Chronic pain patients far more likely than doctors to support expanding cannabis access, Rutgers-led study shows
Rutgers-led study finds adults with chronic pain favor expanding cannabis access far more than physicians do, highlighting gaps in policy and medical education.
Adults with chronic noncancer pain are markedly more supportive of policies to expand cannabis access than the physicians who treat them, according to a Rutgers Health study published in JAMA Network Open. The survey of more than 1,600 people living with chronic pain and roughly 1,000 physicians working in states with medical cannabis programs found clear differences in support for federal legalization, recreational access and insurance coverage for cannabis-based pain treatment. The findings underscore a growing divide between patient demand and clinician caution as state laws evolve and federal restrictions persist.
Survey Findings and support levels
The study reported that 71% of chronic pain patients favored federal legalization of medical cannabis, compared with 59% of physicians. Support diverged further on recreational legalization, with 55% of patients but only 38% of physicians in favor. Views on insurance coverage for cannabis-based pain treatment similarly split: 64% of patients supported requiring insurer coverage versus 51% of physicians.
Researchers gathered responses from two distinct groups: adults with noncancer pain lasting at least six months and a cross-section of primary care and specialty physicians. The sample was drawn from states that already permit medical cannabis use, including New Jersey, offering a snapshot of attitudes where patients may already have access under state law.
State laws contrasted with federal status
The report highlights the complicated policy landscape influencing opinions on cannabis access. Currently, 38 states plus Washington, D.C., have medical cannabis programs, and New Jersey along with 23 other states and D.C. allow adult recreational use. At the same time, cannabis remains a Schedule I substance under federal law, classified by the National Institutes of Health as having high potential for abuse and no recognized medical use.
That tension—state-level permissiveness versus federal prohibition—complicates clinical practice, research and the ability to create uniform standards. Physicians must navigate a patchwork of regulations while patients encounter widely varying access depending on their state, a discrepancy that the study indicates influences public and professional attitudes.
Patient experience shapes support
Personal experience with cannabis strongly correlated with support for expanded access. Adults who reported using cannabis to manage chronic pain expressed the highest levels of support for policies that would broaden availability. Those personal accounts, the authors note, likely reflect observed symptom relief or perceived benefits that shape patients’ policy preferences.
By contrast, physicians who had never recommended cannabis for pain management were the least supportive of expanding access. That reluctance aligns with clinicians’ concerns about limited high-quality evidence, dosing uncertainty and the absence of standardized products across states. The study suggests these practice patterns and lived experiences are central to the divergence in policy preferences.
Demand for clinician education
Both patients and physicians signaled strong support for increased medical education on cannabis. About 70% of respondents in each group favored requiring medical schools to include training on cannabis treatment for chronic noncancer pain. That consensus points to a shared recognition that current clinician preparedness may lag behind patient use and evolving state policies.
Study authors emphasized the need for clearer clinical guidance: whether clinicians should recommend cannabis, which product types or delivery methods are appropriate, and how concentration and formulation affect risk and benefit. Expanded education could help align clinical practice with patient expectations while addressing safety and efficacy questions.
Research barriers tied to federal restrictions
Investigators noted that federal scheduling of cannabis poses a major barrier to the kind of rigorous research needed to resolve clinical uncertainties. Restrictions on access to standardized products, regulatory hurdles for clinical trials, and funding constraints limit large-scale studies of effectiveness, dosing, long-term outcomes and interactions with other medications commonly used for chronic pain.
The Rutgers-led study is part of a National Institute on Drug Abuse-funded project examining how state medical cannabis policies impact opioid-related outcomes for people with chronic pain. Researchers argue that federal reform—whether de-scheduling or other regulatory changes—could remove obstacles to comprehensive research and help standardize product regulation and clinical trials across states.
Policy and clinical implications
The divergence between patient and physician attitudes raises practical questions for policymakers and health systems. With many patients already favoring broader cannabis access and insurance coverage, state and federal lawmakers face pressure to reconcile public demand with the need for safety, quality controls and clinician training. Insurers, too, must consider whether and how to cover cannabis treatments given the current uncertainties around efficacy and standardization.
Clinicians may increasingly encounter patients seeking cannabis for pain management, creating a need for evidence-based guidance and shared decision-making tools. At the same time, policymakers must weigh potential benefits for pain control and opioid-sparing effects against unresolved questions about long-term harms and population-level impacts.
The study’s findings suggest that bridging the gap between patient preferences and physician caution will require coordinated efforts: expanded research, updated medical curricula, clearer clinical guidance and thoughtful regulatory change aimed at improving the evidence base while protecting public health.
