How does cannabis use influence the use of illicit opioids to manage pain? That’s the question at the heart of a just-published study in a special issue of “PLOS Medicine” that focuses on substance use, misuse and dependence. For medical researchers, caregivers and patients, the need for an alternative to opioid painkillers is an urgent one. Opioid-related deaths are still on the rise across the United States and Canada, fueled by the emergence of synthetic opioids like fentanyl and a trend of over-prescribing pharmaceutical opioids. And the role cannabis might play in reducing opioid dependence and abuse is still little-understood.

But the new “PLOS Medicine” study, “Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain,” provides an important perspective on the question by researching individual-level data—something many current studies lack. Following more than 1,100 individuals over a 30-month period, researchers aimed to investigate associations between how often people with chronic pain use cannabis and how often they turn to illicit opioids. And what they found could change the way we look at cannabis and the opioid epidemic in dramatic ways.

Daily Cannabis Use Significantly Lowers Odds of Daily Illicit Opioid Use

Doctors over-prescribing opioid painkillers is undeniably a contributing factor in the opioid epidemic. But what about people suffering from chronic pain who don’t have adequate access to the healthcare system? For such marginalized groups, under-treated—or untreated—pain can promote a higher risk of substance use and abuse, including the use of illicit opioids like heroin or fentanyl and counterfeit pharmaceutical drugs.

Yet people without access to the healthcare system can also turn to cannabis as a pain management strategy. Given the research

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