Tobacco and Cannabis Use Linked to Worse Outcomes in Opioid Pain Patients
Among 827 patients prescribed opioids for pain, tobacco and marijuana use were each associated with worse pain, more psychiatric symptoms, and higher opioid misuse concerns.
Quick Facts
What This Study Found
Tobacco users had greater pain severity, more pain sites, and higher opioid misuse concern, plus higher rates of depression, anxiety, and PTSD. Cannabis users showed similar patterns with higher misuse concern and psychiatric disorders. Interestingly, alcohol use was associated with lower pain severity.
Key Numbers
N=827. Substance use prevalence: alcohol 58.0%, marijuana 28.9%, tobacco 26.2%. Tobacco and cannabis users had more psychiatric comorbidities and opioid misuse concern. Alcohol users had lower pain scores.
How They Did This
Cross-sectional survey of 827 patients with non-cancer pain receiving new opioid prescriptions from two health systems, measuring pain, substance use, and psychiatric symptoms.
Why This Research Matters
Substance use is common among pain patients on opioids. Understanding which substances are associated with poorer outcomes helps clinicians prioritize screening and intervention.
The Bigger Picture
The finding that alcohol use correlates with lower pain while tobacco and cannabis correlate with worse outcomes challenges simple assumptions about substance use in pain management. The mechanisms behind these different patterns deserve further investigation.
What This Study Doesn't Tell Us
Cross-sectional design at a single time point. Cannot determine direction of causation. Self-reported substance use may undercount actual use. No information on cannabis product types or use patterns.
Questions This Raises
- ?Why does alcohol show a different pattern than tobacco and cannabis?
- ?Would addressing tobacco and cannabis use improve opioid therapy outcomes?
- ?Should substance use screening change opioid prescribing decisions?
Trust & Context
- Key Stat:
- Tobacco and cannabis use linked to worse pain and higher opioid misuse concern
- Evidence Grade:
- Moderate-sized multi-site study with validated measures, but cross-sectional design limits causal inference.
- Study Age:
- 2025 study of current opioid prescribing patterns.
- Original Title:
- Alcohol, Tobacco, and Marijuana Use Among Individuals Receiving Prescription Opioids for Pain Management.
- Published In:
- The Clinical journal of pain, 41(1) (2025)
- Authors:
- Miller-Matero, Lisa R(2), Pappas, Celeste, Altairi, Samah, Sehgal, Monica, Chrusciel, Timothy, Salas, Joanne, Secrest, Scott, Wilson, Lauren, Carpenter, Ryan W, Sullivan, Mark D, Ahmedani, Brian K, Lustman, Patrick J, Scherrer, Jeffrey F
- Database ID:
- RTHC-07139
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Does cannabis help with pain in opioid patients?
This study found the opposite pattern: cannabis use among opioid patients was associated with higher opioid misuse concerns and more psychiatric symptoms, though the cross-sectional design cannot determine causation.
Should pain patients be screened for substance use?
Yes. This study found substance use was extremely common (58% used alcohol, 29% marijuana, 26% tobacco) and tobacco and cannabis use were associated with worse pain and mental health outcomes.
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Cite This Study
https://rethinkthc.com/research/RTHC-07139APA
Miller-Matero, Lisa R; Pappas, Celeste; Altairi, Samah; Sehgal, Monica; Chrusciel, Timothy; Salas, Joanne; Secrest, Scott; Wilson, Lauren; Carpenter, Ryan W; Sullivan, Mark D; Ahmedani, Brian K; Lustman, Patrick J; Scherrer, Jeffrey F. (2025). Alcohol, Tobacco, and Marijuana Use Among Individuals Receiving Prescription Opioids for Pain Management.. The Clinical journal of pain, 41(1). https://doi.org/10.1097/AJP.0000000000001257
MLA
Miller-Matero, Lisa R, et al. "Alcohol, Tobacco, and Marijuana Use Among Individuals Receiving Prescription Opioids for Pain Management.." The Clinical journal of pain, 2025. https://doi.org/10.1097/AJP.0000000000001257
RethinkTHC
RethinkTHC Research Database. "Alcohol, Tobacco, and Marijuana Use Among Individuals Receiv..." RTHC-07139. Retrieved from https://rethinkthc.com/research/miller-matero-2025-alcohol-tobacco-and-marijuana
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.