Reasons for cannabis use among adults with disabilities: Findings from the 2023–2024 National Survey on Health and Disabilities

Abstract

Background:

People with disabilities disproportionately use cannabis compared to those without a disability; however, little is known about reasons for use among people with disabilities.

Objective:

The purpose of this study was to assess the prevalence and reasons for cannabis use among people with disabilities.

Methods:

Data from Wave 5 (2023–2024) of the National Survey on Health and Disability (n = 1919), a national online survey of adults aged 18+ who self-identify as living with a disability, were used to estimate the prevalence and reasons for cannabis use among those with any disability and six self-reported limitations (cognitive, hearing, independent living, mobility, self-care, vision). Open-ended responses were analyzed using an inductive content analysis to create themes.

Results:

The prevalence of current cannabis use among survey respondents was 21.9 % and people with cognitive disabilities reported the highest proportion (28.7 %). The most prevalent common reasons for current cannabis use across all domains were to help with pain (71.9 %) and to relax or relieve tension (60.2 %). Analysis of open-ended responses for cannabis use reasons yielded three main themes: medicinal reasons, contextual reasons, and primarily as sensory moderator. Specific medical reasons for using cannabis included assistance with health-related conditions such as migraines, nausea, muscle spasms, seizures, mental health concerns, and sleep disturbances.

Conclusions:

Cannabis use is prevalent across disability domains and the majority of respondents note they use cannabis to help with pain and to relax or relieve tension. Findings highlight the need to monitor cannabis use for pain relief among this population.

1. Introduction

Cannabis use has increased in the U.S. in response to growing public support and state laws that have authorized medical and recreational cannabis use. As of January 2025, at least 38 states had adopted laws that allow physicians to prescribe medical cannabis for adult patients, and at least 24 states have authorized recreational cannabis use.¹ Prior studies have shown that medical cannabis is used to provide relief from chronic neuropathic pain in adults,² as an anti-emetic following chemotherapy treatment, and to relieve pain for those with multiple sclerosis.³ However, frequent cannabis use is also viewed as harmful to public health due to the increased risk of psychotic episodes in young adults⁴ as well as cannabis use disorder.^5,6

Relatively few studies in the U.S. have examined patient reasons for medical cannabis use. One study found that about a quarter (27%) of adults in the U.S. and Canada reported using medical cannabis with the most common reasons for use being the management of pain (53%), anxiety (52%), sleep (46%), depression (40%), headaches/migraines (35%), and other conditions.⁷ Another study of 632 Florida patients found the most common self-reported reasons for medical cannabis use were for anxiety, chronic pain, depression, PTSD, headaches/migraine, fibromyalgia, ADHD, bipolar disorder, and cancer.⁸ However, no prior studies have examined medical cannabis use reasons among people with disabilities.

In 2019, more than 26 percent of adults in the U.S. reported having a functional limitation or disability.⁹ Prior studies have found evidence that working-age adults aged 18–64 years (16.6% vs 10%), young adults aged 18–25 years (9.1% vs 6.2%), and reproductive age women with disabilities (20.8% vs 11.1%) have a higher prevalence of past-month cannabis use compared to those without disabilities.^10–12 Moreover, adults with disabilities have a higher prevalence of cannabis use disorder.¹³ Despite these higher reported prevalences among people with disabilities, little is known about the specific reasons for cannabis use in this population.

Young adults with disabilities have a higher rate of chronic pain compared to those without disabilities.^14–17 Also, musculoskeletal pain is associated with depressive symptoms.^14,18 Since older adults with reduced mobility due to neuropathic conditions have a higher prevalence of chronic pain and depression,^18,19 medical cannabis use to treat chronic pain may be higher among adults with disabilities.

Given a gap in knowledge regarding reasons for cannabis use among adults with disabilities, this study aims to (1) assess the overall prevalence of cannabis use among people with disabilities, and (2) examine the most common reasons for cannabis use in this population.

