Self-reported Opioid and Marijuana Use in a Clinical SCI Setting and Impact on Pain Interference and Depression

This study examines the prevalence and effects of prescription opioid and cannabis use among adults with spinal cord injury (SCI) receiving outpatient care at two university-affiliated clinics in Seattle, Washington. As part of a larger randomized clinical trial focused on collaborative care for SCI-related conditions, 275 adults with traumatic SCI completed structured telephone assessments between 2012 and 2015. Eligible participants reported at least one of the following: chronic pain, moderate depression, or physical inactivity.

Researchers assessed self-reported use of opioids and cannabis, pain intensity and interference, depression symptoms (PHQ-9), physical activity levels, and employment status. Approximately half of participants reported opioid use, and one-third reported cannabis use.

After controlling for pain intensity, opioid use was linked to greater pain interference across all measured domains—activity, mood, sleep, and life enjoyment—as well as higher depression scores and lower employment rates. Cannabis use was associated with greater pain interference in mood and life enjoyment, but not with higher depression severity. Cannabis users were also less likely to be employed and reported more daily television viewing.

These findings underscore the need for nuanced evaluation of pain management strategies in the SCI population. While both substances were commonly used, cannabis appeared less strongly associated with depression than opioids, suggesting it may be viewed as a more tolerable option by some individuals. The results highlight the importance of longitudinal and interventional research to guide safe and effective pain management approaches in SCI care.