Treatment Implications Associated With Cannabis and Tobacco Co-use

McClure, Erin A.; Rabin, Rachel A.; Lee, Dustin C.; Hindocha, Chandni

doi:10.1007/s40429-020-00334-8

Cited by 38 publications

(23 citation statements)

References 94 publications

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“…Because reducing tobacco smoking prevalence remains an important public health goal, cannabis users should be considered a vulnerable population where rates of tobacco smoking are both much higher than in the general population and potentially under‐estimated. Use of cannabis and tobacco should be considered concurrently in the development of policy, public health and treatment approaches [20].…”

Section: Discussionmentioning

confidence: 99%

Cannabis use and co‐use in tobacco smokers and non‐smokers: prevalence and associations with mental health in a cross‐sectional, nationally representative sample of adults in Great Britain, 2020

et al. 2021

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Background and aims In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co‐use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non‐smokers and (2) investigate mental health problems among non‐users, tobacco‐only, cannabis‐only and co‐users of both substances. Design Cross‐sectional national on‐line survey (Action on Smoking and Health) fielded in February–March 2020. Setting Great Britain. Participants Adults in Great Britain aged ≥ 18 years (n = 12 809) Measurements Tobacco use status [smoker (daily or non‐daily) or non‐smoker (never or ex‐smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self‐reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. Findings In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non‐smokers [past‐year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4–12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0–33.6)]. Co‐administration with tobacco was common (46.2% of non‐smokers, 80.8% of tobacco smokers). Co‐users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis‐only (45.8%), tobacco‐only (33.2%) and non‐users (22.7%; all P ≤ 0.05). Conclusion Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non‐smokers. Co‐administration of cannabis and tobacco, via smoking, appears to be common, including among self‐identified non‐smokers. Mental health problems appear to be particularly common among dual users.

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Section: Discussionmentioning

confidence: 99%

Cannabis use and co‐use in tobacco smokers and non‐smokers: prevalence and associations with mental health in a cross‐sectional, nationally representative sample of adults in Great Britain, 2020

et al. 2021

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“…In comparison, one in 100 never cigarette smokers were daily cannabis users [16]. Importantly, co-use is associated with psychiatric, psychosocial and medical harms to its users which have previously been reviewed [17][18][19].…”

Section: Prevalence Of Cannabis and Tobacco Use Globallymentioning

confidence: 99%

Unknown population‐level harms of cannabis and tobacco co‐use: if you don't measure it, you can't manage it

Hindocha

McClure

2020

Addiction

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Background Nationally representative data of cannabis-tobacco co-use have shown that these substances are closely entwined and have significant adverse health consequences, although population-level harms of co-use are largely unknown. Current epidemiological research does not assess co-use in a manner that has yielded the necessary data to draw conclusions regarding health effects. This has given rise to a hidden population of co-users who go under-served. Therefore, this paper has two aims: (1) to review new challenges in the collection of co-use data due to rapidly changing regulations of cannabis and nicotine products and (2) to provide recommendations for the terminology and assessment of couse. Argument We argue that: (1) the prevalence of co-use is not being assessed accurately at a population level and (2) changes in legalization have created novel challenges, but without proper monitoring the impact on co-use will go undetected. We propose a three-level tiered set of recommendations for co-use assessments, which includes assessments of cannabis, tobacco and co-use metrics ranging from least burdensome (self-report of co-administered products) to most burdensome (assays, event-level data). Conclusions We propose that clinical studies begin to incorporate cannabistobacco co-use assessments to justify better their inclusion in clinical trials and national surveillance surveys. Integration of co-use assessments will aid in understanding the true impact on co-use of the changing cannabis and tobacco/nicotine regulatory environments. Co-use is prevalent and problematic, and the ability to make conclusions about its health outcomes is hindered by lack of nuance in data collection. If you do not measure it, you cannot manage it.

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“…The co-use of substances (often involving combinations of licit and illicit drugs) is emerging as a major health concern linked to overdosing and other adverse health outcomes [1]. It is in this context that the paper by Hindoch and McClure [2] argues that one pattern of substance use involving the co-use of cannabis and tobacco raises particular concerns that need to be addressed.…”

Section: Commentariesmentioning

confidence: 99%

“…Hindocha and McClure's [2] argument is largely in three parts. First, the concurrent administration of more than one substance (co-use), in this instance tobacco and cannabis, may lead to specific harms.…”

Section: Commentariesmentioning

confidence: 99%

“…Despite being commonly co-used, tobacco and cannabis are usually separated for treatment purposes as well as in research studies. Treatment options for individuals wishing to address their tobacco and cannabis use have been explored, but few options exist as yet for co-treatment [2][3][4]. We need to more clearly understand what approach is taken within clinical practice and in the digital health domain for those seeking smoking cessation treatment and for those seeking cannabis cessation or reduction treatment with respect to co-use.…”

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confidence: 99%

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