2. Methods

2.1. Data source

Data were obtained from the Wave 5 (October 2023–February 2024) National Survey on Health and Disability (NSHD), which is an annual national online survey of people who self-identify as living with a disability that provides information about the health of adults with disabilities.²⁰ Analyses for this study included all adult participants who were at least 18 years old (n = 1919). The study procedures and survey for the NSHD were approved by the University of Kansas Institutional Review Board.

2.1.1. Measures

2.1.1.1. Disability measures.

All NSHD respondents had self-identified as living with a disability. To further classify disability by functioning domain and make comparisons with other population-level datasets, we used the following American Community Survey (ACS) 6-item set of disability questions²¹: 1) “Are you deaf or do you have serious difficulty hearing?” (hearing); 2) “Are you blind or do you have serious difficulty seeing, even when wearing glasses?” (vision); 3) “Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remember, or making decisions?” (cognition); 4) “Do you have serious difficulty walking or climbing stairs?” (mobility); 5) “Do you have difficulty dressing or bathing?” (self-care); and 6) “Because of a physical, mental or emotional condition, do you have difficulty doing errands alone such as visiting a doctors’ office or shopping?” (independent living). Survey respondents could answer “yes” to multiple disability functional domains. A “no reported limitation” category was created for those respondents who answer “no” to all of the ACS 6-item set of questions.

2.1.1.2. Cannabis use measures.

Current cannabis use was defined as those who indicated ever using, even once, marijuana or hashish and also reported using marijuana or hashish within the past 30 days. Ever cannabis users were those who reported using marijuana or hashish, even once. Never use was defined as those who reported never using marijuana or hashish, even once. Among those who reported ever using cannabis, respondents answered the following question: What are your top three reasons for using marijuana or hashish. Respondents were provided a list of 14 reasons, as well as an “I use it for some other reason(s)” where they could provide a written response.

2.1.1.3. Sociodemographic variables.

Sociodemographic characteristics that were reported in the survey include: age category (18–34 years, 35–64 years, 65+ years), sex (male, female), gender (woman, man, other), employment status (not employed, employed) sexual orientation (bisexual; heterosexual or straight; gay, lesbian, homosexual; asexual; other) race/ethnicity (American Indian/Native American; African American or Black; Asian, Pacific Islander; White; Multi-racial/ethnic; other, not specified; Hispanic; Jewish; Middle Eastern, Southwest Asian, or North African origin), education completed (no formal education; less than high school; high school diploma or GED; some college, technical or training school; 2-year college degree or technical school; 4-year college degree; graduate or doctoral degree), and poverty status (under 138 % FPL [Federal Poverty Line], 138–249 % FPL, 250–399 % FPL, 400 % FPL and above).

3. Data analysis

3.1. Quantitative approach

Data were analyzed using Stata/Standard edition, version 18 (StataCorp LP, College Station, TX). List-wise deletion was used to remove missing data, refused, and I don’t know responses (range = 0.1–7.6; see Supplemental Fig. 1). Descriptive statistics were conducted for all sociodemographic variables. The prevalence of cannabis use was estimated by disability status which was based on having any self-reported functional limitation. Among respondents who currently use cannabis, the number and percentage of adults who provided cannabis use reasons was calculated for all respondents and for each self-reported limitation. A number of less frequent reasons for cannabis use were also combined into an “other reasons” category due to the small number of people who reported these specific reasons.

3.2. Qualitative approach

In addition to survey-provided cannabis use reason options, 215 respondents indicated “I use it for some other reason” and wrote in open-ended responses. One co-author (AO) developed an inductive content analysis coding framework (see Table 1 for code names, definitions and exemplar quotes) to analyze the open-ended responses.²² During the initial coding discussion, the authors discussed collapsing the open-ended reasons under the pre-existing options, since some survey-provided reasons were similar to open-ended responses. However, because the survey-provided reasons did not always correspond to the open-ended responses, the authors decided to code the open-ended responses separately from the survey-provided options. For example, “to help with pain” was a survey-provided answer choice, yet some respondents did NOT select this option but did provide an open-ended response that identified pain relief or reduction as their reason for cannabis use. After AO completed initial coding, the other two authors conducted an audit of the codebook and initially coded excerpts. The authors discussed questions and clarifications together, and code names and applications were adjusted if there was author consensus. After adjustments to code names, definitions and code applications, AO completed a second round of coding that reflected the updated codebook and sought themes that arose from the codes. Themes were established by looking at relationships between codes, such as the relationship between the “sleep” code and “medication” code. During team meetings, all team members provided analytic memos that were used to refine codes and develop themes.²³

Table 1.

