We found that people using cannabis products to manage their own pain differ in the products they use and how they obtain them in comparison to people using cannabis products to manage their dog’s pain. This may reflect variances in the laws and regulations regarding cannabis products, available forms of cannabis products for human and pet uses, and differences in their availability for purchase. Given that many respondents are obtaining cannabis products through informal and unregulated sources, it raises the question about whether they are adequately informed about proper usage, potential contraindications, dosages and risks. A troubling finding is the common reliance, for both groups, on informal and unregulated sources of information. These sources, namely friends or family and online sources, may not provide accurate information needed about the use, dosage, benefits, and side effects of these products. Previous research suggests that not only are internet health websites often misleading and inaccurate, people often do not investigate websites’ credibility (Kogan et al. 2014).

The quantitative results suggest that both groups have similar reasons for using cannabis products for pain management. Frequently cited motivations for choosing cannabis products are that they are natural, safe with no side-effects, and not controlled by pharmaceutical industries; and therefore preferred over conventional medication. Other studies have reported similar motivations for selecting cannabis products to by patients (e.g., Kruger and Kruger 2019) as well as pet owners (Kogan et al. 2016; Kogan et al. 2019a, 2019b). These studies also illustrate how participants emphasize that the natural qualities of cannabis products, which are viewed as safer and with fewer side effects compared to pharmaceutical drugs. As well, participants also report greater trust in medical cannabis products and providers than main stream healthcare or “big pharma” (Ryan and Sharts-Hopko 2017) .

The research on cannabis products for medicinal use, however, highlights the complexity and controversy regarding its efficacy and safety (Hauser et al. 2017; Savage et al. 2016; Whiting et al. 2015). Additionally, despite the perception of and preference for supporting small privately-owned businesses, cannabis companies are quickly becoming consolidated and acquired by large pharmaceutical companies. For example, 70% of both the USA and Canada’s top cannabis patent holders are major multinational pharmaceutical companies (Jones 2019).

The other popular reason for using cannabis products is that they are seen as a good, or even the best, treatment for pain, particularly when other medications do not control the pain. Our results are consistent with other qualitative studies that have found patients using medical cannabis products report greater relaxation, improved sleep and better day-to-day functioning with less side effects than conventional approaches (Lavie-Ajayi and Shvartzman 2019). As well, a recent meta-analysis of quantitative studies shows that pain, anxiety and mood/depression are among the most common reasons patients seek and use medical cannabis (Kosiba et al. 2019). Together, these results suggest that cannabis might be included as part of a multimodal approach to managing chronic pain that not only treats pain symptoms but also comorbid symptoms such as anxiety and depression. In reducing the negative emotional components associated with chronic pain, patients are more likely to adopt effective coping strategies that improve their overall well being (Ciaramella and Poli 2015). Similarly, recent studies on the use and benefits of cannabis products for dogs identified signs of pain relief, reduced inflammation, reduced anxiety and sleep aid as the main reasons for using these products (Kogan et al. 2016; Kogan et al. 2018).

As mentioned above, however, there is mixed evidence for the benefits of cannabis products for relieving human chronic pain. For example, a recent meta-analysis based on 91 publications representing 104 studies (n = 9958 participants) concluded “It seems unlikely that cannabinoids are highly effective medicines for CNCP [chronic noncancer pain]” (Stockings et al. 2018: 1951). Additionally, a recently published four-year prospective study of the effects of cannabis on chronic pain found that patients who used cannabis reported significantly greater pain severity than those not using cannabis (Campbell et al. 2018). In contrast, a study of 2987 users who completed 20,513 cannabis administration sessions over 2 years found that medical cannabis, especially when using higher THC products “is associated with significant improvements in at least short-term pain relief” (Li et al. 2019:128).

While rigorous research is lacking in regards to the use of cannabis products for canine pain relief, preliminary studies appear positive (Gamble et al. 2018; Kogan et al. 2020). Brutlag and Hommerding (2018) provide a comprehensive review of common types of cannabis products that cats and dogs may be exposed to, such as ingesting cannabis edible goods, plant material or prescription medicines, as well as recommendations for diagnosis and treatment plans for veterinarians. It has been suggested that dog owners might benefit from being educated on how to observe and interpret behavioral changes associated with pain as well as how to apply pain scoring tools (Epstein et al. 2015). This may not only offer more reliable pain assessments for pet owners and veterinarians but also may result in more effective pain management and care for their dog.

