Use and Perceptions of Opioids Versus Marijuana among Cancer Survivors


Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients’ perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Lucas P (2012) Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain. J Psychoactive Drugs 44(2):125–133

    PubMed  Article  Google Scholar 

  2. 2.

    Krashin DL, Merrill JO, Trescot AM. Opioids in the management of HIV-related pain. Pain physician. 2012;15(3 Suppl):Es157–68

  3. 3.

    Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 65(1):1–49

    PubMed  Article  Google Scholar 

  4. 4.

    Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E (2016) Management of Chronic Pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 34(27):3325–3345

    PubMed  Article  Google Scholar 

  5. 5.

    Rosenblum A, Marsch LA, Joseph H, Portenoy RK (2008) Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol 16(5):405–416

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Bennett DS, Carr DB (2002) Opiophobia as a barrier to the treatment of pain. Journal of Pain & Palliative Care Pharmacotherapy 16(1):105–109

    Article  Google Scholar 

  7. 7.

    NIDA. Nationwide Trends. June 25, 2015

  8. 8.

    CDC (2015) Drug overdose deaths in the United States continue to increase in:2018

  9. 9.

    Straus MM, Ghitza UE, Tai B (2013) Preventing deaths from rising opioid overdose in the US - the promise of naloxone antidote in community-based naloxone take-home programs. Subst Abus Rehabil 2013(4):65–72

    Article  Google Scholar 

  10. 10.

    Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2016) Increases in drug and opioid overdose deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep 64(50–51):1378–1382

    PubMed  Article  Google Scholar 

  11. 11.

    Boehnke KF, Litinas E, Clauw DJ (2016) Medical Cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain 17(6):739–744

    PubMed  Article  Google Scholar 

  12. 12.

    Vyas MB, LeBaron VT, Gilson AM (2018) The use of cannabis in response to the opioid crisis: a review of the literature. Nurs Outlook 66(1):56–65

    PubMed  Article  Google Scholar 

  13. 13.

    Bradford AC, Bradford WD (2016) Medical marijuana Laws reduce prescription medication use in Medicare part D. Health Aff (Millwood) 35(7):1230–1236

    Article  Google Scholar 

  14. 14.

    Legislatures NCoS. State Medical Marijuana Laws 2019

  15. 15.

    Goyal S, Kubendran S, Kogan M, Rao YJ (2020) High expectations: the landscape of clinical trials of medical marijuana in oncology. Complementary Therapies in Medicine 49:102336

    PubMed  Article  Google Scholar 

  16. 16.

    Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, Foley K, Leonard K, Treisman GJ, Selwyn P (2017) 2017 HIVMA of IDSA clinical practice guideline for the Management of Chronic Pain in patients living with HIV. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 65(10):e1–e37

    Article  Google Scholar 

  17. 17.

    Taddei TH, Lo Re V 3rd, Justice AC (2016) HIV, aging, and viral Coinfections: taking the long view. Current HIV/AIDS reports 13(5):269–278

    PubMed  Article  Google Scholar 

  18. 18.

    Boehnke KF, Litinas E, Clauw DJ (2016) Medical Cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain 17(6):739–744

    PubMed  Article  Google Scholar 

  19. 19.

    Abrams DI, Couey P, Shade SB, Kelly ME, Benowitz NL (2011) Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther 90(6):844–851

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Haroutounian S, Ratz Y, Ginosar Y, Furmanov K, Saifi F, Meidan R, Davidson E (2016) The effect of medicinal Cannabis on pain and quality-of-life outcomes in chronic pain: a prospective open-label study. Clin J Pain 32(12):1036–1043

    PubMed  Article  Google Scholar 

  21. 21.

    Bennett M, Paice JA, Wallace M (2017) Pain and opioids in Cancer care: benefits, risks, and alternatives. American Society of Clinical Oncology Educational Book 37:705–713

    PubMed  Article  Google Scholar 

  22. 22.

    Bachhuber MA, Saloner B, Cunningham CO, Barry CL (2014) Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med 174(10):1668–1673

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Shover CL, Davis CS, Gordon SC, Humphreys K (2019) Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proceedings of the National Academy of Science of the United States of America 116(26):12624–12626

    CAS  Article  Google Scholar 

  24. 24.