Qualitative Codes Describing Self-Reported Reasons for Cannabis Use. Data are from the National Survey of Health and Disability, 2023–2024.

Code Name	Code Definition	Exemplar quote	Resultant Theme
Sleep	Any response that includes the words “sleep”; “sleeping”; “insomnia”	“It’s one of the safer sleep aids”; “I only use it at bedtime!”; “To treat extreme insomnia”	Cannabis for medicinal reasons
Parent code: Medication	Discusses cannabis as pharmaceutical alternative; mentions healthcare provider recommended	“It’s the only medicine that reduces terrible symptoms without producing unwanted side effects. Also helps with sleep.”; “Prescribed by my doctor”	Cannabis for medicinal reasons
Subcode: Reduce nausea	Specific problem to be addressed by using cannabis as medicine; mentions “nausea”	“Chronic nausea”; “Nausea- Zofran makes constipation SO BAD, and then I have to medicate for that ....GI issues are constant in my world”	Cannabis for medicinal reasons
Subcode: Reduce Pain	specific problem to be addressed by using cannabis as medicine; mentions “pain” control or management	“Supported by medical team for chronic pain”; “Migraine treatment”; “Its only use to me is the relief it offers in mitigating my pain”	Cannabis for medicinal reasons
Subcode: Reduce other unwanted symptoms	specific problem to be addressed by using cannabis as medicine; mentions specific symptoms not addressed within the other child codes here (ie, migraines, appetite, gastroparesis)	“To stimulate my appetite”; “Reduce muscle spasms”; “I don’t have seizures when I use it.”	Cannabis for medicinal reasons
Subcode: Reduce mental health concerns	specific problem to be addressed by using cannabis as medicine; mentions “Mental health” or specific diagnoses such as depression	“To relieve severe depression”; “Self-medication for chronic ptsd”; “It is my only relief for severe OCD because I cannot access medicine or a doctor as a trans person in [state]”	Cannabis for medicinal reasons
Subcode: “Safer than alternatives”	in vivo code; describes cannabis use reason as safer than other substances; compares cannabis to other options	“Because it is safer than alternatives”; “Fewer side effects than the prescriptions I have tried in the past”	Cannabis for medicinal reasons/Cannabis for contextual reasons
Autism/Neurodivergence	describes cannabis use for reasons related to neurodivergence or autism	“Cannabis reduces the sensory symptoms of autism in a way that allows me to exist in a world where the electricity in the walls of my own home is so loud it hurts me”; “Reduces autistic overwhelm, lowers my general anxiety, and reduces my ptsd symptoms. I have a medical marijuana card.”	Cannabis for sensory moderation reasons
Youthful Experimentation	attributes cannabis use to age-related activities; uses the words “ youth”; “teenager”; “experiment”	“I was 15, tried it once. not for me.”; “Was experimenting (used it less than 5 times during my life)”	Cannabis for contextual reasons
Non-efficacy	emphasizes that cannabis use did not work for them	“I was hoping it would help ease chronic pain but after trying various kinds, it didn’t.”; “For pain but was ineffective or worsened seizures”	Cannabis for medicinal reasons
Enjoyment	describes cannabis use for enjoyment or enhancement; uses the terms “recreation” or “creativity”	“Helps me shift into a more playful, embodied state. I only use it 2x a month on average”; “Creativity”; “To be silly”	Cannabis for sensory moderation reasons
Access Method	describes how participant accessed cannabis; mentions healthcare provider, “medical card” or legal availability of cannabis	“Recommended by my Mayo Clinic physician”; “It is legal in my State”	Cannabis for contextual reasons

4. Results

Table 2 provides a summary of participant characteristics. The majority of NSHD participants were female (80.5%), heterosexual (62.3%), white (78.1%), and had a graduate degree (37.0%). Among disability functional domains, the most frequently self-reported types of disability were mobility (52.9%), independent living (51.5%), and cognition (51.4%).

