Is smoking cannabis with tobacco bad for you?

A deep rooted but not wholly innocuous practice

Dec. 11, 2019

Cannabis and tobacco have been used recreationally for thousands of years. We don’t know exactly when we started mixing cannabis and tobacco but smoking joints has become one of the most common ways to use cannabis. Both have controversial reputations due to links with a lot of - sometimes fatal - health issues2 and sometimes the information out there can be confusing.

Cannabis and tobacco

Debunking some myths

You can get addicted to cannabis, and of course tobacco too. Cannabis has been shown to be less addictive than tobacco, but mixing them together could make it even harder to quit either drug14. With cannabis you won’t typically become physically dependent like with nicotine in tobacco but you can become habitually addicted and go on to develop cannabis use disorder6.

Mixing cannabis with tobacco doesn’t increase the high from cannabis. Tobacco will do little more than add to the heart rate increase effect from cannabis5, which can be dangerous for people with fragile hearts and increases the likelihood of negative consequences for everyone18.

Why we mix cannabis and tobacco

Cannabis and tobacco are wide-reaching recreational drugs, they’re used throughout the world but in various different ways. Mixing cannabis and tobacco - a joint - seems to be a largely European habit, with 90% favouring joints over other methods7, whereas in North America vaping is the favourite (although this wasn’t always the case!).

The popularity of joints seems to stem from hash. Back in the 70s, hash was widespread in Europe, likely because it was much easier to smuggle than cannabis flowers (bud). However, hash can’t just be rolled up into a spliff (pure cannabis cigarettes), so people started rolling hash into cigarettes12.

In America bud was more easily accessible, probably due to a better-suited climate for growing higher THC cannabis. America never really took to mixing in tobacco because there never was a need. Most Americans smoke spliffs4 or use bongs, both of which work well with bud. That’s probably also why vaping took on so well there.

Potentially positive impacts

Surprisingly, some studies have shown tobacco to have a protective effect on the brain9, potentially reducing some of cannabis’s negative effects. Nicotine, the addictive chemical in tobacco, also helps sharpen the mind. This could partially explain why people continue to mix tobacco and cannabis despite knowing the consequences.

With medical cannabis legalisation fast-growing, it seems like cannabis’ protective effect8 is finally being acknowledged. From Alzheimer’s disease to Parkinson’s disease, anxiety to pain, our understanding of how cannabis can be used medically is always improving, leading to considerable changes in accessibility to medical cannabis too.

Definitely negative consequences

It’s widely known that smoking is bad for your health. When you heat something to such high temperatures, you change it. When you do this with cannabis and tobacco, a huge number of harmful chemicals and carcinogens are released.

Smoking tobacco kills more than 8 million people a year13. It can lead to many diseases that are life-limiting and eventually lead to death. They include heart disease, stroke, various types of cancer, and chronic obstructive pulmonary disorder. All of these conditions are preventable if you stop smoking in early adulthood and stopping smoking any time after that will reduce your risk11,15.

Cannabis and tobacco have a complicated relationship1 that makes it difficult to separate their associated harms. Smoking is definitely one of them. Awareness of its lethal reputation lead to change, creating healthier alternatives to smoking.

Is vaping healthier?

Vaping has become incredibly popular in both cannabis and tobacco smokers as it bypasses some of the risks related to smoking. However, we can’t forget that these are addictive substances. Vaping doesn’t take away all of their potential harm3.

There has been a recent spate of life-changing illnesses and deaths related to vaping, prompting many countries to tighten up laws and even ban e-cigarettes altogether16. In America, the CDC related this epidemic to vitamin E acetate. It’s added to THC- or nicotine- containing e-cigarettes and vaping products, usually as a thickening agent.

