Two-thirds of cannabis users in legal states also use tobacco, and simultaneous use is linked to more cannabis problems | Research

The takeaway

Among nearly 3,000 cannabis users in legal US states, two-thirds also used tobacco, and those who used cannabis and tobacco simultaneously had higher cannabis problem scores.

Harm reduction advocates, tobacco cessation counselors, cannabis policy researchers.

Two-thirds of cannabis users in legal states also use tobacco

What the researchers found

Simultaneous and combined cannabis-tobacco co-use was associated with higher CUDIT-R scores compared to cannabis-only use, even after adjusting for demographics and use frequency. Blunt smoking predominated among simultaneous-only users.

Why it matters

Cannabis and tobacco co-use is extremely common but rarely addressed in prevention. The finding that how these substances are combined matters has implications for harm reduction messaging.

The numbers in context

2,978 participants. Two-thirds co-used tobacco. Over half of co-users used simultaneous modes. Combined and simultaneous-only use had higher CUDIT-R scores. Blunt smoking was dominant simultaneous mode.

How the study worked

Survey of 2,978 adults (21+) who used cannabis in the past 30 days in legal recreational cannabis states, categorized by co-use pattern.

What this study cannot tell us

Cross-sectional; cannot determine causation. Self-reported data. Only legal-state residents.

How to read the evidence

Large survey with appropriate controls, but cross-sectional design limits causal claims.

When this study was published

Published in 2025.

The bigger picture

As cannabis becomes legal in more states, the high rate of tobacco co-use represents a major public health concern, especially via blunts.

Questions still open

Would targeting blunt smoking reduce both cannabis and tobacco harms? Do co-use patterns differ across markets?

Common questions

Is using cannabis with tobacco more harmful?

This study found simultaneous cannabis-tobacco use was linked to higher cannabis problem scores, even accounting for frequency. Blunts were the most common simultaneous mode.

How common is cannabis and tobacco co-use?

Two-thirds of cannabis users in legal states also used tobacco, and over half combined them simultaneously.

Read the original research

Cannabis and Tobacco Co-Use and Cannabis Dependence: A Survey of US Adults in Legal Recreational Cannabis Markets.

Substance use & misuse, 60(13), 1955-1963

View on PubMed ↗Publisher’s paper ↗

Citation

Fairman, Brian J; Dutra, Lauren M. (2025). Cannabis and Tobacco Co-Use and Cannabis Dependence: A Survey of US Adults in Legal Recreational Cannabis Markets.. Substance use & misuse, 60(13), 1955-1963. https://doi.org/10.1080/10826084.2025.2524050