Table 2.

Study population characteristics, National Survey of Health and Disability, 2023–2024 (n = 1919).

Characteristic	na (%)
Age
18–34 years	466 (24.5)
35–64 years	1174 (61.6)
≥65 years	266 (14.0)
Sex
Male	347 (18.2)
Female	1539 (80.5)
Gender
Woman	1287 (67.9)
Man	330 (17.4)
Otherb	278 (14.7)
Employment Status
Not employed	881 (46.3)
Employedc	1021 (53.7)
Sexual Orientation
Bisexual	244 (13.8)
Heterosexual or straight	1104 (62.3)
Gay, Lesbian, or Homosexual	136 (7.7)
Asexual	116 (6.5)
Otherd	173 (9.8)
Race/ethnicitye
American Indian/Native American	14 (0.8)
African American or Black	53 (2.8)
Asian	48 (2.6)
Pacific Islander	0 (0)
White	1458 (78.1)
Multi-racial/ethnic	223 (11.9)
Other, not specified	0 (0)
Hispanic	44 (2.4)
Jewish	23 (1.2)
Middle Eastern, Southwest Asian, or North African origin	4 (0.2)
Education completed
No formal education	2 (0.1)
Less than high school	26 (1.4)
High school diploma or GED	127 (6.7)
Some college, technical or training school	270 (14.2)
2-year college degree or technical school	152 (8.0)
4-year college degree	624 (32.8)
Graduate or Doctoral degree	704 (37.0)
Poverty status
Under 138 % FPL	542 (29.2)
138–249 % FPL	325 (17.5)
250–399 % FPL	381 (20.5)
400 % FPL and above	608 (32.8)
Disability (ACS 6-item set)e
Cognition	972 (51.4)
Hearing	203 (10.8)
Independent Living	988 (51.5)
Mobility	1005 (52.9)
Self-care	649 (34.1)
Vision	204 (10.8)
No limitation	231 (12.0)

^aPercentages are based on non-missing data.

^bOther (e.g., transgender, nonbinary, two-spirit, more than one category selected, genderfluid, bigender, gendervoid).

^cWork for pay, self-employed, or both.

^dOther = Two-Spirit and “I use a different term (write in)” (e.g., demisexual, heteroflexible, pansexual).

^eRespondents could select more than one and therefore percentages may not add up to 1.

4.1. Quantitative findings

Fig. 1 displays the prevalence of cannabis use by self-reported limitation. Overall, 58.7% of people in the survey indicated they had used cannabis, even once, and 21.9% of respondents indicated they currently used cannabis. Among self-reported limitations, those who indicated a cognitive disability had the highest prevalence of current cannabis use (28.7%) and those who reported a vision disability had the lowest prevalence of current cannabis use (14.4%).

Fig. 1.

Ever and current cannabis use by self-reported limitation. Data are from the National Survey of Health and Disability, 2023–2024.

Table 3 displays the reasons for cannabis use among those who currently use cannabis by self-reported limitation. The top reason for using cannabis across all and each self-reported limitations was “to help with pain” while the second most endorsed reason was “to relax or relieve tension.” Among all respondents, 71.9% and 60.2% of respondents selected these reasons, respectively. The third highest endorsed reason was “to feel good or get high” (23.9%)

Table 3.

Reasons for cannabis use among those who currently use by self-reported limitation. Data are from the National Survey of Health and Disability, 2023–2024.

