"You Can't Go Without a Fag, You Need It for Your Hash": How Cannabis and Tobacco Intertwine for Teens | Research

The takeaway

Qualitative research with Scottish teenagers found that cannabis and cigarette smoking were "inextricably linked," with some reporting that smoking joints was their gateway to cigarettes, and cannabis use reinforced tobacco dependence.

Read this if you smoke cannabis mixed with tobacco and are trying to understand why quitting cigarettes is so hard.

Cannabis-tobacco link described as "inextricable" by young smokers

What the researchers found

Among 145 young smokers in Scotland (ages 15-19), cannabis use was regarded as an important and enjoyable part of their lives. Cannabis and cigarette smoking were described as inextricably linked. Several participants reported that smoking joints (which in the UK typically contain tobacco) was their gateway to cigarette smoking, reversing the traditional gateway direction.

While most wanted to quit smoking cigarettes, their cannabis use reinforced their tobacco dependence, and few wanted to stop using cannabis. This created a significant barrier to tobacco cessation: stopping cigarettes was difficult while continuing to smoke cannabis mixed with tobacco.

Why it matters

This study highlighted a public health problem that was largely overlooked: the way cannabis smoking (especially when mixed with tobacco, as is common in the UK) reinforced tobacco dependence among young people. For teens who wanted to quit smoking, their continued cannabis use made it nearly impossible. This has direct implications for how smoking cessation programs should address cannabis use.

The numbers in context

99 participants in paired interviews (ages 16-19). 46 participants in focus groups (ages 15-16). Total: 145 young smokers.

How the study worked

This was a qualitative study using two approaches: semi-structured paired interviews with 99 smokers aged 16-19, and eight focus groups with 46 smokers aged 15-16, all in Scotland. The research explored the role of smoking in participants' lives and how it related to cannabis use.

What this study cannot tell us

Qualitative research with 145 Scottish teenagers cannot be generalized to all young people or all cultural contexts. The UK practice of mixing cannabis with tobacco is less common in North America and some other regions. The findings may not apply where cannabis is consumed without tobacco.

How to read the evidence

This is a qualitative study with 145 participants providing preliminary evidence of lived experience patterns.

When this study was published

Published in 2004. The cannabis-tobacco link remains a public health concern, particularly in the UK where joint smoking with tobacco is common.

The bigger picture

The UK practice of mixing cannabis with tobacco in joints creates a unique public health challenge that differs from North American consumption patterns. This study was influential in raising awareness that tobacco cessation programs needed to address cannabis use, and that cannabis harm reduction should consider the tobacco component.

Questions still open

Has the increasing availability of non-combustion cannabis methods (edibles, vaping) weakened the cannabis-tobacco link? Would tobacco cessation rates improve if young people had access to cannabis consumption methods that did not involve tobacco?

Common questions

Why is it hard to quit smoking if you also use cannabis?

In the UK and many parts of Europe, cannabis is typically smoked mixed with tobacco. This means every time someone smokes a joint, they are also smoking tobacco, reinforcing nicotine dependence and making cigarette cessation nearly impossible without also stopping cannabis.

Is this the same everywhere?

No. In North America, cannabis is often smoked without tobacco, so the link is weaker. But in the UK, Europe, and other regions where joints contain tobacco, cannabis use directly reinforces tobacco dependence.

Read the original research

'You can't go without a fag...you need it for your hash'--a qualitative exploration of smoking, cannabis and young people.

Addiction (Abingdon, England), 99(1), 77-81

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Citation

Amos, Amanda; Wiltshire, Susan; Bostock, Yvonne; Haw, Sally; McNeill, Ann. (2004). 'You can't go without a fag...you need it for your hash'--a qualitative exploration of smoking, cannabis and young people.. Addiction (Abingdon, England), 99(1), 77-81.