Cancer Survivors in Pain Are More Likely to Use Cannabis—But Less Likely to Drink
Across two national samples totaling over 5,000 cancer survivors, higher pain intensity was associated with more cannabis and cigarette use but less alcohol use—suggesting pain drives substance-specific self-medication patterns.
Quick Facts
What This Study Found
This study used two large national datasets to examine how pain relates to substance use among cancer survivors—a population with high rates of both pain and substance use but surprisingly little research on the connection.
The pattern was consistent across both samples: cancer survivors with more pain were significantly more likely to use cannabis and cigarettes, but less likely to drink alcohol. This wasn't a random scatter—it suggests deliberate self-medication choices. People in pain may turn to cannabis and nicotine (both of which have analgesic properties) while avoiding alcohol (which can interfere with pain medications and worsen certain types of pain).
The implications go beyond substance use itself. In both studies, cigarette smoking combined with pain was associated with worse mental health outcomes and lower quality of life. Cannabis use combined with pain showed a different pattern—not as consistently linked to negative mental health outcomes as smoking.
The study also examined treatment-related side effects and found that pain and substance use together created a compounding effect on overall burden. Cancer survivors managing pain, substance use, and treatment side effects simultaneously face a triple challenge that current care systems often address in silos.
Key Numbers
Study 1: N = 1,252 (88% White, 55% female, 60% age ≥65). Study 2: N = 4,130 (83% White, 56% female, mean age 66). Pain associated with increased cannabis use (p < .003 in Study 1), increased cigarette use, and decreased alcohol use (p < .001).
How They Did This
Cross-sectional analysis of two national datasets: Study 1—1,252 adults from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study; Study 2—4,130 adults from the 2020 National Health Interview Survey. All had lifetime cancer diagnosis. Regression analyses examined associations between pain and use of cigarettes, e-cigarettes, cannabis, and alcohol.
Why This Research Matters
Cancer pain is undertreated in many patients, particularly as opioid prescribing has become more conservative. Understanding that pain drives cancer survivors toward cannabis (and away from alcohol) has practical implications: if patients are self-medicating pain with cannabis, that's information oncologists need for treatment planning—not just a substance use issue to be addressed separately.
The Bigger Picture
This connects to the cancer-cannabis cluster: RTHC-00158 (THC:CBD for cancer symptoms), RTHC-00161 (medical marijuana laws reducing opioid prescriptions), and RTHC-00177 (patient perceptions of vaporized cannabis for appetite). Together, they paint a picture of cancer patients increasingly turning to cannabis for multiple symptoms—and the medical system slowly catching up to that reality. The substance-specific pattern (more cannabis, less alcohol) also adds nuance to the self-medication discussion.
What This Study Doesn't Tell Us
Cross-sectional design can't establish whether pain causes cannabis use or whether cannabis-using cancer survivors report more pain. Both datasets relied on self-reported pain and substance use. Predominantly White samples (83–88%) limit racial/ethnic generalizability. Cannabis use was measured as any use, without dose or frequency detail. "Lifetime cancer diagnosis" includes survivors at various stages, from active treatment to long-term survivorship.
Questions This Raises
- ?Is the shift from alcohol to cannabis among cancer survivors in pain a positive development from a health perspective?
- ?Should oncology pain management protocols formally address cannabis as a potential self-medication tool?
- ?Does the combination of pain and cannabis use predict different long-term outcomes than pain and cigarette use?
Trust & Context
- Key Stat:
- Evidence Grade:
- Two large national datasets with consistent findings—strengthened by replication but limited by cross-sectional design and self-report.
- Study Age:
- Published in 2025 with data from 2020–2021, reflecting current substance use patterns among cancer survivors.
- Original Title:
- Relationship between pain and nonopioid substance use in two national samples of cancer survivors.
- Published In:
- Cancer, 131(4), e35701 (2025) — Cancer is a well-respected journal focused on oncology research.
- Authors:
- Powers, Jessica M, LaRowe, Lisa R, Rubenstein, Dana, Paice, Judith A, Hitsman, Brian, Rini, Christine M
- Database ID:
- RTHC-07397
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Read More on RethinkTHC
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Cite This Study
https://rethinkthc.com/research/RTHC-07397APA
Powers, Jessica M; LaRowe, Lisa R; Rubenstein, Dana; Paice, Judith A; Hitsman, Brian; Rini, Christine M. (2025). Relationship between pain and nonopioid substance use in two national samples of cancer survivors.. Cancer, 131(4), e35701. https://doi.org/10.1002/cncr.35701
MLA
Powers, Jessica M, et al. "Relationship between pain and nonopioid substance use in two national samples of cancer survivors.." Cancer, 2025. https://doi.org/10.1002/cncr.35701
RethinkTHC
RethinkTHC Research Database. "Relationship between pain and nonopioid substance use in two..." RTHC-07397. Retrieved from https://rethinkthc.com/research/powers-2025-relationship-between-pain-and
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.