Cannabis Research
Medical Cannabis and Chronic Pain: Why Patients Quit
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A recent study1 published in PLOS ONE explored how patients with chronic musculoskeletal pain use, and often discontinue, medical cannabis. Conducted at an orthopedic institute in Pennsylvania, the study followed 78 patients who were certified for medical cannabis between 2022 and 2024.
At the start, all patients received physician certification and some initial guidance on cannabis composition, dosing, and delivery methods. Researchers then checked in at three months and annually to see who continued using cannabis and who had stopped.
The findings were striking as nearly half of the patients discontinued cannabis within three months, and almost 60 percent stopped within a year. Age also played a role, as patients who discontinued were older on average (71 years) than those who continued (64 years).
Limitations of the Study
While the numbers are eye-opening, the study comes with important limitations. With only 78 participants from a single site, the results cannot be broadly generalized. More critically, the research lacked detail on the very factors that shape patient outcomes:
- Exact THC to CBD ratios were not consistently recorded.
- Data on minor cannabinoids, such as CBG, along with information on terpene profiles were missing.
- Delivery methods, whether tinctures, vaporizers, edibles, or topicals, were not consistently tracked.
- Side effects, patient preferences, and costs were not captured.
Without this information, we can’t know whether patients discontinued because cannabis wasn’t effective, because side effects outweighed benefits, or because of issues like cost, product inconsistency, or lack of access that often burden medical cannabis patients.
Why Ongoing Guidance Is Essential
The study also reveals a deeper problem: a lack of sustained support. Although patients received some physician guidance at certification, ongoing adjustments were limited. For a therapy as individualized as cannabis, that is rarely enough.
Older adults in particular need close follow-up, as they may respond differently to cannabinoids, face greater risks from side effects, or have medication interactions. Without structured monitoring, many patients are left to navigate cannabis treatment on their own.
Unfortunately, this often pushes people toward relying on budtenders for advice. While many are passionate about cannabis, most lack formal training in the endocannabinoid system or the medical complexities of chronic pain. Without proper education and clinical oversight, patients may end up with mismatched products, inappropriate doses, or unmet expectations, leading to early discontinuation.
The Case for Tailored Cannabis Treatment
This study underscores that cannabis is not a one-size-fits-all therapy. To measure its true potential, patients need personalized treatment plans that consider their age, health conditions, sensitivities, and goals. That means:
- Consistent labeling of THC, CBD, and minor cannabinoids and terpene profiles
- Clear guidance on delivery methods and expected effects
- Regular follow-ups to adjust dosing and formulations
- Education for both patients and providers about the endocannabinoid system and how cannabinoids interact with the body
With this kind of support, patients are far more likely to experience meaningful results and remain engaged in their treatment.
Swipe to scroll →
| Key Factor | Why It Matters | Recommendation |
|---|---|---|
| THC:CBD Ratios | Influence pain relief vs. side effects | Consistent labeling, physician guidance |
| Minor Cannabinoids & Terpenes | May enhance or balance effects | Track full cannabinoid/terpene profiles |
| Delivery Method | Changes onset, duration, efficacy | Match method to patient needs |
| Follow-up Support | Adjusts treatment to age, tolerance, goals | Regular physician check-ins |
Moving Research and Policy Forward
For cannabis to be fully evaluated as a treatment for chronic pain, future research must go further. Studies need larger and more diverse patient populations, detailed tracking of cannabinoid ratios, delivery methods, side effects, and patient-reported outcomes over time. Cost, accessibility, and product consistency should also be factored in.
On the policy side, medical cannabis programs should require more than just a yearly certification. Continued physician involvement, accessible patient education, and reliable product standards are key to improving outcomes.
Final Thoughts
The PLOS ONE study provides an important look at medical cannabis use for chronic musculoskeletal pain, showing that many patients, especially older adults, discontinue within the first year. But the research also reveals how little we still know without better data, ongoing support, and tailored treatment approaches.
To move forward, cannabis must be treated not just as a product, but as a therapy; one that requires precision, education, and follow-up care. With the right structure in place, the full potential of cannabinoid medicine can be realized for those living with chronic pain.
References:
1. Khak M, Ramtin S, Chung J, Ilyas AM, Greis A (2025) Discontinuation rates and predictors of Medical Cannabis cessation for chronic musculoskeletal pain. PLOS ONE 20(8): e0329897. https://doi.org/10.1371/journal.pone.0329897
