Comparing Cannabis Use for Pain to Use for Other Reasons in Primary Care Patients

Morgan A. Ford; Gwen T. Lapham; Theresa E. Matson; Casey Luce; Malia M. Oliver; Ingrid A. Binswanger

doi:10.3122/jabfm.2023.230163R1

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Figure 1.
Study population selection criteria.

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Table 1.

Sociodemographic Characteristics of Survey Participants Who Used Cannabis for Pain and Who Used Cannabis for Other Reasons in the Past 30 Days

	Used cannabis for pain (n = 375)	Used cannabis for other reasons^*(n = 558)
Characteristic	n (%)	n (%)	P value
Age at cannabis screen
18 to 29	43 (11.5)	177 (31.7)	<0.001
30 to 49	116 (30.9)	204 (36.6)
50+	216 (57.6)	177 (31.7)
Gender
Woman	197 (52.5)	249 (44.6)	0.018
Man	178 (47.5)	309 (55.4)
Race
American Indian/Alaska Native	16 (4.3)	7 (1.3)	0.057
Asian	13 (3.5)	34 (6.1)
Black/African American	34 (9.1)	50 (9.0)
Hawaiian/Other Pacific Islander	9 (2.4)	11 (2.0)
White	271 (72.3)	399 (71.5)
Other	17 (4.5)	29 (5.2)
Unknown	15 (4.0)	28 (5.0)
Ethnicity
Hispanic/Latino	32 (8.5)	63 (11.3)	0.064
Not Hispanic/Latino	330 (88.0)	461 (82.6)	0.064
Unknown	13 (3.5)	34 (6.1)
Employment status^†
Full-time	175 (46.7)	355 (63.6)	<0.001
Part-time	25 (6.7)	51 (9.1)
School/vocational	4 (1.1)	25 (4.5)
Retired	98 (26.1)	77 (13.8)
Homemaker	9 (2.4)	12 (2.2)
Unemployed	13 (3.5)	18 (3.2)
Disabled	46 (12.3)	8 (1.4)
Other	5 (1.3)	10 (1.8)
Education^†
>4-year college degree	60 (16.1)	126 (22.7)	<0.001
4-year college degree	57 (15.3)	158 (28.5)
Some college	162 (43.4)	186 (33.5)
High school/GED or less	94 (25.2)	85 (15.3)

* Other than pain, reasons for cannabis use assessed include muscle spasm, seizures, nausea or vomiting, sleep, stress, appetite, worry or anxiety, depression or sadness, focus or concentration, other symptoms, none.
^† Column sums for this variable may not total 375 for used cannabis for pain or 558 for used cannabis for other reasons due to missing responses (item-level non-response rate across participants ≤1%).

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Table 2.

Chronic Pain and Substance Use Disorder Diagnosis History; Current Cigarette Smoking Status and Vaping of Tobacco/Nicotine; and Mode, Frequency, and Helpfulness of Cannabis Use in Survey Participants Who Used Cannabis for Pain and Who Used Cannabis for Other Reasons in the Past 30 Days

