Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002–2019

Abstract

SignificanceCannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD).MethodsData were drawn from the 2002–2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1–5 CPD; moderate, 6–15 CPD; heavy, 16+ CPD).ResultsAcross all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use.ConclusionsUS individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.

Effects of dual use of e-cigarette and cannabis during adolescence on cigarette use in young adulthood

“…Furthermore, smokers who also used cannabis were substantially less likely to quit smoking (OR=0.36; 95% CI 0.20 to 0.65) compared with smokers who did not use cannabis. In another study of participants age 12+ years, cigarette dependence was highest among daily users of cannabis than among non-daily or never users 36. Our results extend these previous studies in a young adult population in a longitudinal analytical framework demonstrating the role of nicotine dependence and an increasing trajectory of cigarette use mediating cannabis associations.…”

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products

“… 42 For example, cigarette dependence was reported more frequently by individuals using cannabis daily than by those who use it less frequently or abstain. 43 However, it is important to highlight that in our study, cotinine predicted shorter time to lapse over and above the symptoms of cannabis dependence, and that nicotine dependence was low among the participants exposed to cigarettes (data not shown). Second, tobacco use may also enhance cannabis withdrawal symptoms and consequently increase risk of cannabis relapse.…”

Co-use of cigarettes and cannabis among people with HIV: Results from a randomized controlled smoking cessation trial

“…In addition, factors that influence cannabis use and cigarette cessation simultaneously, such as reasons for use, are in need of further study. Given that co-use of tobacco and cannabis may result in greater nicotine dependence ( Weinberger et al., 2021 ) and cardiovascular toxicity ( Lorenz et al., 2021 ; Smith et al., 2020 ) than use of tobacco or cannabis alone, there is a need for additional research assessing cigarette cessation intervention effects on co-use and the development of integrated treatments that explicitly target both cannabis and tobacco.…”

“…Approximately 35% of people who smoke cigarettes daily are also using cannabis daily ( Gravely et al., 2022 ; Gravely et al., 2020 ). Moreover, co-use of cigarettes/cannabis is associated with greater nicotine dependence compared to cigarette smoking alone ( Weinberger et al., 2021 ) and cigarettes/cannabis co-use may undermine cigarette smokers’ motivation to quit cigarettes and quit success ( Driezen et al., 2022 ; Goodwin et al., 2022 ; Schauer et al., 2017 ; Strong et al., 2018 ; Vogel et al., 2018 ; Weinberger, Delnevo, et al., 2020 ; Weinberger, Pacek, et al., 2020 ; Weinberger et al., 2018 ), though other work suggests that cannabis use may not hinder cigarette smoking cessation after adjusting for other factors ( Rabin et al., 2016 ; Westmaas et al., 2021 ). Still, co-use of cigarettes/cannabis is associated with higher toxicant levels (e.g., acrylonitrile, acrylamide) indicative of cardiovascular disease risk compared to use of cannabis alone, though there are mixed reports on whether such toxicant levels may be similar ( Lorenz et al., 2021 ) or higher ( Smith et al., 2020 ) for cigarette/cannabis co-users compared to cigarette smokers who do not use cannabis.…”