Tobacco use during cannabis cessation: Use patterns and impact on abstinence in a National Drug Abuse Treatment Clinical Trials Network study

Abstract

Background: It is common for cannabis users to also use tobacco. While data suggest that tobacco users have more difficulty achieving cannabis cessation, secondary analyses of clinical trial data sets may provide insight into the moderating variables contributing to this relationship, as well as changes in tobacco use during cannabis treatment. Those were the aims of this secondary analysis. Methods: The parent study was a multi-site trial of N-acetylcysteine for cannabis dependence conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants were treatment-seeking adults (ages 18–50) who met criteria for cannabis dependence (N=302). For cigarette smokers (n=117), tobacco use was assessed via timeline follow-back and nicotine dependence was assessed via the Fagerström Test for Nicotine Dependence (FTND). Outcome measures included: 1) changes in tobacco use based on treatment assignment, nicotine dependence, and concurrent cannabis reduction/abstinence, and 2) independent associations between nicotine dependence and cannabis abstinence. Results: Cigarette smokers accounted for 39% of the sample (117/302), with a median FTND score of 3.0 (10-point scale). Among those with lower baseline nicotine dependence scores, cigarette smoking was reduced in the active treatment group compared to placebo. Those with moderate/high levels of nicotine dependence showed slight increases in smoking following active treatment. Nicotine dependence did not affect cannabis cessation. Conclusions: Cigarette smoking during cannabis treatment was affected, but depended on baseline nicotine dependence severity, though dependence levels did not impact cannabis abstinence. Interventions that address both tobacco and cannabis are needed, especially due to an increasing prevalence of cannabis use.

Tobacco and cannabis co-use and interrelatedness among adults

“…Third, cannabis-tobacco co-use rates among cannabis users in the current study did not appear to be as high as national averages suggest, even in the Southeastern US; 42.1% in this study vs. 69-78% nationally . However, the observed rate in the current study more closely approximates the observed rate in a prior multisite clinical trial for CUD (38%; McClure et al, 2018). It may be the case that those who participate in research studies, even via online recruitment sources, are different from those in the general population (i.e., those who complete household surveys; McClure et al, 2017;Susukida, Crum, Stuart, Ebnesajjad, & Mojtabai, 2016), which may have impacted prevalence rates and the characteristics of the current sample of co-users.…”

“…Within a recent national cannabis cessation clinical trial, lower rates of tobacco co-use were found in the overall sample (38%; Gray et al, 2017) compared to national averages of co-use (Pacek et al, 2018;, though in that trial (Gray et al, 2017), tobacco co-use rates varied based on study site and geographical location in the US. In the two study sites that fell within the Southeastern region of the US, 50% of cannabis users were also tobacco users, compared to 34% at other sites (McClure et al, 2018). Taken together, the Southeastern region of the US is unique when considering cannabis and tobacco co-use and worthy of focused study.…”

Culturally-tailored text-messaging intervention for smoking cessation in rural American Indian communities: Rationale, design, and methods

“…The average FTND score was 5.4 (SD = 2.4) and the mean age of smoking initiation was 15.1 years (SD = 4.4). The average FTND score translates to a population of moderately dependent smokers, not unlike averages among smoking cessation populations our team and others have reported [ [30] , [31] , [32] ]. The randomized sample did not significantly differ across group assignment on any of the baseline characteristics (all p s > 0.05).…”

Depressive symptoms and cannabis use in a placebo-controlled trial of N-Acetylcysteine for adult cannabis use disorder

“…It is possible that associations between depressive symptoms and subsequent cannabis use were stronger because of the reduced lag time between assessments. Lastly, use of alcohol and tobacco was prevalent in this sample (Squeglia et al 2018;McClure et al 2018). More frequent use of tobacco (McClure et al 2018), but not alcohol (Squeglia et al 2018), was associated with greater cannabis use during treatment.…”