# Prevalence, Patterns, and Correlates of Cannabis-Cigarette Co-Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023-2024. > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/cannabis-cigarette-co-use-prevalence-patterns-2023-2024/ > **Published:** 2026-03-26T10:04:48-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:38:00-04:00 > **Clinical Summary:** Explore cannabis cigarette co-use prevalence and patterns from a 2023-2024 multi-state survey, highlighting clinical implications and dual substance use risks. --- CED Clinical Relevance  #56Monitored Relevance  Early-stage or contextual signal requiring further evidence before action. 🔬 Evidence Watch  |  CED Clinic Tobacco[Substance Use](https://cedclinic.com/stroke-risk-assessment-substance-use/)[Harm Reduction](https://cedclinic.com/can-you-mix-weed-and-alcohol/)Population HealthScreening Journal American journal of preventive medicine Study Type [Clinical Study](https://cedclinic.com/cannabis-hyperemesis-syndrome-psychiatric-risk/) Population Human participants Why This Matters With nearly 9% of adults in high-tobacco states co-using cannabis and cigarettes, clinicians need to understand this dual-substance pattern to address combined respiratory and cardiovascular risks. The finding that 45% of cigarette smokers also use cannabis represents a significant clinical population requiring integrated [harm reduction](https://cedclinic.com/can-you-mix-weed-and-alcohol/) strategies. Clinical Summary This probability-sample survey of 9,100 adults across 13 high-tobacco-burden states found 8.7% prevalence of cannabis-cigarette co-use, with nearly half of current cigarette smokers also using cannabis. Co-users averaged 12.8 cigarettes daily and used cannabis 18.9 days monthly, suggesting regular dual consumption patterns. The study provides population-level prevalence data but lacks longitudinal outcomes or direct health impact measurements, limiting conclusions about causality or combined health effects. Dr. Caplan’s Take “This confirms what I observe clinically—cannabis and tobacco use frequently cluster together, particularly in patients with higher baseline [substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) risk. The 45% co-use rate among cigarette smokers tells me I need to routinely screen for both substances when either is present.” Clinical Perspective 🧠 Clinicians should implement dual screening protocols when either cannabis or tobacco use is identified, as co-use appears common and may compound respiratory and cardiovascular risks. Harm reduction counseling should address both substances simultaneously rather than treating them as separate issues, particularly given the high daily frequency of use in this population. 💬 Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan →](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion →](https://cedclinic.com/interact/discussion-forums/forum/cannabis-industry/) Have thoughts on this? Share it: [𝕏 Share on X](https://twitter.com/intent/tweet?text=Just%20read%20this%20on%20CEDclinic.com%3A%20Prevalence%2C%20Patterns%2C%20and%20Correlates%20of%20Cannabis-Cigarette%20Co-Use%3A%20Findings%20From...%20%40drcaplan&url=https%3A//pubmed.ncbi.nlm.nih.gov/41611355/)[in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A//pubmed.ncbi.nlm.nih.gov/41611355/)[🦥 Share on BlueSky](https://bsky.app/intent/compose?text=Just%20read%20this%3A%20Prevalence%2C%20Patterns%2C%20and%20Correlates%20of%20Cannabis-Cigarette%20Co-Use%3A%20Findings%20From...%20--%20via%20%40drcaplan.bsky.social%20https%3A//pubmed.ncbi.nlm.nih.gov/41611355/)[📷 Follow on Instagram](https://www.instagram.com/drbenjamincaplan/)[📝 Read more on Substack](https://substack.com/@doctorapproved)[🔔 Subscribe via RSS](https://cedclinic.com/category/cannabis-news/feed/) 📰 Source: [https://pubmed.ncbi.nlm.nih.gov/41611355/](https://pubmed.ncbi.nlm.nih.gov/41611355/) Table of Contents - [FAQ](#FAQ)[How common is concurrent cannabis and cigarette use among my patients?](#How_common_is_concurrent_cannabis_and_cigarette_use_among_my_patients) - [Which patients are at highest risk for cannabis-cigarette co-use?](#Which_patients_are_at_highest_risk_for_cannabis-cigarette_co-use) - [What usage patterns should I expect in patients who co-use both substances?](#What_usage_patterns_should_I_expect_in_patients_who_co-use_both_substances) - [Are there additional health risks when patients use both cannabis and cigarettes?](#Are_there_additional_health_risks_when_patients_use_both_cannabis_and_cigarettes) - [Should I screen for cannabis use in all my cigarette-smoking patients?](#Should_I_screen_for_cannabis_use_in_all_my_cigarette-smoking_patients) - [Related](#Related) ## FAQ #### How common is concurrent cannabis and cigarette use among my patients? Cannabis-cigarette co-use affects 8.7% of adults in high-tobacco-burden states. Among current cigarette smokers specifically, 45% also use cannabis concurrently, making this a significant clinical concern requiring routine screening. #### Which patients are at highest risk for cannabis-cigarette co-use? Current cigarette smokers have the highest risk, with 45% reporting concurrent [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) compared to 24.5% of former smokers and 12.3% of never-smokers. This pattern suggests shared risk factors and potential cross-reinforcement between substances. #### What usage patterns should I expect in patients who co-use both substances? Co-users typically smoke an average of 12.8 cigarettes per day and use cannabis on 18.9 days per month. This represents substantial exposure to both substances with frequent, regular use patterns. #### Are there additional health risks when patients use both cannabis and cigarettes? Yes, there may be additive health risks associated with cannabis-cigarette co-use beyond the individual risks of each substance. However, the specific nature and magnitude of these combined risks require further research to fully characterize. #### Should I screen for cannabis use in all my cigarette-smoking patients? Given that nearly half of cigarette smokers also use cannabis, routine screening for [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) among smoking patients is clinically warranted. This high co-occurrence rate makes targeted screening an efficient approach for identifying dual substance use. {“@context”: “https://schema.org”, “@type”: “ScholarlyArticle”, “headline”: “Prevalence, Patterns, and Correlates of Cannabis-Cigarette Co-Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023-2024.”, “url”: “https://pubmed.ncbi.nlm.nih.gov/41611355/”, “about”: “american journal preventive medicine clinical study”, “isPartOf”: “American journal of preventive medicine”} [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) RELATED READING AT CED CLINIC Continue exploring the evidence [A mixed-methods evaluation of a statewide naloxone distribution project](https://cedclinic.com/opioid-overdose-prevention-naloxone-distribution-evaluation/) Explore considerations for opioid overdose prevention initiatives through a comprehensive statewide naloxone distribution evaluation. [Read More](https://cedclinic.com/opioid-overdose-prevention-naloxone-distribution-evaluation/) [Perceived Safety of Cannabis Use During Pregnancy and Changes in Perception over Time](https://cedclinic.com/perceived-cannabis-safety-pregnancy-survey-2017-2021/) Review national survey data on changing perceptions of [cannabis safety](https://cedclinic.com/respiratory-effects-inhalational-marijuana/) during pregnancy from 2017 to 2021. [Learn More](https://cedclinic.com/perceived-cannabis-safety-pregnancy-survey-2017-2021/) [Unregulated Substance Abuse and Systemic Inflammation Markers: A Review](https://cedclinic.com/inflammatory-biomarkers-unregulated-substance-use-review/) Understand the relationship between unregulated substance abuse and systemic inflammation through a detailed review. [Explore Article](https://cedclinic.com/inflammatory-biomarkers-unregulated-substance-use-review/) ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Former CMO Canna Care Docs (250,000+ patients supervised), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).