the study for all other authors’ relevant financial disclosures.