Chronic Pain Patients Are More Supportive of Cannabis Access Than Doctors

Adults with chronic pain are significantly more supportive of policies expanding cannabis access than the physicians who treat them, according to a study from Rutgers Health and other institutions.

The study, published in JAMA Network Open, surveyed more than 1,600 people with chronic pain and 1,000 physicians in states with medical cannabis programs, including N.J. Researchers found that 71% of chronic pain patients supported federal legalization of medical cannabis, compared with 59% of physicians.

"Cannabis is unique in terms of the complicated policy landscape," said Elizabeth Stone, a core faculty member at the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the study. "Depending on what state you're in, it could be that medical cannabis is legal, it could be that medical and recreational use are legal, it could be that neither is legal, but some things are decriminalized."

Currently, 38 states and Washington, D.C., have legalized medical cannabis use – and N.J. and 23 more of those states (plus D.C.) have legalized it for adult recreational use. However, cannabis remains a Schedule I controlled substance under federal law. Schedule I drugs are considered to have the highest risk of abuse with no recognized medical use, according to the National Institutes of Health.

Among those polled for the study, 55% of chronic pain patients, but 38% of physicians, supported federal legalization of cannabis for adult recreational use. Some 64% of patients, but 51% of physicians, favored requiring insurance coverage for cannabis treatment of chronic pain.

"Overall, people with chronic pain were more supportive of the policies that would expand access to medical cannabis, and providers were more supportive of the policies that would restrict access to medical cannabis," said Stone, who is also an instructor in the Department of Psychiatry at Rutgers Robert Wood Johnson Medical School.

The researchers tapped two separate survey groups for the study data: One contained adults with noncancer pain lasting six months or more; the other contained primary care providers and various specialty physicians.

Personal experience played a significant role in shaping attitudes for both groups. People who had used cannabis for chronic pain reported the highest levels of support for expanding access. Physicians who hadn’t recommended cannabis for chronic pain management reported the lowest levels of support.

The study also found broad support for increased education for doctors prescribing medical cannabis. About 70% of both patients and physicians favored requiring medical schools to train future doctors on cannabis treatment for chronic noncancer pain.

"I think it points to the need for future guidance around cannabis use and efficacy," Stone said. "Is it something they should be recommending? If so, are there different considerations for types of products or modes of use or concentration?"

The researchers noted that federal restrictions on cannabis make it difficult to do the studies that would answer such questions. Federal legalization could help standardize regulations across states and remove obstacles to conducting more comprehensive studies on cannabis's effectiveness for pain management.

"Currently, there are limitations on the research that can be done on cannabis," Stone said. "Opening up those avenues would likely lead to better understanding."

Stone’s study is part of a National Institute on Drug Abuse-funded project on the impacts of state medical cannabis policies on opioid-related outcomes for people with chronic pain.