311: Living with Opioid Tapering: Phenomenological Vignettes of Cannabis Use in Chronic Pain Care

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Prescription opioids play a central role in the global overdose crisis, creating a need to rethink chronic pain (CP) management(1). Therapeutic cannabis has emerged as a potential opioid-sparing strategy, offering analgesia with lower risks of respiratory depression and dependence(2). While clinical trials directed at validating this therapeutic utility measure pain scores and opioid reductions, they fail to capture the emotional, social, & existential dimensions of tapering(3). Phenomenological vignette methodology provides a rigorous approach to examining those embodied realities(4). This study employed phenomenological vignettes to illuminate how CP patients interpret medically supervised opioid tapering when cannabis is introduced within routine clinical care(5).

Methods: A prospective observational longitudinal study enrolled fourteen chronic pain patients referred between 2022 - 2023 to the Thunder Bay Regional Health Sciences Centre Ambulatory Care Unit. Eligibility required current opioid therapy and consideration for cannabis supported tapering. Participants completed validated measures: the Brief Pain Inventory(6), Generalized Anxiety Disorder(7), Patient Health Questionnaire(8), and Chronic Pain Experience Questionnaire(9) at baseline, 3, 6, and 12-months. Descriptive analyses summarized clinical trends. Consultation notes and clinical encounters were examined using phenomenological analysis to construct interpretive vignettes emphasizing the qualia of relational continuity, dignity(10), and the impact of those experiences on the perceived utility of CBD in opioid tapering.

Results: Participants (mean-age 56 years; female predominance 2.8:1) reported severe longstanding pain (mean-duration 17 years; baseline NRS 7±1). One-third successfully tapered opioids with cannabidiol (CBD) support, and a similar proportion tapered without CBD. Most discontinued CBD due to cost, side effects, or limited benefit. Pain scores remained high at 3-months for 88% of participants. Three phenomenological vignettes revealed tapering as an existential process marked by fear, grief, identity disruption, and efforts to reclaim agency and dignity. Patients described improved mental clarity and emotional presence with CBD despite pain. Success was associated with relational trust, psychological support, and continuity of care.

Conclusions: Phenomenological vignettes functioned as analytic units, bridging longitudinal epidemiologic data and the embodied realities of CP care, revealing why tapering succeeds or fails beyond pharmacologic mechanisms(11). To our knowledge, few prospective studies have integrated opioid tapering trajectories with phenomenologically constructed vignettes. While some patients reported subjective benefit from CBD, tapering outcomes were not uniformly dependent on cannabis use(12). These findings caution against positioning CBD as a primary opioid sparing strategy(13) and underscore the central role of individualized, trauma informed, and relationally grounded care sustainable opioid reduction. Integrating phenomenological approaches into CP research strengthens patient centered models of care(14,15).

References: 1. Volkow ND, Blanco C. The changing opioid crisis: development, challenges and opportunities. Molecular Psychiatry. 2021;26(1):218-233.

2. National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: current state of evidence and recommendations for research. Washington: National Academies Press; 2017.

3. Buchman DZ, Ho A, Illes J. You present like a drug user: patient and clinician perspectives on trust and stigma in chronic pain management. Pain Medicine. 2016;17(8):1394-1404.

4. Agostini E, Schratz M, Eloff I. Vignette research: research methods. London: Bloomsbury Academic; 2024.

5. van Manen M. Researching lived experience: human science for an action sensitive pedagogy. 2nd ed. London: Routledge; 2016.

6. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Annals of the Academy of Medicine Singapore. 1994;23(2):129-138.

7. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097.

8. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613.

9. Lakha SF, Pennefather P. Development of the Chronic Pain Experience Questionnaire. Thunder Bay Regional Health Sciences Centre; 2023.

10. Andrejević M, Hohwy J, Barclay L. Dignity Is Distinct From Respect: How Treating Others With Dignity Entails Accounting for Their Self-Conscious Emotions. Pers Soc Psychol Bull. 2025. doi: 10.1177/01461672251319063.

11. Todres L, Galvin K, Dahlberg K. Lifeworld-led healthcare: revisiting a humanising philosophy that integrates emerging trends. Medicine, Health Care and Philosophy. 2007;10(1):53-63.

12. Nugent SM, Yarborough BJ, Smith NX, Dobscha SK, Deyo RA, Green CA, Morasco BJ. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. Journal of General Internal Medicine. 2018;33(10):1721-1727.

13. Frank AW. The wounded storyteller: body, illness, and ethics. 2nd ed. Chicago: University of Chicago Press; 2013.

14. Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988.

15. Van Alboom M, Baert F, Bernardes SF, Bracke P, Goubert L. Public chronic pain stigma and the role of pain type and patient gender: an experimental vignette study. Journal of Pain. 2023;24(10):1798-1812.

Presenting Author: S.Fatima Lakha
Submitting Author: S. Fatima Lakha

Senior Author: Peter Pennefather

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Hadi: MD - Thunder Bay Regional Health Sciences Centre
• Peter Pennefather: Ph.D - Leslie Dan Faculty of Pharmacy, University of Toronto