Cannabis Use in Hospitalized Patients with Chronic Pain

Introduction: To date, no study has reported the prevalence of cannabis use in chronic pain patients. The aim of this study is to investigate the trends in cannabis use among chronic pain in-patients from 2011 to 2015 in the USA.

Methods: Patients were identified from the National Inpatient Sample (NIS) database using the International Classification of Diseases, Ninth and Tenth Revision, diagnosis codes for chronic pain and cannabis use. Annual estimates and trends were determined for cannabis use, patient characteristics, cannabis use among subgroups of chronic pain conditions, cost, length of stay, and associated discharge diagnosis.

Results: Between 2011 to 2015, a total of 247,949 chronic pain patients were cannabis users, increasing from 33,189 to 72,115 (P < 0.001). There were upward trends of cannabis use in females (38.7-40.7%; P = 0.03), Medicare insured patients (32.7-40.4%; P < 0.01), patients with lowest annual household income (36.1-40.9%; P = 0.02), patients aged 45-64 years (45.9-49.2%; P < 0.001), and patients with tobacco use disorder (63.8-72.4%; P < 0.0001). Concurrently, cannabis use decreased among patients with opioid use disorder (23.8-19.9%; P < 0.001). Cannabis use increased from 2011 to 2015 in patients with chronic regional pain syndrome, trauma, spondylosis, and failed back surgery syndrome. Adjusted total hospitalization cost increased from $31,271 ($1333) in 2011 to $38,684 ($946) in 2015 (P < 0.001).

Conclusions: Cannabis use increased substantially from 2011 to 2015, while the rates of cannabis use in opioid users down-trended simultaneously. Disparities in cannabis use among subgroups should be explored further.

Keywords: Cannabinoids; Cannabis; Chronic pain; Opioid-related disorders; Prevalence.