Tobacco Consumption Decreases in States With Legal Cannabis

According to a new study, the legalization of cannabis is primarily associated with “mild, sometimes significant, long-term decreases in tobacco consumption among adults.”

The researchers found “consistent evidence” that the adoption of adult-use cannabis laws in U.S. states resulted in a slight increase in cannabis consumption among adults – between two and four percentage points, according to the data source – but tobacco did not follow this trend.

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Tobacco Consumption Would Save $10bn if Legal Cannabis Became Nationwide

If the apparent substitution effect from cigarettes to cannabis, induced by legalization, were extended nationwide, it could result in healthcare cost savings of over $10 billion per year, concludes the study.

“We find little empirical support for the hypothesis that recreational cannabis laws increase net tobacco consumption, as measured across a wide range of combustible tobacco products as well as [e-cigarettes],” they write. “The preponderance of evidence instead indicates mild, sometimes significant, long-term decreases in tobacco consumption among adults.

“We conclude that recreational cannabis laws can have beneficial effects on tobacco-related health.”

Legalization of Cannabis and Tobacco Consumption

The authors from Bentley University, San Diego State University, and Georgia State University published these findings in the Journal of Health Economics last month, calling the report the “first to comprehensively examine the impact of recreational cannabis legalization on smoking.” The study relies on federal data from the Population Assessment of Tobacco and Health (PATH) survey and the National Survey on Drug Use and Health (NSDUH).

While cannabis legalization enjoys massive support from Americans, the researchers write that “public health experts have taken a more cautious approach, calling for more research to assess the benefits and costs of cannabis consumption for health, as well as to understand the potentially unintended consequences on other health behaviors.”

Some Fear Re-Normalization of Smoking

Some fear that the reform may lead to a “renormalization” of smoking, potentially reversing nearly half a century of declining cigarette consumption.

Smoking rates have dramatically dropped since the first Surgeon General’s report in 1964, with smoking rates among adult men decreasing from 55% to 16% and smoking rates among women decreasing from 35% to 12%. “While the causes of these declines are subject to much debate,” the study acknowledges, “most public health experts seek to preserve the gains in health.”

Study Authors Note Small but Significant Three-Year Drop in Tobacco Consumption Rates

The authors of the new study acknowledge that their analysis of NSDUH data shows that legalization results in “a statistically (largely) insignificant decrease of 0.5 to 0.7 percentage points in tobacco consumption,” which includes cigarettes, pipe tobacco, smokeless tobacco, and cigars.

“However, this null effect masks small lagged effects of recreational cannabis laws on smoking. Three years or more after the adoption of legalization, we find that tobacco consumption among adults decreases by approximately 1.4 to 2.7 points.”

Regarding cigarette consumption specifically, they continue, “Again, while the overall treatment effect is relatively small […] three years or more after the adoption of legalization, we observe a statistically significant decrease of 1.1 to 1.3 percentage points in cigarette consumption among adults.”

Verification of Tobacco Consumption Observation

In order to verify this observation, the study also analyzed states that legalized cannabis earlier than others.

“The results confirm the hypothesis that smoking has decreased in several of the states that legalized cannabis earliest, including Colorado and the state of Washington, which are also the ones that experienced the greatest increase in cannabis consumption after the enactment of cannabis consumption legalization laws.”

Legalization “is associated with a delayed reduction in the use of electronic nicotine delivery systems (ENDS), which is consistent with the hypothesis that ENDS and cannabis are substitutes.”

The researchers indicated that the reduction in tobacco consumption in legal states is “primarily concentrated among men and for regulations accompanied by open recreational dispensaries,” findings that they consider “consistent with the hypothesis that recreational cannabis and tobacco can be substitutes for certain adults.”

The article notes that potential healthcare cost savings resulting from the substitution of cigarettes with cannabis “could be substantial.”

“Our estimates suggest a reduction in smoking prevalence by 5.1 million people, which would result in tobacco-related healthcare cost savings of approximately $10.2 billion per year,” concludes the article.

Unclear Whether Tobacco Consumption Decrease From Medical or Recreational Legalization

Given that most states that legalized cannabis adopted medical cannabis laws, the study emphasizes that it is possible that “the effects of recreational legalization are confounded with the long-term effects of medical legalization,” especially in light of the often lengthy delays between medical legalization and the start of legal sales in states.

The analyses of PATH data yielded similar conclusions. “Consistent with NSDUH, we find no evidence that the adoption of adult-use cannabis laws significantly increased the use of combustible tobacco or e-cigarettes in the past month,” the authors write.

“Although the estimated lagged effects are positive in most cases for cigarette, cigar, and all combustible tobacco product consumption, the effects are uniformly below one percentage point—often below 0.5 percentage points—and do not statistically differ from zero at conventional levels.”

No Evidence That Cannabis Legalization Increases Smoking

Furthermore, the study found “no evidence that the adoption of legalization significantly increases the initiation of tobacco products among non-established consumers or decreases smoking cessation among established consumers.”

However, legalization has been associated with an increase of 1.2 to 1.3 percentage points in concurrent tobacco and cannabis consumption, which the researchers primarily attribute to “cannabis initiation among the subpopulation of individuals who were already tobacco consumers prior to the policy change.”

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(Featured image by Reza Mehrad via Unsplash)

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