HS, Cannabis, Pain, and Substance Use: A cannabis researcher Review of 7 Key Studies (Including Cannabis)

My name is Jaap, and I am a biomedical scientist that also used to live with severe Hidradenitis Suppurativa, the kind that takes over your life. Today, I am completely asymptomatic because I learned how to heal Hidradenitis Suppurativa from within. More importantly, I’ve had the privilege of helping many other individuals with HS get their lives back, too.

The Intersection That Catches My Eye

As a biomedical scientist, I spend a lot of time reading research. But I also do specific cannabis and cannabinoid research. So, when I see a paper linking cannabis use and Hidradenitis Suppurativa (HS), I immediately click it. It’s a topic that hits close to home, both professionally and personally, having navigated the challenges of severe HS myself. Now I have summarized for you the most interesting papers that link hidradenitis suppurativa and cannabis. This complex intersection of HS, pain, mental health, and substance use, including cannabis, alcohol, and opioids what we will delve in together.

Reading through them sparked a lot of thoughts, my own meditations on the subject. We know HS comes with a heavy burden, physically and emotionally. The pain can be excruciating, and the impact on quality of life is profound. It’s not surprising, then, that substances might enter the picture. There’s the obvious danger of addiction, of course. But there’s also the reality that substances like cannabis or even prescribed opioids might be used desperately seeking relief – relief from physical pain, or sometimes, relief for a soul in pain, trying to soothe the mental health struggles that often accompany this disease.

However, it’s incredibly complex. Cannabis, for example, can be a potential tool for pain or mental ease for some, while for others, it can trigger anxiety [2]. As a scientist, it’s hard to make a simple verdict. The potential for negative consequences exists alongside potential positive applications, but it seems deeply context-dependent, varying hugely based on the individual, their specific situation, and their HS severity. Add to this the known role of our body’s own endocannabinoid system in modulating inflammation and pain, and the picture becomes even more intricate [3].

So, let’s dive into what these seven papers contribute to this conversation, weaving in these reflections.

What the Science Says: A Troubling Correlation

A consistent theme across several studies is the increased prevalence of substance use disorder (SUD) among HS patients compared to the general population. A large US population-based analysis by Dr. Amit Garg and colleagues found the prevalence of SUD among HS patients was double that of controls (4.0% vs 2.0%) [1]. This meta-analysis by Dr. Kevin Phan and his team confirmed this, finding significantly higher odds of substance-related disorders (Odds Ratio 2.84) and alcohol abuse (Odds Ratio 1.94) in individuals with HS [2].

The substances most commonly reported in the Garg study were alcohol (nearly half of HS patients with SUD), followed by opioids and cannabis (each around 30-33% of SUD cases) [1]. A review by Dr. Paola Aldana and Dr. Marcia Driscoll also highlights these three substances as areas of concern [3].

Why the Increased Use? Pain and Mental Health Burden

The research strongly suggests that the physical and psychological toll of HS are major contributing factors.

The Pain Connection: HS is characterized by significant, often chronic pain [3]. This pain is reported by patients as the greatest cause of morbidity [3], interfering with daily life, work, and relationships. It’s so severe that many patients resort to their own methods for relief. A study by Dr. A.H. Ravn Jørgensen and colleagues found that a staggering 82% of HS patients had attempted to drain pus from lesions themselves, primarily using manual pressure, but sometimes needles or even knives [7]. Those who attempted these methods reported significantly higher overall disease-related distress and boil-associated pain scores [7]. This desperation highlights potentially inadequate pain management within the conventional system.

It’s therefore logical that substances with analgesic properties become relevant. Opioids are often prescribed for HS pain, complicating the picture, is high opioid use a sign of abuse, inadequate pain control, or both [1, 3]? Cannabis, too, has known analgesic effects, acting through various mechanisms including direct analgesia and anti-inflammatory pathways [3]. A scoping review by Dr. Dea Metko and colleagues noted that cannabis (smoked or edible) was identified by patients in one survey as highly effective for pain, sometimes more so than acetaminophen or even opioids [5]. Dr. Claude Lesort and team, in a French multicenter study, found that while pleasure was the initial motivation for cannabis use, higher pain scores during remission were significantly associated with cannabis use, suggesting chronic pain might contribute to dependence [4].

The Mental Health Connection: The link between HS and psychiatric comorbidities is stark. Dr. Phan’s meta-analysis found significantly increased odds for schizophrenia, bipolar disorder, depression, anxiety, and personality disorders in HS patients [2]. Tragically, the risk of completed suicide was also found to be doubled [2]. The physical symptoms, pain, malodorous discharge, visible lesions, contribute to feelings of embarrassment, shame, anger, and unworthiness, feeding into depression and anxiety [3]. This emotional distress can understandably lead individuals to seek solace or escape through substances [2, 3]. However, Dr. Garg’s study intriguingly found that HS appeared to be an independent risk factor for SUD, even in patients without diagnosed depression or anxiety, suggesting factors like pain and quality of life impairment might be even stronger drivers than pre-existing psychiatric conditions alone [1].

