{
  "abstract": "Cannabis use is rising fastest among older adults in the U.S., and pain is among the most common reasons they use it. No trial, however, has measured the trade-off between the analgesic and abuse-related effects of {Delta}9-tetrahydrocannabinol ({Delta}9-THC) in this population. In a randomized, double-blind, placebo-controlled trial, 20 adults aged 65 and older were assigned to oral {Delta}9-THC (placebo, 5, 10 mg) or vaporized {Delta}9-THC (placebo, 2, 4 mg) across three eight-hour sessions in counterbalanced order. We assessed laboratory-evoked pain sensitivity using quantitative sensory testing, abuse liability using subjective drug effects and reinforcement value, and also sampled plasma {Delta}9-THC and 11-OH-THC. Analgesia and abuse liability outcomes were measured repeatedly within each session. On a pain sensitivity index, oral 5 mg relieved pain relative to placebo (p=.040), although the oral arm's overall dose effect was not significant (p=.108); oral 10 mg and both vaporized doses did not differ from placebo. Subjective effects increased with dose and were greatest after vaporization, whereas reinforcement value increased only after vaporized 4 mg. After oral 5 mg, analgesia exceeded placebo at every assessment (60-360 min), while its pleasurable effects peaked at 150 min. Vaporized {Delta}9-THC produced pleasurable effects within 30 min but did not significantly change thermal pain sensitivity. While abuse liability tracked {Delta}9-THC exposure, analgesia showed no significant association, and all adverse events occurred at vaporized 4 mg. These findings suggest dose and route selection may help maximize {Delta}9-THC analgesia while minimizing abuse liability, a strategy that warrants evaluation in clinical populations.",
  "abstract_shown": true,
  "affiliations": [
    "Yale University School of Medicine"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "name": "G. P. A. Costa"
    },
    {
      "name": "R. Gueorguieva"
    },
    {
      "name": "M. M. Riggs"
    },
    {
      "name": "T. Dunlap"
    },
    {
      "name": "M. Sofuoglu"
    },
    {
      "affs": [
        0
      ],
      "name": "J. P. De Aquino"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bajmh65472de1.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.02.26367127",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.02.26367127v1.full",
  "id": "bajmh65472de1",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.02.26367127v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "pain medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.02.26367127v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-02",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bajmh65472de1.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T00:20:38Z",
      "native_id": "10.64898/2026.11.02.26367127",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.02.26367127v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:pain medicine",
      "subfield": "surgery"
    }
  ],
  "title": "Balancing Analgesic Effects and Abuse Liability in Older Adults: A Randomized, Placebo-Controlled Trial of Oral and Vaporized Δ9-Tetrahydrocannabinol",
  "title_text": "Balancing Analgesic Effects and Abuse Liability in Older Adults: A Randomized, Placebo-Controlled Trial of Oral and Vaporized Δ9-Tetrahydrocannabinol",
  "type": "preprint",
  "updated_at": "2026-11-06T00:20:52Z",
  "url": "https://research.draconitic.com/paper/bajmh65472de1",
  "venue": "medRxiv",
  "versions": []
}