Tobacco and Cannabis Use Linked to Worse Outcomes in Opioid Pain Patients | Research

The takeaway

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.

Pain management clinicians, prescribers of opioid therapy, addiction medicine specialists

Tobacco and cannabis use linked to worse pain and higher opioid misuse concern

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Moderate-sized multi-site study with validated measures, but cross-sectional design limits causal inference.

When this study was published

2025 study of current opioid prescribing patterns.

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.

Questions still open

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?

Common 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.

Read the original research

Alcohol, Tobacco, and Marijuana Use Among Individuals Receiving Prescription Opioids for Pain Management.

The Clinical journal of pain, 41(1)

View on PubMed ↗Publisher’s paper ↗

Citation

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