Cannabis Use Makes Quitting Tobacco Harder, But CBD Might Help | Research

The takeaway

Naturalistic cannabis co-use reduced tobacco cessation odds by 35%, but targeted CBD interventions showed promise by cutting cigarette consumption by 40%.

People trying to quit tobacco, addiction researchers, and clinicians managing patients who use both cannabis and tobacco.

Cannabis co-use: 35% lower quit odds; CBD: 40% fewer cigarettes

What the researchers found

Meta-analysis of 18 observational studies (N=229,630) found cannabis use was associated with 35% lower odds of quitting tobacco (OR=0.65). However, preclinical and early clinical evidence suggests CBD specifically may reduce cigarette consumption by 40%, reverse attentional bias to smoking cues, and alleviate withdrawal.

Why it matters

With 18-22% of tobacco users also using cannabis, understanding how co-use affects quit attempts is critical. The key distinction here is that casual cannabis use hurts cessation, but pharmacologically targeted CBD could actually help.

The numbers in context

Cannabis co-use: OR=0.65 for cessation (35% lower odds, p<0.0001, N=229,630). CBD reduced cigarette consumption by 40% in clinical studies. CB1 antagonists reduced nicotine self-administration in preclinical models but failed clinically due to psychiatric side effects.

How the study worked

Translational systematic review and meta-analysis following PRISMA 2020 guidelines, searching multiple databases through January 2026. Included 52 studies across three categories: observational co-use studies, preclinical cannabinoid modulator studies, and human experimental ECS-intervention studies.

What this study cannot tell us

High heterogeneity across observational studies (I-squared=88.1%). CBD clinical evidence is still early-stage. The distinction between naturalistic cannabis exposure and targeted CBD intervention is crucial but complicates interpretation.

How to read the evidence

Large meta-analysis with 229,630 participants for the observational findings. CBD clinical evidence is earlier-stage but promising.

When this study was published

2026 meta-analysis with searches through January 2026.

The bigger picture

The failure of CB1 receptor antagonists (like rimonabant) due to depression and suicidality is a cautionary tale. CBD offers a potentially safer path to modulating the endocannabinoid system for smoking cessation, without the psychiatric risks.

Questions still open

What is the optimal CBD dosing regimen for tobacco cessation? Could CBD-based cessation aids eventually compete with nicotine replacement therapy or varenicline?

Common questions

Does smoking cannabis make it harder to quit tobacco?

Yes. Across 18 studies with nearly 230,000 people, cannabis users were 35% less likely to successfully quit tobacco.

How is CBD different from smoking cannabis for quitting tobacco?

CBD is a specific non-psychoactive compound that appears to reduce cigarette cravings and consumption through targeted endocannabinoid system modulation, unlike whole cannabis which contains THC and other compounds that may reinforce smoking behavior.

Read the original research

Cannabis Co-Use and Endocannabinoid System Modulation in Tobacco Use Disorder: A Translational Systematic Review and Meta-Analysis.

medRxiv : the preprint server for health sciences

View on PubMed ↗Publisher’s paper ↗

Citation

P A Costa, Gabriel; Gómez, Oscar; Cerezo-Matias, Mayte A; Funaro, Melissa C; Sofuoglu, Mehmet; De Aquino, Joao P. (2026). Cannabis Co-Use and Endocannabinoid System Modulation in Tobacco Use Disorder: A Translational Systematic Review and Meta-Analysis.. medRxiv : the preprint server for health sciences. https://doi.org/10.64898/2026.02.12.26346166