Among 134,402 U.S. adults using prescription opioids and/or cannabis, 15.2% co-used both, and this group was younger, lower-income, and more psychologically distressed than single-substance users.
Pain management clinicians, addiction specialists, and substance use policymakers.
15.2% of U.S. adults using prescription opioids and/or cannabis used both substances
What the researchers found
Among adults using prescription opioids and/or cannabis medically, 49.5% used opioids only, 35.3% cannabis only, and 15.2% co-used both. Co-users were younger, had lower income, and experienced more psychological distress. Opioid-only users were older, more female, and in large-metro areas. Cannabis-only users were younger, more male, healthier, and in non-metro areas.
Why it matters
Understanding who co-uses opioids and cannabis can help clinicians identify patients who may need additional support and inform policy about cannabis as a potential opioid substitute versus complement.
The numbers in context
134,402 adults. Opioid-only: 49.5%. Cannabis-only: 35.3%. Co-use: 15.2%. Depression similarly affected both groups vs co-use (RRR=0.52). Co-users were more likely to be younger, lower income, and psychologically distressed.
How the study worked
Weighted multinomial logistic regression analysis of 2015-2022 NSDUH data for U.S. adults reporting past-year medical use of prescription opioids and/or cannabis.
What this study cannot tell us
Cross-sectional NSDUH data. Cannot determine if co-use is substitutional, complementary, or incidental. Self-reported medical use may not reflect actual prescriptions. Does not capture dose, frequency, or timing of co-use.
How to read the evidence
Large nationally representative sample with 8 years of data, but cross-sectional design and self-report limitations apply.
When this study was published
2025 publication with 2015-2022 NSDUH data.
The bigger picture
The finding that nearly 1 in 6 medical opioid/cannabis users employ both substances simultaneously complicates the "cannabis as opioid substitute" narrative. For many, cannabis may supplement rather than replace opioid use.
Questions still open
- Are co-users using cannabis to reduce opioid doses, or using both at full doses?
- Do co-users have better or worse pain outcomes than single-substance users?
Read the original research
Co-use of opioids and cannabis versus single-substance use: a national analysis of US adults.
Frontiers in public health, 13, 1623420
Citation
Kang, Hyojung; Tian, Jilin; Milavetz, Gary. (2025). Co-use of opioids and cannabis versus single-substance use: a national analysis of US adults.. Frontiers in public health, 13, 1623420. https://doi.org/10.3389/fpubh.2025.1623420
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