A new study shows that more Americans are now using marijuana rather than smoking cigarettes, despite changing perceptions about the harm of both substances.
Researchers at the State University of New York (SUNY) and the University of Kentucky provided what they called the “most comprehensive” analysis of trends in adults who use only cannabis, only tobacco or both from 2015-2023—revealing a consistent decline in cigarette smoking as marijuana consumption rose.
From 2021 to 2023, data from the National Survey on Drug Use and Health (NSDUH) showed that the rate of people who reported using only cannabis in the past 30 days “rose sharply” from 7.2 percent to 10.6 percent—”overtaking cigarette-only use,” which declined during that period.
“Cannabis-only use increased from 3.9 percent to 6.5 percent in 2015–2019, was 7.1 percent in 2020, and increased again from 7.9 percent to 10.6 percent in 2021–2023. Cigarette-only use decreased from 15.0 percent to 12.0 percent in 2015–2019, was 10.3 percent in 2020, and declined again from 10.8 percent to 8.8 percent in 2021–2023. “Co-use was fairly stable over the various periods.”
The researchers, writing in Addictive Behaviors journal, said the changing trends in usage of these two substances may be an indication of a “substitution” effect due to “changing perceptions of harm, evolving legislation and shifting standards.”
This paper states, “The increasing use of cannabis only by groups is parallel to the expansion in state level recreational marijuana legalization. It increases accessibility and normatization.” The paper says that the decline in smoking cigarettes only is a result of decades-long tobacco control campaigns and changing norms. It is possible that the relatively stable trends in co-use are due to substitution, whereby individuals substitute cigarettes for cannabis. This prevents co-use from increasing along with cannabis only use.
Other researchers, too, have observed the same trend: cannabis being increasingly substituted for alcohol.
“During 2015–2019, cigarette-only use declined, while cannabis-only use increased across nearly all sociodemographic groups.”
According to the study, “socioeconomically disadvantage adults” (those with lower levels of education or income) were most likely to use only cigarettes, while cannabis was more common among those who had higher educational attainment, higher incomes and private insurance.
Although prior studies found that smoking marijuana was not as harmful to your health as tobacco smoke, authors of a recent paper suggest that the increase in cannabis usage is “an alarming trend” among adults.
The authors cautioned that cannabis, if not addressed quickly by policymakers, could be the next health crisis.
The paper states that “Cannabis use alone and cannabis co-use pose similar public health risks to smoking, necessitating focused prevention campaigns.” The paper says that a multi-pronged approach of education and early detection as well as effective treatment is needed to stop cannabis becoming the next major public health issue.
The U.S. Cannabis legislation is changing rapidly. The researchers argue that, while the decline in cigarette consumption is encouraging for smokers, an increase in cannabis usage is alarming. “Although emerging evidence suggests potential therapeutic applications of cannabis—pain management, opioid detoxification and tapering–considerable risks exist, with heterogeneous effects by administration mode, potency, use frequency and intensity, and population.”
Note that the data collected on cannabis in this study includes all consumption forms, including edibles and concentrates. In contrast, data about cigarettes did not include those who vaped.
The study involved an unweighted sample size of 42,163 to 46,906 participants for each time period—with the exception of 2020 when there was a smaller sample of 27,001 amid pandemic-related complications.
The study concludes that “the increasing use of cannabis by adults and the decline in cigarette smoking among adults highlights changing substance-use patterns which warrant monitoring, targeted treatment and policy efforts.”
A recent survey, which supports the point made by the authors about the shifting perceptions, found that marijuana usage is not as harmful to pregnant women as drinking alcohol or smoking tobacco.
Gallup’s survey results released at the end of last year confirm the study. They found that more Americans (15%) smoke marijuana than 11%) who reported to Gallup they have consumed cigarettes during the previous week.
A separate Gallup report at the beginning of last year similarly found that significantly more Americans said they smoked marijuana than cigarettes—with young people being more than five times more likely to consume cannabis compared to tobacco.