National survey reveals how Americans use cannabis: smoking dominates but multimodal use is rising

Past-30-day cannabis use was reported by 14.7% of 119,068 adults. Among users, 77.1% smoked, 44.3% ingested edibles, 32.7% vaped, and 14.0% dabbed. Most commonly, individuals either exclusively smoked (35.4%) or exclusively ingested (15.2%). Exclusive vaping was uncommon (3.1%), though many vapers used multiple methods. Multimodal use was associated with increased frequency. Strong correlations existed between tobacco smoking and cannabis smoking (OR 3.65) and between e-cigarette and cannabis vaping (OR 3.58).

Analysis of 119,068 individuals who answered cannabis questions in the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional survey. Cross-tabulations and logistic regression examined use patterns by demographics, health, and substance use. Negative binomial regression examined frequency correlates.

Understanding how people actually use cannabis is essential for public health planning. The strong correlations between cannabis and tobacco delivery methods suggest shared behavioral patterns, while the rise of multimodal use may indicate escalating consumption patterns.

As cannabis markets diversify with edibles, vapes, and concentrates, use patterns are evolving beyond traditional smoking. This national snapshot shows that while smoking still dominates, a substantial minority uses multiple methods, and delivery method choice is strongly linked to other substance use behaviors.

Cross-sectional BRFSS data relies on self-report. States participating in cannabis modules may not be nationally representative. Cannot assess dose, potency, or THC/CBD content by method. Past-30-day window may not capture occasional users.