Pain Was a Significant Predictor of Starting Cannabis Use for the First Time Among Young Adults | Research

The takeaway

Among over 4,000 emerging adults who had never used cannabis, those with moderate-to-severe pain were significantly more likely to initiate cannabis use over subsequent years, establishing pain as a prospective risk factor for cannabis initiation.

Pain specialists, primary care providers, substance use prevention researchers, and young adults with chronic pain.

What the researchers found

Among 4,185 emerging adults who denied cannabis use at baseline, moderate/severe pain (reported by about 10%) prospectively predicted cannabis initiation across five annual waves. This is the first study to establish pain as a predictor of cannabis initiation (not just increased use) in emerging adults.

Why it matters

Understanding why people start using cannabis is key to prevention. If pain drives cannabis initiation in young adults, improving pain management could prevent cannabis use and its associated risks in this vulnerable population.

The numbers in context

4,185 cannabis-naïve emerging adults. 5 annual waves from PATH study. ~10% reported moderate/severe pain at baseline. Pain significantly predicted subsequent cannabis initiation. First prospective study of pain → cannabis initiation.

How the study worked

Longitudinal analysis of Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study. 4,185 cannabis-naïve emerging adults (ages 18–25) tracked annually. Logistic regression assessed whether baseline moderate/severe pain predicted subsequent cannabis initiation.

What this study cannot tell us

Self-reported pain and cannabis use. Cannot determine if pain led to cannabis through self-medication or shared risk factors. Five annual waves may miss short-term patterns. Cannabis initiation is broadly defined.

How to read the evidence

Large nationally representative longitudinal study with prospective design among cannabis-naïve participants, providing strong causal inference support.

When this study was published

Published 2025, PATH Study Waves 1–5.

The bigger picture

This complements the companion study (pain predicting co-use) by showing pain drives not just escalation but actual initiation. The two studies together paint a picture of pain as a fundamental driver of cannabis use trajectories in young adults — from first use to combined substance use.

Questions still open

Would better pain management in young adults reduce cannabis initiation rates? Do young adults who start cannabis for pain develop different use patterns than those who start recreationally? Should pain screening be part of cannabis prevention programs?

Common questions

Does pain make young people try cannabis?

This study found that emerging adults with moderate-to-severe pain who had never used cannabis were more likely to start using it over subsequent years. While it doesn't prove pain directly causes initiation, the prospective design provides strong evidence for a temporal link.

Should doctors address pain to prevent cannabis use?

This study suggests effective pain management in young adults could reduce cannabis initiation. Rather than viewing cannabis use only as a substance problem, clinicians should also consider whether undertreated pain is driving the behavior.

Read the original research

Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study.

Behavioral medicine (Washington, D.C.), 51(3), 254-263

View on PubMed ↗Publisher’s paper ↗

Citation

Williams, Callon M; Mastroleo, Nadine R; Lenzenweger, Mark F; Zale, Emily L. (2025). Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study.. Behavioral medicine (Washington, D.C.), 51(3), 254-263. https://doi.org/10.1080/08964289.2025.2465525