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J Pain. 2019 May 24. pii: S1526-5900(19)30067-7. doi: 10.1016/j.jpain.2019.05.009. [Epub ahead of print]

Cannabis Use Preferences and Decision-making Among a Cross-sectional Cohort of Medical Cannabis Patients with Chronic Pain.

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Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address:
Anesthesiology Department, University of Michigan Medical School, Ann Arbor, Michigan.
Om of Medicine, Ann Arbor, Michigan.
Scottsdale Research Institute, Phoenix, Arizona.


Cannabis is commonly used to manage chronic pain, but cannabis use patterns among individuals with chronic pain, has not been well-characterized. We report cannabinoid, administration route, and product selection preferences among medical cannabis users with chronic pain from an ongoing, online survey. We also examined whether these preferences are affected by differences in sex, intentions behind use (medical only [MED] vs medical + recreational [MEDREC]), and experience with cannabis (novice: <1 year vs experienced: ≥1 year). The survey was completed by 1,321 participants (59% female) 76.5% of whom used cannabis every day. 93.4% used 2 or more administration routes and 72.5% used 3 or more. Female, MED, and novice users were less likely to smoke or vaporize (all P < .0001), but more likely to rank edibles, tinctures, and topicals as a first-choice administration route than their counterparts. Female and MED users also preferred low THC: high cannabidiol ratios significantly more than their counterparts. Overall, only 2.6% of participants selected cannabis products with input from a medical professional, although 54.9% relied on advice from dispensary employees. More male, MEDREC, and experienced users selected products based on factors that reflected greater comfort with cannabis (eg, smell, visual properties, cannabis variety). The wide variability in cannabis use among these different groups indicates the need for further research to investigate how specific use routines relate to clinical outcomes. PERSPECTIVE: Medical cannabis users with chronic pain show distinct differences in cannabinoid preferences and administration associated with user sex, intentions behind use, and experience with cannabis. This article highlights the wide variability in cannabis preferences among medical cannabis users with chronic pain, which may be relevant for clinical outcomes.


CBD; Cannabis; THC; administration route; cannabis use routine

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