Posttraumatic stress disorder (PTSD) with and without chronic pain is associated with elevated rates and severity of cannabis use disorder, according to a new study published in the journal Anxiety & Depression.

“Much of my research examines the interplay between trauma-related and anxiety disorders, and medical conditions, particularly pain conditions,” said study author Renee El-Gabalawy (@UM_HATLab), an assistant professor at the University of Manitoba and director of the Health, Anxiety and Trauma Lab.

“Cannabis is particularly interesting in the context of both post-traumatic stress disorder (PTSD) and chronic pain conditions as there is growing interest in the use of cannabis as a treatment for both conditions.”

“We also know that PTSD and chronic pain often co-occur and therefore it is essential to understand the impact of comorbidity on cannabis use disorder. Given the legislative changes across North America regarding cannabis, this research is timely.”

For their study, the researchers analyzed data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey conducted by the U.S. National Institute on Alcohol Abuse and Alcoholism.

After controlling for age, sex, race/ethnicity, education, marital status, household income, and other psychiatric conditions, El-Gabalawy and her colleagues found PTSD with and without chronic pain was associated with elevated rates of cannabis use disorder.

PTSD appeared to be driving the relationship more than chronic pain. Participants with PTSD were four times more likely to report symptoms of cannabis use disorder, such craving to use cannabis, recurrent use in situations in which it is physically hazardous, or failing to meet obligations at work, home or school because of recurrent cannabis use.

“Our data suggest that having PTSD both with and without chronic pain is associated with elevated rates and increased severity of cannabis use disorder,” El-Gabalawy told PsyPost.

“This suggests that those who are prescribed or use cannabis for their PTSD symptoms may be at increased risk of misuse and ultimately a cannabis use disorder, which can have significant negative mental and physical health, and social implications.”

But the study — like all research — includes some caveats.

“Unfortunately, in our data we don’t know about where and how these individuals are accessing cannabis so it is unclear whether increased access through, for example, prescription practices is elevating the risk for cannabis use disorder among those with PTSD. We not only need to further understand access, but also how and when therapeutic use becomes problematic,” El-Gabalawy said.

“This research was made possible by funding through the Chronic Pain SPOR Network.”

The study, “Associations of PTSD, chronic pain, and their comorbidity on cannabis use disorder: Results from an American nationally representative study“, was authored by Elena Bilevicius, Jordana L. Sommer, Gordon J. G. Asmundson, and Renée El‐Gabalawy.