The State of the Evidence for Medical Cannabis as a Treatment for Pain-related Sleep Impairments: Integrating Social Determinants of Health into Research Design and Policy

Sleep impairment due to chronic pain is linked to functional impairment and often inadequately addressed with current treatments leading some to seek alternative therapies, including cannabis. The factors associated with chronic pain and sleep impairments are disproportionately experienced by individuals from racial/ethnic minorities, of low socioeconomic status, who live in noisy, chaotic neighborhoods, and who have poor health care access. First, we describe the limited evidence for cannabis to manage pain and pain-related sleep impairment. Second, we highlight how research might exacerbate health inequities due to systematic biases in the populations and products being studied to determine cannabis efficacy. The preponderance of evidence is based on predominantly White samples, a limited subset of cannabis forms, and have been of lower quality. More inclusive, generalizable studies that reflect the real-world ways that individuals use cannabis and evaluate how the social determinants of health interplay with the risks for pain-related sleep impairments are needed.