	Used cannabis for pain (n = 375)	Used cannabis for other reasons^* (n = 558)
	n (%)	n (%)	P value
Chronic pain diagnosis in past 2 years	206 (54.9)	122 (21.9)	<0.001
Limb/joint	127 (33.9)	71 (12.7)	<0.001
Back	93 (24.8)	47 (8.4)	<0.001
Neck	45 (12.0)	30 (5.4)	<0.001
Abdominal and bowel	38 (10.1)	17 (3.0)	<0.001
Fracture/contusion/sprain	28 (7.5)	14 (2.5)	<0.001
Neuropathy	18 (4.8)	4 (0.7)	<.001**
Muscle/chest	15 (4.0)	5 (0.9)	0.001
Headache	14 (3.7)	10 (1.8)	0.066
Other chronic pain diagnosis^†	84 (22.4)	35 (6.3)	<0.001
Any substance use disorder diagnosis in past 2 years	95 (25.3)	90 (16.1)	0.001
Tobacco use disorder	60 (16.0)	60 (10.8)	0.019
Alcohol use disorder	19 (5.1)	17 (3.0)	0.335
Cannabis use disorder	19 (5.1)	21 (3.8)	0.116
Opioid use disorder	10 (2.7)	6 (1.1)	0.066
Other drug use disorder^‡	2 (0.5)	9 (1.6)	.215**
Current cigarette smoking status^§
Every day	54 (14.6)	40 (7.2)	0.001
Some days	17 (4.6)	28 (5.0)	0.001
Not at all/never	300 (80.9)	488 (87.8)
Current vaping of tobacco/nicotine^§
Every day	20 (5.3)	29 (5.2)	0.996
Some days	18 (4.8)	27 (4.9)	0.996
Not at all/never	337 (89.9)	500 (89.9)
All modes of cannabis use endorsed^‖
Smoke	249 (66.4)	422 (75.6)	0.002
Apply	190 (50.7)	59 (10.6)	<0.001
Eat	164 (43.7)	244 (43.7)	0.999
Vape	160 (42.7)	254 (45.5)	0.390
Drink	72 (19.2)	65 (11.6)	0.001
Dab	63 (16.8)	81 (14.5)	0.344
Other	26 (6.9)	13 (2.3)	0.001
Primary mode of cannabis use endorsed^§
Smoke	164 (44.2)	284 (51.5)	<0.001
Apply	55 (14.8)	3 (0.5)
Eat	48 (12.9)	70 (12.7)
Vape	57 (15.4)	139 (25.2)
Drink	18 (4.9)	14 (2.5)
Dab	20 (5.4)	33 (6.0)
Other	9 (2.4)	9 (1.6)
Typical times per day of cannabis use, considering all modes of use^§
<1	7 (1.9)	14 (2.5)	<0.001
1 to 2	188 (50.7)	355 (64.3)
3 to 4	103 (27.8)	115 (20.8)
5 to 9	53 (14.3)	47 (8.5)
10+	20 (5.4)	21 (3.8)
Typical days per week of cannabis use, considering all modes of use^§
<1	17 (4.5)	45 (8.1)	<0.001
1 to 3	52 (13.9)	122 (21.1)	<0.001
4 to 7	305 (81.6)	384 (69.7)
Medical use in the past 30 days^§^,^¶
Both medical and non-medical	226 (60.4)	180 (32.5)	<0.001
Medical	130 (34.8)	48 (8.7)	<0.001
Non-medical	18 (4.8)	325 (58.8)
Perceived helpfulness of cannabis use among those who provided a reason for use^§^,^#
Very/extremely	302 (80.5)	338 (72.7)	0.010^**
Slightly/somewhat	73 (19.5)	125 (26.9)	0.010^**
Not at all	0 (0.0)	2 (0.4)

↵* Other than pain, reasons for cannabis use assessed include muscle spasm, seizures, nausea or vomiting, sleep, stress, appetite, worry or anxiety, depression or sadness, focus or concentration, other symptoms, none.
↵^† Includes acquired deformities (excluding back conditions), arthritic pain, bone infections, cancer-related pain, fibromyalgia, general pain, infectious diseases, orofacial/temporomandibular joint pain, post-operative pain, post-trauma pain, restless legs syndrome, spinal cord injury, systemic disorders, urogenital/pelvic pain, and other painful conditions.
↵^‡ Includes stimulant, hallucinogen, and other drug use disorders.
↵^§ Column sums for this variable may not total 375 for Used cannabis for pain or 558 for used cannabis for other reasons due to missing responses (item-level non-response rate across participants ≤1%).
↵^‖ Responses not mutually exclusive.
↵¶ Response to question “When you used marijuana/cannabis during the past 30 days, was it: 1. For medical reasons, 2. For non-medical reasons, 3. For both medical and non-medical reasons.”
↵# Eighty-five participants in the used cannabis for other reasons group reported no reasons for cannabis use and therefore were not asked about the perceived helpfulness of cannabis.
↵** P value obtained using Fisher’s exact test.

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Table 3.

