In a large clinical trial of smoking cessation medications, people who also used cannabis were equally successful at quitting tobacco compared to tobacco-only smokers.
Read this if you use both cannabis and tobacco and are considering quitting tobacco.
220 cannabis users quit tobacco at the same rate as 1,026 tobacco-only smokers across all treatment arms.
What the researchers found
Among 1,246 treatment-seeking tobacco smokers in a randomized trial, 220 were also current cannabis users. Participants received 12 weeks of either varenicline, nicotine patch, or placebo, all with behavioral counseling.
After controlling for rate of nicotine metabolism, treatment arm, age, sex, alcohol use, and nicotine dependence level, cannabis users achieved biochemically verified 7-day abstinence from tobacco at the same rate as tobacco-only smokers.
This finding challenges the assumption that cannabis co-use undermines tobacco cessation efforts.
Why it matters
Many clinicians assume that cannabis use makes it harder to quit tobacco, which could lead to withholding treatment or adjusting expectations. This study suggests cannabis co-use is not a barrier to tobacco cessation success when appropriate treatment is provided.
The numbers in context
1,246 tobacco smokers, 220 of whom were current cannabis users. Cannabis users had equal success rates for biochemically verified 7-day tobacco abstinence across all treatment arms.
How the study worked
This was a secondary analysis of a large randomized controlled trial. 1,246 treatment-seeking tobacco smokers were randomly assigned to placebo, nicotine patch, or varenicline for 12 weeks with behavioral counseling. The primary outcome was biochemically verified 7-day point prevalence abstinence at end of treatment. Logistic regression controlled for multiple potential confounders.
What this study cannot tell us
This was a secondary analysis, not the primary study aim. Cannabis use was defined as any use in the past 30 days, which includes a wide range of use patterns. The study did not examine whether cannabis use changed during or after the tobacco cessation attempt. Results reflect end-of-treatment outcomes, not long-term abstinence.
How to read the evidence
Moderate evidence from a well-powered secondary analysis of a large RCT, though the cannabis use analysis was not the primary study aim.
When this study was published
Published in 2016. Subsequent studies have continued to examine the tobacco-cannabis co-use relationship.
The bigger picture
Tobacco and cannabis are frequently used together, and many providers may hesitate to initiate tobacco cessation in active cannabis users. This finding removes one justification for that hesitation and supports treating tobacco dependence regardless of concurrent cannabis use.
Questions still open
- Does cannabis use affect long-term tobacco abstinence beyond the treatment period? Do heavy daily cannabis users have different tobacco cessation outcomes than occasional users? Would cannabis cessation alongside tobacco cessation improve or complicate outcomes?
Common questions
Does cannabis use make it harder to quit tobacco?
Should I quit cannabis before trying to quit tobacco?
Read the original research
Does cannabis use moderate smoking cessation outcomes in treatment-seeking tobacco smokers? Analysis from a large multi-center trial.
The American journal on addictions, 25(4), 291-6
Citation
Rabin, Rachel A; Ashare, Rebecca L; Schnoll, Robert A; Cinciripini, Paul M; Hawk, Larry W; Lerman, Caryn; Tyndale, Rachel F; George, Tony P. (2016). Does cannabis use moderate smoking cessation outcomes in treatment-seeking tobacco smokers? Analysis from a large multi-center trial.. The American journal on addictions, 25(4), 291-6. https://doi.org/10.1111/ajad.12382
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