Perceived Prescription Opioid and Medical Cannabis-Related Stigma Among US Adults With and Physicians Who Treat Chronic Pain

Stigma may influence prescription opioid and cannabis use for pain management among people experiencing and physicians treating chronic pain. We assessed differences in perceived stigma around prescription opioids and cannabis for chronic pain among these two groups.

Data were from surveys of adults with chronic pain and physicians in 36 states and DC with medical cannabis laws, administered in March-April 2022 and July-August 2023, respectively. Stigma was measured as whether respondents believed they would be treated unfairly by neighbours, family or employers if using prescription opioids/cannabis for chronic pain. We compared survey-weighted estimates of perceived prescription opioid and cannabis stigma between patients and physicians using chi-squared tests and developed stigma scales (range: 1 [low stigma]-5 [high stigma]) to compare average stigma scores for each substance within subgroups.

Compared to adults with chronic pain, physicians were more likely to believe they would be treated unfairly for managing chronic pain with prescription opioids by neighbours (39.3% vs. 18.4%, p value < 0.001), family (32.8% vs. 17.4%, p value < 0.001) and employers (49.8% vs. 29.8%, p value < 0.001). Findings were consistent for cannabis. Prescription opioid stigma scores were lower than cannabis scores among adults with chronic pain (2.73 vs. 2.83) and physicians (3.22 vs. 3.33).

Relative to adults with chronic pain, physicians were more likely to perceive stigma around prescription opioid or cannabis use. Both perceived more stigma associated with cannabis than prescription opioids for pain management. Group differences may reflect clinical guidance around opioid and cannabis for chronic pain, and substance differences may reflect cannabis's federal illegality.