Multiple Cannabis Methods Linked to Increased Health Risks in Youth

The ways cannabis is consumed, or modes of use, have increased and diversified in recent years, especially among young people. Associations of multimodal cannabis use (1, 2, or 3+ modes) with adverse events were examined among adolescents and young adults. Data from the 2022-2023 National Survey of Drug Use and Health, including non-institutionalized US civilians aged 12-25 reporting past-year cannabis use (n=13,284), were used. Cannabis users were asked about the type (smoking, vaping, dabbing, eating/drinking, and other) and number of cannabis modes used in the past year. Multivariable-adjusted analyses assessed associations of number of modes with adverse events, adjusted for sociodemographic characteristics and frequency of use. Among 51,435 individuals (45.8% adolescents, 51.0% female, 48.1% non-Hispanic white), 13,284 (26.1%) reported past-year cannabis use. Individuals more frequently used 3+ modes (37.5%) than one (34.0%) or two (28.5%), with the most common being smoking (83.9%) followed by vaping (53.3%), eating/drinking (47.6%), and dabbing (27.3%). Individuals using 3+ modes were significantly more likely than single mode users to meet criteria for past-year moderate/severe cannabis use disorder (adjusted odds ratio [aOR], 5.00 [95% confidence interval, 3.99-6.27]), other substance use disorders (aOR, 4.43 [3.59-5.47]), severe mental illness (aOR, 2.18 [1.71-2.78]), major depressive episode (aOR, 2.04 [1.74-2.40]), suicidal thoughts (aOR, 1.80 [1.45-2.23]) and attempts (aOR, 1.70 [1.10-2.61]), poor academic performance (aOR, 1.78 [1.06-2.99]), and delinquent behaviors, especially impaired driving (aOR, 4.92 [4.07-5.94]). With the exception of suicide attempts and academic performance, all associations remained significant after adjusting for frequency of use. Findings highlight a graded association between number of cannabis modes of use and adverse events. This association was independent of cannabis use frequency. In the context of increasing diversification of cannabis products, screening for number of modes of use may help identify young people at greater risk of cannabis-related harms.