Our respondents also indicated how they felt their own sleep or their dog’s sleep had improved from using cannabis products to manage their chronic pain. Research on the benefits of cannabis products for sleep, and in particular, for those suffering from chronic pain, is still in its infancy (Babson et al. 2017). The studies that have been conducted are often based on small samples, and lack control variables and standard measures. As a result, the findings to date are mixed but do suggest cannabis products have the potential to help with sleep and pain (e.g., Piper et al. 2017), although long term, clinical trials are needed. There does not appear to be research on the relationship between dogs’ sleep quality and cannabis treatments.

Improvement in coping, functionality and quality of life were also identified as expectation areas fulfilled by using cannabis products to treat human and dog chronic pain. These findings are similar to those reported in Lavie-Ajayi and Shvartzman’s (2019) phenomenological study that involved interviews with chronic pain patients using medical cannabis. Their interviewees told researchers how the beneficial experiences of using cannabis go beyond the physiological effects. They described the benefits of cannabis as “a sigh of relief” and “a return to normality” – saying that it offers a sense of “restored self” from the overwhelming war against chronic pain that often takes over patients’ entire being and identity. A sense of normalcy and being able to cope with chronic pain may be related to feeling more in control over the situation. The authors note that restored self implies a sense of control over one’s life and regained sense of self that is highly subjective and not necessarily correlated with objective or biomedical markers.

Interestingly, we saw similar references and themes among the dog owners in which they referred to how their dog was a “new dog” or more like his or her “old self” before the pain started. This idea of a restored self for their dog was often expressed by comparing their dog’s activity levels or spirit before and after using cannabis products. Some owners talked about how their dog’s energy level, playfulness, or personality returned after using cannabis products to treat their pain. The comments from both human patients and dog owners highlight the subjective nature of the benefits of cannabis that may be difficult to detect in objective clinical measures, yet nevertheless, are critically important. This poses another methodological and clinical challenge in determining the benefits of cannabis use for medicinal purposes.

For those who did not feel cannabis products met their expectations, the overarching theme was it simply did not work; it failed to alleviate their pain. More detailed comments from human patients and dog owners indicated concerns about proper doses, temporary but not long-term relief, and sporadic but not total or continuous relief. Informed health care providers might be helpful in developing realistic expectations of the potential benefits of pain relief from cannabis products, as well as helping people make educated decisions about what to look for in a product and/or brand. As well, over the past several years, the U.S. Food and Drug Administration has tested the chemical content of new unapproved drugs that allegedly contain CBD and many were found that they do not contain the levels of CBD they claimed to contain (FDA 2019). This may offer a partial explanation of why consumers’ expectations are not being met, particularly if they are purchasing unapproved drugs. Consumers should be warned and educated about how to assess information regarding whether cannabis products are manufactured in compliance with FDA requirements, and whether they are assessed in an authorized laboratory and contain the amount of CDB that their label claims.

There are several limitations in the current study. The results are based on a small self-selected group of participants who were asked to subjectively report pain symptoms and cannabis effects Respondents’ reports did not include the extent to which symptoms objectively changed with cannabis use and we cannot verify respondents’ assessments of chronic pain in themselves or their dogs and changes resulting from the use of cannabis products. Moreover, while humans can articulate their perceptions of their own symptoms and perceived changes in them, dog owners must rely on observable behavioral signs in their dog’s behaviors, which may be highly subject to interpretation. Due to the uncertain legal status of cannabis products, detailed demographic information was not collected from participants or about their dogs to ensure complete anonymity in participating in the survey. As a result, we cannot assess the representativeness of our results but it is important to recognize that generalizability is not the goal of exploratory research such as this. As well, due to the variable nature of each brand and type of cannabis products, we did not inquire about specifics of cannabis products (e.g., type, dose) prescribed and/or used. As a result, we have limited information about the types and dosages of cannabis products that were used and how variations in types and dosages may relate to motivations and expectations. It is important to note, however, that the purpose of this study is not to demonstrate or promote the efficacy of cannabis products in managing chronic pain, but to explore subjective experiences and attitudes regarding motivations and expectations. Our findings suggest that most people are satisfied with the outcomes. More controlled clinical trials are needed to determine the extent to which different forms of cannabis products relate to positive outcomes for human and canine patients.