Cannabis use frequency is associated with emotion dysregulation among persons receiving long-term opioid therapy for chronic pain: A psychophysiological study.

Background: With evolving legislation and attitudes towards cannabis in the United States, individuals receiving long-term opioid therapy (LTOT) for chronic pain increasingly use cannabis intending to relieve pain and reduce opioid consumption. Although they might also use cannabis to compensate for emotion dysregulation, the role of emotion regulation capacity in this population's patterns of cannabis use has not been investigated. This study examined whether deficits in emotion regulation capacity, an endophenotype assessed via psychophysiological measures, are associated with more frequent cannabis use among individuals receiving LTOT for chronic pain.

Methods: We analyzed data from 104 participants (mean age=51.12 years; 68.35 % female; 88.46 % White) receiving LTOT for chronic pain. Cannabis use frequency was quantified by days of use over 90 days. Emotion regulation capacity was indexed using skin conductance response (SCR) and corrugator electromyography (fEMG) during passive viewing or cognitive reappraisal of negative stimuli. Pain severity was assessed using the Brief Pain Inventory.

Results: Smaller reductions in SCR (β=-0.018, p < 0.001) and corrugator fEMG (β=-9.59, p < 0.001) difference scores, signifying weaker emotion regulation capacity, were associated with more days of cannabis use. Pain severity was not significantly associated with cannabis use frequency (β=0.026, p = 0.370).

Conclusions: These findings suggest that impaired emotion regulation capacity might be a more critical endophenotype associated with frequent cannabis use than pain severity and support the notion that cannabis use might primarily modulate affective processes in this population. These results highlight the potential for targeted emotion regulation interventions to address heavy cannabis use among pain patients receiving LTOT.