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Attitudes toward and knowledge of medical cannabis among individuals with spinal cord injury

Spinal Cord Series and Casesvolume 5, Article number: 6 (2019) | Download Citation


Study design

An observational study based on an online survey addressing attitudes toward and knowledge of cannabis among people living with spinal cord injury (SCI).


To characterize attitudes toward and knowledge of cannabis among a nationwide sample (n = 353) of people with SCI. To determine if knowledge and attitudes are influenced by socio-demographic and injury-specific factors.


Three academic medical centers in the US.


Distribution of an online survey through email lists maintained by 3 SCI centers.


Participants largely believed that cannabis use is safe, has potential therapeutic benefits, and ought to be legal. Substantial pluralities felt that cannabis use is attended by moderate to great health-related and social risks (15.5% and 25.5%, respectively), and a majority (55.9%) felt it is attended by moderate to great legal risks. Subjects’ duration of injury, employment status, and personal history of controlled or illicit substances influenced certain beliefs and attitudes.


This study is the first to assess beliefs about and attitudes toward cannabis use among a nationwide sample of people with SCI. While limited, it provides a roadmap for future research. It also offers medical providers an initial understanding of which factors may encourage or dissuade their patients with SCI from seeking medical cannabis treatment.

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  1. 1.

    National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana. An evidence review of research agenda. 2017.

  2. 2.

    Choi NG, DiNitto DM, Marti CN. Nonmedical versus medical marijuana use among three age groups of adults: associations with mental and physical health status. Am J Addict. 2017;26:697–706.

  3. 3.

    Azofeifa A, Mattson ME, Schauer G, McAfee T, Grant A, Lyerla R. National estimates of marijuana use and related indicators—national survey on drug use and health, United States, 2002–2014. MMWR Surveill Summ. 2016;65:1–28.

  4. 4.

    Blazer DG, Wu LT. The epidemiology of substance use and disorders among middle aged and elderly community adults: national survey on drug use and health. Am J Geriatr Psychiatry. 2009;17:237–45.

  5. 5.

    Dinitto DM, Choi NG. Marijuana use among older adults in the U.S.A.: user characteristics, patterns of use, and implications for intervention. Int Psychogeriatr. 2011;23:732–41.

  6. 6.

    Keyhani S, Steigerwald S, Ishida J, Vali M, Cerda M, Hasin D, et al. Risks and benefits of marijuana use: a national survey of U.S. adults. Ann Intern Med. 2018;169:282–90.

  7. 7.

    Schmidt LA, Jacobs LM, Spetz J. Young people’s more permissive views about marijuana: local impact of state laws or national trend? Am J Public Health. 2016;106:1498–503.

  8. 8.

    Hawley LA, Ketchum JM, Morey C, Collins K, Charlifue S. Cannabis use in individuals with spinal cord injury or moderate to severe traumatic brain injury in Colorado. Arch Phys Med Rehabil. 2018;99:1584–90.

  9. 9.

    Cuttler C, Spradlin A. Measuring cannabis consumption: psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU). PLoS One. 2017;12:e0178194.

  10. 10.

    Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abus. 2014;40:23–30.

  11. 11.

    Hartig H, Geiger A. About six-in-ten Americans support marijuana legalization. Available at: Accessed 16 November 2018.

  12. 12.

    Charlifue SW, Weitzenkamp DA, Whiteneck GG. Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being. Arch Phys Med Rehabil. 1999;80:1429–34.

  13. 13.

    New PW. Secondary conditions in a community sample of people with spinal cord damage. J Spinal Cord Med. 2016;39:665–70.

  14. 14.

    Anson CA, Shepherd C. Incidence of secondary complications in spinal cord injury. Int J Rehabil Res. 1996;19:55–66.

  15. 15.

    Adriaansen JJ, Ruijs LE, van Koppenhagen CF, van Asbeck FW, Snoek GJ, van Kuppevelt D, et al. Secondary health conditions and quality of life in persons living with spinal cord injury for at least ten years. J Rehabil Med. 2016;48:853–60.

  16. 16.

    Wollaars MM, Post MW, van Asbeck FW, Brand N. Spinal cord injury pain: the influence of psychologic factors and impact on quality of life. Clin J Pain. 2007;23:383–91.

  17. 17.

    Ataoglu E, Tiftik T, Kara M, Tunc H, Ersoz M, Akkus S. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord. 2013;51:23–6.

  18. 18.

    Nagoshi N, Kaneko S, Fijuyoshi K, Takemitsu M, Yagi M, Iizuka S, et al. Characteristics of neuropathic pain and its relationship with quality of life in 72 patients with spinal cord injury. Spinal Cord. 2016;54:656–61.

  19. 19.

    National Spinal Cord Injury Statistical Center. 2016 Spinal cord injury facts and figures at a glance. University of Alabama at Birmingham. Available at: Accessed 16 December 2017.

  20. 20.

    Krause JS, Reed KS. Barriers and facilitations to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation. Spinal Cord. 2011;49:285–91.

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Author information


  1. Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    • Michael Stillman
    • , Michael Mallow
    • , Tracy Ransom
    • , Kristin Gustafson
    •  & Daniel Graves
  2. Department of Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    • Michael Stillman
  3. Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA

    • Alison Bell


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Michael Stillman.

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