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Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey
  1. Brian Vincent Fix1,
  2. Danielle Smith1,
  3. Richard O’Connor1,
  4. Bryan W Heckman2,
  5. Marc C Willemsen3,4,
  6. Michael Cummings2,
  7. Geoffrey Fong5,6
  1. 1 Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  2. 2 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3 STIVORO, The Hague, The Netherlands
  4. 4 Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
  5. 5 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  6. 6 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  1. Correspondence to Dr Brian Vincent Fix; brian.fix{at}


Objectives Existing evidence shows that co-occurring use of tobacco and cannabis is widespread. Patterns of co-use of tobacco and cannabis may change as more jurisdictions legalise medicinal and/or recreational cannabis sales. This analysis examined predictors of current cannabis use and characterised methods of consumption among smokers and non-smokers in a context where cannabis use is legal.

Setting The 2015 International Tobacco Control Netherlands—Gold Magic Survey conducted between July and August 2015.

Participants Participants (n=1599; 1003 current smokers, 283 former smokers and 390 non-smokers) were asked to report their current (past 30-day) use of cigarettes and cannabis. Cigarette smokers reported whether they primarily used factory made of roll-your-own cigarettes. Those who reported any cannabis use in the last 30 days were asked about forms of cannabis used. X2and logistic regression analyses were used to assess relationships among combustible tobacco and cannabis use.

Results Past 30-day cannabis use was somewhat higher among current tobacco (or cigarette) smokers (n=57/987=5.8%) than among former or never smokers (n=10/288=3.5% and n=6/316=1.9%, respectively). Joints were the most commonly used form of cannabis use for both current cigarette smokers (96.9%) and non-smokers (76.5%). Among those who smoked cannabis joints, 95% current smokers and 67% of non-smokers reported that they ‘always’ roll cannabis with tobacco.

Conclusions In this Netherlands-based sample, most cannabis was reported to be consumed via smoking joints, most often mixed with tobacco. This behaviour may present unique health concerns for non-cigarette smoking cannabis users, since tobacco use could lead to nicotine dependence. Moreover, many non-cigarette smoking cannabis users appear to be misclassified as to their actual tobacco/nicotine exposure.

  • public health
  • tobacco
  • cannabis

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  • Contributors KMC, RJO, MCW, GTF: conception and design of the work and acquisition of data. BVF, DS, RJO, BWH, MCW, KMC, GF: analysis and interpretation of the data. BVF, DMS, RJO, BWH, MCW, KMC, GF: drafting the manuscript and revising it critically for content. All authors have granted final approval for the work published in this manuscript.

  • Funding The study examining consumer interest in using a very low nicotine cigarette was supported by a supplemental grant from the US National Cancer Institute (P01CA138389-06S2). Additional support was provided to Geoffrey T. Fong from a Senior Investigator Award from the Ontario Institute for Cancer Research and from a Foundation Grant from the Canadian Institutes of Health Research (FDN-148477). Dr Heckman was supported by NIDA (K12 DA031794 and K23 DA041616).

  • Competing interests KMC has received consulting fees and grant support from Pfizer for his work in smoking cessation. He has also received fees as a paid expert witness in litigation filed against cigarette manufacturers.

  • Ethics approval University of Waterloo.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional study data is available.

  • Patient consent for publication Not required.

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