Mixing cannabis and tobacco: a research review

A new study examines the relationship between cannabis and tobacco use.

In Europe and North America, it is becoming increasingly common to mix tobacco and cannabis, and it is possible that cannabis legalization will result in this mixing becoming popular. For this reason, it will be important for researchers to more closely examine how cannabis and tobacco use interact. This research will be able to provide critical information to inform public health policy and reduce harms associated with cannabis use.

It is already established that a majority of cannabis users also use tobacco products. This co-use is associated with a greater likelihood of engaging in other risky behaviours, worse mental health status, dependence to either substance, and greater difficulty quitting cannabis. In addition, using both cannabis and tobacco may also be associated with additional health risks compared to just using one or the other, such as more negative effects on the respiratory system.

While important public health research on this has already been conducted on individuals who use both cannabis and tobacco, the simultaneous use (co-administration) of these two substances, such as in blunts (hollowed out cigars filled with cannabis) and spliffs (joints with a mix of tobacco and cannabis), has been less well studied.

To that end, a group of researchers recently undertook a review of all research that has looked at the simultaneous use of cannabis and tobacco in blunts and spliffs. Although the 45 scientific articles they reviewed used varied research methods, making a qualitative analysis of the data impossible, a number of significant trends stood out.

Cannabis and tobacco co-administration seems to have increased significantly in the last decade, and is more likely among adolescents and young adults, males, African American populations, and people with lower income or education. There also seems to be a trend toward increased co-administration among Hispanic populations.

People cite various reasons for co-administration. Some say that mixing the two affected or increased the high, while others say that tobacco helps cannabis burn better, that mixing helps in quitting either cannabis or tobacco, or that mixing results in a product that is better for sharing with others.

Blunt use seems to be associated with increased likelihood of both nicotine and cannabis dependence. Notably, the researchers point out that many youth may be first exposed to tobacco consumption through the simultaneous use of tobacco and cannabis, which may then pave the way for nicotine dependence.

Unfortunately, most existing research on co-administration has been done on blunt use, while very little exists on the use of spliffs. Given the high prevalence of spliff use in European countries and in North America, more research in the future should focus on spliff use.

The trends highlighted in this article point to a need for future research addressing why co-administration is more prevalent in certain populations, as well as on prevention and treatment approaches that may help to address and reduce co-administration. It will also be important to implement longitudinal studies that evaluate long-term health risks to determine whether co-administration is associated with any unique health risks.

For interested readers, the journal article can be found here.

- Featured image by ashton - Flickr: When in Amsterdam

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