Background & Aims

A growing number of studies focus on the therapeutic potential of cannabinoids [1, 2]. However, international and national organizations do not endorse their use for pain management because of lack of strong evidence on efficacy and safety [3-6]. Interestingly, one third of people living with chronic pain (CP) (pain for >3 months [7]) use cannabis [8] and patients’ perception towards cannabis seems positive [9, 10]. In Canada, medical cannabis has been legal since 2001 and non-medical (recreational) cannabis is legal since 2018. This legalization leads some patients to use cannabis as a treatment without guidance from healthcare professionals (self-medication) [11-13]. However, few studies have addressed self-medication with cannabis, and even fewer explored associated factors. This study aimed to compare characteristics of individuals living with CP pain who self-medicate against those who do not self-medicate with cannabis.

Methods

This analysis was conducted using data from a prior cross-sectional descriptive study aiming at describing cannabis self-medication prevalence among persons living with CP (n=73). French-speaking adults from all regions of the province of Quebec (Canada), living with pain for more than three months, and using cannabis for their pain (currently or in the last 12 months; medical or non-medical) were included. Structured telephone interviews were conducted in 2023. Participants reporting using cannabis without the guidance of a registered healthcare professional were classified as self-medicating. Factors to be compared between individuals who reported self-medicating and those not self-medicating (chi-square tests) included sociodemographic profile, pain characteristics and variables chosen according to Wen et al. self-medication framework (past experience, attitudes, costs, disease, environment) [14].

Results

Among the 73 participants, most were female (76.7%) and lived with pain for 10 years or more (83.1%). Mean age was 54.4 ± 12.1 years. A majority was self-medicating with cannabis (61.64%). As compared to individuals who had guidance for their cannabis use, self-medicating participants were younger (52.22 vs. 57.79 years, p=0.027), more often started the use of cannabis before the age of 24 (66.67% vs. 39.29%, p= 0.022), more often used dried cannabis (64.44% vs. 25.00%, p=0.001) and more often used alcohol and drugs more than intended in the last 12 moths (p=0.006). Both groups were similar in terms of sex at birth (p=0.284), family annual income (p=0.889), employment status (p=0.094), average pain intensity in the last 7 days (0-10 scale; p=0.894), pain duration (p=0.284), pain catastrophizing (PCS scale; p=0.179), region of residence (p=0.384) and frequency of cannabis use (p=0.343).

Conclusions

A majority of individuals living with CP and using cannabis (6 out of 10) are self-medicating. Those individuals are younger, more likely to have used cannabis before the age of 24 years old and to have consumed alcohol and drug more than intended in the last 12 moths, and they use more dried cannabis (vs. oil, edibles, pills, etc.). However, larger-scale studies allowing for multivariable analyses should be conducted to provide a deeper understanding of contributing factors. Based on our study, the components of the self-medication model proposed by Wen et al. (China), originally developed for medication use, are not necessarily transferable to cannabis self-medication (differences for such variables were not statistically significant between groups). It is thus warranted to develop specific models for self-medication with cannabis in the Canadian context, particularly among a population living with CP.

References

1.Stockings, E., et al., Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain, 2018. 159(10): p. 1932-1954.
2.Treister-Goltzman, Y., et al., Trends in Publications on Medical Cannabis from the Year 2000. Popul Health Manag, 2019. 22(4): p. 362-368.
3.IASP, International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement. PAIN, 2021. 162: p. S1-S2.
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8.Godbout-Parent, M., et al., Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain. Canadian Journal of Pain, 2022. 6(1): p. 65-77.
9.Furrer, D., et al., Cannabis against chronic musculoskeletal pain: a scoping review on users and their perceptions. Journal of Cannabis Research, 2021. 3(1): p. 41.
10.Schilling, J.M., et al., Cannabidiol as a Treatment for Chronic Pain: A Survey of Patients’ Perspectives and Attitudes. J Pain Res, 2021. 14: p. 1241-1250.
11.Hill, K.P., et al., Cannabis and Pain: A Clinical Review. Cannabis Cannabinoid Res, 2017. 2(1): p. 96-104.
12.Romero-Sandoval, E.A., et al., Cannabis for Chronic Pain: Challenges and Considerations. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2018. 38(6): p. 651-662.
13.Sznitman, S.R. and A.L. Bretteville-Jensen, Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies. Harm Reduction Journal, 2015. 12(1): p. 46.
14.Wen, Y., et al., A qualitative study about self-medication in the community among market vendors in Fuzhou, China. Health & Social Care in the Community, 2011. 19(5): p. 504-513.

Presenting Author

Claudie Audet

Poster Authors

Claudie Audet

MSc

Université du Québec en Abitibi-Témiscamingue

Lead Author

E-mail

Topics

  • Treatment/Management: Cannabinoids and Cannabis