Cannabis Use Patterns Among Survey Participants Who Used Cannabis for Pain in the Past 30 Days, by Each Mode of Use*

	Mode(s) of use endorsed
	Smoke (n = 249)	Apply (n = 190)	Eat (n = 164)	Vape (n = 160)	Drink (n = 72)	Dab (n = 63)	Other (n = 26)
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Medical use in the past 30 days^†
Both medical and non-medical	187 (75.1)	115 (60.5)	104 (63.8)	111 (69.4)	37 (52.1)	43 (68.3)	13 (50.0)
Medical	47 (18.9)	69 (36.3)	52 (31.9)	43 (26.9)	32 (45.1)	18 (28.6)	13 (50.0)
Non-medical	15 (6.0)	6 (3.2)	7 (4.3)	6 (3.8)	2 (2.8)	2 (3.2)	0 (0.0)
Typical times per day, specific to each mode of use^‡
<1	6 (2.4)	14 (7.4)	15 (9.1)	8 (5.0)	7 (9.7)	9 (14.3)	4 (15.4)
1 to 2	111 (44.9)	139 (73.2)	138 (84.1)	81 (50.6)	58 (80.6)	26 (41.3)	19 (73.1)
3 to 4	84 (34.0)	30 (15.8)	9 (5.5)	38 (23.8)	7 (9.7)	18 (28.6)	3 (11.5)
5 to 9	36 (14.6)	6 (3.2)	1 (0.6)	24 (15.0)	0 (0.0)	8 (12.7)	0 (0.0)
10+	10 (4.0)	1 (0.5)	1 (0.6)	9 (5.6)	0 (0.0)	2 (3.2)	0 (0.0)
Typical days per week, specific to each mode of use^‡
<1	9 (3.6)	24 (12.6)	48 (29.3)	21 (13.2)	26 (36.1)	15 (24.2)	7 (26.9)
1 to 3	61 (24.6)	68 (35.8)	69 (42.1)	56 (35.2)	21 (29.2)	16 (25.8)	7 (26.9)
4 to 7	178 (71.8)	98 (51.6)	47 (28.7)	82 (51.6)	25 (34.7)	31 (50.0)	12 (46.2)

↵* Participants could report more than one mode of use.
↵^† Response to question “When you used marijuana/cannabis during the past 30 days, was it: 1. For medical reasons, 2. For non-medical reasons, 3. For both medical and non-medical reasons.”
↵^‡ Column sums for this variable may not equal the total for the mode of use due to missing responses.

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Table 4.

Past-Year Experience of Cannabis Use Disorder (CUD) Symptoms and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) CUD Category Among Survey Participants Who Used Cannabis for Pain and Who Used Cannabis for Other Reasons in the Past 30 Days

	Used cannabis for pain (n = 375)	Used cannabis for other reasons^* (n = 558)
	n (%)	n (%)	P value
Individual CUD Symptoms
Tolerance	57 (15.5)	149 (26.8)	<0.001
Withdrawal	45 (12.1)	118 (21.3)	<0.001
Failed attempts to cut down	12 (3.2)	62 (11.2)	<0.001
Craving	84 (22.5)	181 (32.8)	0.001
Uncontrolled escalation of use	97 (25.9)	219 (39.3)	<0.001
Time spent	6 (1.6)	26 (4.7)	0.012
Continued use despite consequences	13 (3.5)	57 (10.3)	<0.001
Interference with role obligations	5 (1.3)	48 (8.6)	<0.001^†
Interpersonal problems	9 (2.4)	27 (4.8)	0.062
Hazardous situations	46 (12.4)	112 (20.1)	0.002
Gave up activities	6 (1.6)	45 (8.1)	<0.001
Any CUD symptom	194 (51.7)	341 (61.1)	0.005
DSM-5 CUD Category
No CUD (0 to 1 symptom)	278 (74.1)	317 (56.8)	<0.001^†
Mild CUD (2 to 3 symptoms)	75 (20)	124 (22.2)
Moderate CUD (4 to 5 symptoms)	19 (5.1)	63 (11.3)
Severe CUD (6+ symptoms)	3 (0.8)	54 (9.7)

↵* Other than pain, reasons for cannabis use assessed include muscle spasm, seizures, nausea or vomiting, sleep, stress, appetite, worry or anxiety, depression or sadness, focus or concentration, other symptoms, none.
↵^† P value obtained using Fisher’s exact test.

