# Cannabis Co-Use and Endocannabinoid System Modulation in Tobacco Use Disorder: A Translational Systematic Review and Meta-Analysis > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/cannabis-co-use-tobacco-cessation-impact-quit-success/ > **Published:** 2026-03-20T17:44:17-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T15:54:56-04:00 > **Clinical Summary:** Explore cannabis co-use tobacco cessation and its impact on quit success rates in tobacco use disorder with endocannabinoid system insights. --- CED Clinical Relevance  #96High Clinical Relevance  Strong evidence or policy relevance with direct clinical implications. 🔬 Evidence Watch  |  CED Clinic Tobacco CessationCannabis Co-Use[Endocannabinoid System](https://cedclinic.com/endocannabinoid-system-fear-extinction/)AddictionSystematic Review Journal medRxiv: the preprint server for health sciences Study Type Systematic Review Population Human participants Why This Matters With [cannabis legalization](https://cedclinic.com/the-forgotten-history-of-hemp-in-america/) expanding and nearly one in five tobacco users also using cannabis, clinicians need evidence-based guidance on how co-use affects smoking cessation success. This comprehensive review addresses a critical knowledge gap as we manage patients with dual substance use patterns. Clinical Summary This systematic review and meta-analysis examined 52 studies across observational, preclinical, and human experimental designs to understand cannabis co-use impacts on tobacco cessation and [endocannabinoid system](https://cedclinic.com/endocannabinoid-system-fear-extinction/) therapeutic potential. Meta-analysis of 18 observational studies involving over 229,000 participants found that [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) was associated with reduced tobacco cessation success rates. The review synthesized evidence from multiple study types to provide a translational perspective on endocannabinoid system modulation for tobacco use disorder, where current pharmacotherapies achieve less than 30% twelve-month abstinence rates. Dr. Caplan’s Take “This confirms what I observe clinically – patients using both cannabis and tobacco face additional complexity in cessation efforts. While the endocannabinoid system remains an intriguing therapeutic target, the current evidence suggests cannabis co-use may complicate rather than facilitate tobacco cessation.” Clinical Perspective 🧠 Clinicians should screen for [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) in tobacco cessation patients and counsel that concurrent use may reduce quit success rates. Until more definitive intervention studies emerge, standard evidence-based tobacco cessation approaches remain first-line, with awareness that cannabis co-use may require modified expectations and support strategies. 💬 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%20Cannabis%20Co-Use%20and%20Endocannabinoid%20System%20Modulation%20in%20Tobacco%20Use%20Disorder%3A%20A...%20%40drcaplan&url=https%3A//pubmed.ncbi.nlm.nih.gov/41728311/)[in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A//pubmed.ncbi.nlm.nih.gov/41728311/)[🦥 Share on BlueSky](https://bsky.app/intent/compose?text=Just%20read%20this%3A%20Cannabis%20Co-Use%20and%20Endocannabinoid%20System%20Modulation%20in%20Tobacco%20Use%20Disorder%3A%20A...%20--%20via%20%40drcaplan.bsky.social%20https%3A//pubmed.ncbi.nlm.nih.gov/41728311/)[📷 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/41728311/](https://pubmed.ncbi.nlm.nih.gov/41728311/) Table of Contents - [FAQ](#FAQ)[Does using cannabis make it harder to quit smoking tobacco?](#Does_using_cannabis_make_it_harder_to_quit_smoking_tobacco) - [What kinds of studies were included in this review?](#What_kinds_of_studies_were_included_in_this_review) - [How effective are current medications for tobacco use disorder?](#How_effective_are_current_medications_for_tobacco_use_disorder) - [Does the review suggest the endocannabinoid system could help treat tobacco addiction?](#Does_the_review_suggest_the_endocannabinoid_system_could_help_treat_tobacco_addiction) - [Related](#Related) ## FAQ ### Does using cannabis make it harder to quit smoking tobacco? It appears to be linked to lower success. A meta-analysis of 18 observational studies involving more than 229,000 participants found that cannabis use was associated with reduced tobacco cessation success rates. The review reports this as an association drawn from observational studies. ### What kinds of studies were included in this review? The review examined 52 studies spanning observational, preclinical, and human experimental designs. It aimed to understand how cannabis co-use affects tobacco cessation and whether the endocannabinoid system has therapeutic potential. It was posted on medRxiv, a preprint server for health sciences. ### How effective are current medications for tobacco use disorder? According to the review, current pharmacotherapies for tobacco use disorder achieve twelve-month abstinence rates below 30%. Put another way, fewer than three in ten people treated with existing medications are still abstinent a year later, based on the figure the review reports. ### Does the review suggest the endocannabinoid system could help treat tobacco addiction? The review considered that question. It synthesized evidence from multiple study types to offer a translational perspective on endocannabinoid system modulation for tobacco use disorder. However, the summary does not report specific findings on whether targeting this system improves quit rates, so no conclusion about effectiveness can be drawn from it. {“@context”: “https://schema.org”, “@type”: “ScholarlyArticle”, “headline”: “Cannabis Co-Use and Endocannabinoid System Modulation in Tobacco Use Disorder: A Translational Systematic Review and Meta-Analysis.”, “url”: “https://pubmed.ncbi.nlm.nih.gov/41728311/”, “about”: “medrxiv preprint server health sciences systematic”, “isPartOf”: “medRxiv: the preprint server for health sciences”} [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 [Modulating the endocannabinoid system in alcohol use disorder: A translational systematic review and meta-analysis of preclinical and human studies.](https://cedclinic.com/cbd-alcohol-use-disorder-treatment-research-systematic-review/) This review explores endocannabinoid system modulation in [alcohol use disorder](https://cedclinic.com/cannabis-infused-drinks-may-help-people-cut-their-alcohol-intake-in-half/), providing insights relevant to substance use treatment strategies. [Read More](https://cedclinic.com/cbd-alcohol-use-disorder-treatment-research-systematic-review/) [The Effects of Extended Cannabis Abstinence in Comorbid Posttraumatic Stress Disorder and Cannabis Use Disorder.](https://cedclinic.com/cannabis-cessation-ptsd-dual-diagnosis-effects/) Examines the clinical outcomes of extended cannabis abstinence in patients with PTSD and [cannabis use disorder](https://cedclinic.com/sex-differences-cannabis-stress-reactivity-oxytocin/), highlighting therapeutic considerations. [Explore Study](https://cedclinic.com/cannabis-cessation-ptsd-dual-diagnosis-effects/) [Cannabis use patterns and perception of acute pain during brief abstinence: sex-dependent associations with circulating cannabinoid levels.](https://cedclinic.com/acute-pain-cannabinoid-withdrawal-sex-dependent-cannabis-study/) Investigates how cannabis use patterns affect pain perception during abstinence, with implications for clinical management of co-occurring conditions. [Learn More](https://cedclinic.com/acute-pain-cannabinoid-withdrawal-sex-dependent-cannabis-study/) ### 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).