Nicotine-containing E-cigarette Cessation Unaffected by Cannabis Co-use Among Youth

Laboratory research suggests that nicotine and tetrahydrocannabinol (THC) may enhance one another’s rewarding and dependence-related effects, raising concerns that cannabis use could interfere with nicotine cessation attempts. To clarify these relationships clinically among youth with nicotine-containing e-cigarette use, investigators conducted a secondary analysis of a single-site randomized controlled trial involving 261 participants aged 16–25 years. Participants were assigned to: 1) varenicline plus counseling; or 2) placebo plus counseling; or 3) enhanced usual care. At 12 weeks, nicotine-containing e-cigarette abstinence was assessed via self-report and verified with salivary cotinine testing. Investigators evaluated whether cannabis use frequency or cannabis use disorder (CUD) symptom severity affected nicotine cessation outcomes, and whether cannabis use moderated treatment effects of varenicline on nicotine vaping cessation.

• At baseline, 28 percent of participants reported no past-month cannabis use, 38 percent reported cannabis use more than 0 days and less than 4 days per week, and 30 percent reported cannabis use 4–7 days per week.
• Cannabis use frequency was not significantly associated with nicotine abstinence, nor did it affect varenicline’s effectiveness for nicotine cessation.
• CUD symptom severity was not associated with nicotine abstinence, nor did it affect varenicline’s effectiveness for nicotine vaping cessation.

Comments: These findings indicate that cannabis and nicotine co-use does not hinder nicotine cessation among youth, nor does it reduce the therapeutic benefits of varenicline. These results support offering patients standard nicotine cessation treatments—including varenicline—regardless of cannabis use.

Susan L. Calcaterra, MD, MPH, MS

Reference: Gilman JM, Cather C, Reeder HT, et al. Cannabis use and nicotine vaping cessation outcomes: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2025;8(12):e2547799.