How people consume cannabis may signal risk for heavy use and addiction
NYU Langone Health / NYU Grossman School of Medicine
Nearly half of adults in the United States who use cannabis mainly smoke it, but about 1 in 7 use it in nearly every form available, a behavior tied to daily cannabis use and increased addiction risk, a new study shows.
Cannabis can be consumed through smoking, vaping, eating, or dabbing, a practice in which people heat cannabis concentrates and inhale the vapor. According to recent national survey data, about 43.8 million people in the US ages 12 and older (more than 15 percent) had used cannabis in the past 30 days.
Led by NYU Langone Health researchers, the study showed that 48 percent mainly smoked, 21 percent both smoked and vaped, 17 percent mainly used edibles, and 14 percent, the “polymodal group,” used cannabis in nearly every form.
Published online August 8 in the journal Addictive Behaviors, the work showed that about half of the polymodal group used cannabis every day. By comparison, 28 percent of those who mostly smoked, 31 percent of those who smoked and vaped, and about 13 percent of those who mostly ate edibles used cannabis every day. Cannabis use disorder, the clinical term for related addiction, followed the same pattern, affecting about 67 percent of polymodal users versus 36 percent of those who primarily smoked, 47 percent of those who smoked and vaped, and 15 percent of those who mainly consumed edibles.
“Our findings suggest that using cannabis in multiple forms may be a red flag for heavier use and symptoms of addiction,” said study lead author Omar El-Shahawy, MD, PhD, MPH, an assistant professor in the Department of Population Health at NYU Grossman School of Medicine. “Asking patients not only whether but how they use cannabis could help clinicians identify when a fuller assessment may be warranted.”
In the first national study to examine how these methods naturally cluster, the researchers analyzed data from 17,732 adults who reported using cannabis in the past month on the 2022–2023 National Survey on Drug Use and Health. The authors used a statistical approach that grouped participants based on their reported patterns.
The results also revealed that types of cannabis users varied demographically. Nearly 1 in 3 people in the smoking-and-vaping and polymodal groups were young adults ages 18 to 25, compared with about 1 in 6 of those who mainly smoked. More than half of the edibles group were women, and edibles were especially prevalent among college graduates. Since the researchers did not examine why participants chose particular methods of cannabis use, the reason behind these patterns remains uncertain, said Dr. El-Shahawy.
Another key finding was that people who smoked cannabis were more likely to also smoke cigarettes, compared with those who mainly vaped or used edibles. Both cigarette and cannabis smoke involve combustion (burning), which can be hard on the lungs, so doing both may add to their overall health risks.
“The strong tie between smoking cannabis and smoking cigarettes is of concern because this subset of people are breathing in a wider range of chemicals via combustion, and their lungs are at risk,” said senior author Joseph J. Palamar, PhD, MPH, a professor in the Department of Population Health at NYU Grossman School of Medicine.
“Public health messages about cannabis still focus mostly on smoking, but people now use the drug in many different ways,” said Dr. El-Shahawy. “For younger adults, that means talking about the risks of vaping and combining multiple forms, while for people who prefer edibles, the message is to ‘start low and go slow’ because the effects take time to kick in.”
According to Dr. El-Shahawy, the team next plans to examine why people choose one method over another—for example, whether those who favor edibles are using cannabis for pain or sleep.
The researchers cautioned that the findings rely on the participants’ self-reports of their cannabis use and that some use may have been underreported. In addition, the study could not establish cause and effect.
Funding for the study was provided by the National Institutes of Health grant R01DA055675.
In addition to Drs. El-Shahawy and Palamar, NYU Langone researchers involved in the study were Mohsen Abbasi-Kangevari, MD, MPH; Michelle He; and Xiaoying Zheng. Another study co-investigator was Neal Doran, PhD, at the University of California, San Diego.
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About NYU Langone Health
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 118 comprehensive academic medical centers across the nation four years in a row, and it continues to have the most No. 1– and top 10–ranked specialties among medical centers in the United States, according to U.S. News & World Report. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 330 outpatient locations in the New York City area and Florida. The system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise
Journal
Addictive Behaviors
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Cannabis use modalities are associated with sociodemographic characteristics and patterns of cannabis use among US adults: A latent class analysis
Article Publication Date
8-Aug-2026
Trends in the prevalence and severity of alcohol and cannabis use disorders among US adults
JAMA Psychiatry
About the Study:
In this cross-sectional study of 186,823 US adults, moderate-to-severe cannabis use disorder prevalence increased from 2021 through 2024 among males and females, while moderate-to-severe alcohol use disorder prevalence remained largely stable. The findings highlight diverging trends in cannabis and alcohol use disorders across age and sex groups.
