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

The takeaway

In a smoking cessation trial of 392 Black adults, the 47% who also used cannabis increased their cannabis consumption through week 26 while reducing cigarettes at similar rates to non-cannabis users, suggesting a compensatory pattern.

Smoking cessation clinicians, tobacco researchers, and public health professionals addressing polysubstance use.

47% of smoking cessation participants also used cannabis

What the researchers found

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.

Why it matters

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.

The numbers in context

392 participants; 47.2% dual CIG-CAN users; cannabis use increased through week 26 (p<0.001); CPD reduction similar between groups; OTP showed compensatory increase (p<0.0001).

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Secondary analysis of a well-designed RCT provides useful data, but not prospectively designed for cannabis outcomes.

When this study was published

2025 secondary analysis of a smoking cessation RCT (NCT03897439).

The bigger picture

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.

Questions still open

Should smoking cessation programs routinely address concurrent cannabis use?
Does the cannabis increase during quit attempts offset the health benefits of cigarette reduction?

Common questions

Do people smoke more cannabis when trying to quit cigarettes?

In this trial, dual cigarette-cannabis users increased their cannabis consumption through 26 weeks while successfully reducing cigarettes, suggesting a compensatory pattern.

Should quit-smoking programs address cannabis use?

This study suggests yes. Nearly half of participants used cannabis, and the increase in cannabis during the quit attempt may limit the health benefits of cigarette reduction.

Read the original research

Change in Cigarette, Other Tobacco Product, and Cannabis Use Among Individuals Who Used or Did Not Use Cannabis During a Smoking Cessation Trial.

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 27(9), 1641-1646

View on PubMed ↗Publisher’s paper ↗

Citation

Lambart, Leah M; Cox, Lisa Sanderson; Mayo, Matthew S; Brown, Alexandra R; Leavens, Eleanor L S; Ahluwalia, Jasjit S; Nollen, Nicole L. (2025). Change in Cigarette, Other Tobacco Product, and Cannabis Use Among Individuals Who Used or Did Not Use Cannabis During a Smoking Cessation Trial.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 27(9), 1641-1646. https://doi.org/10.1093/ntr/ntaf045