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Table 5.

Past 30-Day Helpfulness of Cannabis among Survey Participants Who Used Cannabis for Pain, by Mode and Frequency of Use and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Cannabis Use Disorder (CUD) Category

	Slightly/somewhat (n = 73)	Very/extremely (n = 302)
Past 30-day helpfulness of cannabis	n (%)	n (%)	P value
Primary mode of use endorsed^*
Smoke	24 (33.3)	140 (46.8)	0.028^†
Apply	17 (23.6)	38 (12.7)
Eat	8 (11.1)	40 (13.4)
Vape	10 (13.9)	47 (15.7)
Drink	8 (11.1)	10 (3.3)
Dab	4 (5.6)	16 (5.4)
Other	1 (1.4)	8 (2.7)
Typical times per day, considering all modes of use^*
<1	3 (4.2)	4 (1.3)	0.054^†
1 to 2	44 (61.1)	144 (48.2)
3 to 4	16 (22.2)	87 (29.1)
5 to 9	5 (6.9)	48 (16.1)
10+	4 (5.6)	16 (5.4)
Typical days per week, considering all modes of use^*
<1	8 (11.0)	9 (3.0)	<0.001
1 to 3	19 (26.0)	33 (11.0)	<0.001
4 to 7	46 (63.0)	259 (86.0)
DSM-5 CUD Category
No CUD (0 to 1 symptom)	61 (83.6)	217 (71.9)	0.052^†
Mild CUD (2 to 3 symptoms)	12 (16.4)	63 (20.9)
Moderate CUD (4 to 5 symptoms)	0 (0.0)	19 (6.3)
Severe CUD (6+ symptoms)	0 (0.0)	3 (1.0)

↵* Column sums for this variable may not total 73 for slightly/somewhat or 302 for very/extremely due to missing responses.
↵^† P value obtained using Fisher’s exact test.

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Appendix Table 1.

Cannabis Use Survey Items

Reasons for and modes and helpfulness of marijuana/cannabis use among survey participants who used it in the past 30 days
1. When you used marijuana/cannabis during the past 30 days, was it:	For medical reasons
	For non-medical reasons
	Both medical and non-medical reasons
2. During the past 30 days, how did you use marijuana/cannabis? (Select all that apply.)	Smoke it (for example, in a joint, bong, blunt, spliff or pipe)
	Vaporize it (for example, hash oil in an e-cigarette-like vaporizer, vape pen or another vaporizing device)
	Dab it (for example, using waxes or concentrates in a dab rig or other dabbing device)
	Eat it (for example, in brownies, cakes, cookies, or candy)
	Drink it (for example, in a tincture, tea, cola, or alcohol)
	Apply it to skin (for example, lotion, ointment, patch, or salve)
	Use it some other way (please list):
3. During the past 30 days, how did you use marijuana/cannabis most often?	AUTOFILL modes of use [smoke/vaporize/dab/eat/drink/apply/use it some other way] selected:
	▫ … ▫ … ▫ … ▫ …

	[LOGIC RULE: Allow one checked reason]
4. During the past 30 days, have you used marijuana/cannabis to help you manage any of the following: (Select all that apply.)	[yes/no] Pain
	[yes/no] Muscle spasm
	[yes/no] Seizures
	[yes/no] Nausea or vomiting
	[yes/no] Sleep
	[yes/no] Stress
	[yes/no] Appetite
	[yes/no] Worry or anxiety
	[yes/no] Depression or sadness
	[yes/no] Focus or concentration
	Other symptoms (please specify):
	None of the above
5. Please check the reason you used marijuana/cannabis most often during the past 30 days.	AUTOFILL reasons checked (in previous question):
	▫ … ▫ … ▫ … ▫ …
	[LOGIC RULE: Allow one checked reason]
6. During the past 30 days, how helpful has marijuana/cannabis been for [reason used most often during the past 30 days]?	Extremely helpful
	Very helpful
	Somewhat helpful
	Slightly helpful
	Not at all helpful
	[LOGIC RULE: SKIP if no reason for use selected]

