In a survey of 1,321 medical cannabis users with chronic pain, approximately 80% reported substituting cannabis for traditional pain medications, including 53% for opioids and 22% for benzodiazepines, citing fewer side effects.
Pain management clinicians, patients with chronic pain, opioid policy researchers, and medical cannabis program administrators.
53% substituted for opioids
What the researchers found
80% of 1,321 medical cannabis users with chronic pain reported substituting cannabis for traditional pain medications: 53% for opioids, 22% for benzodiazepines. Reasons cited were fewer side effects and better symptom management. Experienced users (1+ years) were more likely to take no concomitant pain medications (43% vs 30%) and report improved health (74% vs 67%).
Why it matters
Chronic pain is the most common reason for medical cannabis licenses. If cannabis consistently enables patients to reduce opioid and benzodiazepine use, it has direct implications for the opioid crisis and benzodiazepine dependency epidemic.
The numbers in context
1,321 participants. 80% substituted cannabis for pain meds. 53% for opioids, 22% for benzodiazepines. Medical-only users: older (52 vs 47), less likely to drink (66% vs 79%), more likely to currently take opioids (21% vs 11%). Experienced users: no concomitant meds 43% vs 30%; improved health 74% vs 67%.
How the study worked
Ongoing nationwide online survey of medical cannabis users with chronic pain. 1,321 participants (59% female, 54% aged 50+). Examined effects of cannabis on pain management, health, and medication use, stratified by recreational co-use and duration of cannabis experience.
What this study cannot tell us
Self-reported data from medical cannabis users, biased toward those who found cannabis helpful. No clinical verification of medication changes. Cross-sectional design. No pain severity or functional outcome measures. Cannot determine whether substitution is medically appropriate.
How to read the evidence
Rated moderate because the large sample provides robust descriptive data, though the self-selected population and lack of clinical verification are limitations.
When this study was published
Published in 2019 from an ongoing national survey.
The bigger picture
The high substitution rate and the finding that experienced users are more likely to eliminate other medications suggest cannabis may function as a practical opioid exit ramp for chronic pain patients. The public health implications are significant.
Questions still open
- Is cannabis substitution for opioids clinically appropriate and safe? Do patients who substitute maintain adequate pain control? What role should physicians play in guiding substitution decisions?
Common questions
Do chronic pain patients replace opioids with cannabis?
Why do patients prefer cannabis over traditional pain medications?
Does longer cannabis use lead to better outcomes?
Read the original research
Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain.
The journal of pain, 20(7), 830-841
Citation
Boehnke, Kevin F; Scott, J Ryan; Litinas, Evangelos; Sisley, Suzanne; Williams, David A; Clauw, Daniel J. (2019). Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain.. The journal of pain, 20(7), 830-841. https://doi.org/10.1016/j.jpain.2019.01.010
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