Cannabis Problem Experiences Among Users of the Tobacco-Cannabis Combination Knows As Blunts

Rationale: Most epidemiological research on youthful cannabis involvement overlooks the extent to which cannabis is used along with tobacco. In the US, half of current cannabis smokers combine tobacco in a ‘blunts’ formulation, with cannabis plant material inserted into a hollowed-out cigar. Blunt smoking may potentially increase the degree of cannabis problems, prolong concurrent cigarette/tobacco smoking, and impair cessation treatment for both substances.

Objective: This study estimates associations that link smoking of blunts with levels and subtypes of cannabis problems (CP) among samples of mostly adolescent and emerging adults (60%).

Methods: The four independent and nationally representative samples of recently-active cannabis smokers are from the US National Surveys on Drug Use and Health (NSDUH), 2009-2012 (total n = 27,767). Ten self-report items on DSM-IV cannabis use disorder clinical features tap a one-dimensional latent trait of CP, which is regressed on covariate terms for blunts use and potential confounding variables. Meta-analysis is used to summarize the four sets of individual year estimates.

Results: Blunts smoking and smoking blunts more frequently was associated with statistically higher levels of CP consistently across four year survey replicate samples even after adjusting for potentially confounding factors. With CP level held constant, blunt smokers were more likely to experience subjectively felt tolerance and to spend more time (obtaining or using), and were less likely to manifest cannabis-attributed socially maladaptive behavior.

Conclusions: Use of ‘blunts’ might promote development of cannabis dependence and problematic cannabis use patterns especially among emerging youth. Differential responses (e.g., tolerance) require more investigation. Findings highlight the need to address ‘real-world’ patterns of tobacco-cannabis co-consumption in studies of cannabis use disorders. Public policy implications at the intersection between tobacco and marijuana regulation will be discussed.