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A study of 17,732 U.S. adults who had used cannabis in the past month found that 14% used it in nearly every available form. This group had higher rates of daily use and cannabis use disorder than groups favoring smoking, vaping or edibles, but the observational findings do not show that using multiple forms causes addiction.
A national study found that U.S. adults who used cannabis in nearly every available form had higher rates of daily use and cannabis use disorder than people who mainly smoked, vaped or ate cannabis. The analysis, led by researchers at NYU Langone Health and based on 17,732 adults who had used cannabis in the previous month, identifies a consumption pattern that could help clinicians decide when to ask more about a person’s use; it does not establish that using multiple forms causes addiction.
The researchers analyzed responses from the 2022–2023 National Survey on Drug Use and Health, grouping participants according to similarities in how they consumed cannabis. They identified four patterns: 48% primarily smoked it, 21% combined smoking and vaping, 17% mainly used edibles, and 14% used cannabis in nearly every available form. The study was published online August 8 in the journal Addictive Behaviors.
About half of the polymodal group reported daily cannabis use. Daily use was reported by 31% of people who smoked and vaped, 28% of those who primarily smoked, and about 13% of those who mainly used edibles. Cannabis use disorder rates followed a similar pattern: 67% in the polymodal group, compared with 47% among people who smoked and vaped, 36% among primarily smokers and 15% among primarily edible users.
Cannabis use disorder is a medical diagnosis associated with problematic cannabis use. The reported percentages describe survey participants in each group; they do not predict an individual’s outcome. Lead author Omar El-Shahawy said asking patients how they use cannabis, as well as whether they use it, could help clinicians identify when a fuller assessment may be appropriate.
How Use Patterns May Guide Screening
The findings suggest that asking only whether someone uses cannabis may miss differences relevant to a clinical conversation. Asking about the methods and frequency of use could provide additional information, especially when someone reports using several forms. El-Shahawy described multiple methods as a possible “red flag” for heavier use and addiction symptoms, not as a diagnosis on its own.
The results may also matter for public health communication. The authors said prevention messages often focus on smoking, while cannabis is also vaped, eaten and used in concentrated forms. Messages tailored to different consumption methods could address risks that a smoking-only approach does not cover. The study does not test whether such tailored messages change behavior or reduce cannabis use disorder.
Researchers also reported that people who smoked cannabis were more likely to smoke cigarettes than people who mainly vaped cannabis or consumed edibles. Senior author Joseph J. Palamar said smoking both substances may expose the lungs to a wider range of chemicals through combustion. That observation is a concern raised by the study authors, rather than a measured assessment of lung injury in this analysis.
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Four Patterns in a National Survey
The analysis concerns people who reported cannabis use in the 30 days before the survey, not all U.S. adults. The source report cites separate national figures estimating that about 43.8 million people ages 12 and older—more than 15% of that age group—used cannabis in the previous 30 days. That broader estimate is background; the study’s analysis focused on 17,732 adults.
The groups also differed in their reported characteristics. Adults ages 18 to 25 made up nearly one-third of both the smoking-and-vaping group and the polymodal group, compared with about one-sixth of primarily smokers. Women made up more than half of the primarily edible group, and edible use was particularly common among college graduates. The researchers did not investigate why participants chose particular methods, so those demographic patterns do not explain people’s motivations.
The study’s approach was to use statistical methods to identify how methods of cannabis use clustered in survey responses. Its value is in describing associations across a large national sample. It was not a trial assigning people to consumption methods, and it cannot determine whether a particular method preceded or led to more frequent use or disorder.
“Our findings suggest that using cannabis in multiple forms may be a red flag for heavier use and symptoms of addiction.”
— Omar El-Shahawy, lead author and assistant professor at NYU Grossman School of Medicine
Association, Not a Cause
The study was observational, so it cannot show that using cannabis through multiple methods causes cannabis use disorder or heavier use. The analysis identifies an association between consumption patterns and reported use; it does not establish which came first or what factors might explain the relationship.
Participants described their own cannabis habits, and some may have reported them inaccurately or incompletely. The researchers also did not examine why people selected particular methods. It remains unclear whether differences reflect motivations, circumstances or other factors not resolved by the survey analysis.
The study reports group-level rates, not a diagnostic test for individuals. A person’s use of several cannabis products alone does not establish a disorder. The supplied report does not specify how the study’s estimates might apply to people outside the survey sample or whether the same patterns hold in other populations.
Researchers Plan Follow-Up Work
El-Shahawy and colleagues hope to study the reasons people choose particular cannabis methods. One question they plan to explore is whether people who prefer edibles are more likely to use cannabis to manage concerns such as pain or difficulty sleeping. Those motivations were not measured in this analysis.
The authors also argue that prevention messages should address vaping, edibles and combinations of methods alongside smoking. No specific new campaign, policy or clinical guideline is announced in the source report. For now, the study offers an association that clinicians and public health researchers may consider while awaiting research that can clarify motivations, timing and possible causal pathways.
Key Questions
What did the study find?
Among 17,732 adults who reported cannabis use in the previous month, 14% belonged to a group that used cannabis in nearly every available form. This group had the highest reported rates of daily use, at about 50%, and cannabis use disorder, at 67%, among the four consumption patterns.
Does using cannabis in several forms cause addiction?
The study does not show that it does. It was observational and found an association between using multiple forms and higher rates of daily use and cannabis use disorder. It cannot establish cause and effect.
What is cannabis use disorder?
It is a medical diagnosis associated with problematic cannabis use. The study reports the share of participants in each consumption group who met the disorder criteria; the figures are group-level estimates, not an individual diagnosis.
Why did some people choose edibles or multiple methods?
The researchers did not investigate participants’ reasons for choosing particular methods. They said future work may examine motivations, including whether some people who use edibles do so to manage concerns such as pain or difficulty sleeping.
When and where was the study published?
The study was published online August 8 in Addictive Behaviors. It analyzed responses from the 2022–2023 National Survey on Drug Use and Health.
Source: sciencedaily.com
