Cannabis use among women with pelvic pain jumped from 13% to 22% after Canadian legalization | Research

The takeaway

Among 3,426 women with pelvic pain at a Canadian clinic, recreational cannabis use rose from 13.3% to 21.5% after legalization, with post-legalization users being more educated, more anxious, and using fewer daily opioids than pre-legalization users.

Gynecologists, pelvic pain specialists, cannabis policy researchers, women with chronic pelvic pain

Cannabis use rose from 13.3% to 21.5% post-legalization (p<0.001)

What the researchers found

14.9% of all patients were current cannabis users. After legalization, use increased from 13.3% to 21.5% (p<0.001). Cannabis users had worse scores for depression, anxiety, pain catastrophizing, quality of life, and pain severity. Post-legalization users were more educated, had worse anxiety and pain catastrophizing, but used fewer antiinflammatories, neuroleptics, and daily opioids.

Why it matters

Cannabis legalization significantly increased use among women with chronic pelvic pain. The shift toward more educated users with fewer opioid prescriptions suggests a changing profile of who turns to cannabis for pain management.

The numbers in context

3,426 women; 509 (14.9%) current cannabis users; use rose from 13.3% to 21.5% post-legalization (p<0.001); cannabis users had worse depression, anxiety, pain catastrophizing, quality of life, and pain severity (all p<0.001); post-legalization users took fewer daily opioids (p=0.026)

How the study worked

Retrospective analysis of a prospective registry at a Vancouver tertiary pelvic pain clinic, 2013-2019 (n=3,426). Compared cannabis users vs. non-users and pre-legalization (before October 17, 2018) vs. post-legalization users on demographics, clinical measures, and validated questionnaires.

What this study cannot tell us

Tertiary care sample may not represent all women with pelvic pain. Retrospective design. Cannot determine if cannabis use preceded or followed pain worsening. Post-legalization period was relatively short (about 1 year). Recreational use data only.

How to read the evidence

Large prospective registry with validated measures and pre/post-legalization comparison, though retrospective analysis and single-center design limit causal inference.

When this study was published

Published in 2021 using 2013-2019 registry data.

The bigger picture

The post-legalization shift to more educated users with lower opioid use suggests legalization may be attracting a different population to cannabis, possibly those seeking alternatives to conventional pain management. The concurrent reduction in daily opioid use warrants further investigation.

Questions still open

Are post-legalization cannabis users reducing opioids intentionally as a substitution strategy? Would these findings apply to other chronic pain populations?

Common questions

Did legalization increase cannabis use among pain patients?

Yes, significantly. Current cannabis use increased from 13.3% before legalization to 21.5% after, a relative increase of about 62%. The new users tended to be more educated than pre-legalization users.

Were cannabis users in more pain?

Cannabis users had significantly worse scores on every measure: depression, anxiety, pain catastrophizing, quality of life, and pelvic pain severity. This likely reflects that patients with more severe symptoms were more motivated to try cannabis.

Read the original research

Recreational Cannabis Use Before and After Legalization in Women With Pelvic Pain.

Obstetrics and gynecology, 137(1), 91-99

View on PubMed ↗Publisher’s paper ↗

Citation

Geoffrion, Roxana; Yang, Emily C; Koenig, Nicole A; Brotto, Lori A; Barr, Alasdair M; Lee, Terry; Allaire, Catherine; Bedaiwy, Mohamed A; Yong, Paul J. (2021). Recreational Cannabis Use Before and After Legalization in Women With Pelvic Pain.. Obstetrics and gynecology, 137(1), 91-99. https://doi.org/10.1097/AOG.0000000000004207