Method of Use Matters: Cannabis Product Type and Polysubstance Use Among Adult Cannabis Users.

Moscrop-Blake K.; Leal W. · Substance use & misuse · 2026

**Background & Methods** This review examined associations between cannabis product types and polysubstance use among adult cannabis users using data from the 2023 National Survey of Drug Use and Health (NSDUH), a large nationally representative sample. The study analyzed eight distinct forms of cannabis use (smoking, vaping, eating/drinking, dabbing, drops/lozenges, topical, pills, other) and created a cannabis modality variety scale to assess relationships with concurrent use of additional substances including cigarettes, alcohol, cocaine, heroin, methamphetamine, inhalants, hallucinogens, and ecstasy. **Key Findings** • Different cannabis product types demonstrate differential associations with polysubstance use patterns, suggesting that method of cannabis consumption significantly influences likelihood of concurrent substance use with other drugs and alcohol. • Cannabis modality variety—using multiple cannabis product types—was consistently and positively associated with both increased polysubstance use and higher levels of polysubstance engagement across all measured substances. • The findings reveal meaningful heterogeneity among cannabis users based on product type and consumption modality, indicating that cannabis users are not a homogeneous population and risk profiles vary substantially depending on consumption methods employed. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** As a review study utilizing cross-sectional NSDUH data, this research provides observational evidence rather than causal inference. Key limitations include the inability to establish temporal relationships or causality between cannabis product type and polysubstance use patterns. The reliance on self-reported substance use data may introduce recall bias and social desirability bias. Additionally, the study cannot determine whether specific cannabis products directly facilitate other substance use or whether individuals with higher substance use propensity simply select multiple consumption methods. The cross-sectional design prevents assessment of whether polysubstance users gravitate toward multiple cannabis modalities or whether multimodal cannabis use leads to polysubstance engagement. Despite these limitations, the large nationally representative sample and systematic examination of eight cannabis product types provide valuable epidemiological insight into cannabis user heterogeneity in the post-legalization context.

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