Study Links Chronic Pain With Tobacco and Cannabis Use


A study out of the Duke University School of Medicine shows a surprising link between the dual use of tobacco and cannabis among chronic pain sufferers. Published late last year, the study poses two interesting questions: does pain increase the likelihood of using the two substances and does consumption of tobacco and cannabis make pain worse?

Answering both questions seems rather important given the debate over whether not cannabis truly relieves pain through some sort of biological or physiological function. If it turns out that the mechanism behind cannabis-related pain relief is due to the placebo effect only, we then need to consider the long-term effects of treating pain with cannabis.

More About the Study

The previously mentioned study was published in the Addictive Behaviors journal in November 2023. Its researchers looked at data pertaining to 32,014 adults who reported both pain and the use of tobacco and cannabis. Participants reporting a consistent moderate to severe pain experience were two times more likely to use tobacco and 1.5 times more likely to use cannabis.

More importantly, those experiencing pain were nearly three times more likely to report using both tobacco and cannabis simultaneously. That is the most surprising number. The question still unanswered is why dual use? Given what we know about tobacco and its detrimental impacts on human health, it is not clear why people experiencing chronic pain would mix tobacco with cannabis. Sticking with cannabis alone would seem to make more sense unless a chronic pain patient is smoking cannabis.

A Link Between Nicotine and Cannabis

Although researchers were unable to conclusively draw a link between nicotine and cannabis, they surmised that it is possible some patients are experiencing better pain relief when the two substances are mixed. Let us assume such is the case. What we would have is a real life demonstration of what the medical community refers to as the ‘entourage effect’.

The entourage effect describes a scenario in which two substances offer moderate benefits when used separately. When combined, their benefits are enhanced. The two substances work better together than each one does alone. Is that the case with nicotine and cannabis? Duke researchers cannot say for sure.

Chronic Pain and Cannabis

Even though the Duke University study ends up posing more questions than it answers, there is one thing we know about chronic pain and cannabis: the two are almost synonymous from a treatment perspective. The vast majority of patients who use state-legal medical cannabis do so as a treatment for chronic pain.

That’s certainly the case in Utah, where the experts behind the website say that nearly 80% of the state’s medical cannabis card holders report chronic pain is their qualifying condition.

Medical science is still unclear as to why, or even how, cannabis relieves pain. A study released in late 2022 seems to suggest that any relief chronic pain patients experience through cannabis is due to the placebo effect alone. Yet other scientific studies indicate that cannabis performs better than placebo for pain relief.

The Long Term Risks

Duke researchers were unable to definitively answer the question of why people in pain would combine tobacco and cannabis. They also cannot say if combining the two substances increases pain over the long term. They do have legitimate questions about long term safety that remain unanswered.

Perhaps future research will provide some of the answers. In the meantime, we know that millions of people around the country rely on medical cannabis to relieve their chronic pain. Perhaps many of them are also tobacco users.

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