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Review
. 2012 Jul;107(7):1221-33.
doi: 10.1111/j.1360-0443.2012.03837.x. Epub 2012 Apr 17.

The co-occurring use and misuse of cannabis and tobacco: a review

Arpana Agrawal  1 , Alan J Budney, Michael T Lynskey
Affiliations
Review

The co-occurring use and misuse of cannabis and tobacco: a review

Arpana Agrawal et al. Addiction. 2012 Jul.

Abstract

Aims: Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use.

Methods: Selective review of published studies.

Results: Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking.

Conclusions: There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge.

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Figures

FIGURE 1
FIGURE 1
Overview of mechanisms contributing to the lifetime co-occurrence of cannabis and tobacco use.
FIGURE 2
FIGURE 2
Prevalence of cannabis use, cigarette smoking, cannabis use disorders (past 12 months) and nicotine dependence (based on the Fagerstrom Test of Nicotine Dependence (130)) in those aged 12 and older from the 2009 National Household Survey of Drug Use and Health (NSDUH)(5). For instance, 57.9% of cigarette smokers (including former smokers) report ever using cannabis compared with 11.9% of those who have never smoked cigarettes. Nicotine dependence based on Fagerstrom Test for Nicotine Dependence. Both cannabis use disorder (abuse/dependence) and nicotine dependence are recent.
FIGURE 3
FIGURE 3
Stages of progression from drug use to drug use disorders, followed by cessation or persistence and the influential role of withdrawal and treatment on these latter stages.
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