Individuals’ Values and Preferences Regarding Medical Cannabis for Chronic Pain: A Descriptive Qualitative Study

Abstract

Background

Cannabis for medical purposes has been legal in Canada since 2001; however, physicians receive no formal training in this modality, and clinical use of cannabis remains controversial. This study aims to explore the values and preferences of people living with chronic pain (PLwCP) in using medical cannabis for chronic pain to inform guideline development and shared decision-making in clinical practice.

Methods

We conducted a descriptive qualitative study using in-depth interviews with PLwCP. Using a deductive/inductive approach, we developed concepts and themes related to values and preferences of PLwCP on their use (or avoidance) of medical cannabis for chronic pain.

Results

We interviewed 52 PLwCP, including current medical cannabis users (40), previous users (10) and non-users (2). Most PLwCP who used cannabis therapeutically reported the need for experimentation to determine what cannabis products, routes, and doses worked for them. Perceived benefits of medical cannabis among current users included relief from pain, better sleep, and improved mental health. Reasons for discontinuing use of medical cannabis included lack of improvement in pain or sleep or undesirable side effects. Cannabidiol (CBD) dominant products were reported to result in minimal adverse effects (eg, physical or mental impairment) compared to tetrahydrocannabinol (THC) dominant products. Perceived barriers or facilitators to use included social acceptability, availability or access, cost, and attitudes and knowledge among healthcare providers. Participants noted different routes of cannabis use including oral routes that provided longer-lasting pain relief with a slower onset and inhaled routes with a more rapid onset with shorter-lived effects.

Conclusion

Participants’ decisions to use medical cannabis for chronic pain were varied, which suggests these decisions are likely to be sensitive to individuals’ values and preferences. There is a call for further research and information-sharing to help PLwCP understand the complexities of cannabis use for medical purposes, including ideal dosing and timing.

Plain Language Summary

In Canada, cannabis for medical reasons has been legal since 2001. It has been used as one of the many strategies for chronic or ongoing pain, but doctors are not given consistent information regarding its use, and existing guidance does not include the patient point of view. We did this study to explore how people living with chronic pain feel about the use of medical cannabis. We asked 52 people living with chronic pain, including current medical cannabis users, previous users, and non-users. We found that many people who used cannabis for their pain had to experiment to determine what cannabis products, routes, and doses worked for them. Benefits of medical cannabis included relief from pain, better sleep, and improved mental health. Reasons for stopping medical cannabis included no to little improvement in pain and/or sleep or the presence of unwanted side effects. Cannabidiol (CBD) products resulted in fewer unwanted effects (eg, physical or mental impairment) compared to tetrahydrocannabinol (THC) products. People discussed different routes of cannabis use including oral routes that provided longer-lasting pain relief but with a slower onset and inhaled routes with a faster onset of relief but with shorter-lived effects. People’s decisions regarding medical cannabis use for chronic pain were varied, suggesting these decisions are likely to be sensitive to individual’s values and preferences. More research is needed to learn what doses, products, and routes work for specific chronic pain conditions.

Keywords:

• medical cannabis
• chronic pain
• health services
• guideline
• patient values and preferences
• Canada

Abbreviations

PLwCP, people living with chronic pain; HCP, healthcare provider; CBD, cannabidiol; THC, tetrahydrocannabinol.

Acknowledgments

This work was supported by the Canadian Institutes of Health Research (CIHR). JWB is supported, in part, by a CIHR Research Chair in the prevention and management of chronic pain.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.