Title:
The Intersection of Marijuana and Opioid Use in Chronic Pain Management: A Retrospective Cohort Study
Introduction:
• Legalization of medical and recreational cannabis in many states has contributed to its increased usage in the general population.
• Neurobiological mechanisms such as cross-sensitization and dopaminergic system activation amongst substances may contribute to marijuana’s association with an increased risk of opioid addiction.
• This study assessed:
• Prevalence of marijuana and opioid use in pain clinic.
• Risk factors for marijuana and opioid use.
Methods:
• A retrospective cohort study of 200 first-time chronic pain patients at our outpatient clinic was performed from July 1, 2022, to February 29, 2024.
• We collected urine/saliva drug screen results, demographic information, and self-reported history of prior opioid prescriptions.
• Marijuana positivity as a potential predictor of opioid positivity was evaluated.
Results:
• Among 200 new patients, 14.5% of chronic pain patients tested positive for marijuana.
• Marijuana positivity varied by race: 34.8% of African American patients, 15.4% of White patients, and 9.6% of Hispanic patients.
• Opioid positivity varied by race: 34.8% of African American patients, 21.5% of White patients, and 9.6% of Hispanic patients.
• Patients testing positive for marijuana demonstrated a significantly higher rate of opiate use without a prescription (10.3%) than those testing negative for marijuana (1.8%)(p=0.041).
Discussion:
• Our study of 200 chronic pain patients found that individuals testing positive for marijuana use were more likely to test positive for opioids use without a prescription.
• African American patients were disproportionately affected in this cohort, showing an even stronger correlation between marijuana and opioid. consumption, suggesting potential demographic factors at play.
• These findings suggest that marijuana use may serve as a risk factor for opioid use.
Limitations:
• Sample size – Findings from 200 patients at Columbia University Medical Center may not represent all chronic pain populations.
• Polysubstance use – The use of other substances (e.g., alcohol, etc.) was not accounted for, which could confound results.
References:
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2. American Medical Association Journal of Ethics. Ethical implications of the opioid epidemic. AMAJ Ethics. 2020;22(8):E743–E750. doi:10.1001/amajethics.2020.743
3. Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–574.doi:10.1146/annurev-publhealth-031914-122957
4. Mannes ZL, Wall MM, Alschuler DM, et al. Cannabis Legalization and Opioid Use Disorder in Veterans Health Administration Patients. JAMA Health Forum. 2025;6(6):e251369.doi:10.1001/jamahealthforum.2025.1369
