Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States

Abstract

Aims: With increased liberalization of cannabis policies in North America, there is growing interest in the use of cannabis to manage pain instead of opioids. The objectives of the study were to (1) examine the use of cannabis for pain relief in Canada and the United States (US) in 2018 and 2019; (2) examine the association between recreational cannabis laws and changes in the use of cannabis for pain relief, instead of opioids or prescription pain medication. Methods: Repeat cross-sectional survey data were used from Wave 1 and Wave 2 of the International Cannabis Policy Study conducted in 2018 and 2019 in Canada and the US. Respondents were recruited through commercial panels, aged 16–65, and had ever tried cannabis (N = 44,119). Weighted binary logistic regression models examined the association between the legal status of recreational cannabis and cannabis use for pain relief instead of opioids or prescription pain medication (n = 15,092). Results: Between 14–33% of cannabis consumers in Canada and the US reported using cannabis to manage headaches or pain. Of these consumers, 79% and 78% respondents in Canada; 80% and 83% in US illegal states; and 83% and 84% in US legal states, in 2018 and 2019, respectively, reported cannabis use for pain relief instead of opioids or prescription pain medication. There was little evidence of an association between the legal status of recreational cannabis and cannabis use for pain relief instead of opioids or prescription pain medication, among Canadian (AOR = 0.98, 95% CI: 0.78, 1.22) and US respondents (AOR = 1.11, 95% CI: 0.96, 1.28). Conclusions: Although substitution of cannabis for opioids or prescription pain medication is common among those who use cannabis for pain, there does not seem to be a significant difference according to cannabis legality. Future research should examine cannabis and opioid substitution using different research designs and time frames.

Keywords:

• Opioids
• pain
• cannabis
• marijuana
• legalization
• substitution

Disclosure statement

DH has served as a paid expert witness on behalf of governments in legal challenges to public health laws and regulations initiated by cannabis and tobacco companies. The authors have indicated they have no potential conflicts of interest to declare.

Additional information

Funding

Funding for this study was provided by a Canadian Institutes of Health Research Project Bridge Grant [PJT-153342] and a Canadian Institutes of Health Research Project Grant. Additional support was provided by a Public Health Agency of Canada-Canadian Institutes of Health Research Chair in Applied Public Health (DH) and a Vanier Canada Graduate Scholarship (EW). LH is funded by the Wellcome Trust [209158/Z/17/Z]. The funders had no role in study design, collection, analysis or interpretation of the data, report writing, or decision to submit the report for publication.