Rabin Rachel A, Lerman Caryn, Schnoll Robert, Tyndale Rachel F, George Tony P
Department of Psychiatry, McGill University, Montreal, Quebec and Douglas Mental Health University Institute, Montreal, Quebec, Canada.
Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, CA, USA.
Drug Alcohol Depend. 2025 Sep 1;274:112778. doi: 10.1016/j.drugalcdep.2025.112778. Epub 2025 Jul 3.
Approximately 30 % of people who use tobacco also use cannabis, and rates of co-use are rising. Relative to people who use tobacco alone (TO), individuals who co-use tobacco and cannabis (TC) experience greater difficulty with tobacco cessation, yet mechanisms underlying this phenomenon remain unexplored. Leveraging data from a multi-site, double-blind clinical trial for tobacco cessation, we compared the trajectory of tobacco withdrawal, a strong predictor of relapse, between TC and TO during 11-weeks of tobacco treatment.
People seeking treatment for tobacco were randomized to one of three arms (placebo, nicotine patch or varenicline) and followed for 11-weeks. Participants were parsed according to their cannabis use status determined by a cannabis-positive urine toxicology at screen (N = 1246). We selected participants with end-of-treatment biochemically verified 7-day point prevalence tobacco abstinence (N = 330; TC, n = 55 and TO, n = 275) and examined group differences in tobacco withdrawal severity using the Minnesota Nicotine Withdrawal Scale (MNWS) at baseline, week 1, 4, 8, and week 11 (end-of-treatment).
Controlling for age, treatment arm, and site, we found a significant interaction (group x time) effect for withdrawal severity (p < 0.01). Bonferroni-corrected post-hoc comparisons revealed that relative to TO, TC had elevated withdrawal scores at week 1 (TC, M=9.3 ± 5.5; TO, M=7.1 ± 5.6; p < 0.01); no other timepoints showed between-group differences.
People who co-use experience greater tobacco withdrawal severity one-week post abstinence compared to people who only use tobacco. Personalized interventions that target immediate tobacco withdrawal and/or cannabis use may help improve tobacco cessation rates for people who co-use both substances.
约30%的烟草使用者也使用大麻，且同时使用这两种物质的比例正在上升。相对于仅使用烟草的人（TO），同时使用烟草和大麻的人（TC）在戒烟方面面临更大困难，但这一现象背后的机制仍未得到探索。利用一项多中心、双盲戒烟临床试验的数据，我们比较了在为期11周的烟草治疗期间，TC组和TO组之间烟草戒断的轨迹，而烟草戒断是复发的一个强有力预测指标。
寻求烟草治疗的人被随机分配到三个组之一（安慰剂组、尼古丁贴片组或伐尼克兰组），并随访11周。根据筛查时大麻阳性尿液毒理学检测确定的大麻使用状况对参与者进行分类（N = 1246）。我们选择了治疗结束时经生化验证的7天时间点流行率戒烟者（N = 330；TC组，n = 55；TO组，n = 275），并在基线、第1周、第4周、第8周和第11周（治疗结束时）使用明尼苏达尼古丁戒断量表（MNWS）检查两组在烟草戒断严重程度上的差异。
在控制年龄、治疗组和研究地点后，我们发现戒断严重程度存在显著的交互作用（组×时间）效应（p < 0.01）。经Bonferroni校正的事后比较显示，相对于TO组，TC组在第1周的戒断得分更高（TC组，M = 9.3 ± 5.5；TO组，M = 7.1 ± 5.6；p < 0.01）；其他时间点两组之间均未显示出差异。
与仅使用烟草的人相比，同时使用烟草和大麻的人在戒烟一周后烟草戒断严重程度更高。针对即刻烟草戒断和/或大麻使用的个性化干预措施可能有助于提高同时使用这两种物质的人的戒烟率。
