Opioid-Cannabis Co-Users Are Younger, Lower Income, and More Psychologically Distressed
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 15.2% of U.S. adults using prescription opioids and/or cannabis used both substances
- Evidence Grade:
- Large nationally representative sample with 8 years of data, but cross-sectional design and self-report limitations apply.
- Study Age:
- 2025 publication with 2015-2022 NSDUH data.
- Original Title:
- Co-use of opioids and cannabis versus single-substance use: a national analysis of US adults.
- Published In:
- Frontiers in public health, 13, 1623420 (2025)
- Authors:
- Kang, Hyojung(3), Tian, Jilin, Milavetz, Gary(11)
- Database ID:
- RTHC-06790
Evidence Hierarchy
Read More on RethinkTHC
- CBD-oil-quality-guide
- anxiety-medication-after-quitting-weed
- cannabis-chemotherapy-nausea
- cannabis-chronic-pain-research
- cannabis-epilepsy-CBD-Epidiolex
- cbd-anxiety-research-evidence
- cbd-for-weed-withdrawal
- cbd-vs-thc-difference
- medical-benefits-of-cannabis
- quitting-weed-before-surgery
- quitting-weed-medication-interactions
- quitting-weed-pregnancy
- quitting-weed-pregnant
- seniors-older-adults-cannabis-risks-medications
- weed-breastfeeding-THC-breast-milk
Cite This Study
https://rethinkthc.com/research/RTHC-06790APA
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
MLA
Kang, Hyojung, et al. "Co-use of opioids and cannabis versus single-substance use: a national analysis of US adults.." Frontiers in public health, 2025. https://doi.org/10.3389/fpubh.2025.1623420
RethinkTHC
RethinkTHC Research Database. "Co-use of opioids and cannabis versus single-substance use: ..." RTHC-06790. Retrieved from https://rethinkthc.com/research/kang-2025-couse-of-opioids-and
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.