    Society AC. Facts & Figures 2019: US Cancer death rate has dropped 27% in 25 years. 2019

    Google Scholar 

  25. 25.

    Ball SC (2014) Increased longevity in HIV: caring for older HIV-infected adults. Care management journals : journal of case management. The journal of long term home health care 15(2):76–82

    Article  Google Scholar 

  26. 26.

    Lewis-Patterson P, Palos GR, Dains J, Jackson TL (2016) Cancer prevention in the survivorship setting. Semin Oncol Nurs 32(3):291–305

    PubMed  Article  Google Scholar 

  27. 27.

    Pain IAftSo. Persistent pain in Cancer survivors: pathogenesis and treatment options. IASP. 2016;24

  28. 28.

    Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N et al (2014) Pain in Cancer Survivors 32(16):1739–1747

    CAS  Google Scholar 

  29. 29.

    Leach CR, Troeschel AN, Wiatrek D, Stanton AL, Diefenbach M, Stein KD, Sharpe K, Portier K (2017) Preparedness and Cancer-related symptom management among Cancer survivors in the first year post-treatment. Ann Behav Med 51(4):587–598

    PubMed  Article  Google Scholar 

  30. 30.

    Wu HS, Harden JK (2015) Symptom burden and quality of life in survivorship: a review of the literature. Cancer Nurs 38(1):E29–E54

    PubMed  Article  Google Scholar 

  31. 31.

    van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ (2016) Update on prevalence of pain in patients with Cancer: systematic review and meta-analysis. J Pain Symptom Manag 51(6):1070–1090 e9

    Article  Google Scholar 

  32. 32.

    Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C, National comprehensive cancer network. (2015) Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw 13(8):1012–1039

    Article  Google Scholar 

  33. 33.

    Byun E, Gay CL, Lee KA (2016) Sleep, fatigue, and problems with cognitive function in adults living with HIV. J Assoc Nurses AIDS Care 27(1):5–16

    PubMed  Article  Google Scholar 

  34. 34.

    Society AC. Managing Cancer as a chronic illness. 2016

    Google Scholar 

  35. 35.

    Stanton AL (2006) Psychosocial concerns and interventions for cancer survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24(32):5132–5137

    Article  Google Scholar 

  36. 36.

    Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP (2011) Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the steps study. AIDS Behav 15(6):1161–1170

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Althoff KN, Smit M, Reiss P, Justice AC (2016) HIV and ageing: improving quantity and quality of life. Curr Opin HIV AIDS 11(5):527–536

    PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Voon P, Karamouzian M, Kerr T. Chronic pain and opioid misuse: a review of reviews. Subst Abuse Treat Prev Policy. 2017;12(1):36-

  39. 39.

    Shah S, Diwan S (2010) Methadone: does stigma play a role as a barrier to treatment of chronic pain? Pain Physician 13(3):289–293

    PubMed  Google Scholar 

  40. 40.

    Carr DB (2016) Patients with pain need less stigma. Not More Pain Med 17(8):1391–1393

    PubMed  Article  Google Scholar 

  41. 41.

    Page R, Blanchard E (2019) Opioids and Cancer pain: Patients' needs and access challenges. J Oncol Pract 15(5):229–231

    PubMed  Article  Google Scholar 

  42. 42.

    Elikkottil J, Gupta P, Gupta K (2009) The analgesic potential of cannabinoids. J Opioid Manag 5(6):341–357

    PubMed  Article  Google Scholar 

  43. 43.

    Rosenstock IMJHem. The health belief model and preventive health behavior. 1974;2(4):354–86

  44. 44.

    Lalazaryan A (2014) Zare-Farashbandi F. A Review of models and theories of health information seeking behavior 2(4):193–203

    Google Scholar 

  45. 45.

    Wilson TD (2000) Human information behavior. Informing Science 3(2):49–56

    Article  Google Scholar 

  46. 46.

    Cutilli CC. Seeking Health Information: What Sources Do Your Patients Use? 2010;29(3):214–9

  47. 47.

    Ramo DE, Prochaska JJ (2012) Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. J Med Internet Res 14(1):e28

    PubMed  PubMed Central  Article  Google Scholar 

  48. 48.

