Skip to content
DraconiticResearch
Search Sources API
197,785 studies31 sourcesUpdated 17 min ago
PreprintCC BY-NC-NDmedRxiv

Nicotine and Cannabis Co-Use are Associated with Higher Symptom Burden than Use of Either Drug Alone in Early Psychosis: Results from a Multisite Study

  • J. Smucny
  • E. M. Campbell
  • K. M. Pierce
  • H. B. Ward
  • C. S. Carter
  • T. A. Niendam
  • T. A. Lesh1
  1. 1University of California Davis
Read full textPDFDOICite

Abstract

Background: Despite their high usage rates and associations with risk for psychosis and earlier age of symptom onset, few studies have examined relationships between nicotine and cannabis co-use and symptoms. Here we examined associations between symptom burden and cannabis/nicotine use/co-use in individuals with early psychosis (EP). Methods: This cross-sectional, multisite cohort study used data from 738 individuals (mean age 22 years, 62% male) from the Early Psychosis Intervention Network (EPI-NET). Relationships between cannabis and/or nicotine use and frequency (over the prior 30 day period) and Modified Colorado Symptom Index (MCSI) scores were examined using mixed effects models, with site as a random factor and age, sex, and cannabis/nicotine use (none, nicotine only, cannabis only, or both) as fixed factors. Exploratory analyses also examined effects of frequency of use (daily vs. less than daily). Results: 59% of the sample used neither nicotine nor cannabis, 17% only nicotine, 9% only cannabis, and 16% both. Significant effects of use were observed on total MCSI score (F = 6.69, p < .001) driven by greater symptoms in individuals who used both cannabis and nicotine relative to neither, only nicotine, or only cannabis. More frequent use, furthermore, was associated with higher total score. Conclusions: These results suggest that co-use of cannabis and nicotine is associated with greater symptom burden in EP, which may have implications for treatment strategies. Neuropharmacological mechanisms that may underlie this association are discussed.

Related

  1. Use of Alcohol and Nicotine in the Context of cannabis Legalization: Considerations from a German Perspective.
    Jakob Manthey, Daniel Kotz
    Nordisk alkohol- & narkotikatidskrift : NATPeer-reviewedCC BY-NCFull textEpidemiology & public healthEurope PMCPMC
  2. White matter signatures of addiction diverge across opioids, cannabis and nicotine and predict impulsive choice in cannabis dependence
    Richard O. Nkrumah, Lea Wetzel, Justin Böhmer +6
    Translational PsychiatryPeer-reviewedCC BY 4.0Full textMedical imaging & radiologyCrossref
  3. Unequal Burden: Sex Differences in Cannabis Withdrawal Symptom Severity in People With Multiple Sclerosis—A Short Report
    Cecilia Meza, Anthony Feinstein
    International Journal of MS CarePeer-reviewedLicence not statedFull textPharmacology & toxicologyPMC
  4. Cannabis use and duration of untreated psychosis: a systematic review of clinical predictors and neurobiological correlates
    Valerio Ricci, Stefania Chiappini, Giovanni Martinotti +1
    Frontiers in PsychiatryPeer-reviewedCC BY 4.0Psychiatry & mental healthCrossref
  5. Persistent Amotivation After Cannabis-Related Psychosis: Diagnostic Challenges and Clinical Course With Electroconvulsive Therapy: A Case Report.
    Yukina Kitano, Ryohei Takada, Minobu Ikehara +3
    Neuropsychopharmacology reportsPeer-reviewedCC BYFull textPsychiatry & mental healthEurope PMCPMC

Cite

BibTeXRIS
BibTeX
@misc{smucny2026nicotine,
  title = {{Nicotine and Cannabis Co-Use are Associated with Higher Symptom Burden than Use of Either Drug Alone in Early Psychosis: Results from a Multisite Study}},
  author = {J. Smucny and E. M. Campbell and K. M. Pierce and H. B. Ward and C. S. Carter and T. A. Niendam and T. A. Lesh},
  howpublished = {medRxiv},
  year = {2026},
  month = nov,
  doi = {10.64898/2026.11.03.26367232},
  url = {https://www.medrxiv.org/content/10.64898/2026.11.03.26367232v1},
  note = {CC BY-NC-ND},
}
RIS
TY  - UNPB
TI  - Nicotine and Cannabis Co-Use are Associated with Higher Symptom Burden than Use of Either Drug Alone in Early Psychosis: Results from a Multisite Study
AU  - J. Smucny
AU  - E. M. Campbell
AU  - K. M. Pierce
AU  - H. B. Ward
AU  - C. S. Carter
AU  - T. A. Niendam
AU  - T. A. Lesh
PY  - 2026
DA  - 2026/11/03
PB  - medRxiv
DO  - 10.64898/2026.11.03.26367232
UR  - https://www.medrxiv.org/content/10.64898/2026.11.03.26367232v1
AB  - Background: Despite their high usage rates and associations with risk for psychosis and earlier age of symptom onset, few studies have examined relationships between nicotine and cannabis co-use and symptoms. Here we examined associations between symptom burden and cannabis/nicotine use/co-use in individuals with early psychosis (EP). Methods: This cross-sectional, multisite cohort study used data from 738 individuals (mean age 22 years, 62% male) from the Early Psychosis Intervention Network (EPI-NET). Relationships between cannabis and/or nicotine use and frequency (over the prior 30 day period) and Modified Colorado Symptom Index (MCSI) scores were examined using mixed effects models, with site as a random factor and age, sex, and cannabis/nicotine use (none, nicotine only, cannabis only, or both) as fixed factors. Exploratory analyses also examined effects of frequency of use (daily vs. less than daily). Results: 59% of the sample used neither nicotine nor cannabis, 17% only nicotine, 9% only cannabis, and 16% both. Significant effects of use were observed on total MCSI score (F = 6.69, p < .001) driven by greater symptoms in individuals who used both cannabis and nicotine relative to neither, only nicotine, or only cannabis. More frequent use, furthermore, was associated with higher total score. Conclusions: These results suggest that co-use of cannabis and nicotine is associated with greater symptom burden in EP, which may have implications for treatment strategies. Neuropharmacological mechanisms that may underlie this association are discussed.
ER  -