	Any (n = 402) n (%a)	Cognitive (n = 265) n (%a)	Hearing (n = 30) n (%a)	Independent Living (n = 229) n (%a)	Mobility (n = 218) n (%a)	Self-care (n = 151) n (%a)	Vision (n = 28) n (%a)	No self-reported limitation (n = 32) n (%a)
Reasons for cannabis use (among those who currently use)b
To feel good or get high	96 (23.9)	59 (22.3)	6 (20.0)	33 (14.4)	37 (17.0)	37 (17.0)	12 (42.9)	16 (50.0)
To have a good time with my friends	37 (9.2)	22 (8.3)	5 (16.7)	14 (6.1)	12 (5.5)	8 (5.3)	4 (14.3)	8 (25.0)
To experiment and see what it is like	13 (3.2)	4 (1.5)	2 (6.7)	8 (3.5)	7 (3.2)	3 (2.0)	3 (10.7)	1 (3.1)
To relax or relieve tension	242 (60.2)	155 (58.5)	17 (56.7)	128 (55.9)	115 (52.8)	77 (51.0)	16 (57.1)	23 (71.9)
To help with pain	289 (71.9)	192 (72.5)	22 (73.3)	188 (82.1)	182 (83.5)	126 (83.4)	17 (60.7)	16 (50.0)
Other reasonsc	96 (23.9)	72 (27.2)	8 (26.7)	55 (24.0)	42 (19.3)	27 (17.9)	8 (28.6)	9 (28.1)

c Respondents could select their top 3 reasons and therefore percentages may not add up to 100 %.

^aPercentages are based on non-missing data.

^bCurrent users = respondents who indicated ever cannabis use and past 30-day cannabis use.

^cOther reasons = “Because of boredom or nothing else to do”, “To get away from my problems or troubles”, “Because of anger or frustration”, “To fit in with a group I like”, “To get through the day”, “Because it is affordable”, “Because someone in my family uses or used it”, or “Because media or other public figures uses or used it”.

4.2. Qualitative findings

Two-hundred fifteen of the respondents completed an open-ended answer for the survey question, “What are your top three reasons for using marijuana or hashish?” These answers were coded inductively using 10 codes (See Table 1 for codes, definitions and exemplar quotes). After multiple coding rounds and input from all authors, respondents with disabilities reported using cannabis for reasons related to cannabis as medicine, cannabis as sensory moderator, and cannabis-related contextual issues. These themes are described below.

4.2.1. Theme 1: Medicinal reasons for cannabis use

The first theme, cannabis as medicine, emphasized how many respondents described using cannabis to address some kind of pathology. This theme was the most frequently observed. While some respondents explained that they accessed cannabis through a medical provider, reporting, for instance, that “doctor prescribed it,” other respondents were more specific in describing the issue they needed addressed. Respondents specifically invoked problems of sleep, nausea, mental health concerns, and other issues such as muscle spasms, seizures and gastroparesis to describe reasons for cannabis use. Notably, cannabis as a sleep aid constituted 40 % of all coding applications. A subset of respondents also described using cannabis for multiple health-related issues, such as one respondent who explained that they used cannabis for “Anxiety, pain, pressure feeling in my head decreases.”

Some respondents also emphasized that medicinal cannabis was their only intervention that they were able to access. For example, one respondent explained, ““It is my only relief for severe OCD because I cannot access medicine or a doctor as a trans person in [state].” Other respondents echoed this sentiment, explaining that their insurance would not cover other needed drugs or that they could not afford other drugs.

In addition to emphasizing cannabis as an accessible medicine, respondents also underscored the increased efficacy of medicinal cannabis relative to pharmaceutical drugs, saying, “It’s the only medicine that reduces terrible symptoms without producing unwanted side effects. Also helps with sleep.” A smaller subset of respondents explained that while cannabis had been recommended to them as medicinal, they had found it non-efficacious. For example, one respondent stated, “Recommended to try for my chronic illness. It did not help so I didn’t keep doing it.”

Related to respondents’ emphasis on efficacy, some respondents also highlighted cannabis as a safer alternative to other medicines. Cannabis was identified as a “safer sleep aid,” and “safer than alternatives.” Respondents’ explanations of cannabis as safer is both a specific aspect of cannabis as medicine and also relates to the second theme of how respondents explained their cannabis use through contextual reasons.

