Cannabis Users Who Try to Quit Smoking Increase Their Cannabis Use as Compensation

47.2% of participants were cigarette-cannabis dual users. Both groups reduced cigarettes similarly (p=0.18 for group difference). Cannabis users increased their cannabis consumption through week 26 (p<0.001). When cigarettes decreased, other tobacco products increased as compensation (p<0.0001), but cannabis did not follow the same compensatory pattern (p=0.37). Cannabis users maintained higher other tobacco product use throughout.

Secondary analysis of an 18-week smoking cessation RCT with 26-week follow-up. 392 Black adults wanting to quit cigarettes. Standard or adapted pharmacotherapy. Self-reported cigarettes, cannabis, and other tobacco use at weeks 0, 2, 6, 12, 18, 26.

Nearly half of Black adults attempting to quit smoking also use cannabis, yet cannabis use is rarely addressed in cessation programs. The increase in cannabis use during a quit attempt may undermine the health benefits of reducing cigarettes.

Smoking cessation interventions typically ignore concurrent cannabis use. This study suggests that for the large proportion of smokers who also use cannabis, a cigarette-only approach may shift consumption patterns rather than reduce overall harm.

Secondary analysis, not prospectively designed for cannabis outcomes. Self-reported data. Predominantly Black adult sample may not generalize. Cannabis quantity not precisely measured. Cannot determine if cannabis increase is causal compensation.