Typical marijuana/cannabis use among survey participants who used marijuana/cannabis in the past 30 days, by ways they used it
These next questions ask about your typical marijuana/cannabis use. You said that in the past 30 days, you used marijuana/cannabis in the following way(s):
[AUTOFILLED for questions if ‘Smoke it’, ‘Vaporize it’, ‘Dab it’, ‘Eat it’, ‘Drink it’, ‘Apply it to skin’, ‘Use it some other way’ endorsed]
7. How many days per week do you typically [smoke/vaporize/dab/eat/drink/apply it/use marijuana/cannabis in another way]?	Less than 1
	1
	2
	3
	4
	5
	6
	7
8. On a typical day that you [smoke/vaporize/dab/eat/drink/apply marijuana/cannabis/use marijuana/cannabis in another way], how many times per day do you [smoke/vaporize/dab/eat/drink/apply/use] it?	Less than 1
	1 to 2
	3 to 4
	5 to 9
	10 to 14
	15 to 19
	20 or more
[AUTOFILLED for questions if ≥ 2 modes of use selected]
Now consider all the ways you use marijuana/cannabis…
9. How many days per week do you typically use any marijuana/cannabis?	Less than 1
	1
	2
	3
	4
	5
	6
	7
10. On a typical day that you use any marijuana/cannabis, how many times per day do you use it?	Less than 1
	1 to 2
	3 to 4
	5 to 9
	10 to 14
	15 to 19
	20 or more

Symptoms of cannabis use disorder in the past year
11. In the past year, did you ever need larger amounts of marijuana/cannabis to get an effect, or did you ever find that you could no longer get high on the amount you used to use?	Yes
	No
12. Was there ever a time in the past year when you stopped, cut down, or went without using marijuana/cannabis and then experienced withdrawal symptoms?	Yes No
Withdrawal symptoms can include cravings for marijuana/cannabis, irritability, restlessness, anxiety, depression and other mood changes, sleeplessness, sweating, appetite loss, and headaches.
13. Was there ever a time in the past year when you used marijuana/cannabis to keep from having withdrawal symptoms?	Yes
Withdrawal symptoms can include cravings for marijuana/cannabis, irritability, restlessness, anxiety, depression and other mood changes, sleeplessness, sweating, appetite loss, and headaches.	No
14. Were there times in the past year when you tried to stop or cut down on your use of marijuana/cannabis and found that you were not able to do so?	Yes
	No

Symptoms of cannabis use disorder in the past year, continued
15. Was there ever a time in the past year when you often had such a strong desire to use marijuana/cannabis that you couldn’t stop using or found it difficult to think of anything else?	Yes
	No
16. Did you ever have times in the past year when you used marijuana/cannabis even though you planned not to or when you used a lot more than you intended?	Yes
	No
17. Were there times in the past year when you used marijuana/cannabis more frequently or for more days in a row than you intended?	Yes
	No
18. In the past year, did you ever have several days or more when you spent so much time using or getting over the effects of marijuana/cannabis use that you had little time for anything else?	Yes
	No
19. In the past year, did you ever continue to use marijuana/cannabis when you knew you had a serious physical or emotional problem that might have been caused by or made worse by using marijuana/cannabis?	Yes
	No
20. Was there ever a time in the past year when your use of marijuana/cannabis frequently interfered with your work or responsibilities at school, on a job, or at home?	Yes
	No
21. Was there ever a time in the past year when your use of marijuana/cannabis caused arguments or other serious or repeated problems with your family, friends, neighbors, or co-workers?	Yes
	No
22. Did you continue to use marijuana/cannabis even though it caused problems with these people?	Yes
	No
23. Were there times in the past year when you were often under the influence of marijuana/cannabis in situations where you could have gotten hurt – for example when riding a bicycle, driving, operating a machine, or anything else?	Yes
	No
24. In the past year, were there times when you experienced strong desires or cravings to use marijuana/cannabis?	Yes
	No
25. In the past year, was there ever a time when you gave up or greatly reduced important activities because of your marijuana/ cannabis use – for example, sports, work, or seeing friends and family?	Yes
	No

