BUFFALO, N.Y. – The cannabis marketplace continues to grow and evolve, offering consumers new ways to use cannabis — and new ways to combine it with other substances, such as alcohol. That practice can be particularly detrimental to adolescents, who are known to use both substances in high numbers.
And when it comes to cannabis use and binge drinking among high school seniors, modality matters, according to new research from the University at Buffalo finding that differing modes of cannabis consumption may be associated with risky alcohol use behaviors in this population.
The study is among the first to evaluate modes of cannabis use on binge drinking outcomes among U.S. 12th graders. Researchers sought to first assess modes of cannabis administration among 12th grade students. The next objective was to understand the association between different methods of cannabis use, such as smoking, vaping or consuming via edibles, and multi-modal cannabis use — the use of two or more cannabis products — with binge drinking outcomes over the previous two weeks.
Published last month in Substance Use & Misuse , the study leveraged 2018-2021 data from a nationally representative sample of high school seniors who completed surveys as part of Monitoring the Future, an ongoing study of the behaviors, attitudes and values of Americans from adolescence through adulthood.
It's not just the ways cannabis can be consumed that's increasing, largely due to the greater availability of vaped and edible cannabis products. The use of two or more cannabis products among U.S. 12th graders is also on the rise.
"Different ways of using cannabis matters. Students who smoke, vape or dab cannabis are more likely to binge drink compared to those who don't use or use other modes of cannabis," says study first author Michelle Goulette, who obtained her PhD in community health and health behavior from UB's School of Public Health and Health Professions this fall.
"Additionally, using more than one mode increases the risk of binge drinking. Students who use at least two or more modes of cannabis administration are at an increased risk for engaging in recent binge drinking," adds Goulette, who conducted the research during her PhD program.
Goulette wanted to study cannabis use risks following New York State's legalization of recreational cannabis in 2021.
"I wanted to study the risks associated with use as they are often overlooked. People may not know that there are different levels of risk associated with cannabis use depending on the way that it is administered," she says.
Among survey participants, nearly 31% reported using cannabis within the previous year. At 87%, smoking was the most reported method of cannabis use, followed by edible consumption (49%) and vaping (45%). In addition, the majority of cannabis users, or 65%, reported multi-modal cannabis use, which means they used at least two or more different ways of consuming cannabis.
Smoking, vaping and dabbing — the process of vaporizing highly potent cannabis concentrates at extremely high temperatures — all were associated with any past two-week binge drinking occurrence.
"What surprised me was that edible forms of cannabis were not associated with binge drinking," Goulette says. "I initially thought that drinkable cannabis products might be linked to the higher use of alcohol. I was surprised when it was only associated with combustible modes of cannabis. This could be from the high levels of THC that are often found within these drinkable products, but I can't say for certain as I did not assess THC levels."
Advertising might provide one explanation for the increase in the prevalence of cannabis product use. Goulette and her colleagues cited previous research that found that cannabis advertisement exposure was highest among U.S. adolescents compared to any other age group.
The researchers conclude that cannabis use methods need to be evaluated more frequently among adolescents to better understand the risks associated with different cannabis products and that tighter regulation should be considered if certain products are found to have more risks compared to others.
"We know that new forms of cannabis enter the market every day and vary between states due to cannabis legislation. If certain modes of cannabis are associated with an increased risk of binge drinking in adolescents, we should educate adolescents on what those modes are," Goulette says. "There are both benefits and risks to cannabis use, and providing clear education about these distinctions can help guide adolescents toward safer choices."
Co-authors on the paper are Alison Haney, PhD, assistant professor; Gregory Homish, PhD, chair and professor; and Jessica Kulak, PhD, clinical associate professor, all of the UB Department of Community Health and Health Behavior.
