Cannabis Legalization Linked to Shifts in Tobacco and Cannabis Use Patterns, Study Finds

U.S. Cannabis Legalization Linked to Shifts in Substance Use Patterns

An analysis of health behavioral data suggests a link between cannabis legalization and the start of retail sales in the U.S. and shifts in substance use patterns. The study, published in Tobacco Control, indicates a rise in recreational cannabis use and concurrent use of tobacco, alongside a decrease in sole tobacco use.

These patterns were observed in higher-risk groups, such as individuals with poor mental health, and in groups historically less likely to use recreational cannabis, including older adults and those with higher education levels.

Concurrent use of tobacco and cannabis is associated with increased dependence risk and potentially greater health consequences than using either substance alone.

Context: A Changing Landscape

Since 2012, U.S. states have been legalizing recreational cannabis, with 24 states plus D.C. doing so for adults aged 21+ by July 2025. This period has coincided with increased adult cannabis use amidst an overall decline in tobacco use.

The Study: Data and Approach

Researchers utilized data from the annual Behavioral Risk Factor Surveillance System (2016-2023). This extensive dataset included 854,878 respondents aged 18+ from 38 states. Respondents reported past-month use of marijuana/hashish and frequency of tobacco/vape use. This information was then categorized into: no use, tobacco only, cannabis only, or concurrent use.

Key Findings: Shifting Patterns of Use

The study found that from 2016 to 2023, sole tobacco use remained stable at 14%, and sole cannabis use remained stable at 7%. However, concurrent use of both substances increased significantly from over 4% to nearly 5.5%.

Following the implementation of legalization policies, the study observed notable shifts:

• The likelihood of sole cannabis use rose by 88%.
• The likelihood of concurrent use increased by 44%.
• Conversely, the likelihood of sole tobacco use fell by 13%.

Distinct demographic patterns also emerged:

• Sole cannabis use increased across all age groups, with larger rises among 18–24 year olds (over 6%) and those aged 65+ (2.5%).
• Sole tobacco use decreased more among women than men.
• Cannabis use also saw an increase among adults with a high school education or higher.
• Concurrent use rose among various racial and ethnic groups and among adults reporting poor mental health.

The analysis further indicated additional increases in sole cannabis use and concurrent use following the opening of licensed recreational cannabis retail stores.

Important Considerations and Study Limitations

The study is observational, which limits definitive conclusions on cause and effect. Other limitations include:

• Reliance on self-reported data.
• Lack of specific information on the timing or method of concurrent use.
• Findings may not be applicable to all states, as participation was limited to 38 states.

Implications and Researcher Insights

Researchers suggest their findings contribute to evidence that adults are altering product use in response to cannabis legalization, potentially narrowing disparities in use by increasing levels among populations historically less likely to use cannabis.

They caution that policy changes, increased access to cannabis products, and changing public perceptions of cannabis safety could lead to increased co-use of tobacco and cannabis through multiple pathways, despite downward pressure on tobacco use from policy restrictions.