Cannabis use didn't prevent young people from successfully quitting nicotine vaping in a clinical trial—but those with cannabis use disorder showed more vaping on days they also used cannabis.
Young people who vape and use cannabis wondering if they need to quit weed before tackling nicotine, and clinicians designing cessation programs for dual users.
What the researchers found
This secondary analysis followed 192 young people (ages 16–25) enrolled in a nicotine vaping cessation trial that tested varenicline against placebo and an enhanced usual care texting program. The researchers wanted to know whether cannabis use—common in this age group—would undermine quit attempts.
The headline result was reassuring: baseline cannabis use frequency and cannabis use disorder severity did not predict whether someone successfully quit vaping at 12 weeks. Heavy cannabis users were just as likely to achieve biochemically verified abstinence as non-users.
But the day-level data told a more nuanced story. On days when participants used both cannabis and nicotine, their nicotine vaping was higher than on days they used neither. This co-use pattern suggests the two substances may reinforce each other in the moment, even if cannabis use doesn't derail the overall quit attempt.
Participants with more severe cannabis use disorder symptoms also reported more days of nicotine vaping throughout the trial, though this didn't translate into lower quit rates at the 12-week mark.
Why it matters
Clinicians sometimes worry that treating nicotine addiction in someone who also uses cannabis is futile—that the cannabis will sabotage the quit attempt. This trial provides evidence against that assumption. For the roughly 75% of young vapers who also use cannabis (per RTHC-00156's data), these findings suggest vaping cessation programs shouldn't exclude or deprioritize dual users.
The numbers in context
192 participants aged 16–25. Cannabis use frequency and CUD severity were not significant predictors of 12-week quit success. On co-use days, nicotine vaping was higher than on non-use days.
How the study worked
Secondary analysis of a single-site randomized clinical trial conducted in Massachusetts (June 2022–May 2024). Three arms: varenicline + counseling, placebo + counseling, and enhanced usual care (text-based support). Cannabis use measured via self-reported days per week and CUDIT scores at baseline. Primary outcome was biochemically verified 7-day point prevalence nicotine vaping abstinence at week 12.
Who was studied
N=261 participants aged 16-25, 53% female, recruited in Massachusetts.
What this study cannot tell us
Single-site trial in Massachusetts limits generalizability. Self-reported cannabis use (no biochemical verification). Secondary analysis—the trial wasn't designed or powered to detect cannabis-related effects on vaping cessation. The 12-week follow-up is relatively short for assessing long-term quit maintenance.
How to read the evidence
Secondary analysis of a randomized clinical trial with biochemical verification of the primary outcome, though the cannabis analysis wasn't the trial's original focus.
When this study was published
Published in 2025 with data from 2022–2024, reflecting current vaping products and cannabis market.
The bigger picture
This fits into a growing body of evidence showing that co-occurring substance use doesn't necessarily doom individual cessation efforts. RTHC-00156 found that 31.7% of adolescent dual users achieved abstinence from both vaping and cannabis simultaneously—suggesting that quitting one substance may even support quitting the other. The day-level co-use finding here also aligns with research on cross-substance cue reactivity.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- Would longer follow-up reveal cannabis-related relapse patterns that aren't visible at 12 weeks? Does the day-level co-use association mean simultaneous cessation programs would be more effective than sequential ones? Would results differ in states with legal recreational cannabis markets?
Read the original research
Cannabis Use and Nicotine Vaping Cessation Outcomes: A Secondary Analysis of a Randomized Clinical Trial.
JAMA network open, 8(12), e2547799
JAMA Network Open is a reputable, peer-reviewed medical journal known for publishing high-quality research.
Citation
Gilman, Jodi M; Cather, Corinne; Reeder, Harrison T; Evohr, Bryn; Pachas, Gladys N; Gray, Kevin M; McClure, Erin A; Schuster, Randi M; Evins, A Eden. (2025). Cannabis Use and Nicotine Vaping Cessation Outcomes: A Secondary Analysis of a Randomized Clinical Trial.. JAMA network open, 8(12), e2547799. https://doi.org/10.1001/jamanetworkopen.2025.47799
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