In 108 Dutch people with psychotic disorders, pain and pain interference did not predict cannabis use, but those on less-sedating antipsychotics used more cannabis.
psychiatrists, psychosis researchers, substance use clinicians
What the researchers found
Pain and interference from pain were not significant predictors of cannabis use (yes/no) or amount of cannabis use in people with psychotic disorders. However, use of antipsychotics with low sedating effects was associated with greater cannabis use (p=0.028). 59% of the sample experienced some pain and 18.5% used cannabis.
Why it matters
The assumption that people with psychosis might use cannabis to self-medicate pain was not supported. Instead, the link between less-sedating antipsychotics and greater cannabis use raises questions about whether some patients use cannabis for sedation or relaxation that their medications do not provide.
The numbers in context
108 participants. 59% experienced some pain. 18.5% used cannabis. Pain: not a significant predictor. Low-sedation antipsychotics: associated with greater cannabis use (p=0.028). Covariates: age, sex, psychosis severity, sedating medication.
How the study worked
Cross-sectional analysis of 108 Dutch people with psychotic disorders from the VAT observational cohort. Regression models tested whether pain (RAND-36-SF items) predicted cannabis use, controlling for age, sex, psychosis severity, and sedating antipsychotic use.
What this study cannot tell us
Small sample size (108). Cross-sectional design. Self-reported pain and cannabis use. Dutch sample may not generalize. Cannabis may effectively suppress pain, making users report less pain (reverse causation). Single-site cohort study.
How to read the evidence
Small cross-sectional sample from a single cohort limits evidence to preliminary.
When this study was published
Data from the Dutch VAT observational cohort study.
The bigger picture
The antipsychotic sedation finding suggests cannabis use in psychosis may be driven more by a desire for subjective effects that less-sedating medications do not provide, rather than by pain management. This could influence medication selection decisions.
Questions still open
- Are patients on less-sedating antipsychotics using cannabis for relaxation or sleep?
- Would switching to a more sedating antipsychotic reduce cannabis use in this population?
Common questions
Do people with psychosis use cannabis for pain?
What did predict cannabis use in psychosis?
Read the original research
Pain Is Not a Predictor of Cannabis Use in People With Psychotic Disorders.
Journal of dual diagnosis, 21(3), 183-190
Citation
Smid, Mirjam H; Bruins, Jojanneke. (2025). Pain Is Not a Predictor of Cannabis Use in People With Psychotic Disorders.. Journal of dual diagnosis, 21(3), 183-190. https://doi.org/10.1080/15504263.2025.2517176
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