Associations Between Medical Cannabis Use and Prescription Pain Reliever Use in U.S. Adults, 2022-2023

Chronic pain is a prevalent and costly public health issue in the United States. Prescription opioids remain a common treatment but carry significant risks. Medical cannabis has emerged as a potential alternative, though access and use may vary by state medical cannabis laws. Prior research using 2015-2019 National Survey on Drug Use and Health data found that appropriate use and misuse of prescription pain relievers were associated with increased odds of medical cannabis use. We extend this work using 2022-2023 data.

To assess the prevalence of past-year medical cannabis use among United States adults, both in all states and in states without legalized medical cannabis use, and to examine associations with prescription pain reliever use and demographic, substance use, and psychiatric characteristics.

We analyzed pooled 2022-2023 National Survey on Drug Use and Health data. The outcome was past-year medical cannabis use and the primary predictor was past-year prescription pain reliever use. Survey-weighted Rao-Scott chi-square tests and multivariable logistic regression examined associations with covariates.

Among 256 million U.S. adults, 3.9% reported past-year medical cannabis use. Appropriate prescription pain reliever use (OR = 1.76, CI = 1.53-2.03, p < 0.001) and misuse (OR = 1.94, CI = 1.49-2.51, p < 0.001) were associated with higher odds of medical cannabis use after adjustment.

Medical cannabis use remains stable overall but more prevalent among adults using prescription pain relievers, suggesting co-use rather than substitution and a need for updated clinical guidance on medical cannabis for pain management.