Harm reduction for cannabis and tobacco

Legalisation of cannabis also aims to promote using cannabis without tobacco. There’s a huge range of alternatives now; capsules, tinctures, sprays and many more. They avoid health conditions caused by smoking whilst still providing you with the potential benefits. And given the recent vaping epidemic, it’s important to highlight that you should always purchase any cannabis-based products from reliable retailers. Look for brands that are well-known, have reviews and are open about their ingredients.

As with any drug, you can reduce the risks in a variety of ways, but there is no method that is 100% safe. One thing you can do is educate yourself and those around you. Head over to our website to see the variety of guides, including cannabis and tobacco, which provide you with an in-depth but concise look at certain drugs, with an emphasis on harm reduction.

The work we do at Drugs and Me is mostly fuelled by volunteers (we’re always looking for helping hands!), so we rely heavily on your support. Why not become a patron or if you prefer, send us a one-off donation and help keep our vital work going. Liking and sharing us on social media also helps a lot!


Photo by GRAS GRÜN on Unsplash

  1. Hindocha C. Associations between cigarette smoking and cannabis dependence: A longitudinal study of young cannabis users in the United Kingdom. Drug And Alcohol Dependence [Internet]. 2015 [cited 10 December 2019];(148):165-171. Available from:

  2. Jones H, Gage S, Heron J. Association of Combined Patterns of Tobacco and Cannabis Use in Adolescence With Psychotic Experiences. JAMA Psychiatry [Internet]. 2018 [cited 10 December 2019];75(3):240. Available from:

  3. Tashkin D. How beneficial is vaping cannabis to respiratory health compared to smoking?. Addiction [Internet]. 2015 [cited 10 December 2019];110(11):1706-1707. Available from:

  4. A Strange Blend: Why Are Europeans Mixing Cannabis and Tobacco? - Volteface [Internet]. Volteface. 2019 [cited 2 December 2019]. Available from:

  5. Adding tobacco to cannabis doesn't affect the high, but impacts memory and heart [Internet]. UCL News. 2019 [cited 15 November 2019]. Available from:

  6. Patel J, Marwaha R. Cannabis Use Disorder [Internet]. 2019 [cited 28 November 2019]. Available from:

  7. GDS 2019 | Global Drug Survey [Internet]. 2019 [cited 19 November 2019]. Available from:

  8. Kumar R, Chambers W, Pertwee R. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia [Internet]. 2008 [cited 22 November 2019];56(11):1059-1068. Available from:

  9. Hindocha C, Freeman T, Xia J, Shaban N, Curran H. Acute memory and psychotomimetic effects of cannabis and tobacco both ‘joint’ and individually: a placebo-controlled trial. Psychological Medicine [Internet]. 2017 [cited 27 November 2019];47(15):2708-2719. Available from:

  10. Hambury M. Medical cannabis in the UK [Internet]. 2019 [cited 10 December 2019]. Available from:

  11. West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health [Internet]. 2017 [cited 10 December 2019];32(8):1018-1036. Available from:

  12. Booth, M. (2003). Cannabis: A History. London. Doubleday

  13. Tobacco [Internet]. World Health 2019 [cited 27 November 2019]. Available from:

  14. Hindocha C. No Smoke without Tobacco: A global overview of cannabis and tobacco routes of administration and their association with intention to quit. Front Psychiatry [Internet]. 2017 [cited 2 December 2019];(7):104. Available from:

  15. What are the health risks of smoking? [Internet]. 2019 [cited 2 December 2019]. Available from:

  16. Snaith E. What are the dangers of vaping? [Internet]. The Independent. 2019 [cited 2 December 2019]. Available from:

  17. Outbreak of Lung Injury associated with e-cigarette use, or vaping. [Internet]. Centers for Disease Control and Prevention. 2019 [cited 2 December 2019]. Available from:
  18. Ream G, Benoit E, Johnson B, Dunlap E. Smoking tobacco along with marijuana increases symptoms of cannabis dependence. Drug and Alcohol Dependence [Internet]. 2008 [cited 22 November 2019];95(3):199-208. Available from:

Return to blog