Scholars@Duke publication: Pain is associated with exclusive use and co-use of tobacco and cannabis: Findings from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study

Pain is associated with exclusive use and co-use of tobacco and cannabis: Findings from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study

Publication , Conference

Rubenstein, D; McClernon, FJ; Powers, JM; Aston, ER; Keefe, FJ; Sweitzer, MM

Published in: Addictive Behaviors

November 1, 2023

Introduction: Rates of tobacco and cannabis use are disproportionately high among individuals with pain, and evidence suggests that pain may engender greater likelihood of substance co-use, yielding additive risk. This study examined national associations of pain with past-month tobacco use, cannabis use, and co-use of tobacco and cannabis. Methods: Data came from a nationally representative US sample of adults in Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health study (N = 32,014). The sample included civilian, non-institutionalized people who use tobacco and people who do not use tobacco. Past-week pain intensity (0–10) was dichotomized (0–4 no/low pain; 5–10 moderate/severe pain). Multinomial models adjusted for demographics examined substance use category membership (no tobacco or cannabis use, exclusive cannabis use, exclusive tobacco use, co-use) as a function of pain status. Results: Moderate/severe pain was associated with increased relative risk of exclusive tobacco use (RRR [CI] 2.26 [2.05, 2.49], p <.001), exclusive cannabis use (1.49 [1.22, 1.82], p <.001), and co-use of tobacco and cannabis (2.79 [2.51, 3.10], p <.001), in comparison to no tobacco or cannabis use. Additionally, moderate/severe pain was associated with increased risk of co-use compared to exclusive tobacco use (1.23 [1.11, 1.37], p <.001) and exclusive cannabis use (1.88 [1.54, 2.29], p <.001). Discussion: Findings suggest that not only is pain independently associated with greater risk of exclusively using tobacco or cannabis, but pain is also associated with heightened risk of co-using both products. Future work should examine the dynamic and potentially bidirectional relationships between pain and use of cannabis and tobacco.