Science & Health
More Americans Now Use Marijuana Than Smoke Cigarettes, New Study Shows
More Americans now use marijuana than smoke cigarettes amid shifting perceptions of harm of the two substances, according to a new study.
Researchers at the State University of New York (SUNY) and the University of Kentucky provided what they called the “most comprehensive” analysis of trends in adults who use only cannabis, only tobacco or both from 2015-2023—revealing a consistent decline in cigarette smoking as marijuana consumption rose.
From 2021 to 2023, data from the National Survey on Drug Use and Health (NSDUH) showed that the rate of people who reported using only cannabis in the past 30 days “rose sharply” from 7.2 percent to 10.6 percent—”overtaking cigarette-only use,” which declined during that period.
“Cannabis-only use increased from 3.9 percent to 6.5 percent in 2015–2019, was 7.1 percent in 2020, and increased again from 7.9 percent to 10.6 percent in 2021–2023. Cigarette-only use decreased from 15.0 percent to 12.0 percent in 2015–2019, was 10.3 percent in 2020, and declined again from 10.8 percent to 8.8 percent in 2021–2023. Co-use was relatively stable across the different periods.”
Writing in the journal of Addictive Behaviors, the researchers said that the evolving trends in use of the two substances could be evidence of a “substitution” effect amid “changing harm perceptions, evolving legislation, and shifting norms.”
“The rising cannabis-only use across groups parallels the expanding state-level recreational cannabis legalization, increasing accessibility and normalization,” the paper says. “Conversely, continued declines in cigarette-only use align with decades of tobacco control efforts and evolving norms surrounding smoking. The relatively stable co-use trends may reflect substitution dynamics whereby some individuals replace cigarettes with cannabis, preventing co-use from rising in tandem with cannabis-only use.”
Other researchers have also separately observed a similar trend where cannabis is increasingly used as an alcohol substitute.
“During 2015–2019, cigarette-only use declined, while cannabis-only use increased across nearly all sociodemographic groups.”
Cigarette-only use was most prevalent “among socioeconomically disadvantaged adults (with lower education, income, or lacking insurance),” the study found, whereas cannabis-only use “predominated among more socioeconomically advantaged groups (college-educated, high-income, and privately insured).”
While prior studies have concluded that marijuana smoke exposure is not equally or more dangerous to health than tobacco smoking, the authors of the new paper suggested that the “surge in cannabis use” as “tobacco use wanes” represents “a worrisome trend among adults.”
“Without timely policy response, cannabis may become the next public health crisis,” they cautioned.
“Cannabis-only use and co-use trends pose public health risks akin to cigarettes, necessitating targeted prevention campaigns,” the paper says. “A multi-pronged strategy of public health education, early detection, and effective treatment development is vital to prevent cannabis from becoming the next public health crisis.”
“U.S. cannabis legislation is rapidly evolving. While declining cigarette use is encouraging, rising cannabis use is concerning,” the researchers argued. “Although emerging evidence suggests potential therapeutic applications of cannabis—pain management, opioid detoxification and tapering–considerable risks exist, with heterogeneous effects by administration mode, potency, use frequency and intensity, and population.”
It should be noted that data on cannabis use in the study included all forms of consumption, from smokable flower and vaping concentrates to edibles and tinctures. By contrast, the data on cigarettes excluded those who vaped nicotine.
The study involved an unweighted sample size of 42,163 to 46,906 participants for each time period—with the exception of 2020 when there was a smaller sample of 27,001 amid pandemic-related complications.
“Increasing adults’ cannabis use alongside declining cigarette use highlights evolving substance use patterns warranting monitoring and targeted prevention, treatment, and policy efforts,” the study concluded.
To the authors’ point about shifting perceptions of harm, a recent survey found that, on the list of activities that Americans say is dangerous for pregnant women to engage in, using marijuana falls below drinking alcohol or smoking cigarettes.
Consistent with the latest study, survey data from Gallup that was released late last year found that 15 percent of U.S. adults reported that they smoke cannabis, which is more than the 11 percent of who told the polling firm that they have smoked any cigarettes in the past week.
A separate Gallup report at the beginning of last year similarly found that significantly more Americans said they smoked marijuana than cigarettes—with young people being more than five times more likely to consume cannabis compared to tobacco.
