Contrary to popular belief, young adults can experience significant acute and even chronic pain—which can motivate them to use cannabis.

A pair of recent articles by researchers in Binghamton University’s Psychology Department shed light on this dynamic.

The study titled “Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study” was recently published in Behavioral Medicine, while another paper titled “Pain Predicts Past-Month Co-Use of Alcohol and Cannabis Among Emerging Adults” appeared in the journal Alcohol.

The research for both articles derives from lead author Callon Williams’s doctoral dissertation; additional authors include Professor Nadine R. Mastroleo, Distinguished Professor Mark F. Lenzenweger, and Williams’s advisor, Assistant Professor Emily L. Zale.

“Emerging adults are thought of as a healthy, pain-free population, and there’s a lot of normative substance use that occurs. And yet, pain is still predictive of cannabis initiation among this group,” said Williams, Ph.D., who currently has a postdoctoral fellowship at Toronto General Hospital.

The research focuses on emerging adults, the period between ages 18 and 25, using data from PATH, an epidemiological survey that provides nationally representative data concerning substance use and health-related behaviors among youth and adults. The study includes 45,971 adults and youth in the United States, a sizeable research sample, from 2013 to 2019.

During that period, cannabis was legalized for medicinal or recreational use in an additional 15 and nine states, respectively. Because of this, the definition of cannabis use expanded over subsequent waves of the survey, to include smoking, vaping and using hash oils, although edibles weren’t included.

Coping strategies

It’s a common misconception that pain—acute or chronic—is limited to older adults. Instead, rates of some pain conditions in the younger population mirror those in older populations around the world.

“We know that the prevalence of certain chronic pain conditions reaches its peak and then remains stable past emerging adulthood,” Zale explained. “They don’t necessarily get the same attention because the expectation is that they’re young and healthy, but we are able to consistently replicate rates of both acute and chronic pain in our emerging adult samples that we would expect based on worldwide data.”

The survey relies on the 10-point pain rating scale common in doctors’ offices. The research in both articles focuses on moderate to severe pain, with a score of 4 or greater.

What Williams found is that individuals with moderate to severe pain were more likely to start using cannabis over a four-year period, and to take it up earlier during that period, than those with low or no pain at baseline. They were also 1.4 times more likely to use both alcohol and cannabis together, a riskier behavior associated with heavier use of both substances and more consequences, such as impaired driving, risky sexual behavior or impaired mental health.

While the published studies don’t determine whether cannabis use, alone or with alcohol, persists or worsens over time, other research indicates that this is likely the case, Zale said.

Clinicians and other practitioners who work in substance-use intervention among emerging adults may consider assessing patients’ pain levels to ascertain whether they are using cannabis and/or alcohol as a coping strategy, Williams noted.

“When we do substance-use work with emerging adults, we need to know how much pain is a factor in their decisions,” she said. “This research provides a starting point for pain as a predictor of initiation.”