Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State


  • Sunil K. Aggarwal, PhD, MD Candidate
  • Gregory T. Carter, MD, MS
  • Mark D. Sullivan, MD, PhD
  • Craig ZumBrunnen, PhD
  • Richard Morrill, PhD
  • Jonathan D. Mayer, PhD



cannabis, marijuana, cannabinoids, chronic pain, opioids, opiates


Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).
Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.
Setting: Regional pain clinic staffed by university faculty.
Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.
Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.
Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patientyears of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.
Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.

Author Biographies

Sunil K. Aggarwal, PhD, MD Candidate

Medical Scientist Training Program, University of Washington, Seattle, Washington.

Gregory T. Carter, MD, MS

Professor, Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington.

Mark D. Sullivan, MD, PhD

Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington Seattle, Washington; Department of Bioethics and Humanities, School of Medicine, University of Washington Seattle, Washington.

Craig ZumBrunnen, PhD

Professor, Department of Geography, University of Washington, Seattle, Washington.

Richard Morrill, PhD

Professor Emeritus, Department of Geography, University of Washington, Seattle, Washington.

Jonathan D. Mayer, PhD

Professor, Department of Epidemiology, University of Washington, Seattle, Washington; Department of Geography, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Department of Family Medicine, University of Washington, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.


“Workshop on the medical utility of marijuana,” Report to the Director, National Institutes of Health, by the Ad Hoc Group of Experts, August 1997. Available at Accessed May 10, 2009.

American College of Physicians: “Supporting research into the therapeutic role of marijuana,” A Position Paper, January 2008, with July 2008 Addendum. Available at Accessed May 10, 2009.

Joy JE, Watson SJ, Benson JA (eds.): Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academy Press, 1999. Available at Accessed May 10, 2009.

Hanus LO: Pharmacological and therapeutic secrets of plant and brain (endo)cannabinoids. Med Res Rev. 2009; 29: 213-271.

Pacher P, Batkai S, Kunos G: The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006; 58: 389-462.

Aggarwal SK, Carter GT, Sullivan M, et al.: Medicinal use of cannabis in the United States: Historical perspectives, current trends, future directions. J Opioid Manag. 2009; 5(3): 153-168.

Ellis RJ, Toperoff W, Vaida F, et al.: Smoked medicinal cannabis for neuropathic pain in HIV: A randomized, crossover clinical trial. Neuropsychopharmacology. 2009; 34(3): 672-680.

Wilsey B, Marcotte T, Tsodikov A, et al.: A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008; 9: 506-521.

Abrams DI, Jay CA, Shade SB, et al.: Cannabis in painful HIVassociated sensory neuropathy: A randomized placebo-controlled trial. Neurology. 2007; 68: 515-521.

Malfait AM, Gallily R, Sumariwalla PF, et al.: The nonpsychoactive cannabis constituent cannabidiol is an oral antiarthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci USA. 2000; 97: 9561-9566.

Rog DJ, Nurmiko T, Friede T, et al.: Randomized controlled trial of cannabis based medicine in central neuropathic pain due to multiple sclerosis. Neurology. 2005; 65: 812-819.

Abrams DI, Hilton JF, Leiser RJ, et al.: Short-term effects of cannabinoids in patients with HIV-1 infection. A randomized, placebo-controlled clinical trial. Ann Intern Med. 2003; 139: 258-266.

Lynch ME, Young J, Clark AJ: A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations. J Pain Symptom Manag. 2006; 32: 497-501.

Ko MC, Woods JH: Local administration of delta9-tetrahydrocannabinol attenuates capsaicin-induced thermal nociception in rhesus monkeys: A peripheral cannabinoid action. Psychopharmacology. (Berl) 1999; 143: 322-326.

Berman JS, Symonds C, Birch R: Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: Results of a randomized controlled trial. Pain. 2004; 112: 299-306.

Agarwal N, Pacher P, Tegeder I, et al.: Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat Neurosci. 2007; 10:870-879.

Li J, Daughters RS, Bullis C, et al.: The cannabinoid receptor agonist WIN 55,212-2 mesylate blocks the development of hyperalgesia produced by capsaicin in rats. Pain. 1999; 81: 25-33.

Berlach DM, Shir Y, Ware MA: Experience with the synthetic cannabinoid nabilone in chronic noncancer pain. Pain Med. 2006; 7: 25-29.

Russo EB, Mathre ML, Byrne A, et al.: Chronic cannabis use in the compassionate investigational new drug program: An examination of benefits and adverse effects of legal clinical cannabis. J Cannabis Ther. 2002; 2: 3-57.

Wade DT, Makela P, Robson P, et al.: Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler. 2004; 10: 434-441.

Wade DT, Robson P, House H, et al.: A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003; 17: 18-26.

Baker D, Pryce G, Giovannoni G, et al.: Therapeutic potential of cannabis. Lancet Neurol. 2003; 2: 291-298.

