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BINGHAMTON, NY – A new study from Binghamton University reveals a concerning trend: young adults experiencing moderate to severe pain are more likely to initiate cannabis use earlier and frequently combine it with alcohol. This research challenges the common perception that pain is primarily a concern for older adults, highlighting its significant impact on emerging adults aged 18 to 25.
Two recent papers, published in Behavioral Medicine and Alcohol, respectively, utilized data from the Population Assessment of Tobacco and Health (PATH) study, a large-scale epidemiological survey. The study, involving 45,971 participants from 2013 to 2019, found a strong correlation between pain levels and cannabis initiation.
“Emerging adults are thought of as a healthy, pain-free population, and there’s a lot of normative substance use that occurs. And yet, pain is still predictive of cannabis initiation among this group,” stated lead author Callon Williams, Ph.D., currently a postdoctoral fellow at Toronto General Hospital.
The research focused on moderate to severe pain, defined as a score of 4 or higher on a 10-point pain rating scale. The findings revealed that individuals with such pain levels were more likely to start using cannabis within a four-year period and to do so earlier than those with lower pain levels. Moreover, they were 1.4 times more likely to co-use alcohol and cannabis, a behavior associated with increased risks such as impaired driving, risky sexual behavior, and mental health issues.
“We know that the prevalence of certain chronic pain conditions reaches its peak and then remains stable past emerging adulthood,” explained Assistant Professor Emily L. Zale. “They don’t necessarily get the same attention because the expectation is that they’re young and healthy, but we are able to consistently replicate rates of both acute and chronic pain in our emerging adult samples that we would expect based on worldwide data.”
The study period, 2013-2019, saw significant changes in cannabis legalization across the United States, expanding the definition of cannabis use in the survey to include smoking, vaping, and hash oils. Edibles, however, were not included.
Researchers suggest that clinicians and practitioners working with emerging adults should consider assessing pain levels to understand potential coping strategies involving cannabis and alcohol. “When we do substance-use work with emerging adults, we need to know how much pain is a factor in their decisions,” Williams noted. “This research provides a starting point for pain as a predictor of initiation.”
The researchers also noted that while the studies did not examine if cannabis use, alone or with alcohol, persisted or worsened over time, other research indicates that this is likely the case.
For more information, refer to the published studies:
- Callon M. Williams et al, Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study, Behavioral Medicine (2025). DOI: 10.1080/08964289.2025.2465525
- Callon M. Williams et al, Pain Predicts Past-Month Co-Use of Alcohol and Cannabis Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study, Alcohol (2025). DOI: 10.1016/j.alcohol.2025.02.003
Disclaimer: This article is based on research findings and should not be taken as medical advice. The information provided is for educational purposes only. If you are experiencing pain or have concerns about substance use, please consult with a healthcare professional. The potential risks associated with cannabis and alcohol use, particularly in combination, should be thoroughly understood before engaging in such behaviors. The legal status of cannabis varies by location, and it is important to comply with local laws and regulations.
