Importance: Characterizing cannabis use (CU) rates in pediatric pain is critical as adolescence is a period of increased substance use and risk for negative outcomes. Youths with chronic pain may engage in CU to cope with symptoms.

Question: What are the rates of cannabis use among treatment-seeking youths with pain disorders, and how often is use associated with attempts to alleviate symptoms?

Findings: In this cross-sectional study of 245 adolescents with chronic pain, 25.3% reported lifetime cannabis use, and 77.4% of users endorsed instrumental use, primarily for pain, sleep, and anxiety. Youths endorsing instrumental use had greater functional disability and more pain days than recreational users.

Meaning: Despite limited evidence supporting cannabis for pain, sleep, or anxiety, these findings suggest many youths with pain use it instrumentally, underscoring the need for education on self-medication risks and development of alternative coping strategies.