If marijuana has analgesic properties, people will try it to potentially manage their pain, but it is unclear if it does or not. Fortunately, the U.S. Drug Enforcement Administration signaled it is expanding its marijuana research program will draft guidelines for producing the drug for scientific and medical research. 

Until there are science answers it is people trying all of the above, and that creates confounders for other kinds of research. A new study says adults who take prescription opioids for severe pain are more likely to have increased anxiety, depression and substance abuse issues if they also use marijuana. But did marijuana cause the depression or is it being used to mitigate it? 

We aren't going to get answers from surveys but that is all there is for now. And the recent survey of 450 adults throughout the United States who had experienced moderate to severe pain for more than three months revealed not only elevated anxiety and depression symptoms, but also tobacco, alcohol, cocaine and sedative use among those who added the cannabis, compared with those who used opioids alone.

No increased pain reduction was reported.

Co-use of substances generally is associated with poorer outcomes than single substance use, so what does that mean about the impact of mixing opioids and cannabis?

A few years ago opioids were barely discussed and fentanyl was not part of the cultural lexicon but now it is portrayed as a significant drug abuse problem and legitimate pain patients have been hit with the stigma of recreational users. America is the most over-medicated country in the world and many people report chronic pain, making opioids the most widely prescribed class of medications. 

Yet an argument for medical marijuana was that it works for chronic pain. And kratom. You name it, and someone will sell you something claiming it will alleviate pain. But being grown does not mean products are safer than opioids created in a lab. 

Cannabis is another substance that has recently garnered attention in the chronic pain literature, as increasing numbers of people use it to manage chronic pain.

"There's been a lot of buzz that maybe cannabis is the new or safer alternative to opioid, so that's something we wanted to investigate," said University of Houston graduate student and first author of the paper Andrew Rogers, who said the idea for the study evolved from a conversation with advisor Michael Zvolensky. Rogers was studying opioid use and pain management when they began discussing the role of cannabis in managing pain. "The findings highlight a vulnerable population of polysubstance users with chronic pain and indicates the need for more comprehensive assessment and treatment of chronic pain."