Tobacco/nicotine product use, employment, and education
26. Have you ever smoked at least 100 cigarettes in your entire life?	Yes
	No
	Don’t know
If Yes: Do you now smoke cigarettes…..?	Every day
	Some days
	Not at all/never
	Don’t know
27. Have you ever used an e-cigarette or other electronic vaping product for tobacco/nicotine, even just one time, in your entire life?	Yes
	No
	Don’t know
If Yes: Do you now use e-cigarettes or other electronic ‘vaping’ products for tobacco/nicotine?	Every day
	Some days
	Not at all/never
	Don’t know
28. What best describes your current employment? Please check the best response.	Employed full time (includes self-employed)
	Employed part time (includes self-employed)
	In school or vocational training
	Retired
	Home maker
	Unemployed, laid-off or looking for work
	Disabled or unable to work for health reasons
	Other [SPECIFY: ]

Tobacco/nicotine product use, employment, and education, continued
29. What is the highest grade or level of school that you completed?	8^th grade or less
	Some high school, but not a graduate
	High school graduate or GED
	Some college or 2-year degree
	4-year college degree
	More than 4-year college degree

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Appendix Table 2.

Sociodemographic Characteristics of Survey Participants Who Used Cannabis for Pain, for Pain – Secondary, and for Other Reasons in the Past 30 Days

	Used cannabis for pain (n = 375)	Used cannabis for pain– secondary (n = 536)	Used cannabis for other reasons^* (n = 558)
	n (%)	n (%)	n (%)	P value
Age at cannabis screen
18 to 29	43 (11.5)	184 (34.3)	177 (31.7)	<0.001
30 to 49	116 (30.9)	198 (36.9)	204 (36.6)	<0.001
50+	216 (57.6)	154 (28.7)	177 (31.7)
Gender
Woman	197 (52.5)	306 (57.1)	249 (44.6)	<0.001
Man	178 (47.5)	230 (42.9)	309 (55.4)
Race
American Indian/Alaska Native	16 (4.3)	11 (2.1)	7 (1.3)	0.183
Asian	13 (3.5)	31 (5.8)	34 (6.1)
Black/African American	34 (9.1)	61 (11.4)	50 (9.0)
Native Hawaiian or Other Pacific Islander	9 (2.4)	9 (1.7)	11 (2.0)
White	271 (72.3)	370 (69)	399 (71.5)
Other	17 (4.5)	26 (4.9)	29 (5.2)
Unknown	15 (4.0)	28 (5.2)	28 (5.0)
Ethnicity
Hispanic/Latino	32 (8.5)	57 (10.6)	63 (11.3)	0.234
Not Hispanic/Latino	330 (88.0)	452 (84.3)	461 (82.6)	0.234
Unknown	13 (3.5)	27 (5.0)	34 (6.1)
Employment status^†
Full time	175 (46.7)	335 (62.9)	355 (63.6)	<0.001
Part time	25 (6.7)	49 (9.2)	51 (9.1)
School/vocational	4 (1.1)	15 (2.8)	25 (4.5)
Retired	98 (26.1)	74 (13.9)	77 (13.8)
Homemaker	9 (2.4)	11 (2.1)	12 (2.2)
Unemployed	13 (3.5)	23 (4.3)	18 (3.2)
Disabled	46 (12.3)	15 (2.8)	8 (1.4)
Other	5 (1.3)	11 (2.1)	10 (1.8)
Education^†
>4-year college degree	60 (16.1)	68 (12.8)	126 (22.7)	<0.001
4-year college degree	57 (15.3)	120 (22.6)	158 (28.5)
Some college	162 (43.4)	238 (44.7)	186 (33.5)
HS/GED or less	94 (25.2)	106 (19.9)	85 (15.3)

↵* Other than pain, reasons for cannabis use assessed include muscle spasm, seizures, nausea or vomiting, sleep, stress, appetite, worry or anxiety, depression or sadness, focus or concentration, other symptoms, none.
↵^† Column sums for this variable may not total 375 for used cannabis for pain, 536 for used cannabis for pain - secondary, or 558 for used cannabis for other reasons due to missing responses.

