Addressing tobacco use during cannabis treatment is feasible but tobacco quit rates remain poor

No significant differences in cannabis outcomes between simultaneous and sequential tobacco treatment during weeks 1-12. Most simultaneous participants engaged with the tobacco intervention (62% initiated counseling, 50% made quit attempts). However, only 30% of sequential participants continued to the delayed tobacco phase, highlighting the risk of deferring treatment.

Proof-of-concept RCT with 67 adults receiving simultaneous (SIM) or sequential (SEQ) tobacco cessation during outpatient cannabis use disorder treatment. SIM received tobacco intervention weeks 1-12; SEQ received it weeks 13-24. Both included web-based counseling plus nicotine replacement therapy.

Tobacco use is common among people seeking cannabis treatment and predicts worse cannabis outcomes. Clinicians often hesitate to address both substances simultaneously, but this study suggests that concern may be unfounded.

The finding that 39% of sequential participants spontaneously attempted tobacco cessation before it was offered suggests patients are motivated to address tobacco when they are already working on cannabis. Delaying the intervention may miss this window.

Small sample (67), proof-of-concept design. High attrition in the sequential arm compromised comparison. Tobacco cessation outcomes were poor in both groups. Single-site study.