Prevalence Rates, Perceptions of Risk, and Motivations for Nonmedical Cannabis Use in Pediatric Pain.

IMPORTANCE

Characterizing cannabis use (CU) rates in pediatric pain is critical as adolescence is a period of increased substance use and risk for negative outcomes. Youths with chronic pain may engage in CU to cope with symptoms.

OBJECTIVE

To examine CU rates, risk perceptions, and motivations for use among treatment-seeking youths with diagnosed pain disorders.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey study conducted from September 2021 to May 2024 at a pain treatment clinic at a pediatric hospital in the Northeast United States. Participants were 251 adolescents receiving treatment for diagnosed pain conditions. Of 312 approached, 40 did not complete the survey; 17 were excluded.

EXPOSURES

Validated self-report measures assessing demographics, pain, and substance use.

MAIN OUTCOMES AND MEASURES

CU rates, motivations for use, and perceived risks.

RESULTS

Of 245 adolescents providing complete data (mean [SD] age 16.9 [1.4] years; 168 [68.6%] female; 1 [0.4%] American Indian, 3 [1.2%] Asian, 3 [1.2%] Black, 19 [7.8%] Hispanic or Latino, and 201 [82.1%] White), 62 (25.3%) endorsed lifetime CU, with a mean (SD) age at first use of 15.3 (1.9) years. Among those endorsing CU, past-year prevalence was 90.2% (56 of 62 participants) and past-month prevalence was 64.5% (40 of 62 participants). The CU group was older (mean difference, 0.9 years; 95% CI, 0.5 to 1.2 years; P < .001), included fewer female participants (difference, -14.0%; 95% CI, -32.6% to -2.9%; P = .03), and reported greater pain interference scores (mean difference, 2.7; 95% CI, 0.8-4.6; P = .01) and depressive symptoms scores (mean difference, 6.2; 95% CI, 2.8-9.5; P < .001) compared with the no CU group. The no CU group perceived cannabis as riskier (odds ratio, 2.37; 95% CI, 1.28-4.39; P = .01). Among youths endorsing CU, 48 of 62 (77.4%) endorsed instrumental use (IU) to alleviate psychological or physical symptoms (primarily pain, sleep, and anxiety), representing an overall IU prevalence of 19.6% (48 of 245 participants). Youths reporting IU were younger (mean difference, -0.7 years; 95% CI, -1.3 to -0.1 years; P = .04) and reported greater functional disability scores (mean difference, -8.4; 95% CI, 2.1 to 12.6; P = .01) compared with the no IU group.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, approximately 25% of treatment-seeking youths with chronic pain reported CU, with more than 75% using cannabis instrumentally to treat symptoms despite limited evidence supporting cannabis for pain, sleep, or anxiety. Given CU rates in this population, education about the risks of self-medication and the development of alternative coping strategies are needed.