Table 4.
Summary of strategies for reducing and preventing cannabis and tobacco co-use and areas and future directions.
| Strategy | Evidence-base |
|---|---|
| Promote reduction of both simultaneous and co-occurring use | Simultaneous users are 5.1 times more likely to experience cannabis dependence (3, 22) Cigarette smoking alongside cannabis use increases symptoms of cannabis dependence and relapse (27, 41) In comparison to those with cannabis dependence alone, those who are also nicotine dependent have more severe psychosocial and psychiatric outcomes (42) |
| Promote alternative ROAs, such as vaporizers | Vaporizers may be an acceptable harm reduction intervention to promote as they do less damage to the respiratory system (43). Users rate vaporizers as the most important way of reducing cannabis-related harms (www.globaldrugsurvey.com/brands-highwaycode) |
| Avoid e-cigarettes | 75% of cannabis vaporizer users have also used a nicotine e-cigarette (25). Marketing of cannabis vaporizers alongside e-cigarettes may increase co-use and these devices should be separated at the point of sale |
| Motivation to change | Administering cannabis without tobacco may increase motivation to reduce tobacco use |
| Regional variation | Administering cannabis with tobacco is most common in Europe. Dialog between policies to reduce tobacco smoking and those regarding cannabis may be helpful |
| Future directions | |
| Vaporizers | Further research is required to better define the harm reduction benefits of vaporizers on respiratory health and function as well as potential harms and/or benefits associated with vaporizer use |
| Harm reduction | Health promotion campaigns should focus on dissociating the use of tobacco and cannabis and should consider differential harm reduction campaigns for cannabis users who smoke cannabis with tobacco |
| Monitoring | A more accurate description of how cannabis is consumed worldwide through better monitoring and screening tools is required |
| Controlled experimental studies | Investigating the reasons behind simultaneous use with hypothesis-driven controlled experimental studies including researching the acute psychopharmacological interaction on cognition (8) and reward is warranted |