Determining the impact of cannabis use and severity on tobacco cessation outcomes: A prospective tobacco treatment trial

项目概要/摘要 在过去的几十年里，美国的烟草使用率一直在稳步下降， 尽管烟草造成的负担仍然是惊人的。烟草使用率不成比例地 在同时患有药物使用障碍和精神疾病的人中， 一般人口。特别是，烟草使用者共同使用大麻极为普遍， 美国成年人中的共同使用似乎正在增加，这与大麻的总体增长一致 美国成年人的使用率。鉴于目前的大麻形势，大麻使用有可能进一步增加。 并可能导致大麻和烟草同时使用的持续增加。尽管共同使用的比率很高， 关于这一人群的治疗建议和对 共同使用对成功戒烟的影响。关于大麻对戒烟影响的文献 具体而言，成果好坏参半，充满局限性，包括方法上的差异，缺乏 生物化学核查，以确认大麻使用状况和严重程度，以及研究样本的变化。 目前，尚未进行前瞻性研究来评估大麻使用对烟草的影响 停止此外，没有研究收集烟草治疗期间大麻使用的变化，以评估 减少、禁欲或更大的关注，补偿性（即，增加）由于烟草的使用 减少/禁欲。本申请是一项为期12周的前瞻性戒烟试验， 建立戒烟试验的典型方法和结果，但特别是招募 大麻将对共同使用者进行过采样（2：1），并将其与仅吸烟的受试者进行比较。所有 参与者（年龄18-40岁; N=172）将接受主动戒烟治疗（伐尼克兰，应急 管理和心理咨询）12周，而大麻的使用不会特别 处理。烟草和大麻使用的生化核查将在整个12周内收集 除了通过移动的每日日记自我报告使用情况外，这项拟议研究的目的是： 1)研究大麻共同使用对共同使用者戒烟结果的影响， 在大麻共同使用者中，评估大麻使用期间的变化， 烟草治疗（目标#2），和3）评估大麻共同使用严重程度的剂量依赖性影响 戒烟（探索性目标#1）。这项拟议应用的结果有可能影响 治疗同时使用大麻的人的烟草使用障碍，并将有助于 对供应商的治疗建议。随着大麻使用率的不断增加， 戒烟试验中的使用者和临床护理中的使用者将继续常见， 这项研究将有助于指导他们的治疗，并为他们提供长期禁欲的最佳机会。

PROJECT SUMMARY/ABSTRACT Tobacco use rates in the United States (US) have been steadily declining over the past several decades, though the burden resulting from tobacco continues to be staggering. Tobacco use rates are disproportionately high among those with co-occurring substance use disorders and psychiatric conditions compared to the general population. In particular, cannabis co-use among tobacco users is exceedingly common and rates of co-use appear to be increasing among adults in the US, which is consistent with overall increases in cannabis use rates among US adults. Given the current cannabis landscape, further increases in cannabis use are likely and may result in continued increases in the co-use of cannabis and tobacco. Despite high rates of co-use, there is little consensus regarding treatment recommendations for this population and an understanding of the impact of co-use on successful cessation. The literature on the impact of cannabis on tobacco cessation outcomes specifically has been mixed and fraught with limitations, including methodological variation, lack of biochemical verification to confirm cannabis use status and severity, and variations in study samples. Currently, no prospective studies have been conducted to evaluate the impact of cannabis use on tobacco cessation. Further, no studies have collected cannabis use changes during tobacco treatment to assess for reductions, abstinence, or of greater concern, compensatory (i.e., increased) use as a result of tobacco reduction/abstinence. This proposed application is a prospective 12-week tobacco cessation trial using established methods and outcomes typical of tobacco cessation trials, but specifically recruiting co-users of cannabis. Co-users will be oversampled (2:1) and will be compared to tobacco only participants. All participants (ages 18-40; N=172) will receive active tobacco cessation treatment (varenicline, contingency management, and psychosocial counseling) for 12 weeks, while cannabis use will not be specifically addressed. Biochemical verification of tobacco and cannabis use will be collected throughout the 12-week treatment, in addition to self-reports of use through mobile daily dairies. The aims of this proposed study are to; 1) examine the impact of cannabis co-use on tobacco cessation outcomes among co-users compared to tobacco only participants (Aim #1), 2) among cannabis co-users, assess changes in cannabis use during tobacco treatment (Aim #2), and 3) assess for a dose-dependent impact of cannabis co-use severity on tobacco cessation (Exploratory Aim #1). The results from this proposed application have the potential to impact the treatment of tobacco use disorder among those concurrently using cannabis and will contribute to treatment recommendations for providers. As cannabis use rates continue to increase, the presence of co- users in tobacco cessation trials and presenting in clinical care will continue to be common and results from this study will help to guide their treatment and provide them with the best chances of long-term abstinence.