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By Scott LaNeve

October 4, 2019

While still classified as a schedule 1 drug at the federal level, Marijuana is now legal in one form or another in 33 states. In 11 of those states and Washington, DC marijuana has been approved for both medical and recreational uses.1

The 2018 National Survey of Drug Use and Health estimated 43.5 million Americans age 12 and older had used marijuana in the past year (15.9 percent of the U.S. population). In comparison, an estimated 9.9 million had misused prescription pain relievers.2 Because of its schedule 1 classification, in national surveys marijuana use is classified as illicit drug use regardless of its legal recreational or medical use on a state level.

To date, little research has been done to determine how much marijuana use can be allocated to medical or recreational reasons. One February 2019 study found that, at nearly 65 percent, chronic pain is the most common qualifying condition reported by medical cannabis patients. Of all patient-reported qualifying conditions, nearly 86 percent had some evidence of therapeutic efficacy.3 Another July 2019 study found that adults with medical conditions had a significantly higher prevalence of current and daily marijuana use than those without medical conditions.4

When seeking to understand the current relationship between chronic pain, marijuana and opioids, the controversy in published research and educated opinion is almost overwhelming. Some suggest that increased marijuana use will result in reduced opioid misuse.5,6 Others say it will make no difference.7,8 Other studies recommend a combination of opioids and marijuana for chronic pain, while others caution against combined use.9,10,11,12

Because clinical research and recommendations are not yet clear on the matter, healthcare providers and patients should use caution and make informed decisions when considering marijuana use in addition to or instead of opioids. One way providers can enhance the information used in their clinical decision-making processes is to incorporate patient monitoring that meets state and national opioid prescribing guidelines. For those providers who find patient monitoring difficult to fit into the process, hc1 Opioid Advisor™ can help with automated, intelligent data, so actionable comparisons can be made in real-time with a single click. Visit to request a learn more or request a demo.



  1. Dai H, Richter KP. (20 Sept 2019). A National Survey of Marijuana Use among US Adults with Medical Conditions, 2016-2017. JAMA Netw Open.
  2. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  3. Boehnke, K. F., Gangopadhyay, S., Clauw, D. J., Haffajee, R. J. (2019 Feb). Qualifying Conditions Of Medical Cannabis License Holders In The United States. Health Affairs 38:2.
  4. Dai, PhD, H., Richter, PhD, K. P. (2019 Sept). A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017. JAMA Netw Open.
  5. Segura, MD, MPH, L.E ., Mauro, PhD, C. M., Levy, MPH, N. S., et al. (17 July 2019). Association of US Medical Marijuana Laws With Nonmedical Prescription Opioid Use and Prescription Opioid Use Disorder. JAMA Netw Open.
  6. Grinspoon, MD, P. (2019 June 25). Access to medical marijuana reduces opioid prescriptions. Harvard Health Blog.
  7. Lembke, PhD, A. (25 Dec 2018). Can medical marijuana replace opioids to relieve cancer pain? HemOnc Today.
  8. Mauro, C., Levy, N., Khauli, N., Philbin, M, Mauro, P. (17 Jul 2019). Prescription opioid misuse: What do medical marijuana laws have to do with it? Columbia University’s Mailman School of Public Health.
  9. Wiese B, Wilson-Poe AR. (2018). Emerging evidence for cannabis’ role in opioid use disorder, Cannabis and Cannabinoid Research 3:1, 179–189.
  10. Experimental Biology. (2019, April 9). Combining opioids and marijuana may be advantageous for pain sufferers: Study suggests using the two drugs together could reduce risk of dependency without causing cognitive problems. ScienceDaily.
  11. Wachter, K. (24 Jun 2019). Navigating Cannabis Options for Chronic Pain. PPM.
  12. (24 Feb 2018). Marijuana: How Can It Affect Your Health?
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