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: ‘The science about the benefits of cannabis is limited’: Does legalizing marijuana lead to an increase in tobacco use?


The smoke signals surrounding marijuana and tobacco usage are mixed.

Legalizing the recreational use of cannabis does not appear to be getting more Americans hooked on tobacco. At least that was the conclusion of a new working paper distributed by the National Bureau for Economic Research.

The study was co-authored by researchers from Georgia State University, San Diego State University and Bentley University. The researchers hailed the study as “the first to comprehensively examine the impact of the legalization of recreational marijuana on adult tobacco use.”

“While public support for recreational marijuana has skyrocketed in recent decades, public-health experts have taken a more cautious approach, urging more research to assess the health benefits and costs of marijuana use, as well as to understand potentially unintended consequences on other health behaviors,” the researchers wrote.

Joseph Sabia, one of the authors of the study, acknowledges research support from the Center for Health Economics & Policy Studies at San Diego State University, which has received grant funding from the Charles Koch Foundation and the Troesh Family Foundation. Charles Koch, the right-wing billionaire libertarian, has previously said that he is a supporter of marijuana legalization.

What’s more, other studies appear to contradict these findings. A 2015 study in Drug and Alcohol Dependence, a peer-reviewed scientific journal on biomedical and psychosocial approaches to addiction, concluded, “Cigarette smoking is related to concurrent cannabis dependence independently of cannabis use frequency.”

“Cigarette smoking also mediates the relationship between cannabis use and cannabis dependence suggesting tobacco is a partial driver of cannabis dependence in young people who use cannabis and tobacco,” it added.

‘Threat to public health’

Public-health advocates are skeptical. Both the American Medical Association and the American Public Health Association have expressed reservations about legalizing the recreational use of marijuana until more research is completed to determine what, if any, adverse health impacts there might be.

“The science about the benefits of cannabis is limited, while the available evidence demonstrates that legalizing the adult use of cannabis poses a threat to public health,” Dr. Susan R. Bailey, the American Medical Association’s immediate past president, noted in a post to the organization’s website.

Bailey added that the AMA “does not support legalization of cannabis for adult use until additional scientific research has been completed to fully document the public health, medical and economic consequences of its use.”

“‘The available evidence demonstrates that legalizing the adult use of cannabis poses a threat to public health.’”

— Dr. Susan R. Bailey, the American Medical Association’s immediate past president

Among the chief concerns for doctors and public-health officials regarding legalizing cannabis are the possible spillover effects in terms of tobacco use.

Cigarette smoking has plummeted in the decades since the first Surgeon General report outlining its harmful effects was released in 1964, falling from 55% of men to just 16% of men. Nevertheless, tobacco use remains the leading cause of preventable death in the U.S., and it is associated with roughly half a million deaths each year. And amid the pandemic, tobacco use increased, likely due to many Americans turning to vices to cope with the stresses of the health crisis.

Cannabis use could encourage smoking in general, opponents have warned, as well as use of vape products since some e-cigarettes can be fitted with cartridges that provide either nicotine or cannabis. Plus, some cannabis users smoke marijuana and tobacco together.

‘Declines in adult tobacco use’

However, as the working paper distributed Monday suggested, marijuana legalization did not lead to an uptick in tobacco use. In the short-term, no changes were noted in terms of tobacco use. But in the longer run, there were “declines in adult tobacco use, more consistent with the hypothesis that recreational marijuana and tobacco may be substitutes,” the researchers noted.

When their findings were extrapolated to a national level, they estimated that as many as 5.1 million fewer people may stop using tobacco as marijuana is legalized, which they projected could generate $10.2 billion in healthcare cost savings per year.

The biggest change in tobacco use was discovered among adults ages 20 or younger, who are under the legal age to purchase marijuana for recreational purposes. Nevertheless, these individuals tended to substitute marijuana for tobacco in places where it was legalized.

Similarly, studies have suggested that many people would reduce their consumption of alcohol if cannabis were legalized for recreational use.

Still, separate research has suggested there may be other drawbacks to more widespread consumption of cannabis. For instance, one study found that parents who used marijuana were more likely to displace their children with corporal punishment or engage in physical abuse.

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