Wang T, Collet J, Shapiro S, et al.: Adverse effects of medical cannabinoids: A systematic review. CMAJ. 2008; 178: 1669-1678.

Radbruch L, Nauck F: A review of side effects and complications with cannabinoid treatment. Schmerz. 2003; 17(4): 274-279.

Aggarwal SK, Kyashna-Tocha M, Carter GT: Dosing medical marijuana: Rational guidelines on trial in Washington State. Med Gen Med. 2007; 9(3): 52.

Carter GT, Weydt P, Kyashna-Tocha M, et al.: Medical marijuana: Rational guidelines for dosing. IDrugs. 2004; 7(5): 464-470.

Aggarwal S, Carter GT, Steinborn J: Clearing the air: What the latest Supreme Court decision regarding medical marijuana really means. Am J Hosp Palliat Care. 2005; 22(5): 327-329.

Steinborn J, Chinn AK, Carter GT: The latest buzz on medicinal marijuana: A legal and medical perspective. Am J Hosp Palliat Care. 2001; 18(5):295-296.

Gieringer D: Medical use of cannabis: Experience in California. In Grotenhermen F, Russo E (eds.): Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. Binghamton, NY: Haworth Press, 2001: 153-170.

Sylvestre DL, Clements BJ, Malibub Y: Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. Eur J Gastroenterol Hepatol. 2006, 18: 1057-1063.

O’Connell TJ, Bou-Matar CB: Long term marijuana users seeking medical cannabis in California (2001-2007): Demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduct J. 2007; 4: 16. Available at Accessed May 10, 2009.

Doblin R: DEA/NIDA and the Obstruction of Privately Funded Research. Presentation at Fifth National Clinical Conference on Cannabis Therapeutics, Pacific Grove, CA, April 4-5, 2008. Available at,-dea-.html. Accessed October 10, 2009.

Ramamurthy S, Alanmanou E, Rogers JN (eds.): Decision Making in Pain Management. Philadelphia: Mosby Elsevier, 2006: 67-75.

ONDCP: 2008 Marijuana Sourcebook. MARIJUANA: THE GREATEST CAUSE OF ILLEGAL DRUG ABUSE. Section: “THE ‘MEDICAL MARIJUANA’ ISSUE”, “San Diego Marijuana Dispensaries, 2006”, p. 20. Office of National Drug Control Policy Executive Office of the President. July 2008. Marijuana 08-1 [07-29]. Available at Accessed May 10, 2009.

Chapkis W, Webb RJ: Dying to Get High: Marijuana as Medicine. New York: New York University Press, 2008.

Reiman A: Medical cannabis patients: Patient profiles and health care utilization patterns. Complementary Health Pract Rev. 2007; 12: 31-50.

Corral VL: Differential effects of medical marijuana based on strain and route of administration: A three-year observational study. J Cannabis Ther. 2001; 1: 43-59.

Harris D, Jones RT, Shank R, et al.: Self-reported marijuana effects and characteristics of 100 San Francisco medical marijuana club members. J Addict Dis. 2000; 19: 89-103.

Child C, Mitchell TF, Abrams DI: Patterns of therapeutic marijuana use in two community-based cannabis buyers’ cooperatives. [abstract no. 60569] Proceedings of the 12th World Conference on AIDS, Geneva, Switzerland, 1998; 12:1105. Available at Accessed May 10, 2009.

McPartland JM, Pruitt PL: Side effects of pharmaceuticals not elicited by comparable herbal medicines: The case of tetrahydrocannabinol and marijuana. Altern Ther Health Med. 1999; 5: 57-62.

Ben Amar M: Cannabinoids in medicine: A review of their therapeutic potential. J Ethnopharmacol. 2006; 105: 1-25.

Grinspoon L, Bakalar JB: The use of cannabis as a mood stabilizer in bipolar disorder: Anecdotal evidence and the need for clinical research. J Psychoactive Drugs. 1998; 30(2): 171-177.

Russo EB, Burnett A, Hall B, et al.: Agonistic properties of cannabidiol at 5-HT1a receptors. Neurochem Res. 2005; 30(8): 1037-1043.

Mechoulam R, Hanus L: Cannabidiol: an overview of some chemical and pharmacological aspects. Part I: Chemical aspects. Chem Phys Lipids. 2002; 121(1-2): 35-43.

Bardhi F, Sifaneck SJ, Johnson BD, et al.: Pills, thrills and bellyaches: Case studies of prescription pill use and misuse among marijuana/blunt smoking middle class young women. Contemp Drug Probl. 2007; 34(1): 53-101.

DEA: 2008. Available at Accessed May 10, 2009.



How to Cite

Aggarwal, PhD, MD Candidate, S. K., Carter, MD, MS, G. T., Sullivan, MD, PhD, M. D., ZumBrunnen, PhD, C., Morrill, PhD, R., & Mayer, PhD, J. D. (2018). Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State. Journal of Opioid Management, 5(5), 257–286.

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