The Cannabis Conundrum: Trigger, Treatment, or Coping Mechanism?

Cannabis use warrants special attention due to its complex role and changing legal status [3]. Dr. Lesort’s study found a significantly higher prevalence of cannabis use among HS patients (34%) compared to psoriasis patients (11.6%) and the general French population (11%), with nearly half of HS users reporting daily consumption [4]. Patients with HS also had higher scores on a cannabis addiction scale compared to psoriasis patients [4].

While some studies show this high prevalence among HS patients [1, 4, 5], a recent retrospective cohort study by Dr. Naeha Pathak and colleagues looked at the question differently. They investigated whether starting cannabis or tobacco use was associated with a later diagnosis of HS [6]. Interestingly, while they confirmed an association for cigarette smoking (especially in Black patients and females), they found no significant association between starting cannabis use and subsequently developing HS [6].

This contrast is fascinating. It might suggest that while cannabis use doesn’t necessarily trigger the onset of HS, the condition itself (the pain, the inflammation, the mental burden) may drive patients towards using cannabis later on, either for relief or as a coping mechanism, leading to the high prevalence rates seen in other studies [1, 4, 5]. As Dr. Aldana and Dr. Driscoll point out, the increasing legalization of cannabis for medical and recreational purposes makes defining abuse difficult [3]. Is using cannabis daily for chronic HS pain considered abuse, self-medication, or legitimate therapy under evolving laws?

The “Knowledge Gap” and the HS Armor Philosophy

This collection of research paints a clear picture: HS patients are suffering immensely, physically and mentally, and substance use is significantly elevated in this population, likely driven by pain and psychological distress. Conventional medicine often focuses on the statistics, the odds ratios, the prevalence rates, and might recommend screening for SUD or psychiatric issues [1, 3]. This is important, but it often feels like a downstream approach, addressing the consequences without fully tackling the upstream causes.

Using our ‘Fire and Smoke Alarm’ analogy: the pain, lesions, and mental health struggles are the blaring smoke alarms. Substance use, in many cases, might be a desperate attempt to cope with the noise and the smoke. Conventional treatments often try to manage the smoke (e.g., painkillers, antidepressants, SUD treatment) but may not adequately extinguish the underlying fire, the root cause systemic inflammation driving the HS itself.

At HS Armor, we believe true healing requires putting out the fire. By focusing on highly effective, evidence-based nutrition, lifestyle changes, and natural therapies, we aim to address the root causes of inflammation. When the fire diminishes, the smoke clears, and the alarms quiet down naturally. Addressing the foundational inflammation can profoundly reduce pain, improve skin, and alleviate the mental health burden, thereby reducing the need to rely on substances for coping or relief. Pharmaceuticals and SUD treatments have their place as vital shields, but they shouldn’t be the only strategy when the source of the fire remains unaddressed.

Key Takeaways

• Higher Risk: Patients with HS have significantly higher rates of substance use disorder (cannabis, alcohol, opioids), psychiatric comorbidities (depression, anxiety, etc.), and suicide compared to the general population [1, 2, 3].
• Pain is a Major Driver: Severe, chronic pain is a hallmark of HS and strongly linked to substance use and desperate self-alleviation methods [3, 4, 5, 7].
• Mental Health Matters: The immense psychological burden of HS fuels depression, anxiety, and isolation, contributing to substance use [2, 3]. HS itself appears to be an independent risk factor for SUD [1].
• Cannabis is Complex: Cannabis use is highly prevalent in HS patients [4, 5], potentially used for pain/stress relief, but carries risks of dependence and anxiety [2, 4]. Starting cannabis use doesn’t seem to cause HS onset, suggesting usage may be a consequence of the disease burden [6].
• Address the Root Cause: Focusing solely on managing SUD or psychiatric symptoms misses the underlying driver. A holistic approach targeting the root inflammation of HS is crucial for reducing pain and mental suffering, thereby lessening the reliance on substances.
• Smoking Link: Cigarette smoking (but not chewing tobacco) is associated with increased odds of developing HS [6].

Conclusion: A Call for Holistic Healing

From my perspective as a cannabinoid researcher who has published in this field, and also as someone who has personally overcome severe Hidradenitis Suppurativa, I want to be clear: cannabis cannot cure or completely resolve HS. I do believe, however, that in specific contexts and under the guidance of a knowledgeable medical professional, its use might be appropriate for managing aspects like inflammation and pain. It may offer symptomatic relief, but it’s crucial to weigh this against potential side effects. These can include anxiety (counterintuitively), the possibility of worsening inflammatory imbalances rather than improving them, the risk of addiction, and in some individuals, the potential exacerbation of psychiatric conditions like depression or schizophrenia [2]. Careful, informed consideration and professional oversight are essential when exploring this option.