4.2.2. Theme 2: Contextual reasons for cannabis use

The second theme was using cannabis for contextual reasons. This theme captures respondents’ descriptions of cannabis use for external reasons, including state legality status, prescription from a medical provider, or other externally recommended reasons. For instance, when some respondents described medicinal cannabis use, they often invoked a medical provider’s suggestion or prescription as their reason for cannabis use. Respondents explained, “My doctor recommended it for sleep and pain” and “Was told it could help with long COVID.” Here, the invocation of an outside authority plays a role in reasoning for cannabis use. Other respondents emphasized the legality of cannabis, saying, “It is legal in my state.” Some respondents emphasized that they used THC gummies as opposed to smoking cannabis, explaining that the cannabis was legally obtained. Still other respondents included their frequency of cannabis use within their open-ended response, indicating that cannabis use was rare or limited.

4.2.3. Theme 3: Sensory moderating reasons for cannabis use

Lastly, the third theme, cannabis as primarily sensory moderator, captures respondents’ reports of using cannabis for reasons primarily related to either sensory enhancement, such as increased focused or creativity, or sensory reduction. For instance, one participant explained that cannabis “helps me focus, my mind slows down, I think clearly, and I am very aware of the present.” Another respondent explained the “muting” function of cannabis, saying that cannabis helped them with their “sensory sensitivity.” Several respondents tied the sensory reduction to autism, explaining that cannabis helped them manage sensory overwhelm more effectively. Taken together, these themes increase understanding of people with disabilities’ reasons for cannabis use, characterized through open-ended survey responses as medicinal reasons, external reasons, and sensory moderation reasons.

5. Discussion

Using data from a national survey of people with disabilities, we found that approximately one fifth of adults with disabilities had reported using cannabis currently. The majority of survey respondents were white, women, and college educated. Although previous research on cannabis use among adults with disabilities indicates males have greater odds of cannabis use than females, cannabis use prevalence among survey respondents with disabilities was still consistent with a prior nationally representative study, which found approximately 20% of adults with disabilities currently used cannabis.¹⁰ This prevalence of use is also higher than the prevalence of cannabis use among the general population (15.3%).²⁴ Among disability domains, cannabis use was the most prevalent for people with cognitive disabilities, which supports previous findings that indicate that those with cognitive disabilities have among the highest prevalence when compared to other disability domains.^11,12 The most common reason for using cannabis among current users across types of disability was to help with pain management. Our analysis of open-ended responses for cannabis use reasons yielded three main themes: medicinal reasons, contextual reasons, and primarily as sensory moderator.

Results on cannabis use reasons for people with any disability and across disability domains provide novel information. Previous studies of young adults have found the main reasons for cannabis use were to feel good or get high²⁵ and for enjoyment, with medical use second to last.²⁶ However, the current study indicates the primary reasons for cannabis use among people with disabilities may be different than those without disabilities. The use of medical cannabis may improve the quality of life for many people with disabilities²⁷ and people with disabilities may have cannabis prescribed by doctors to relieve chronic pain and multiple sclerosis symptoms.³ However, cannabis use poses a number of risks (e.g., increased risk of heart disease and psychosis)²⁸ that may be especially relevant to people with disabilities. For example, for adults with schizophrenia, bipolar disorder, or major depression, the use of cannabis may be harmful by increasing the risk of a psychotic episode.²⁹ Additionally, cannabis use in older adults with chronic disease and multimorbidity has increased from 2021 to 2023, and the use of cannabis can increase risks of cardiovascular and respiratory conditions in this population.³⁰

People with disabilities perceive cannabis to be less harmful than those without a disability,³¹ which may contribute to the decision to use cannabis for pain. People with disabilities have higher odds of using opioids and misuse³² and people with chronic pain report using cannabis to substitute for pain medications, including opioids.³³ Therefore, it could be possible people with disabilities are using cannabis to avoid using opioids. In this survey, respondents’ open-ended reasons for cannabis use included because they thought cannabis was safer than alternative methods, as well as because a doctor advised them to use cannabis and for various medical reasons (e.g., sleep, nausea, chronic pain, migraine treatment). These medical reasons dovetail with previous research among the general population with people who use medical cannabis, which indicate specific reasons for use are to manage pain, migraines, and sleep.^7,8

