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New Studies Shed Light on Co-Administration of Tobacco and Marijuana

Researchers at Battelle are examining trends and exposure risks related to co-administration of tobacco and marijuana. Two papers based on recent studies have now been accepted for publication in peer-reviewed journals.

Marijuana use is on the rise, with 8.4% of the population older than 12 reporting use in the past month in the most recent Substance Abuse and Mental Health Service Administration (SAMHSA) survey. Nearly 70% of adults who smoke marijuana also smoke tobacco. However, much remains unknown about the specific behaviors and exposure risks related to co-administration of tobacco and marijuana. In particular, there are many research questions around the growing trend of smoking blunts (partially or entirely hollowed out cigar wrappers refilled with marijuana) or spliffs/mulled cigarettes (joints filled with both loose-leaf tobacco and marijuana). These administration methods, which combine marijuana and tobacco in the same product to be smoked at the same time, may lead to different patterns of addictive behavior and compounded health effects.

The two Battelle studies examine different aspects of tobacco and marijuana co-administration.

  • “Marijuana And Tobacco Co-Administration In Blunts, Spliffs And Mulled Cigarettes: A Systematic Literature Review” has been accepted for publication inAddictive Behaviors. Battelle researchers Gillian Schauer, Zachary Rosenberry and Erica Peters conducted a literature review to determine what is currently known about co-administration behaviors. The researchers found that the majority of studies have been qualitative, observational/descriptive or mixed method studies, with many focused on specific subpopulations of youth, males and African Americans. A systematic review of the studies suggests that co-administration of marijuana and tobacco may be associated with greater dependence, greater subjective effects and lowered perception of risk. However, experimental research is needed to directly compare smoking patterns for co-administered products to those of marijuana-only or tobacco-only users. Significant questions remain to be answered, such as: how much nicotine exposure do users get in co-administered products? Will non-tobacco using youth exposed to co-administered products develop nicotine addiction and tobacco use behaviors? Are health effects or addictive behaviors compounded by administering tobacco and marijuana together?
  • “Does Marijuana ‘Blunt’ Smoking Contribute to Nicotine Exposure? Preliminary Product Testing of Nicotine Content in Wrappers of Cigars Commonly Used for Blunt Smoking” has been accepted for publication in Drug and Alcohol Dependence. In this study, Battelle researchers Erica Peters, Gillian Schauer, Zachary Rosenberry and Wallace Pickworth quantified the nicotine content in the wrappers of cigar products commonly used for blunt smoking. The preliminary study was conducted in order to provide a basis for understanding the potential for nicotine exposure when using hollowed-out cigar wrappers to smoke marijuana. Five cigar products, including three large cigars and two cigarillos, were analyzed using gas chromatography/mass spectrometry to determine the concentration of nicotine in the wrappers. Wrappers for all five products contained quantifiable levels of nicotine, indicating that blunt smokers are likely to have some level of nicotine exposure even if all tobacco has been removed from the wrapper. This suggests that blunts could contribute to nicotine addiction among non-tobacco users. Further experimental studies are needed to examine the efficacy of nicotine delivery via blunt smoking and evaluate the contribution of blunt smoking to nicotine dependence.

Battelle has a long history of work in tobacco and nicotine exposure and addiction. The Battelle Public Health Center for Tobacco Research is nationally and internationally known for cutting-edge work with a wide variety of tobacco and nicotine products, including cigars and cigarettes, smokeless tobacco products, e-cigarettes, waterpipes and other emerging tobacco and nicotine delivery products. Marijuana products and co-administered products are a logical extension of this work.

Battelle researchers plan to extend this work with additional studies around the use of blunts and spliffs, and in particular the role of flavorings in influencing use behaviors. They recently completed a pilot study survey to determine how flavored tobaccos are being used in co-administered products. The study determined that flavored tobaccos are widely used in co-administration, especially wine and fruit flavors. However, additional research is needed to determine why users prefer flavored tobaccos, how often they use flavored tobaccos, and whether the availability of flavored tobaccos (especially sweet varieties) encourages greater product use or influences initiation of smoking behaviors in youth.

With marijuana legalized for medical or recreational use in more than half of all U.S. states, increased access and changing perceptions of risk are altering use behaviors among all age groups. Additional studies are urgently needed to guide public policy and educational outreach efforts related to marijuana use by itself and in co-administered products. The Battelle Public Health Center for Tobacco Research continues to lead the way in asking—and answering—critical questions around exposure risks and use behaviors for tobacco and marijuana, used together or separately.