Problematic Use of Prescription Opioids and Medicinal Cannabis Among Patients Suffering from Chronic Pain

Pain Med. 2017 Feb 1;18(2):294-306. doi: 10.1093/pm/pnw134.


Objective: To assess prevalence rates and correlates of problematic use of prescription opioids and medicinal cannabis (MC) among patients receiving treatment for chronic pain.

Design: Cross-sectional study.

Setting: Two leading pain clinics in Israel.

Subjects: Our sample included 888 individuals receiving treatment for chronic pain, of whom 99.4% received treatment with prescription opioids or MC.

Methods: Problematic use of prescription opioids and MC was assessed using DSM-IV criteria, Portenoy’s Criteria (PC), and the Current Opioid Misuse Measure (COMM) questionnaire. Additional sociodemographic and clinical correlates of problematic use were also assessed.

Results: Among individuals treated with prescription opioids, prevalence of problematic use of opioids according to DSM-IV, PC, and COMM was 52.6%, 17.1%, and 28.7%, respectively. Among those treated with MC, prevalence of problematic use of cannabis according to DSM-IV and PC was 21.2% and 10.6%, respectively. Problematic use of opioids and cannabis was more common in individuals using medications for longer periods of time, reporting higher levels of depression and anxiety, and using alcohol or drugs. Problematic use of opioids was associated with higher self-reported levels of pain, and problematic use of cannabis was more common among individuals using larger amounts of MC.

Conclusions: Problematic use of opioids is common among chronic pain patients treated with prescription opioids and is more prevalent than problematic use of cannabis among those receiving MC. Pain patients should be screened for risk factors for problematic use before initiating long-term treatment for pain-control.

Keywords: Prescription Opioids; Medicinal Cannabis; Problematic Use; Chronic Pain; Portenoy’s Criteria.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use
  • Chronic Pain / drug therapy*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Israel / epidemiology
  • Male
  • Marijuana Abuse / epidemiology*
  • Medical Marijuana / therapeutic use
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Prevalence
  • Young Adult


  • Analgesics, Opioid
  • Medical Marijuana