Corresponding Author: Nora D. Volkow, MD, National Institute on Drug Abuse, National Institutes of Health, 3WFN Room 09D20, MSC 6025, 301 N Stonestreet Ave, Bethesda, MD 20892 (nvolkow@nida.nih.gov).
10.1001/jamapsychiatry.2026.2497
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Journal
JAMA Psychiatry
Nearly half of intoxicating hemp posts on Instagram use youth-oriented marketing; Just 2.5% carry warnings
Public Health Institute
Oakland, CA—Brands selling intoxicating hemp products such as Delta-8 THC are using memes, cartoons and pop-culture references to market on Instagram while rarely warning about health risks or age limits, according to a new study in the journal Addiction.
Researchers analyzed 837 Instagram posts published between February 2024 and February 2025 from nine leading brands of products containing intoxicating hemp-derived cannabinoids (intoxicating hemp) such as Delta-8 THC, HHC and THC-P. Prior research shows that cannabis marketing, especially on social media, increases both positive perceptions of cannabis and its use, and that youth-oriented visuals are particularly appealing to young audiences.
Key findings:
- Nearly half of posts included youth-oriented content. Imagery and cultural cues such as memes, cartoons and pop-culture references appeared in 49.6% of the 837 posts analyzed.
- Recreational marketing was widespread. Fifty-two percent of posts promoted effects like relaxation and happiness or showed products in everyday social and leisure settings.
- Safety information was rare. Health and age warnings appeared in just 2.5% of posts.
- Appeals varied by product type. Beverage posts were the most aggressive—84.3% used recreational themes and 56.9% youth-oriented themes—followed by cartridges and vapes (53.5% youth-oriented) and edibles (49.2%).
“These findings show how brands selling intoxicating hemp products target youth audiences with dangerously few safeguards,” said Alisa A. Padon, Ph.D., a study co-author and research director of Getting it Right from the Start (GIRFTS), a program of the Public Health Institute. “As Congress considers the future of these products, maintaining the federal prohibition scheduled to take effect in November is critical. Additionally, regulations that set standards for social media content are needed to restrict marketing these products to young people.”
The nine brands evaluated were CannaAid, Cycling Frog, Delta Extrax, Elyxr, Fly Urb, Hometown Hero, Koi CBD, Mood and Official Canna River. Researchers coded each post for product descriptions and imagery, recreational appeals, youth-oriented cues, brand positioning, health claims and health and age warnings. The analysis builds on previous research by Dr. Padon and colleagues, which identified elements of cannabis marketing that appeal to young people.
Use of intoxicating hemp products has grown in the United States in recent years, alongside reported poisonings, emergency department visits and psychotic episodes. The study authors note that largely underregulated social media marketing may be contributing to that growth.
The findings come at a pivotal moment for federal policy. In 2025, Congress closed the 2018 Farm Bill loophole that let intoxicating hemp-derived products proliferate outside many of the safeguards governing state-regulated cannabis markets. Public Law 119-37, effective November 12, 2026, prohibits these products by narrowing the federal definition of hemp and capping THC per package. Those protections now face renewed challenges: the Senate has passed a bill—awaiting House approval—delaying the restrictions to December 11, 2026, and separate legislation (H.R. 9830) would replace the prohibition outright with a permissive framework allowing high THC levels and certain synthesized THC types.
“For years, public health experts warned that the loophole created by the 2018 Farm Bill would lead to a largely unregulated market for intoxicating hemp products, including products that are easily accessible and appealing to young people. Unfortunately, that is exactly what happened,” said Lynn Silver, M.D., MPH, director of GIRFTS, who was not involved in the study. “Replacing the prohibition set forth in Public Law 119-37 with a new permissive regulatory framework will create a backdoor to a federally legal market for intoxicating THC products, bypassing both the state-regulated legal cannabis systems and state prohibitions. This study demonstrates why maintaining the federal prohibition is so important.”
Study:
La Capria K, Meng S, Padon AA, Tillett KK, Donaldson SI, Allem JP, Rossheim ME, LoParco C, Berg CJ, Jackson KM, Chen-Sankey J. Marketing Features of Derived Intoxicating Cannabinoid Product Brands on Instagram: A Content Analysis. Addiction. 2026 Aug. volume/issue/pages. doi: (number)
To request an interview with Dr. Padon or Dr. Silver, contact Renate Myles or Katie Mullan at media@phi.org or 510-368-9077.
The Public Health Institute is a national independent nonprofit that advances the health and wellbeing of all people and communities, particularly those facing the greatest barriers. Rooted in 60 years of public health experience, PHI moves ideas into action through practice, policy, research and community engagement, while serving as the operational backbone for more than 40 programs delivering evidence-based solutions to complex health challenges. For more information, visit www.phi.org.
