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A study of 17,732 U.S. adults who had used cannabis in the previous month found that people using it in nearly every available form had higher rates of daily use and cannabis use disorder than other consumption groups. The observational findings show an association, not proof 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 it. The analysis, led by researchers at NYU Langone Health and published online August 8 in the journal Addictive Behaviors, points to consumption patterns as a possible signal for clinicians to ask more about a patient’s use; it does not show that combining methods causes addiction.
The researchers analyzed responses from 17,732 adults who reported using cannabis in the month before the survey. The data came from the 2022–2023 National Survey on Drug Use and Health. Statistical analysis grouped participants by similarities in how they consumed cannabis, producing four patterns: primarily smoking, smoking and vaping, primarily edibles, and use of nearly every available form.
Nearly half of participants, 48 percent, primarily smoked cannabis. Another 21 percent combined smoking and vaping, 17 percent mainly used edibles, and 14 percent were in the study’s “polymodal” group. About half of that last group reported daily use, compared with 31 percent of those who smoked and vaped, 28 percent of primarily smokers, and about 13 percent of primarily edible users.
The differences were also apparent in rates of cannabis use disorder, a clinical diagnosis. About 67 percent of polymodal users met the study’s criteria, compared with 47 percent of those who smoked and vaped, 36 percent of primarily smokers and 15 percent of primarily edible users. These are rates within the study’s groups, not estimates that show what caused the disorder or how an individual’s risk will change.
How Consumption Patterns May Guide Screening
The results suggest clinicians may learn more by asking how people use cannabis, as well as whether they use it, rather than treating smoking as the default pattern. Study lead author Omar El-Shahawy said asking about methods could help identify when a fuller assessment may be warranted. The findings do not establish a screening rule, but they offer a potential prompt for conversations about frequency, symptoms and different products.
The group differences also matter for public health communication. A message focused only on smoking may not reach people who vape, eat edibles or combine methods. El-Shahawy said younger adults may need information about vaping and using multiple forms, while people using edibles should be advised to start with a low amount and wait for effects, which can take time to appear.
The study also reported that cannabis smokers were more likely to smoke cigarettes than people who mainly vaped cannabis or used edibles. Senior author Joseph J. Palamar raised concern that smoking both substances can expose people to a wider range of chemicals from combustion. The analysis identifies an association; it does not measure the resulting lung effects.
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Four Patterns in Recent Cannabis Use
The analysis used national survey responses from adults who had consumed cannabis in the prior month. The researchers described it as the first national analysis of how cannabis consumption methods naturally cluster together. The methods covered included smoking, vaping, eating edibles and dabbing, in which concentrated cannabis products are heated and the vapor inhaled.
The study’s demographic findings varied by group. Adults ages 18 to 25 made up nearly one-third of both the smoking-and-vaping group and the polymodal group, but about one-sixth of the primarily smoking group. Women accounted for more than half of primarily edible users, and edible use was more common among college graduates. The researchers did not investigate why people selected particular methods.
The report cited national survey figures indicating that about 43.8 million Americans ages 12 and older—more than 15 percent of that population—had used cannabis in the previous 30 days. That broader figure gives a sense of the scale of recent use; it is separate from the adult sample used to identify consumption patterns.
“Our findings suggest that using cannabis in multiple forms may be a red flag for heavier use and symptoms of addiction.”
— Omar El-Shahawy, study lead author and assistant professor at NYU Grossman School of Medicine
What the Survey Cannot Establish
The study is observational, so it cannot show that using cannabis in multiple forms increases the likelihood of cannabis use disorder. The higher rates may reflect other differences among participants, and the analysis does not establish which factors account for the association.
Participants reported their own consumption, meaning some may have recalled or described their use inaccurately or incompletely. The researchers also did not examine why people chose particular methods, including whether some edible users were seeking relief from problems such as pain or difficulty sleeping. The reported group rates should not be treated as a diagnosis or an individual prediction.
Researchers Plan to Study Motivations
The research team said future work will examine what motivates people to use particular forms of cannabis, including whether people who prefer edibles are more likely to use them to manage pain or sleep difficulties. The supplied report does not give a timeline for that research or describe a planned follow-up study.
For now, the findings provide an association that researchers say could inform further study and clinical questions. Whether multiple-method use predicts later disorder, or plays any causal role, remains to be tested.
Key Questions
What did the study identify as a possible warning sign?
Using cannabis in nearly every available form was associated with higher rates of daily use and cannabis use disorder in the survey analysis. The authors described this pattern as a possible signal for further assessment, not a confirmed cause.
How many people were included in the analysis?
The researchers analyzed responses from 17,732 adults who reported using cannabis during the preceding month. The responses came from the 2022–2023 National Survey on Drug Use and Health.
Does using multiple forms cause cannabis use disorder?
The study cannot answer that. It was observational and found an association between consumption patterns and disorder rates; it did not show that combining methods caused the disorder.
Which group had the lowest reported disorder rate?
About 15 percent of participants who mainly used edibles met the study’s criteria for cannabis use disorder, the lowest rate among the four groups. That group-level result does not determine any one person’s risk.
What do researchers say should be studied next?
The team wants to investigate why people choose particular consumption methods, including whether some people who favor edibles use cannabis in response to pain or difficulty sleeping. The report did not provide a schedule for that work.
Source: sciencedaily.com
