Cannabis Use in Individuals With Spinal Cord Injury or Moderate to Severe Traumatic Brain Injury in Colorado

Published:March 07, 2018DOI:



      To describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.


      Mixed-methods observational study, using focus group data and telephone survey.




      Colorado adults who sustained SCI or moderate to severe TBI and received services through Craig Hospital.



      Main Outcome Measures



      Focus group participants identified issues that were then included in the survey development. Seventy percent of the 116 participants surveyed reported cannabis use before their injury (67% SCI, 74% TBI) and 48% reported use after their injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%) and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use.


      A majority of this sample reported using cannabis before injury, and approximately half reported using cannabis after injury. Both groups reported recreational use, whereas the group with SCI also highly endorsed using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual’s medical management. Further research in this area is needed.


      List of abbreviations:

      SCI (spinal cord injury), SCIMS (spinal cord injury model system), TBI (traumatic brain injury), TBIMS (traumatic brain injury model system), THC (tetrahydrocannabinol)
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        • ElSohly M.A.
        • Radwan M.M.
        • Gul W.
        • Chandra S.
        • Galal A.
        Phytochemistry of Cannabis sativa L.
        Prog Chem Org Nat Prod. 2017; 103: 1-36
        • Mandelbaum D.E.
        • de la Monta S.M.
        Adverse structural and functional effects of marijuana on the brain: evidence reviewed.
        Pediatr Neurol. 2017; 66: 12-20
        • Center for Behavioral Health Statistics and Quality
        Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health: methodological summary and definitions.
        Substance Abuse and Mental Health Services Administration, Rockville, MD2015
        • Colorado Department of Public Health & Environment
        Marijuana use in Colorado: Colorado adults, ages 18 and older.
        (Available at:)
        Date: 2014
        Date accessed: July 18, 2017
        • Hill K.P.
        Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review.
        JAMA. 2015; 313: 2474-2483
        • National Academies of Sciences, Engineering and Medicine
        The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research 2017.
        National Academies Press, Washington, DC2017
        • McCarberg B.H.
        • Barkin R.L.
        The future of cannabinoids as analgesic agents: a pharmacologic, pharmacokinetic, and pharmacodynamic overview.
        Am J Ther. 2007; 14: 475-483
        • World Health Organization
        (Available at:)
        • Whiting P.F.
        • Wolff R.F.
        • Deshpande S.
        • et al.
        Cannabinoids for medical use: a systematic review and meta-analysis.
        JAMA. 2015; 313: 2456-2473
        • Rao V.
        • Spiro J.
        • Vaishnavi S.
        • et al.
        Prevalence and types of sleep disturbances acutely after traumatic brain injury.
        Brain Inj. 2008; 22: 381-386
        • Viola-Saltzman M.
        • Watson N.F.
        Traumatic brain injury and sleep disorders.
        Neurol Clin. 2012; 30: 1299-1312
        • Nampiaparampil D.E.
        Prevalence of chronic pain after traumatic brain injury: a systematic review.
        JAMA. 2008; 300: 711-719
        • Widerström-Noga E.G.
        • Felipe-Cuervo E.
        • Yezierski R.P.
        Chronic pain after spinal injury: interference with sleep and daily activities.
        Arch Phys Med Rehabil. 2001; 82: 1571-1577
        • Bonica J.J.
        Introduction: semantic, epidemiologic, and educational issues.
        in: Casey K.L. Pain and central nervous system disease. Raven Press, New York1999: 13-29
        • Walter J.S.
        • Sacks J.
        • Othman R.
        • et al.
        A database of self-reported secondary medical problems among VA spinal cord injury patients: its role in clinical care and management.
        J Rehabil Res Dev. 2002; 39: 53-61
        • Maynard F.
        • Karunas R.
        • Waring 3rd, W.
        Epidemiology of spasticity following traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1990; 71: 566-569
        • Malec J.
        • Harvey R.F.
        • Cayner J.J.
        Cannabis effect on spasticity in spinal cord injury.
        Arch Phys Med Rehabil. 1982; 63: 116-118
        • Cardenas D.D.
        • Jensen M.P.
        Treatments for chronic pain in persons with spinal cord injury: a survey study.
        J Spinal Cord Med. 2006; 29: 109-117
        • Drossel C.
        • Forchheimer M.
        • Meade M.A.
        Characteristics of individuals with spinal cord injury who use cannabis for therapeutic purposes.
        Top Spinal Cord Inj Rehabil. 2016; 22: 3-12
        • Allen S.
        • Stewart S.H.
        • Cusimano N.
        • Asbridge M.
        Examining the relationship between traumatic brain injury and substance use outcomes in the Canadian population.
        Subst Use Misuse. 2016; 51: 1577-1586
        • Wyndaele M.
        • Wyndaele J.J.
        Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?.
        Spinal Cord. 2006; 44: 523-529
        • Kim S.H.
        • Manes F.
        • Kosier T.
        • Baruah S.
        • Robinson R.G.
        Irritability following traumatic brain injury.
        J Nerv Ment Dis. 1999; 187: 327-335
        • Hart T.
        • Brockway J.A.
        • Fann J.R.
        • Maiuro R.D.
        • Vaccaro M.J.
        Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment.
        Contemp Clin Trials. 2015; 40: 180-192