Medical marijuana legalization and cigarette and marijuana co-use in adolescents and adults

Drug Alcohol Depend. 2016 Sep 1;166:32-8. doi: 10.1016/j.drugalcdep.2016.06.016. Epub 2016 Jul 18.


Background: Medical marijuana legalization is associated with a higher prevalence of marijuana use which may affect cigarette use and nicotine dependence in co-users. In the present study, we examined relationships between statewide legalization of medical marijuana and prevalence of cigarette and marijuana co-use and nicotine dependence in co-using adolescents and adults.

Methods: Data were analyzed from the 2013 National Survey on Drug Use and Health. We compared cigarette and marijuana co-use in the past 30days across age categories (12-64 years) by statewide medical marijuana legalization. Logistic regression models were used to estimate the odds of having nicotine dependence among current cigarette smokers who also reported past 30-day marijuana use and "ever but not current" marijuana use (vs. "never" use) adjusting for covariates including statewide legalization of medical marijuana.

Results: Overall, 5.1% of the sample reported past 30-day cigarette and marijuana co-use and a higher proportion of co-users resided in states where medical marijuana was legal compared to illegal (5.8% vs. 4.8%; p=0.0011). Co-use was associated with greater odds of having nicotine dependence compared to cigarette-only use across age categories. Odds were highest and up to 3-times higher in adolescents aged 12-17 years (OR=3.54; 95%CI: 1.81-6.92) and adults aged 50-64 years (OR=3.08; CI: 1.45-6.55).

Conclusion: Marijuana policy could inadvertently affect cigarette and marijuana co-use and pose challenges to tobacco cessation.

Keywords: Cigarette; Co-use; Marijuana; Medical marijuana policy; Nicotine dependence; Tobacco control.

MeSH terms

  • Adolescent
  • Adult
  • Cannabis
  • Child
  • Cross-Sectional Studies
  • Female
  • Humans
  • Legislation, Drug* / trends
  • Male
  • Marijuana Smoking / epidemiology*
  • Marijuana Smoking / legislation & jurisprudence*
  • Marijuana Smoking / trends
  • Medical Marijuana / administration & dosage*
  • Middle Aged
  • Smoking / epidemiology*
  • Smoking / trends
  • Tobacco Products*
  • Young Adult


  • Medical Marijuana