Advertisement

Cannabis Use Preferences and Decision-making Among a Cross-sectional Cohort of Medical Cannabis Patients with Chronic Pain

      Highlights

      • Medical cannabis users reported wide variability in cannabinoid use preferences.
      • Differences in sex, intentions behind use, and duration of use affected cannabis use behavior.
      • The majority of users reported preference for cannabidiol-containing products.
      • Very few users consulted with a doctor about cannabinoid product selection.

      ABSTRACT

      Cannabis is commonly used to manage chronic pain, but cannabis use patterns among individuals with chronic pain, has not been well-characterized. We report cannabinoid, administration route, and product selection preferences among medical cannabis users with chronic pain from an ongoing, online survey. We also examined whether these preferences are affected by differences in sex, intentions behind use (medical only [MED] vs medical + recreational [MEDREC]), and experience with cannabis (novice: <1 year vs experienced: ≥1 year). The survey was completed by 1,321 participants (59% female) 76.5% of whom used cannabis every day. 93.4% used 2 or more administration routes and 72.5% used 3 or more. Female, MED, and novice users were less likely to smoke or vaporize (all P < .0001), but more likely to rank edibles, tinctures, and topicals as a first-choice administration route than their counterparts. Female and MED users also preferred low THC: high cannabidiol ratios significantly more than their counterparts. Overall, only 2.6% of participants selected cannabis products with input from a medical professional, although 54.9% relied on advice from dispensary employees. More male, MEDREC, and experienced users selected products based on factors that reflected greater comfort with cannabis (eg, smell, visual properties, cannabis variety). The wide variability in cannabis use among these different groups indicates the need for further research to investigate how specific use routines relate to clinical outcomes.

