Abstract
BackgroundAdolescents cannabis users are at a substantially elevated risk for use of highly addictive drugs such as cocaine, heroin, and nonmedical use of prescription drugs. Unknown is whether this elevated risk applies to adolescent cannabis users who have never smoked a combustible cigarette, a group that has grown considerably in size in recent years. This study documents the recent growth in the proportion of adolescent cannabis users who abstain from combustible cigarette use, and examines their probability for use of addictive drugs.MethodsData are annual, cross-sectional, nationally-representative Monitoring the Future surveys of 607,932 U.S. 12th grade students from 1976 to 2020.ResultsAmong ever cannabis users, the percentage who had never smoked a combustible cigarette grew from 11% in 2000 to 58% in 2020. This group had levels of addictive drug use that were 8% higher than their peers. In comparison, adolescents who had ever used cannabis—regardless of whether they had ever smoked a cigarette—had levels of addictive drug use 500% higher than their peers.ConclusionsAdolescent cannabis users who have not smoked a combustible cigarette have much lower levels of addictive drug use than the group of cannabis users as a whole. These results suggest policies and laws aimed at reducing adolescent prevalence of addictive drugs may do better to focus on cigarette use of adolescent cannabis users rather than cannabis use per se.
Highlights
Adolescent cannabis users have a substantially elevated probability for illicit use of highly addictive drugs such as cocaine, heroin, hallucinogens, and nonmedical use of prescription drugs [1–3]. This elevated probability is a major concern of parents, teachers, and government, and it is a cornerstone for theories, legal policies, and prevention strategies in the drug field. It is the basis for both the “gateway” and “liability” theories, with the former positing that cannabis use causes the elevated probability and the latter positing that individual predisposition for drug use plays a confounding role [2, 4–6]
In terms of policy and practice these results suggest that targeting cigarette use may be a promising strategy to reduce addictive drug use among adolescent cannabis users
The results of this study suggest that the aim of reducing addictive drug use could potentially be addressed by preventing cigarette use among adolescent cannabis users, using the public health approach of tobacco control
Summary
Adolescent cannabis users have a substantially elevated probability for illicit use of highly addictive drugs such as cocaine, heroin, hallucinogens, and nonmedical use of prescription drugs [1–3]. This elevated probability is a major concern of parents, teachers, and government, and it is a cornerstone for theories, legal policies, and prevention strategies in the drug field. Results Among ever cannabis users, the percentage who had never smoked a combustible cigarette grew from 11% in 2000 to 58% in 2020 This group had levels of addictive drug use that were 8% higher than their peers. These results suggest policies and laws aimed at reducing adolescent prevalence of addictive drugs may do better to focus on cigarette use of adolescent cannabis users rather than cannabis use per se
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