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Using Cannabis and Nicotine Together Increases Rates of Cannabis Use and Cannabis Use Disorder

February 1, 2023
Meg Brunner, MLIS
Citation: McClure EA, et al. Cannabis and nicotine co-use among primary care patients in a state with legal cannabis access. Addiction Behaviors 2023; 140:107621.
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What’s the Question?

The use of both cannabis and nicotine/tobacco products is common in the U.S. and is associated with greater prevalence of mental health issues. Though several studies have found that people who use both cannabis and nicotine use more cannabis and have greater rates of cannabis dependence, this hasn’t yet been demonstrated in a primary care sample. Plus, few studies have looked at different modes of nicotine delivery and how they might impact cannabis co-use and the relationship between the two substances.

This study aimed to fill some of these information gaps by comparing cannabis use outcomes in primary care patients who only use cannabis with those who use both cannabis and nicotine, then looking at whether type of nicotine co-use (cigarettes, vaping, or both) has any impact on use or outcomes. 

How Was This Study Conducted?

Researchers used data from the NIDA Clinical Trials Network protocol CTN-0077-Ot (“Medical Cannabis Use Among Primary Care Patients: Using Electronic Health Records to Study Large Populations”), a study that used a cannabis survey to assess primary care patient cannabis use, including modes of use and use of cannabis for medical or non-medical reasons.

For the purposes of this study, the authors looked just at participants in the original trial who endorsed past 30-day cannabis use and dug deeper to look at details such as prevalence of cannabis use, days of cannabis use per week and times used per day, methods of use, THC:CBD content, non-medical and/or medical use, health symptoms managed, and cannabis use disorder (CUD) symptom severity. 

What Did Researchers Find Out?smoker

Analysis revealed that nicotine co-use (reported by 25.4% of participants) was associated with differences in method of cannabis use (more likely to smoke cannabis), THC:CBD content, days of use per week and times used per day, number of health symptoms managed, and CUD severity (compared to patients reporting cannabis use only). 

Additionally, patients who co-used cannabis and vaped nicotine reported greater cannabis vaping and concentrate use (dabs), as well as higher prevalence of CUD, while patients who reported smoking cigarettes were more likely to also smoke cannabis ad report greater days per week of cannabis use. 

What Are the Implications for the Workforce?

The association between nicotine and cannabis co-use and increased rates of cannabis use and cannabis use disorder is important for providers to be aware of, as is the fact that vaping nicotine appears to be correlated with vaping or dabbing cannabis concentrates, products that typically have higher concentrations of THC. This information highlights the importance of identifying co-use in the primary care setting in order to refer and/or intervene on that use. While tobacco screening in primary care settings is already common, stepping up screening for cannabis use or co-use may help better identify those at risk for cannabis use disorder or cannabis-related psychological or psychosocial issues.