      Perspective

      Medical cannabis users with chronic pain show distinct differences in cannabinoid preferences and administration associated with user sex, intentions behind use, and experience with cannabis. This article highlights the wide variability in cannabis preferences among medical cannabis users with chronic pain, which may be relevant for clinical outcomes.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abuhasira R
        • LB-l Schleider
        • Mechoulam R
        • Novack V
        Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly.
        Eur J Internal Med. 2018; 49: 44-50
        • Bachhuber MA
        • Saloner B
        • Cunningham CO
        • Barry CL
        • Rolland B
        Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.
        JAMA Intern Med. 2014; 174: 1668-1673
        • Baron EP
        • Lucas P
        • Eades J
        • Hogue O
        Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.
        J Headache Pain. 2018; 19: 37
        • Boehnke KF
        • Gangopadhyay S
        • Clauw DJ
        • Haffajee RL
        Qualifying conditions of medical cannabis license holders in the United States.
        Health Aff. 2019; 38: 295-302
        • Boehnke KF
        • Litinas E
        • Clauw DJ
        Medical cannabis associated with decreased opiate medication use in retrospective cross-sectional survey of chronic pain patients.
        J Pain. 2016; 17: 739-744
        • Boehnke KF
        • Scott JR
        • Litinas E
        • Sisley S
        • Williams DA
        • Clauw DJ
        Pills to pot: Observational analyses of cannabis substitution among medical cannabis users with chronic pain.
        J Pain. 2019; : 1-12
        • Bonn-Miller MO
        • Boden MT
        • Bucossi MM
        • Babson KA
        Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users.
        Am J Drug Alcohol Abuse. 2014; 40: 23-30
        • Bradford AC
        • Bradford WD.
        Medical marijuana laws reduce prescription medication use in medicare part d.
        Health Aff. 2016; 35: 1230-1236
        • Bradford AC
        • Bradford WD.
        Medical Marijuana laws may be associated with a decline in the number of prescriptions for medicaid enrollees.
        Health Aff. 2017; 36: 945-951
        • Bradford AC
        • Bradford WD
        • Abraham A
        • Adams GB
        Association between US state medical cannabis laws and opioid prescribing in the medicare part D population.
        JAMA Intern Med. 2018; 30602: 1-6
        • Carlini BH
        • Garrett SB
        • Carter GT
        Medicinal cannabis: A survey among health care providers in Washington State.
        Am J Hospice Palliative Med. 2015; 32: 1-7
        • Casey SL
        • Atwal N
        • Vaughan CW
        Cannabis constituent synergy in a mouse neuropathic pain model.
        Pain. 2017; 158: 2452-2460
        • Cohen NL
        • Heinz AJ
        • Ilgen M
        • Bonn-Miller MO
        Pain, cannabis species, and cannabis use disorders.
        J Studies Alcohol Drugs. 2016; 77: 515-520
        • Compton WM
        • Han B
        • Jones CM
        • Blanco C
        • Hughes A
        Marijuana use and use disorders in adults in the USA, 2002–14: Analysis of annual cross-sectional surveys.
        Lancet Psych. 2016; 3: 954-964
        • Corroon J
        • Phillips JA.
        A cross-sectional study of cannabidiol users.
        Cannabis Cannabinoid Res. 2018; 3: 152-161
        • Corroon JM
        • Mischley LK
        • Sexton M
        Cannabis as a substitute for prescription drugs - A cross-sectional study.
        J Pain Res. 2017; 10: 989-998
        • Crippa AS
        • Derenusson GN
        • Martin-santos R
        • Vinı M
        • Bhattacharyya S
        • Fusar-poli P
        • Atakan Z
        • McGuire PK
        • Filho S
        • Cecı M
        • Zuardi AW
        • Busatto GF
        • Eduardo J
        Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: A preliminary report.
        J Psychopharmacol. 2011; 25: 121-129
        • Finnerup NB
        • Attal N
        • Haroutounian S
        • McNicol E
        • Baron R
        • Dworkin RH
        • Gilron I
        • Haanpää M
        • Hansson P
        • Jensen TS
        • Kamerman PR
        • Lund K
        • Moore A
        • Raja SN
        • Rice ASC
        • Rowbotham M
        • Sena E
        • Siddall P
        • Smith BH
        • Wallace M
        Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.
        Lancet Neurol. 2015; 14: 162-173
        • Hammell DC
        • Zhang LP
        • Ma F
        • Abshire SM
        • McIlwrath SL
        • Stinchcomb AL
        • Westlund KN
        Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis D.C.
        Eur J Pain. 2016; 20: 936-948
        • Han B
        • Compton WM
        • Blanco C
        • Jones CM
        Trends in and correlates of medical marijuana use among adults in the United States.
        Drug Alcohol Depend. 2018; 186: 120-129
        • Haroutounian S
        • Ratz Y
        • Ginosar Y
        • Furmanov K
        • Saifi F
        • Meidan R
        • Davidson E
        The effect of medicinal cannabis on pain and quality of life outcomes in chronic pain: A prospective open-label study.
        Clin J Pain. 2016; 32: 1036-1043
        • Haug NA
        • Kieschnick D
        • Sottile JE
        • Babson KA
        • Vandrey R
        • Bonn-Miller MO
        Training and practices of cannabis dispensary staff.
        Cannabis Cannabinoid Res. 2016; 1: 244-251
        • Hauser W
        • Petzke F
        • Sommer C
        Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome.
        J Pain. 2010; 11: 505-521
        • Huestis MA
        Human cannabinoid pharmacokinetics.
        Chem Biodivers. 2007; 4: 1770-1804
        • Huestis MA
        • Smith ML.
        Cannabinoid markers in biological fluids and tissues: revealing intake.
        Trends Mol Med. 2018; 24: 156-172
        • Iffland K
        • Grotenhermen F.
        An update on safety and side effects of cannabidiol: A review of clinical data and relevant animal studies.
        Cannabis Cannabinoid Res. 2017; 2: 139-154
        • Institute of M, Medicine Io, Institute of M.
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
        The National Academies Press, Washington, DC2011
        • Lee MC
        • Ploner M
        • Wiech K
        • Bingel U
        • Wanigasekera V
        • Brooks J
        • Menon DK
        • Tracey I
        Amygdala activity contributes to the dissociative effect of cannabis on pain perception.
        PAIN. 2013; 154: 124-134
        • Lin LA
        • Ilgen MA
        • Jannausch M
        • Bohnert KM
        Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample.
        Addict Behav. 2016; 61: 99-103
        • Lucas P
        • Walsh Z
        Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.
        Int J Drug Policy. 2017; 42: 30-35
        • Lucas P
        • Walsh Z
        • Crosby K
        • Callaway R
        • Belle-Isle L
        • Kay R
        • Capler R
        • Holtzman S
        Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors.
        Drug Alcohol Rev. May 2016; 35: 326-333
        • MacCallum CA
        • Russo EB
        Practical considerations in medical cannabis administration and dosing.
        Eur J Intern Med. 2018; 49: 12-19
        • Malfait AM
        • Gallily R
        • Sumariwalla PF
        • Malik AS
        • Andreakos E
        • Mechoulam R
        • Feldmann M
        The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
        Proc Natl Acad Sci U S A. 2000; 97: 9561-9566
        • Nugent SM
        • Morasco BJ
        • O'Neil ME
        • Low A
        • Kondo K
        • Elven C
        • Zakher B
        • Motu'apuaka M
        • Paynter R
        • Kansagara D
        The effects of cannabis among adults with chronic pain and an overview of general harms a systematic review.
        Ann Intern Med. 2017; 167: 319-331
        • Philpott HT
        • O'Brien M
        • McDougall JJ
        Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis.
        Pain. 2017; 158: 2442-2451
        • Piomelli D
        • Russo EB
        The cannabis sativa versus cannabis indica debate: An interview with Ethan Russo, MD.
        Cannabis Cannabinoid Res. 2016; 1: 44-46
        • Piper BJ
        • Beals ML
        • Abess AT
        • Nichols SD
        • Martin M
        • Cobb CM
        • DeKeuster RM
        Chronic pain patients’ perspectives of medical cannabis.
        Pain. 2017; 158: 1373-1379
        • Powell D
        • Pacula RL
        • Jacobson M
        Do medical marijuana laws reduce addictions and deaths related to pain killers?.
        J Health Econ. 2018; 58: 29-42
      1. Procon.org. 33 Legal Medical Marijuana States and DC. 2018.