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Journal
Addiction
Method of Research
Content analysis
Subject of Research
Not applicable
Article Title
Marketing Features of Derived Intoxicating Cannabinoid Product Brands on Instagram: A Content Analysis
Article Publication Date
19-Aug-2026
COI Statement
Alisa A. Padon, Ph.D., reports no conflicts of interest
Leading hemp-derived cannabinoid brands lean on lifestyle and youth appeals on social media
Rutgers researchers find frequent recreational and youth-oriented themes, but limited safety information, in Instagram marketing
Rutgers University
Brands that market hemp-derived, intoxicating cannabinoid products are capitalizing on lack of oversight on social media platforms to reach consumers, according to Rutgers Health researchers.
Since the passage of the 2018 U.S. Farm Bill, use of these products — Delta-8 THC, HHC and THC-P delivered as edibles, beverages, vapes, concentrates and extracts — has been on the rise throughout the United States. Brand marketing on social media, which is largely underregulated, may contribute to this growth.
The study, published in the journal Addiction, evaluated the marketing features used by leading brands on social media to inform consumer protection and youth prevention strategies, as well as public health policy responses.
“Stronger standards are needed to restrict content that is potentially misleading and directed at youth and even reconsider whether commercial brands that market intoxicating substances should be permitted to maintain social media accounts,” said Julia Chen-Sankey, an assistant professor at the Rutgers School of Public Health.
The researchers analyzed 837 Instagram posts published by accounts representing nine leading brands between February 2024 and February 2025. They evaluated the posts for key marketing themes, including product descriptions, recreational appeals, imagery oriented for youth 18 and younger, health claims and safety warnings.
They found the brands placed an emphasis on lifestyle and recreational marketing, with minimal attention given to consumer safety warnings. Product description and imagery were featured in 75% of posts and 52% showed recreational images that depicted hemp-derived, intoxicating cannabinoid products as part of daily routines and social or leisure experiences. Youth-oriented imagery, such as memes, cartoons and pop culture references, were present in nearly 50% of the posts.
The marketing approach varied by product type. Cannabis beverages were the most heavily promoted product category, with 97% featuring product imagery, 84% emphasizing recreational themes, 57% using youth-oriented appeals and 40% focusing on brand positioning. Youth-focused themes also were prominent in posts marketing vapes and cartridges (54%) and edibles (49%). Recreational themes were common in posts for edibles (61%) and pre-rolls or blunts (53%).
The researchers said social media platforms’ policies use broad and vague language regarding restrictions on the sale and promotion of cannabis and THC products. This ambiguity allows brands to continue posting content that, while not directly selling these products, may still promote their use among young people.
“Although this study focused on Instagram, similar indirect marketing practices warrant closer examination on platforms such as YouTube, Facebook and TikTok,” said Chen-Sankey, a co-author of the study.
Approximately half of the posts included youth-oriented elements, such as cartoon imagery, memes, and influencers, is notable given the reported increase in hemp-derived, intoxicating cannabinoid product use in youth, the researchers said.
“Although many states prohibit youth-appealing marketing strategies, these restrictions do not explicitly extend to hemp-derived, intoxicating cannabinoid products or to social media platforms, where regulatory oversight and enforcement remain limited,” said co-author Kathryn La Capria, a research associate at Rutgers Institute for Nicotine and Tobacco Studies. “Age restrictions limiting who could view brand social media content and notices that products were for adults aged 21 or older were rarely observed, leaving much of the content accessible to underage users, potentially increasing youth exposure to content that normalizes use among young people.”
U.S. Public Law 119-37 effectively prohibits intoxicating hemp-derived products that are currently sold commercially by narrowing the federal definition of hemp and maximum THC per package. However, the researchers cautioned that brands with established social media audiences may continue using indirect lifestyle and brand marketing even as the product marketplace changes.
“These findings highlight important gaps in platform policies and enforcement,” Chen-Sankey said. “In addition to maintaining the prohibition on intoxicating hemp products set forth in Public Law 119-37, regulators and social media companies need clearer standards addressing youth-oriented features, such as cartoons and memes, as well as potentially misleading health claims and inadequate safety information.”
Other Rutgers authors include Siyan Meng, Scott Donaldson and Jon-Patrick Allem.
Journal
Addiction
Method of Research
Content analysis
Subject of Research
Not applicable
Article Title
Marketing Features of Derived Intoxicating Cannabinoid Product Brands on Instagram: A Content Analysis
Article Publication Date
19-Aug-2026
COI Statement
Matthew E. Rossheim manages an independent consulting firm and receives compensation for presentations and consultations, including expert work in litigation against the alcohol, cannabis, tobacco, nitrous oxide, and kratom industries. Neither the author nor his consulting firm accepts funding from these industries.
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