Pills to Pot : Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain, K.F. Boehnke, 2019

Pills to Pot : Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain

Kevin F. Boehnke, J. Ryan Scott, Evangelos Litinas, Suzanne Sisley, David A. Williams, Daniel J. Clauw
The Journal of Pain, 2019


  • Medical cannabis users reported substituting cannabis for pain medications.
  • User rationale for substitution was fewer side effects and better pain management.
  • Most users reported improved pain and health since using cannabis.
  • Intentions behind and duration of cannabis use affected substitution behavior.
  • Unlike previous studies, >50% of participants were women and adults >50 years old.


Chronic pain is common, costly, and challenging to treat. Many individuals with chronic pain have turned to cannabis as an alternative form of pain management. We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use. We also examined whether and how these parameters were affected by concomitant recreational use, and duration of use (novice: <1 year vs experienced: ≥1 year). There were 1,321 participants (59% female, 54% ≥50 years old) who completed the survey. Consistent with other observational studies, approximately 80% reported substituting cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines), citing fewer side effects and better symptom management as their rationale for doing so. Medical-only users were older (52 vs 47 years old; P < .0001), less likely to drink alcohol (66% vs 79%, P < .0001), and more likely to be currently taking opioids (21% vs 11%, P < .0001) than users with a combined recreational and medical history. Compared with novice users, experienced users were more likely to be male (64% vs 58%; P < .0001), take no concomitant pain medications (43% vs 30%), and report improved health (74% vs 67%; P = .004) with use. Given that chronic pain is the most common reason for obtaining a medical cannabis license, these results highlight clinically important differences among the changing population of medical cannabis users. More research is needed to better understand effective pain management regimens for medical cannabis users.

Perspective: This article presents results that confirm previous clinical studies suggesting that cannabis may be an effective analgesic and potential opioid substitute. Participants reported improved pain, health, and fewer side effects as rationale for substituting. This article highlights how use duration and intentions for use affect reported treatment and substitution effects.

Keywords : Cannabis, opioid substitute, chronic pain, side effects, pain management