Medical and recreational cannabis laws were associated with significantly greater increases in cannabis use disorder among VA patients with chronic pain than those without, especially ages 65-75.
Pain medicine specialists, VA healthcare providers, and cannabis policy researchers.
19.4% attributable to RCLof CUD increase among chronic pain patients aged 65-75 in recreational cannabis law states
What the researchers found
Among patients with chronic pain, MCL led to 0.14% and RCL to 0.19% absolute increases in CUD prevalence, with 8.4% and 11.5% of total increases attributable to legalization. Effects were significantly greater than in patients without pain.
Why it matters
Chronic pain patients are increasingly turning to cannabis as opioid prescriptions decline, but they face higher CUD risk, creating a public health concern that grows as legalization expands.
The numbers in context
Yearly n=3.2M-4.6M VHA patients (2005-2019). Pain patients: MCL +0.14%, RCL +0.19% CUD increase. No-pain patients: MCL +0.037%, RCL +0.042%. Ages 65-75 with pain: 19.4% of CUD increase attributable to RCL.
How the study worked
Staggered-adoption difference-in-difference analysis of VHA electronic health records (2005-2019), stratified by chronic pain status with state and year fixed effects and demographic covariates.
Who was studied
U.S. Veterans Health Administration patients aged 18-75 with and without chronic pain (yearly n=3.2M-4.6M, 2005-2019).
What this study cannot tell us
Observational design cannot prove legalization caused CUD increases. VHA patients are predominantly male and may not represent general population. CUD diagnosis rates may reflect increased screening rather than true prevalence increases.
How to read the evidence
Large-scale quasi-experimental design with staggered adoption providing strong observational evidence.
When this study was published
Covers 15 years of VHA data (2005-2019) across changing state cannabis laws.
The bigger picture
As U.S. opioid prescribing declines and cannabis legalization expands, chronic pain patients may substitute cannabis for opioids. While cannabis has a better mortality profile, CUD carries significant impairment and comorbidity.
Replication
Companion to RTHC-04614 and RTHC-04615; findings consistent across related analyses.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Is cannabis substitution for opioids a net positive or negative for chronic pain patients?
- Should cannabis legalization legislation include specific protections for chronic pain populations?
Read the original research
Chronic Pain, Cannabis Legalization and Cannabis Use Disorder in Veterans Health Administration Patients, 2005 to 2019.
medRxiv : the preprint server for health sciences
Citation
Hasin, Deborah S; Wall, Melanie M; Alschuler, Dan; Mannes, Zachary L; Malte, Carol; Olfson, Mark; Keyes, Katherine M; Gradus, Jaimie L; Cerdá, Magdalena; Maynard, Charles C; Keyhani, Salomeh; Martins, Silvia S; Fink, David S; Livne, Ofir; McDowell, Yoanna; Sherman, Scott; Saxon, Andrew J. (2023). Chronic Pain, Cannabis Legalization and Cannabis Use Disorder in Veterans Health Administration Patients, 2005 to 2019.. medRxiv : the preprint server for health sciences. https://doi.org/10.1101/2023.07.10.23292453