This review of seven papers underscores the profound suffering associated with Hidradenitis Suppurativa and its complex relationship with substance use. While substances like cannabis present a double-edged sword, offering potential relief but also carrying risks, the overarching message is clear: the pain and psychological distress of HS are potent drivers of substance use.

As a researcher and someone who has healed from HS, I believe the path forward lies in a truly holistic approach. We must manage pain effectively, provide robust mental health support, and screen for substance misuse. But fundamentally, we must prioritize extinguishing the inflammatory fire at its source. By addressing the root causes through dedicated lifestyle changes, targeted nutrition, and natural therapies, we can alleviate the suffering that pushes individuals towards substance use and offer a sustainable path to remission and a reclaimed life.

References

1. Garg, A., Papagermanos, V., Midura, M., Strunk, A., & Merson, J. (2018). Opioid, alcohol, and cannabis misuse among patients with hidradenitis suppurativa: A population-based analysis in the United States. Journal of the American Academy of Dermatology, 79(3), 495-500.e1. https://doi.org/10.1016/j.jaad.2018.02.053
2. Phan, K., Huo, Y. R., & Smith, S. D. (2020). Hidradenitis suppurativa and psychiatric comorbidities, suicides and substance abuse: systematic review and meta-analysis. Annals of Translational Medicine, 8(13), 821. https://doi.org/10.21037/atm-20-1028
3. Aldana, P. C., & Driscoll, M. S. (2019). Is substance use disorder more prevalent in patients with hidradenitis suppurativa? International Journal of Women’s Dermatology, 5(5), 335-339. https://doi.org/10.1016/j.ijwd.2019.09.007
4. Lesort, C., Villani, A. P., Giai, J., Becherel, P. A., Delaunay, J., Fattouh, K., Ducroux, E., Jullien, D., & Guillem, P. (2019). High prevalence of cannabis use among patients with hidradenitis suppurativa: results from the VERADDICT survey. British Journal of Dermatology, 181(4), 839–841. https://doi.org/10.1111/bjd.17930
5. Metko, D., Mehta, S., & Piguet, V. (2024). Cannabis Usage Among Patients With Hidradenitis Suppurativa: A Scoping Review. Journal of Cutaneous Medicine and Surgery, 28(3), 287-310. https://doi.org/10.1177/12034754241238719
6. Pathak, N., Alani, O., Patel, D., & Lipner, S. R. (2024). Association Between Tobacco and Cannabis Use and Hidradenitis Suppurativa: A Retrospective Cohort Study. International Journal of Dermatology. Advance online publication. https://doi.org/10.1111/ijd.17999 (Note: Published online ahead of print, final volume/issue/pages may change)
7. Ravn Jørgensen, A. H., Yao, Y., Thomsen, S. F., & Ring, H. C. (2021). Self-reported pain alleviating methods in patients with hidradenitis suppurativa. Actas Dermo-Sifiliográficas (English Edition), 112(2), 153-158. https://doi.org/10.1016/j.ad.2020.08.009

Important Medical Disclaimer

1. Not Medical Advice: All content and information on this website is for informational and educational purposes only. It does not constitute medical advice and is not a substitute for professional diagnosis, treatment, or consultation with a qualified healthcare provider.

2. My Role and Qualifications: I am a biomedical scientist and PhD candidate and share information from that perspective, combined with my personal experience as a patient with Hidradenitis Suppurativa. However, I am not a medical doctor, physician, or registered healthcare professional. Do not consider our relationship a doctor-patient relationship.

3. Consult Your Doctor: Always seek the advice of your medical doctor or another qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If you suspect you are experiencing a medical emergency, or a severe infection, do not rely on this website or the HS Armor community, please call your local emergency services or go to the nearest emergency room immediately.

4. A Critical Warning on Medication: Pharmaceutical drugs are a crucial tool in managing Hidradenitis Suppurativa for many people. Under absolutely no circumstances should you ever alter, reduce, or stop taking your prescribed medication without the explicit direction of the doctor who prescribed it. Doing so can be dangerous. Always consult with your doctor before doing anything related to your treatment plan.

5. No Liability: Your use of this website and reliance on any information provided is solely at your own risk.

6. Individual Results May Vary: Every patient’s biological baseline, genetics, and adherence to the protocol is different. Therefore, I cannot guarantee specific results, cures, or timelines for your Hidradenitis Suppurativa.

7. Scientific and Expressive Freedom: The articles published on this blog are distinct from formal peer-reviewed academic literature. They serve as an independent platform for my personal viewpoints, scientific hypotheses, and philosophical reflections as an independent scientist and HS patient. While grounded in biomedical research, I exercise a degree of expressive freedom to translate rigid academic data into insights from a patient perspective. These writings are my personal meditations on the science of HS and should be read as my individual perspective, not as universally accepted clinical consensus or formal peer-reviewed literature.