Veterans in Addiction Treatment Describe Using Cannabis to Manage Pain | Research

The takeaway

Veterans in substance use treatment described using cannabis to reduce chronic pain and related anxiety and sleep problems — often viewing it as a safer alternative to the substances they were trying to quit.

VA clinicians treating veterans with co-occurring pain and addiction, harm reduction program designers, veterans navigating pain management during recovery.

What the researchers found

Through interviews with 33 veterans receiving care in a VA substance use disorder treatment program, researchers documented how veterans with chronic pain viewed and used cannabis alongside their addiction treatment.

Most participants had a primary diagnosis of alcohol use disorder (70%), followed by opioid use disorder (18%) and stimulant use disorder (12%). The treatment program allowed continued use of substances other than the primary focus of treatment as a harm reduction strategy — meaning cannabis use was permitted while patients worked on quitting alcohol, opioids, or stimulants.

Veterans described using cannabis to manage three interconnected problems: chronic pain itself, pain-related anxiety, and pain-disrupted sleep. Many framed cannabis as a harm reduction tool — a less dangerous substitute for the opioids, alcohol, or other substances they were trying to stop using. This framing positioned cannabis not as recreational drug use but as self-directed pain management.

The interviews revealed the complexity of cannabis's role in this population: it was simultaneously a potential therapeutic tool for pain and a substance with its own use disorder potential, used within a treatment program that pragmatically accepted this tension.

Why it matters

Veterans have disproportionately high rates of both chronic pain and substance use disorders, and the intersection of these conditions drives much of the opioid crisis among this population. Understanding how veterans conceptualize cannabis within their pain management and recovery adds patient perspectives to the clinical and pharmacological evidence — a dimension often missing from the research.

The numbers in context

33 veterans interviewed. Primary SUD diagnoses: alcohol (70%), opioid (18%), stimulant (12%). All had comorbid chronic pain. Cannabis used for pain, anxiety, and sleep in the context of harm reduction-oriented addiction treatment.

How the study worked

Qualitative study using interviews with 33 US military veterans diagnosed with chronic pain who were enrolled in a VA substance use disorder treatment program. Thematic analysis of interview transcripts exploring perspectives on cannabis use for pain management during addiction treatment.

Who was studied

N=33 U.S. military veterans with chronic pain, enrolled in a Veterans Affairs SUD treatment program

What this study cannot tell us

Small qualitative sample from a single VA program with an unusually permissive harm reduction approach. Veterans' perspectives on cannabis may differ from civilian populations. Self-reported cannabis use for pain cannot verify therapeutic effect. The harm reduction treatment model is not standard across VA or civilian SUD programs.

How to read the evidence

Qualitative interview study — provides rich patient perspectives but cannot measure whether cannabis use actually improved pain or recovery outcomes.

When this study was published

Published in 2026, reflecting current veteran perspectives on cannabis in an era of expanding legal access and evolving VA substance use policies.

The bigger picture

This qualitative evidence connects to the quantitative pain literature (RTHC-00233, RTHC-00225) showing modest cannabinoid pain relief in trials, and to the PTSD-cannabis research (RTHC-00274, RTHC-00276) documenting the complex relationship between cannabis and trauma symptoms. The veterans' harm reduction framing — cannabis as a less harmful substitute — reflects a real-world clinical pragmatism that the JAMA therapeutic review (RTHC-00250) doesn't fully capture.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

Do veterans who use cannabis as a substitute for other substances have better long-term recovery outcomes? Should SUD treatment programs formally integrate cannabis as a harm reduction tool, or does this risk replacing one dependency with another? How do clinicians in more traditional abstinence-based programs handle patients who want to use cannabis for pain?

Read the original research

A qualitative study on cannabis use for harm reduction and pain among veterans enrolled in an SUD treatment program.

Harm reduction journal

Harm Reduction Journal focuses on research and discussions related to harm reduction strategies in health.

View on PubMed ↗Publisher’s paper ↗

Citation

Pleasant, Traben; Ono, Sarah; Kansagara, Devan; Lovejoy, Jennette; Lovejoy, Travis; Wyse, Jessica. (2026). A qualitative study on cannabis use for harm reduction and pain among veterans enrolled in an SUD treatment program.. Harm reduction journal. https://doi.org/10.1186/s12954-026-01412-2