<p>Chronic pain is a prevalent discomfort among hemodialysis patients. Managing this pain is challenging, which requires researching alternative treatments. Therefore, this study aimed to explore the average difference in chronic pain severity associated with smoking cannabis in hemodialysis patients. A cross-sectional observational study was conducted among 186 males. The exposure was the use of cannabis smoking and chronic pain severity was the primary outcome. Confounding variables were collected through a structured questionnaire. The severity of chronic pain was measured using the Numerical Rating Scale. Statistical analysis was performed using the Inverse Probability of Treatment Weighting to reduce imbalance in measured covariates between control and smoker groups. After weighting, all confounder variables were well balanced. The average difference in pain severity associated with smoking cannabis was β =-1.541 (95% CI, -2.219 to -0.863). The sensitivity analysis, including the analgesic use, indicates that the association was modestly attenuated compared to the main model, β = -1.299 (95% CI, -1.868 to -0.730). Cannabis smoking is associated with a decrease in mean pain severity compared with non-smokers. The sex-specific sample, observational design and potential unmeasured confounding constitute the main limitations of this study. Further research should focus on prospective studies with more exposure details.</p>