Cannabis and nicotine co-use among primary care patients in a state with legal cannabis access

Addict Behav. 2023 May:140:107621. doi: 10.1016/j.addbeh.2023.107621. Epub 2023 Jan 20.


The aim of this exploratory analysis was to evaluate cannabis exposure, reasons for use and problematic cannabis use among adult primary care patients in Washington state (United States) who co-use cannabis and nicotine (tobacco cigarettes and/or nicotine vaping) compared to patients who endorse current cannabis use only. As part of a NIDA Clinical Trials Network (CTN) parent study, patients who completed a cannabis screen as part of routine primary care were randomly sampled (N = 5,000) to a receive a confidential cannabis survey. Patients were stratified and oversampled based on the frequency of past-year cannabis use and for Black, indigenous, or other persons of color. Patients who endorsed past 30-day cannabis use are included here (N = 1388). Outcomes included; prevalence of cannabis use, days of cannabis use per week and times used per day, methods of use, THC:CBD content, non-medical and/or medical use, health symptoms managed, and cannabis use disorder (CUD) symptom severity. We conducted unadjusted bivariate analyses comparing outcomes between patients with cannabis and current nicotine co-use to patients with cannabis-only use. Nicotine co-use (n = 352; 25.4 %) was associated with differences in method of cannabis use, THC:CBD content, days of use per week and times used per day, number of health symptoms managed, and CUD severity (all p < 0.001), compared to primary care patients with cannabis-only use (n = 1036). Interventions targeting cannabis and nicotine co-use in primary care are not well-established and further research is warranted given findings of more severe cannabis use patterns and the adverse health outcomes associated with co-use.

Keywords: Cannabis; Co-use; Nicotine; Polysubstance use; Primary care; Tobacco.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cannabis*
  • Electronic Nicotine Delivery Systems*
  • Hallucinogens*
  • Humans
  • Marijuana Smoking* / adverse effects
  • Marijuana Smoking* / epidemiology
  • Nicotine / adverse effects
  • Primary Health Care
  • United States / epidemiology


  • Nicotine
  • Hallucinogens