Cannabis Users Had Worse Tobacco Withdrawal in the First Week of Quitting | Research

The takeaway

People who co-use cannabis and tobacco experienced significantly worse tobacco withdrawal symptoms during the first week of quitting compared to tobacco-only users, even when successfully abstinent.

People trying to quit tobacco who also use cannabis, smoking cessation counselors, addiction medicine specialists.

Week 1 withdrawal: 9.3 vs 7.1 (p < 0.01)

What the researchers found

Among 330 participants with verified tobacco abstinence from a cessation trial (55 cannabis co-users, 275 tobacco-only), cannabis co-users had significantly elevated withdrawal scores at week 1 (mean 9.3 vs 7.1, p < 0.01). No differences were found at weeks 4, 8, or 11. The effect was significant after controlling for age, treatment arm, and site.

Why it matters

About 30% of tobacco users also use cannabis, and this population has greater difficulty quitting tobacco. This study identifies a specific mechanism: worse withdrawal in the critical first week. This is actionable information for designing cessation interventions that provide extra support during the initial quit period for co-users.

The numbers in context

1,246 total participants. 330 with verified abstinence (55 co-users, 275 tobacco-only). Week 1 withdrawal: co-users 9.3 vs tobacco-only 7.1 (p < 0.01). No differences at weeks 4, 8, or 11.

How the study worked

Secondary analysis of a multi-site double-blind clinical trial for tobacco cessation. Participants were randomized to placebo, nicotine patch, or varenicline and followed for 11 weeks. Cannabis co-use was determined by urine toxicology. Analysis focused on 330 participants with biochemically verified 7-day abstinence, comparing withdrawal trajectories using the Minnesota Nicotine Withdrawal Scale (MNWS) at baseline and weeks 1, 4, 8, and 11.

What this study cannot tell us

Secondary analysis. Cannabis use classified by single urine screen rather than quantified use patterns. Only included participants who achieved abstinence, so cannot comment on those who relapsed. Co-use group was relatively small (N=55). Cannot determine whether cannabis use worsened withdrawal or whether shared vulnerability drives both.

How to read the evidence

Moderate: derived from a rigorous multi-site RCT with biochemically verified abstinence, though cannabis classification was limited to urine screen.

When this study was published

2025 study

The bigger picture

The first week of tobacco cessation is when relapse risk is highest. The finding that cannabis co-use amplifies withdrawal specifically during this critical window helps explain why co-users have lower quit rates and suggests that targeted interventions during week 1 could improve outcomes.

Questions still open

Would pausing cannabis use during tobacco cessation reduce withdrawal severity? Could cannabis co-users benefit from different pharmacotherapy protocols? Is the enhanced withdrawal driven by cross-tolerance or shared neurobiological pathways?

Common questions

Does cannabis make it harder to quit tobacco?

This study found cannabis co-users experienced significantly worse withdrawal symptoms during the first week of quitting tobacco. After week 1, withdrawal levels were similar to tobacco-only users.

Should I stop using cannabis when trying to quit tobacco?

The study did not test this directly, but the amplified first-week withdrawal in co-users suggests that addressing cannabis use alongside tobacco cessation could improve outcomes.

Read the original research

A multi-site study examining the tobacco withdrawal trajectory in people with tobacco and cannabis co-use.

Drug and alcohol dependence, 274, 112778

View on PubMed ↗Publisher’s paper ↗

Citation

Rabin, Rachel A; Lerman, Caryn; Schnoll, Robert; Tyndale, Rachel F; George, Tony P. (2025). A multi-site study examining the tobacco withdrawal trajectory in people with tobacco and cannabis co-use.. Drug and alcohol dependence, 274, 112778. https://doi.org/10.1016/j.drugalcdep.2025.112778