Two-thirds of cannabis users in legal states also use tobacco, and simultaneous use is linked to more cannabis problems
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
Survey of 2,978 adults (21+) who used cannabis in the past 30 days in legal recreational cannabis states, categorized by co-use pattern.
Why This Research 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 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.
What This Study Doesn't Tell Us
Cross-sectional; cannot determine causation. Self-reported data. Only legal-state residents.
Questions This Raises
- ?Would targeting blunt smoking reduce both cannabis and tobacco harms?
- ?Do co-use patterns differ across markets?
Trust & Context
- Key Stat:
- Two-thirds of cannabis users in legal states also use tobacco
- Evidence Grade:
- Large survey with appropriate controls, but cross-sectional design limits causal claims.
- Study Age:
- Published in 2025.
- Original Title:
- Cannabis and Tobacco Co-Use and Cannabis Dependence: A Survey of US Adults in Legal Recreational Cannabis Markets.
- Published In:
- Substance use & misuse, 60(13), 1955-1963 (2025)
- Authors:
- Fairman, Brian J, Dutra, Lauren M(2)
- Database ID:
- RTHC-06433
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
- 420-sober-survival-guide
- CBT-cannabis-recovery
- cannabis-dependence-physical-psychological-addiction-science
- cannabis-perception-vs-evidence-gap
- cannabis-relapse-cycle-pattern
- cannabis-use-disorder-test
- cold-turkey-vs-taper-quit-weed
- cross-addiction-quit-weed-start-drinking
- dating-sober-after-quitting-weed
- exercise-quitting-weed-anxiety-brain
- grieving-quitting-weed-loss
- help-someone-quit-weed
- how-to-quit-weed
- is-weed-addictive
- is-weed-addictive-science
- journaling-weed-withdrawal
- marijuana-anonymous-SMART-recovery-compare
- meditation-mindfulness-weed-withdrawal
- partner-still-smokes-weed
- partner-still-smokes-weed-quitting
- pink-cloud-sobriety-cannabis
- quit-weed-cold-turkey
- quit-weed-or-cut-back-which-is-better
- quit-weed-regret-went-back
- quitting-weed-20s
- quitting-weed-30s
- quitting-weed-after-years
- quitting-weed-and-alcohol
- quitting-weed-during-crisis-divorce-job-loss
- quitting-weed-exercise
- quitting-weed-grief-loss-coping
- quitting-weed-legal-state
- quitting-weed-success-stories
- quitting-weed-triggers-environment
- rehab-for-weed-addiction-necessary
- relapsed-smoking-weed-what-to-do
- relapsed-weed
- should-i-quit-weed
- signs-of-cannabis-use-disorder
- sober-music-festival-concert-without-weed
- supplements-weed-withdrawal
- telling-friends-quitting-weed
- weed-relapse-prevention-plan
- weed-relapse-why-it-happens
- weed-ritual-replacement
- weed-ruined-relationships
- weed-social-media-triggers-quit
- weed-vape-pen-addiction
Cite This Study
https://rethinkthc.com/research/RTHC-06433APA
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
MLA
Fairman, Brian J, et al. "Cannabis and Tobacco Co-Use and Cannabis Dependence: A Survey of US Adults in Legal Recreational Cannabis Markets.." Substance use & misuse, 2025. https://doi.org/10.1080/10826084.2025.2524050
RethinkTHC
RethinkTHC Research Database. "Cannabis and Tobacco Co-Use and Cannabis Dependence: A Surve..." RTHC-06433. Retrieved from https://rethinkthc.com/research/fairman-2025-cannabis-and-tobacco-couse
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.