Marijuana and Tobaco Use

The fast growing movement towards marijuana legalization in the U.S. has generated increased interest in the overlap of marijuana use with other substances, and its potential impact on public health. This fact sheet offers a brief overview of the co-use of marijuana and tobacco. It includes prevalence data from the U.S. National Survey of Drug Use and Health (NSDUH)*, patterns of marijuana and tobacco co-administration, possible risks, and current research gaps.

Prevalence, Characteristics, and Trends of Marijuana and Tobacco Use

* The National Survey on Drug Use and Health (NSDUH) is a nationally representative annual survey and is the primary source of data on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug use and abuse and mental disorders in the U.S. civilian, non-institutionalized population, age 12 and older.

According to the 2011-2012 NSDUH, 5.2% of adults 18 and over report using tobacco and marijuana in the last thirty days (Schauer et al, 2015). For comparison, 2.3% reported marijuana use but no tobacco use during the same time period, indicating that the overlap of marijuana and tobacco use is more common than the use of marijuana alone. Another way to look at this same information is to focus only on marijuana users: 78.3 % of last-30-days adult marijuana users report using tobacco during the same period of time (Schauer et al, 2015).

Co-users of marijuana and tobacco differ from marijuana-only users in a number of ways: they are more likely to report heavy drinking (5 or more days of having five or more drinks in the past month) and use of other substances, being male, black, and younger in age (Schauer et al, 2016).

NSDUH trend analysis reveals a significant increase in the co-use of marijuana and tobacco, rising from 4.4% to 5.2% between 2003 to 2012. Notably, this increase was due to an uptake of marijuana by tobacco users rather than the other way around; in fact, the use of tobacco among marijuana users has decreased over that period of time (Schauer et al, 2016).

 

Co-use Patterns: Sequential, Substitution, and Co-administration

While the prevalence of tobacco and marijuana co-use is known in the U.S., there is scarce research on the actual consumption patterns of this dual use (Schauer et al, 2017). In one qualitative study among Seattle-area adults aged 18-34 years, three modes of marijuana and tobacco co-use were identified, with distinct reasons associated with them (Schauer et al, 2016b).

What are the Potential Risks of Tobacco and Marijuana Co-use?

This is an understudied topic. The relatively few studies available vary considerably in quality and methods of inquiry (National Academy of Sciences, 2017, Chapter 14). There is some evidence that:

Further Research Needed

Legalization of marijuana in many U.S. states is changing the substance use landscape rapidly. Knowledge produced before legalization may not apply in states where marijuana is available in retail stores for any adult 21 and over and where marijuana stores are advertised in billboards, as is the case in Washington. Longitudinal population surveys and comparative studies of marijuana policies are needed as they will continuously bring new discoveries in future years. It is important to keep in mind, however, that marijuana legalization for non-medical purposes is still too recent to indicate the net result of legal marijuana on co-use and/or tobacco use rates (Pacula & Sevigny, 2014).

Some of the most pressing areas in need of further research are:

Epidemiology: More NSDUH analysis using 2013 or more recent data and making state comparisons is needed to monitor changes in prevalence and patterns of marijuana and tobacco co-use. New devices have the potential to change behaviors, e.g. portable vaporizers with temperature control and tanks that allow tobacco or marijuana consumption using only one device, which increases the likelihood of co-use (McDonald et al, 2016).  On the other hand, the legalization of marijuana may decrease the need of substituting marijuana for tobacco in certain circumstances, thereby decreasing co-use.

Health consequences of co-use: The research in this area is incipient and somewhat inconclusive (National Academy of Sciences, 2017; Subramaniam et al, 2016). It is possible that the health consequences vary by co-use pattern. Co-administration may differ from sequential use in terms of nicotine exposure and absorption, or in terms of THC-related impairment.

Effects of marijuana policy on tobacco use: Tobacco use kills almost a half million Americans each year. Enthusiasts of lifting marijuana prohibition have long advocated that more accessibility to marijuana could encourage substitution of tobacco by marijuana, a less-harmful product not associated with high mortality (Hindocha et al, 2016). Those less favorable towards marijuana legalization argue that any increase in use of a specific substance may result in increased use of other substances as well, including tobacco. More research is needed to explore these hypotheses, with a focus on vulnerable populations such as pregnant women, those with low income, and racial and ethnic minorities.

References

Citation: Carlini BH. Marijuana and Tobacco Use. Alcohol & Drug Abuse Institute, University of Washington, August 2017.  URL: http://LearnAboutMarijuanaWA.org/factsheets/tobacco.htm.

This report was produced with support from the Washington State Dedicated Marijuana Fund for research at the University of Washington.