Finally, several respondents reported using cannabis as a sensory moderator, such as to mute their sensory sensitivity or manage overwhelming sensory experiences, which might be a reason to use unique to some disability types and different from the general population. This finding resonates with other studies that demonstrate efficacy and tolerability of cannabis use among children and youth with autism to alleviate autism-related symptoms.^34,35 One retrospective cohort study found that young adults with autism used cannabis specifically for epilepsy and aggression.³⁶ Findings related to cannabis as a sensory moderator may also help explain the higher prevalence of use among people who report cognitive disability.

Results of the study have a number of implications. Respondent-reported cannabis reasons in the current study suggest that for many people with disabilities, cannabis may be the only substance available to them due in part to lack of healthcare access. People with disabilities who live in states where medical cannabis is legal are more likely to report past-month cannabis use¹⁰ and therefore access to cannabis use may contribute to cannabis use prevalence. However, people with disabilities frequently report barriers to healthcare such as access difficulties and insurance costs. In addition to these instrumental barriers, people with disabilities and their families increasingly report experiences of medical ableism.³⁷ Medical ableism describes experiences of discrimination or oppression on the basis of healthcare providers’ negative perceptions about disability.^38,39 For instance, doctors may perceive people with disabilities as incompetent and vulnerable and therefore treat them differently.³⁷ It is possible that our study respondents, when reporting symptoms to their healthcare provider, may not be believed, leading them to look elsewhere for solutions to chronic pain and other symptom management.⁴⁰ In addition, our results suggest that for individuals experiencing intersectional oppression, such those who identify as both disabled and transgender, healthcare encounters may be even more fraught, potentially leading to these individuals relying on cannabis as their primary form of intervention. From a practice and advocacy standpoint, the results highlight the importance of pain management among people with disabilities and ensuring access to appropriate pain management treatments. However, the potential increase in risk of psychotic episodes in young adults due to cannabis use⁴ and cannabis use disorder^5,6 while managing pain should be considered.

6. Study limitations

This study has several limitations. First, all data are self-reported. Second, the cannabis use reason question does not ask specifically why respondents are currently using cannabis, and therefore respondents may have endorsed reasons for cannabis use in the past. Third, the sample is not a representative sample and is majority white, female, college-educated, and affluent; therefore, the generalizability of these results to other demographics is unknown. Future research should explore the rate and amount cannabis use among people with disabilities and how cannabis use differs between those with and without disabilities, as people with disabilities have a higher prevalence of cannabis use disorder as compared to those without disabilities.¹⁰ Additionally, future studies should explore whether cannabis use is different among those with multiple disabilities as previous research indicates rates of cannabis use is higher among those with multiple disabilities.¹⁰ Finally, future research should explore the harm perceptions of cannabis among people with disabilities to assess whether people with disabilities understand the risk of cannabis and if this population believes the benefits of cannabis outweigh the risks. Although some participants noted cannabis was not effective for them, self-reported participant perceptions of cannabis use in this study mostly focused on positive aspects of cannabis.

7. Conclusions

Cannabis use among NSHD participants, all of whom self-identified as having a disability, was prevalent (21.9%) across disability domains. Most respondents noted they used cannabis to help with managing pain, to relax, or to relieve tension. People with disabilities may experience various barriers to care, and these findings highlight the need to address symptom management among people with disabilities. Although some people with disabilities may benefit from medical cannabis use as an alternative to opioids for chronic pain relief, caution is warranted for people with severe mental health conditions, including schizophrenia or bipolar disorder, because of the increased risk of a harmful psychotic episode. Finally, messaging around cannabis use may need to consider the unique reasons for use among people with disabilities and ensure health information is accessible to people with disabilities.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.dhjo.2025.101979.