CANNABIS use disorder was most common among U.S. adults using multiple or inhaled cannabis modes nationally.
Mode of cannabis use may be an important clinical marker for cannabis use disorder, according to a cross-sectional analysis of 2022 to 2023 National Survey on Drug Use and Health data. The study examined nationally representative data from adults aged 18 years or older who reported past-year cannabis use, representing an estimated 58.9 million U.S. adults.
With cannabis legalization, product diversification, and normalization expanding across the United States, the findings point to the need for clinicians to ask not only how often patients use cannabis, but how they use it. Routes examined included smoke-only, vape-only, oral or mucosal-only, dab-only, topicals-only, and multimodal use, defined as use of at least two modes.
Multimodal Cannabis Use Carried the Highest Risk
More than half of past-year cannabis users, 53.9%, reported multimodal cannabis use. Overall cannabis use disorder prevalence was 30.3%, but rates varied sharply by mode. Prevalence was lowest among adults reporting oral or mucosal-only use, at 4.4%, and highest among multimodal users, at 40.5%. Among adults reporting dab-only use, prevalence was 28.9%.
Moderate-to-severe cannabis use disorder affected 13.2% of all adults using cannabis and was concentrated among multimodal and dab-only users. After adjustment for demographic, behavioral, clinical, and policy-related factors, multimodal users had more than fourfold higher odds of past-year cannabis use disorder compared with oral or mucosal-only users. Smoke-only users also had elevated odds, as did vape or dab-only users.
The highest odds were seen among adults using smoke, vape, oral or mucosal, and dab modes together. This group had nearly 20-fold higher odds of cannabis use disorder compared with adults using oral or mucosal cannabis plus topicals.
Clinical Assessment Should Include Cannabis Mode
These findings suggest that cannabis use disorder assessment should extend beyond frequency and perceived risk to include mode of use and multimodal patterns. Inhaled routes and combined use modes may signal higher-risk patterns that warrant closer screening, counseling, and prevention strategies.
The authors concluded that mode of cannabis use appears statistically associated with both prevalence and severity of cannabis use disorder in U.S. adults.
Reference
Baral A et al. Associations between modes of cannabis use and cannabis use disorder: Evidence from the 2022 to 2023 United States National Survey on Drug Use and Health. Addiction. 2026;DOI:10.1111/add.70474.
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