More than one-third of veterans enrolled in a substance use disorder (SUD) treatment program reported using cannabis to manage chronic pain, anxiety, and sleep problems, according to research published in Harm Reduction Journal. The findings offer fresh insights into how veterans navigate pain management while recovering from addiction—and what healthcare providers need to know.
The study, conducted at a Veterans Affairs (VA) medical center, interviewed 33 military veterans with chronic pain diagnoses who were receiving treatment for SUDs unrelated to cannabis use. Most participants had primary diagnoses of alcohol use disorder (70%), followed by opioid use disorder (18%) and stimulant use disorder (12%).
Cannabis as a Harm Reduction Strategy
What makes this research particularly compelling is its focus on a treatment program that permits continued use of some substances as part of a harm reduction approach. Rather than demanding complete abstinence from all substances, the program allows patients to use cannabis and other non-primary substances while they work toward abstaining from the substance at the center of their SUD treatment.
Approximately one-third of veterans in the study reported active cannabis use during their recovery. Their motivations were clear: alleviating physical pain, reducing pain-related anxiety, and improving poor sleep quality. Many framed cannabis not as recreational intoxication, but as a therapeutic tool and harm reduction strategy.
One participant explained the difference between cannabis and prescribed medications: “Marijuana helps me relax…and I can function, or I take all these pills they want me to take and I’m a zombie.” Another veteran noted that high-concentration CBD “really takes the pain away.”
For these veterans, cannabis represented what they perceived as a safer alternative to opioids or other potentially more harmful substances. Some specifically used different cannabis products for different needs—RSO (Rick Simpson Oil) for physical pain and vape pens for anxiety.
Why Some Veterans Abstain
Despite cannabis being permitted within the treatment program, approximately half of the veterans chose to abstain. Their reasons varied but fell into three main categories:
Negative past experiences: Some veterans reported that cannabis increased their anxiety or made them feel “groggy and sleepy.” One participant mentioned that cannabis “tends to have me focus on the pain instead of relieving it.”
Policy and legal concerns: Even when permitted by their treatment program, some veterans avoided cannabis to comply with federal policies or state laws prohibiting its use.
Interestingly, some non-users expressed curiosity about future cannabis use for pain management, influenced by emerging research, conversations with friends, and growing acceptance of medical cannabis in their communities.
Real-World Implications for Healthcare Providers
This research arrives at a critical moment. Two-thirds of Americans now support medical and recreational cannabis use, and 39 states plus Washington, D.C., have legalized medical cannabis. Yet VA clinicians—as federal employees—remain unable to prescribe cannabis, even in states where it’s legal.
The study authors emphasize that VA healthcare professionals and other federally employed clinicians need to prepare for these conversations. Veterans are clearly interested in cannabis as a pain management option, whether or not their providers can prescribe it.
Recent evidence suggests cannabis may offer therapeutic benefits. A 2025 systematic review by the Agency for Healthcare Research and Quality found that cannabis formulations with equivalent THC and CBD may produce small reductions in pain severity, particularly for neuropathic pain.
For SUD specifically, research shows mixed but promising results. Some studies indicate that cannabidiol (CBD) may help reduce drug-seeking behaviors in animal models and decrease consumption frequency in human studies involving nicotine, cannabis, and opioids. However, available research remains sparse, and more human data is needed.
Navigating Complex Conversations Around Substance Use Disorder and Cannabis
Healthcare providers face a delicate balancing act. Cannabis lacks the strict regulation of standard pharmaceuticals, leading to considerable variability in potency and effects between products.
The study authors recommend that VA and federally employed healthcare professionals—particularly in states where cannabis is legal—prepare to educate patients on the medical evidence, existing knowledge gaps, applicable policies, and federal and state laws regarding cannabis use. This education empowers patients to make informed decisions about their healthcare, even when providers cannot directly prescribe cannabis.
Moving Forward
This research highlights the complex relationship between chronic pain, substance use disorders, and cannabis among veterans. For some, cannabis serves as a valuable tool for managing co-occurring conditions and supporting recovery.
What’s clear is that veterans with SUD are actively making decisions about cannabis use, whether or not their healthcare providers are equipped to guide them. The average pain intensity reported by participants was 5.6 on a 0-10 scale—moderate to severe pain that significantly impacts quality of life.
As cannabis policies continue to evolve and research expands, healthcare providers must stay informed about the latest evidence while respecting the real-world experiences of patients navigating pain and addiction recovery.
The study’s limitations include its small sample size, focus on one VA treatment program, and predominantly male population. Larger epidemiologic studies are needed to better understand the prevalence of cannabis use during SUD treatment and its long-term outcomes.
Nevertheless, this research takes an important step toward understanding how veterans perceive and use cannabis during recovery—information that’s essential for developing patient-centered care approaches that acknowledge the realities of pain management in addiction treatment settings.