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Appendix Table 3.

Sensitivity Analysis of Past-Year Experience of Cannabis Use Disorder (CUD) Symptoms and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) CUD Category Among Survey Participants Who Used Cannabis for Pain and Who Used Cannabis for Other Reasons in the Past 30 Days, Excluding Participants Who Apply Cannabis Only (n = 21)

	Used cannabis for pain (n = 354)	Used cannabis for other reasons^* (n = 558)
	n (%)	n (%)	P value
Individual CUD Symptoms
Tolerance	57 (16.5)	149 (26.8)	<0.001
Withdrawal	45 (12.8)	118 (21.3)	0.001
Failed attempts to cut down	12 (3.4)	62 (11.2)	<0.001
Craving	84 (23.9)	181 (32.8)	0.004
Uncontrolled escalation of use	97 (27.5)	219 (39.3)	<0.001
Time spent	6 (1.7)	26 (4.7)	0.018
Continued use despite consequences	13 (3.7)	57 (10.3)	<0.001
Interference with role obligations	5 (1.4)	48 (8.6)	<0.001
Interpersonal problems	9 (2.6)	27 (4.8)	0.086
Hazardous situations	46 (13.1)	112 (20.1)	<0.001
Gave up activities	6 (1.7)	45 (8.1)	<0.001
Any CUD symptom	194 (54.8)	341 (61.1)	0.059
DSM-5 CUD Category
No CUD (0 to 1 symptom)	257 (72.6)	317 (56.8)	<0.001^†
Mild CUD (2 to 3 symptoms)	75 (21.2)	124 (22.2)
Moderate CUD (4 to 5 symptoms)	19 (5.4)	63 (11.3)
Severe CUD (6+ symptoms)	3 (0.8)	54 (9.7)

↵* Other than pain, reasons for cannabis use assessed include muscle spasm, seizures, nausea or vomiting, sleep, stress, appetite, worry or anxiety, depression or sadness, focus or concentration, other symptoms, none.
↵^† P value obtained using Fisher’s exact test.

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Appendix Table 4.

Adjusted Analysis^*

	Used cannabis for pain		Used cannabis for other reasons		Comparison of pain groups
Outcome 1: Most Common Mode of Use
	Adjusted %	(95% CI)	Adjusted %	(95% CI)	RRR^†	(95% CI)	P value
Inhale	63.9	(59.2 to 68.7)	82.7	(79.6 to 85.7)	REF
Apply	15.6	(11.6 to 19.6)	0.3	(−0.1–0.8)	109.5	(21.3 to 562.9)	<0.001
Ingest	18.2	(14.1 to 22.2)	15.3	(12.4 to 18.2)	2.0	(1.3–3.1)	0.003
Other	2.3	(0.7–3.9)	1.7	(0.6–2.9)	2.1	(0.7–6.4)	0.170

Outcome 2: Typical Times per Day
	Adjusted %	(95% CI)	Adjusted %	(95% CI)	RR^‡	(95% CI)	P value
>2 Times per day	46.4	(41.5 to 51.2)	33.4	(29.8 to 37.1)	1.4	(1.2–1.6)	<0.001

Outcome 3: Typical Days per Week
	Adjusted %	(95% CI)	Adjusted %	(95% CI)	RR^‡	(95% CI)	P value
4 to 7 Days per week	77.8	(73.6 to 82)	71.4	(67.8 to 74.9)	1.1	(1.0 to 1.2)	0.025

↵* Adjusted for age, gender, race/ethnicity, employment status, education, and other cannabis outcomes (i.e., most common mode of use is adjusted for typical times per day and typical days per week, typical times per day is adjusted for typical days per week and modes of use, and typical days per week is adjusted for typical times per day and modes of use).
↵^† Relative risk ratio estimated using a multinomial logistic regression model.
↵^‡ Relative risk estimated using a modified Poisson regression model.
Abbreviation: CI, confidence interval.