Cannabis and Nicotine Co-Use Among Youth Is Rising
THC and nicotine, increasingly combined, present new addiction and mental health risks.
By Mark S Gold M.D.
Published by Psychology Today on June 11, 2026
Key points
• Cannabis–nicotine co-use is increasingly driven by vaping devices and nicotine pouches rather than cigarettes.
• Perceived risks of cannabis continue their decline even as perceived harms of tobacco continue to rise.
• Nicotine and cannabis reinforce one another through shared brain reward pathways, increasing dependence risk.
• Modern nicotine delivery systems and changing norms have made THC–nicotine co-use common but mostly invisible.
Cigarette smoking among American adolescents has fallen to historic lows, representing one of the most significant public health successes of recent decades. Yet nicotine exposure has not disappeared; it has simply changed form. Today, many youth encounter nicotine through alternative products such as e-cigarettes and nicotine pouches, which supply nicotine orally without requiring the constant spitting associated with traditional smokeless tobacco. While these products may reduce many harms associated with combustible cigarettes, they can still lead to chronic nicotine dependence.
