People who use both cannabis and nicotine showed exaggerated blood pressure responses to stress and higher cannabis cravings during nicotine withdrawal compared to single-substance users.
People trying to quit nicotine who also use cannabis, addiction researchers, smoking cessation providers
Higher cannabis craving in co-users (p<0.01)
What the researchers found
Cannabis co-users exhibited exaggerated diastolic blood pressure responses to stress compared to non-cannabis users, and people using both nicotine and cannabis had higher cannabis craving than cannabis-only users (p<0.01). Nicotine users showed attenuated cortisol and systolic BP stress responses.
Why it matters
Cannabis and nicotine co-use is increasingly common, yet most smoking cessation research focuses on nicotine alone. Understanding how cannabis changes the withdrawal experience could help develop better quit strategies for co-users.
The numbers in context
79 participants across four groups. Nicotine-cannabis co-users had significantly higher cannabis craving than cannabis-only users (p<0.01). Cannabis users showed exaggerated diastolic BP responses to stress.
How the study worked
Laboratory study with 79 participants in four groups (nicotine-only, cannabis-only, both, neither). Nicotine users attended two stress assessment sessions: one during ad libitum use and one during nicotine abstinence. Saliva cortisol, subjective states, and cardiovascular measures were collected.
What this study cannot tell us
Small sample size (79 across four groups). Laboratory stress may not replicate real-world stress. Cannot determine whether cannabis amplifies withdrawal or withdrawal amplifies cannabis effects.
How to read the evidence
Controlled laboratory study with physiological measures, but small sample across four groups limits power.
When this study was published
2024 study with laboratory stress assessments
The bigger picture
Nicotine and cannabis interact in complex ways during withdrawal. The finding that co-users experience heightened cannabis cravings during nicotine withdrawal suggests that quitting one substance may intensify urges for the other.
Questions still open
- Would addressing cannabis use simultaneously with nicotine cessation improve quit rates? Do the exaggerated stress responses in co-users translate to higher relapse risk?
Common questions
Does cannabis make it harder to quit nicotine?
What happened to cortisol during nicotine withdrawal?
Read the original research
Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use.
Psychopharmacology, 241(2), 253-262
Citation
al'Absi, Mustafa; DeAngelis, Briana N; Nakajima, Motohiro; Hodges, James S; Budney, Alan; Hatsukami, Dorothy; Allen, Sharon. (2024). Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use.. Psychopharmacology, 241(2), 253-262. https://doi.org/10.1007/s00213-023-06481-w
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