    Lankenau SE, Kioumarsi A, Reed M, McNeeley M, Iverson E, Wong CF (2018) Becoming a medical marijuana user. Int J Drug Policy 52:62–70

    PubMed  Article  Google Scholar 

  49. 49.

    Pergam SA, Woodfield MC, Lee CM, Cheng GS, Baker KK, Marquis SR, Fann JR (2017) Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer. 123(22):4488–4497

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  50. 50.

    Boyd-Seale D, Wilkie DJ, Kim YO, Suarez ML, Lee H, Molokie R, Zhao Z, Zong S (2010) Pain barriers: psychometrics of a 13-item questionnaire. Nurs Res 59(2):93–101

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Park J-Y, Wu L-T (2017) Prevalence, reasons, perceived effects, and correlates of medical marijuana use: a review. Drug Alcohol Depen 177:1–13

    Article  Google Scholar 

  52. 52.

    Stumbo SP, Yarborough BJ, McCarty D, Weisner C, Green CA (2017) Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement. J Subst Abus Treat 73:47–54

    Article  Google Scholar 

  53. 53.

    Friedman J, Kim D, Schneberk T, Bourgois P, Shin M, Celious A, Schriger DL (2019) Assessment of racial/ethnic and income disparities in the prescription of opioids and other controlled medications in California. JAMA Intern Med 179(4):469–476

    PubMed  PubMed Central  Article  Google Scholar 

  54. 54.

    Jacobs W, Amuta AO, Alvares C. Health information seeking in the digital age: An analysis of health information seeking behavior among US adults. Cogent Social Sciences. 2017;3(1)

  55. 55.

    Satterlund TD, Lee JP, Moore RS (2015) Stigma among California's medical marijuana patients. J Psychoactive Drugs 47(1):10–17

    PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Bottorff JL, Bissell LJ, Balneaves LG, Oliffe JL, Capler NR, Buxton J (2013) Perceptions of cannabis as a stigmatized medicine: a qualitative descriptive study. Harm Reduct J 10:2

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Availability of Data and Material

Data is available by request.

Code Availability

SPSS code is available by request .


This research was supported by the Atlanta Clinical & Translational Science Institute Research Seed Grant Program (now the Georgia Clinical and Translational Science Alliance) (PHS Grant UL1TR000454 from the National Center for Advancing Translational Sciences, NIH). Dr. Berg is also supported by the US National Cancer Institute (NCI) (R01CA215155-01A1, PI: Berg; R01CA179422–01, PI: Berg; R01CA239178-01A1, MPIs: Berg, Levine), the US Fogarty International Center/National Institutes of Health (NIH) (1R01TW010664–01, MPIs: Berg, Kegler), and the US National Institute of Environmental Health Sciences/Fogarty International Center (D43ES030927–01, MPIs: Berg, Marsit, Sturua). Ms. Vu. is supported by NCI (F31 CA243220–01, PI: Vu). Dr. Yeager is supported by NIH (1 R01 CA236871–01, PI: Yeager; U10CA180868 PiIs: Wolmark, Curran, Mannel; 1 R01 AG061971–01, PI: Hepburn and P30NR018090–02, PI: Song).

Author information




Dr. Berg led data collection, data analysis, and conceptualization of the overall project and paper, and co-led the writing of the paper. J. Potts led the writing of the paper. B. Getachew co-led data collection. B. Getachew, E. Nehl, K. Yeager, C. Leach, and M. Vu contributed to the analyses and writing of the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Carla J Berg.

Ethics declarations

Conflicts of Interest/Competing Interests

The authors declare no conflicts of interest.

Ethics Approval

The Emory University Institutional Review Board approved this study, IRB00095978.

Consent to Participate

All participants provided informed consent to participate in the study.

Consent to Publish

All participants provided informed consent to participate in the study, which indicated the study team’s intent to publish findings.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Potts, J.M., Getachew, B., Vu, M. et al. Use and Perceptions of Opioids Versus Marijuana among Cancer Survivors. J Canc Educ (2020).

Download citation


  • Opioid
  • Marijuana, patient perspectives
  • Cancer survivors