The Intersection of Rurality, Unmet Treatment Need, and Cannabis Use for Adults with Chronic Pain

Objective: Rates of chronic pain are higher among rural versus urban individuals and rural individuals experience higher levels of socioeconomic disadvantage, poor or no health insurance coverage, and unmet treatment need. Medical cannabis is legal in Oklahoma. With 40% of Oklahoma’s population living in rural areas, and nearly 17% uninsured, the medical legalization of cannabis may present as an accessible and relatively low-cost alternative treatment, particularly for those with chronic pain. This study investigated differences in cannabis use by rural (vs. urban) status and unmet (vs. met) treatment need among adults with and without chronic pain living in Oklahoma. Method: To be eligible, participants had to be 18 years or older, reside in Oklahoma, and be able to read and write English-language surveys. Results: The sample (N = 3622) was primarily made up of non-Hispanic White (70.4%) females (53.8%) in their early middle age (M = 41.80, SD = 16.88), employed full-time or part-time (53.8%), with some college/technical school (37.2%) or a bachelor’s degree (28.5%). Nearly one-fifth of the sample (18.2%) endorsed chronic pain, and individuals with chronic pain were eight times more likely to report past 30-day cannabis use. No difference was detected when only rurality (vs. urban residence) was examined. Among adults with chronic pain, those who were rural dwelling and who reported unmet treatment need were almost two times more likely to report past 30-day cannabis use, compared to urban dwelling chronic pain adults with unmet treatment need. Conclusions: In Oklahoma, adults in rural areas with unmet treatment need and chronic pain may benefit from increasing access to chronic pain treatment, as well as education on cannabis use and harm reduction strategies to inform healthcare decision-making.