      2. Procon.org. Number of Legal Medical Marijuana Patients. 2018.

        • Reiman A
        • Welty M
        • Solomon P
        Cannabis as a substitute for opioid-based pain medication: patient self-report.
        Cannabis Cannabinoid Res. 2017; 2: 160-166
        • Russo EB
        Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.
        Br J Pharmacol. 2011; 163: 1344-1364
        • Schleider LB-l
        • Mechoulam R
        • Lederman V
        • Hilou M
        Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer.
        Eur J Internal Med. 2018; 49: 37-43
        • Sexton M
        • Cuttler C
        • Finnell JS
        • Mischley LK
        A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy.
        Cannabis Cannabinoid Res. 2016; 1: 131-138
        • Shi Y
        Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever.
        Drug Alcohol Depend. 2017; 173: 144-150
        • Steigerwald S
        • Wong PO
        • Cohen BE
        • Ishida JH
        • Vali M
        • Madden E
        • Keyhani S
        Smoking, vaping, and use of edibles and other forms of marijuana among U.S. adults.
        Ann Intern Med. Dec 2018; 169: 890-892
        • Steigerwald S
        • Wong PO
        • Khorasani A
        • Keyhani S
        The form and content of cannabis products in the United States.
        J Gen Intern Med. 2018; 33: 1426-1428
        • Stith SS
        • Vigil JM
        • Adams IM
        • Reeve AP
        Effects of legal access to cannabis on scheduled II–V drug prescriptions.
        J Am Med Dir Assoc. 2018; 19: 59-64
        • Stockings E
        • Campbell G
        • Hall WD
        • Nielsen S
        • Zagic D
        • Rahman R
        • Murnion B
        • Farrell M
        • Weier M
        • Degenhardt L
        Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: A systematic review and meta-analysis of controlled and observational studies.
        Pain. 2018; 159: 1932-1954
        • Sznitman SR
        Do recreational cannabis users, unlicensed and licensed medical cannabis users form distinct groups?.
        Int J Drug Policy. 2017; 42: 15-21
        • The National Academies of Sciences E, Medicine
        The Health Effects of Cannabis and Cannabinoids.
        2017 (978-0-309-45304-2)
        • Troutt WD
        • DiDonato MD.
        Medical cannabis in arizona: patient characteristics, perceptions, and impressions of medical cannabis legalization.
        J Psychoactive Drugs. 2015; 47: 259-266
        • Vigil JM
        • Stith SS
        • Adams IM
        • Reeve AP
        Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.
        PLoS One. 2017; 12 (e0187795-e0187795)
        • Volkow ND
        • Baler RD
        • Compton WM
        • Weiss SRB
        Adverse health effects of marijuana use.
        N Engl J Med. 2014; 370: 2219-2227
        • Wall MM
        • Liu J
        • Hasin DS
        • Blanco C
        • Olfson M
        Use of marijuana exclusively for medical purposes.
        Drug Alcohol Depend. Feb 2019; 195: 13-15
        • Wallace M
        • Schulteis G
        • Atkinson JH
        • Wolfson T
        • Lazzaretto D
        • Bentley H
        • Gouaux B
        • Abramson I
        Dose-dependent effects of smoked cannabis on capsaicin- induced pain and hyperalgesia in healthy volunteers.
        Anesthesiology. 2007; 107: 785-796
        • Wallace MS
        • Marcotte TD
        • Umlauf A
        • Gouaux B
        • Atkinson JH
        Efficacy of inhaled cannabis on painful diabetic neuropathy.
        J Pain. 2015; 16: 616-627
        • Walsh Z
        • Callaway R
        • Belle-Isle L
        • Capler R
        • Kay R
        • Lucas P
        • Holtzman S
        Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use.
        Int J Drug Policy. 2013; 24: 511-516
        • Whiting PF
        • Wolff RF
        • Deshpande S
        • Di Nisio M
        • Duffy S
        • Hernandez AV
        • Keurentjes JC
        • Lang S
        • Misso K
        • Ryder S
        • Schmidlkofer S
        • Westwood M
        • Kleijnen J
        Cannabinoids for medical use: A systematic review and meta-analysis.
        JAMA. 2015; 313: 2456-2473