A new national study suggests that the way people consume cannabis may reveal important clues about their likelihood of using it heavily or developing an addiction. While smoking remains the most popular method among US adults who use cannabis, roughly one in seven consumes it in nearly every available form. Researchers found that this group had particularly high rates of daily use and cannabis use disorder.
Cannabis is consumed in several ways, including smoking, vaping, eating edibles, and dabbing, which involves heating concentrated cannabis products and inhaling the resulting vapor. Its use is widespread in the United States. Recent national survey figures indicate that approximately 43.8 million Americans ages 12 and older (more than 15 percent) had consumed cannabis within the previous 30 days.
Researchers at NYU Langone Health identified four distinct patterns of cannabis consumption. Nearly half of users, 48 percent, primarily smoked cannabis, while 21 percent combined smoking and vaping. Another 17 percent mainly consumed edibles. The remaining 14 percent belonged to what researchers called the “polymodal group,” meaning they used cannabis in almost every available form.
Cannabis Addiction Rates Differ Sharply by Consumption Pattern
The findings, published online August 8 in the journal Addictive Behaviors, revealed major differences in how frequently these groups consumed cannabis. Approximately half of people in the polymodal group reported using it every day. Daily use was considerably less common among other participants, occurring in 28 percent of those who primarily smoked, 31 percent of those who smoked and vaped, and about 13 percent of those who mainly consumed edibles.
An even more striking difference emerged when researchers examined cannabis use disorder, the medical diagnosis associated with cannabis addiction. About 67 percent of polymodal users met the criteria for the disorder, compared with 47 percent of those who both smoked and vaped, 36 percent of those who mainly smoked, and just 15 percent of participants who primarily used edibles.
“Our findings suggest that using cannabis in multiple forms may be a red flag for heavier use and symptoms of addiction,” said study lead author Omar El-Shahawy, MD, PhD, MPH, an assistant professor in the Department of Population Health at NYU Grossman School of Medicine. “Asking patients not only whether but how they use cannabis could help clinicians identify when a fuller assessment may be warranted.”
To investigate these patterns, the research team examined responses from 17,732 adults who had used cannabis during the preceding month. The information came from the 2022-2023 National Survey on Drug Use and Health. Using statistical methods to identify similarities in participants’ consumption habits, the researchers conducted the first national analysis of how different methods of cannabis use naturally group together.
Younger Adults More Likely to Use Multiple Forms of Cannabis
The researchers also discovered notable differences in the characteristics of people who preferred particular consumption methods. Young adults ages 18 to 25 accounted for nearly one-third of both the smoking and vaping group and the polymodal group. In contrast, only about one sixth of participants who primarily smoked cannabis belonged to that age range.
Edibles showed a different demographic pattern. Women made up more than half of those who mainly consumed edible cannabis products, and this method was particularly common among college graduates. However, the study did not investigate what motivated participants to choose specific consumption methods, leaving the reasons for these differences unresolved, according to Dr. El-Shahawy.
Another finding raised concerns about the potential effects of inhaling smoke. People who smoked cannabis were more likely to also smoke cigarettes than those who mainly vaped cannabis or consumed edibles. Because both tobacco and cannabis smoking involve combustion (burning), people who regularly smoke both substances may expose their lungs to additional harmful chemicals.
“The strong tie between smoking cannabis and smoking cigarettes is of concern because this subset of people are breathing in a wider range of chemicals via combustion, and their lungs are at risk,” said senior author Joseph J. Palamar, PhD, MPH, a professor in the Department of Population Health at NYU Grossman School of Medicine.
Why Cannabis Prevention Messages May Need to Change
The findings suggest that health education should account for the different ways people consume cannabis rather than concentrating primarily on smoking. Different consumption patterns may call for different approaches to explaining potential risks, particularly among younger adults and people who regularly combine several methods.
“Public health messages about cannabis still focus mostly on smoking, but people now use the drug in many different ways,” said Dr. El-Shahawy. “For younger adults, that means talking about the risks of vaping and combining multiple forms, while for people who prefer edibles, the message is to ‘start low and go slow’ because the effects take time to kick in.”
The researchers hope to investigate the motivations behind these consumption patterns in future work. According to Dr. El-Shahawy, one question is whether people who favor edibles are more likely to use cannabis to manage problems such as pain or difficulty sleeping.
The team also emphasized several limitations. Because participants described their own cannabis habits, some may not have reported their consumption accurately or completely. The observational study also cannot determine whether using multiple forms of cannabis directly increases addiction risk. It establishes an association between consumption patterns and cannabis use disorder, rather than proving that one causes the other.
The research received funding from the National Institutes of Health through grant R01DA055675.
Additional NYU Langone researchers who contributed to the study included Mohsen Abbasi-Kangevari, MD, MPH; Michelle He; and Xiaoying Zheng, alongside Drs. El-Shahawy and Palamar. Neal Doran, PhD, of the University of California, San Diego, also served as a study co-investigator.
