Young people who used cannabis in 3+ ways (smoking, vaping, edibles, dabbing) were 5 times more likely to have cannabis use disorder and nearly 5 times more likely to drive impaired — independent of how often they used.
Clinicians screening youth cannabis use, parents, public health officials, and cannabis harm reduction advocates
What the researchers found
Using 3+ cannabis modes vs. one was associated with 5x higher CUD risk (aOR=5.00), 4.4x higher other SUD risk, 2x higher severe mental illness, 1.8x higher suicidal thoughts, and 4.9x higher impaired driving — even after adjusting for frequency.
Why it matters
Cannabis product diversification means young people can now use in many ways — this study shows the number of modes is an independent risk marker, not just a proxy for more frequent use.
The numbers in context
13,284 cannabis users; 37.5% used 3+ modes; smoking 83.9%, vaping 53.3%, edibles 47.6%, dabbing 27.3%; 3+ modes: CUD aOR=5.00, other SUD aOR=4.43, severe mental illness aOR=2.18, impaired driving aOR=4.92.
How the study worked
Analysis of 2022-2023 NSDUH data on 13,284 past-year cannabis users aged 12-25, examining associations between number of cannabis modes and adverse outcomes with multivariable adjustment including use frequency.
What this study cannot tell us
Cross-sectional NSDUH data cannot establish causation; multimodal use may reflect higher engagement/severity not captured by frequency alone; self-reported adverse events.
How to read the evidence
Large nationally representative sample with adjustment for use frequency, published in a top preventive medicine journal.
When this study was published
Published in 2026 with 2022-2023 NSDUH data, reflecting the current diversified cannabis product landscape.
The bigger picture
As cannabis markets diversify, simply asking 'do you use cannabis?' is insufficient — clinicians should screen for how many ways someone uses, as this independently predicts harm.
Questions still open
- Does multimodal use lead to harm, or do higher-risk individuals gravitate toward more modes? Could screening for multimodal use improve clinical risk assessment?
Common questions
Does it matter how many ways you use cannabis?
What's the most common way young people use cannabis?
Read the original research
Association of Multimodal Cannabis Use with Adverse Events among Adolescents and Young Adults.
American journal of preventive medicine, 108313
Citation
Bommersbach, Tanner J; Olfson, Mark; Rhee, Taeho Greg. (2026). Association of Multimodal Cannabis Use with Adverse Events among Adolescents and Young Adults.. American journal of preventive medicine, 108313. https://doi.org/10.1016/j.amepre.2026.108313
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide