Baseline Factors Associated with Intention to Initiate Medical Cannabis among Older Adults with Chronic Pain in a Prospective Cohort

INTRODUCTION: Older adults with chronic pain are a priority population for research on the health effects of medical cannabis (MC). While studies of current and new MC users have informed the field, research on the pre-initiation phase - identifying factors associated with intention to start MC - is scarce. This study compares demographic characteristics, pain-related symptom severity, and treatment use among older adults with chronic pain who do or do not intend to start MC and identifies factors most associated with intention. METHODS: Baseline data were analyzed from 218 adults with chronic non-cancer pain enrolled in a prospective cohort study (65.1% female; 75.7% white; M age = 64, SD = 9). Participants reported their intention to start MC (45% yes) and completed sociodemographic and health assessments. Descriptive statistics and logistic regression identified characteristics associated with intention. RESULTS: Those intending to start MC reported more severe short-term pain, greater pain interference, and lower subjective sleep quality, with small effect sizes. Groups did not differ in sociodemographic factors, comorbidity burden, polypharmacy, opioid use, or other pain treatment utilization. In multivariable logistic regression, lower subjective sleep quality and higher pain interference were the strongest correlates of intention, with higher income trending. Each unit decrease in subjective sleep quality on a 4-point scale was associated with 69% increase in the odds of intending to start MC (ORa = 1.69, CI [1.125, 2.604]). Each 10-unit increase in pain interference was associated with a 13% increase in the odds of intending to start MC (ORa = 1.13, CI [1.001, 1.283]). CONCLUSION: Among older adults with chronic pain, poorer sleep quality and greater pain interference were associated with intention to start MC. Because these factors also affect health outcomes, they should be considered when evaluating the effects of MC in clinical practice and in research comparing MC users with non-users.