40% of Cannabis-Using Chronic Pain Patients at High Risk for Cannabis Use Disorder | Research

The takeaway

A 2-year study of 1,453 chronic pain patients found 40% of cannabis users at high CUD risk, linked to worse baseline mental health but not worsening pain over time.

Pain management clinicians, addiction medicine specialists, chronic pain patients using cannabis

39.8% of cannabis-using chronic pain patients at high CUD risk

What the researchers found

Among 1,453 chronic pain patients followed for 2 years, 36.3% used cannabis and 39.8% of users showed high CUD risk. Higher CUD risk was associated with worse baseline pain, central sensitization, and mental health symptoms, but pain trajectories over 2 years did not differ between CUD risk groups and non-users.

Why it matters

Nearly 4 in 10 chronic pain patients who use cannabis may develop problematic use. The finding that CUD risk does not worsen pain trajectories suggests these patients are not harming their pain prognosis, but the mental health burden warrants attention.

The numbers in context

N=1,453, 65.5% female, 86.1% White. 36.3% used cannabis. 39.8% of users at high CUD risk. Higher CUD risk associated with younger age, male sex, lower SES, higher alcohol risk, worse mental health. Pain trajectories: no difference by CUD risk.

How the study worked

Two-year longitudinal study of 1,453 chronic pain patients recruited online, with baseline, 3-, 12-, and 24-month assessments using the Cannabis Abuse Screening Test and Brief Pain Inventory.

What this study cannot tell us

Online recruitment may not represent all chronic pain patients. Self-reported cannabis use and CUD screening. Cannot determine causation. Predominantly White female sample limits generalizability.

How to read the evidence

Large longitudinal design with 2-year follow-up provides strong temporal evidence, though online recruitment and self-report measures have limitations.

When this study was published

2025 longitudinal study with 2-year follow-up.

The bigger picture

The high CUD risk prevalence challenges assumptions about the safety of self-directed cannabis use for pain. However, the lack of worsening pain outcomes provides nuance, suggesting CUD in chronic pain may primarily be a mental health concern rather than a pain management failure.

Questions still open

Should chronic pain patients be routinely screened for CUD? Does treating CUD improve mental health outcomes in this population? What interventions best reduce CUD risk while maintaining pain management?

Common questions

Can chronic pain patients develop cannabis addiction?

This study found nearly 40% of chronic pain patients who used cannabis were at high risk for cannabis use disorder. These individuals had worse mental health symptoms at baseline, though their pain outcomes over 2 years were similar to non-users.

Does cannabis use disorder make chronic pain worse?

Surprisingly, no. Despite having worse baseline symptoms, patients at high CUD risk did not show worsening pain trajectories over 2 years compared to non-users. The main concern was the associated mental health burden.

Read the original research

Risk of Cannabis Use Disorder in Chronic Pain: Longitudinal Links to Pain Outcomes.

Journal of addiction medicine, 19(5), 545-551

View on PubMed ↗Publisher’s paper ↗

Citation

Mun, Chung Jung; Timmons, Patricia; Perez, Iosef I; Meier, Madeline H; Wegener, Stephen T; Campbell, Claudia M; Aaron, Rachel V. (2025). Risk of Cannabis Use Disorder in Chronic Pain: Longitudinal Links to Pain Outcomes.. Journal of addiction medicine, 19(5), 545-551. https://doi.org/10.1097/ADM.0000000000001446