TY - JOUR
T1 - A systematic review and Bayesian meta‐analysis of interventions which target or assess co‐use of tobacco and cannabis in single or multi‐substance interventions
AU - Walsh, Hannah
AU - McNeill, Ann
AU - Purssell, Edward
AU - Duaso, Maria
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background and aims: Tobacco and cannabis are commonly co-used, and evidence for the influence of co-use on quit outcomes for either substance is mixed. We sought to determine the efficacy of tobacco and/or cannabis use interventions delivered to co-users on cannabis and tobacco use outcomes. Method: Systematic review with meta-analysis and narrative review, using five databases and author requests for co-use data. Controlled and uncontrolled intervention studies focusing on treatment of tobacco and/or cannabis use assessing use of both pre- and post-intervention were included. Prevention interventions were excluded. Bayesian meta-analysis was used across four outcome measures: risk ratio for tobacco and cannabis cessation post-intervention separately; standardized mean change for tobacco and cannabis reduction post-intervention separately. Narrative reporting of the same outcome measures in non-randomized clinical trials (non-RCTs) and quality assessment of all included studies were conducted. Results: Twenty studies (12 RCTs and eight uncontrolled) were included. Bayesian meta-analysis with informative priors based on existing data of 11 RCTs (six single-substance, five multi-substance interventions) delivered to co-users (n = up to 1117) showed weak evidence for an effect on cannabis cessation [risk ratio (RR) = 1.48, credibility interval (CrI) = 0.92, 2.49, eight studies] and no clear effect on tobacco cessation (RR = 1.10, CrI = 0.68, 1.87, nine studies). Subgroup analysis suggested that multi-substance interventions might be more effective than cannabis-targeted interventions on cannabis cessation (RR = 2.19, CrI = 1.10, 4.36 versus RR = 1.39, CrI = 0.75, 2.74). A significant intervention effect was observed on cannabis reduction (RR = 0.25, CrI = 0.03, 0.45, nine studies) but not on tobacco reduction (RR = 0.06, CrI = −0.11, 0.23, nine studies). Quality of evidence was moderate, although measurement of co-use and cannabis use requires standardization. Uncontrolled studies targeting both cannabis and tobacco use indicated feasibility and acceptability. Conclusions: Single and multi-substance interventions addressing tobacco and/or cannabis have not shown a clear effect on either tobacco or cannabis cessation and reduction among co-users. However, dual substance interventions targeting tobacco and cannabis appear feasible.
AB - Background and aims: Tobacco and cannabis are commonly co-used, and evidence for the influence of co-use on quit outcomes for either substance is mixed. We sought to determine the efficacy of tobacco and/or cannabis use interventions delivered to co-users on cannabis and tobacco use outcomes. Method: Systematic review with meta-analysis and narrative review, using five databases and author requests for co-use data. Controlled and uncontrolled intervention studies focusing on treatment of tobacco and/or cannabis use assessing use of both pre- and post-intervention were included. Prevention interventions were excluded. Bayesian meta-analysis was used across four outcome measures: risk ratio for tobacco and cannabis cessation post-intervention separately; standardized mean change for tobacco and cannabis reduction post-intervention separately. Narrative reporting of the same outcome measures in non-randomized clinical trials (non-RCTs) and quality assessment of all included studies were conducted. Results: Twenty studies (12 RCTs and eight uncontrolled) were included. Bayesian meta-analysis with informative priors based on existing data of 11 RCTs (six single-substance, five multi-substance interventions) delivered to co-users (n = up to 1117) showed weak evidence for an effect on cannabis cessation [risk ratio (RR) = 1.48, credibility interval (CrI) = 0.92, 2.49, eight studies] and no clear effect on tobacco cessation (RR = 1.10, CrI = 0.68, 1.87, nine studies). Subgroup analysis suggested that multi-substance interventions might be more effective than cannabis-targeted interventions on cannabis cessation (RR = 2.19, CrI = 1.10, 4.36 versus RR = 1.39, CrI = 0.75, 2.74). A significant intervention effect was observed on cannabis reduction (RR = 0.25, CrI = 0.03, 0.45, nine studies) but not on tobacco reduction (RR = 0.06, CrI = −0.11, 0.23, nine studies). Quality of evidence was moderate, although measurement of co-use and cannabis use requires standardization. Uncontrolled studies targeting both cannabis and tobacco use indicated feasibility and acceptability. Conclusions: Single and multi-substance interventions addressing tobacco and/or cannabis have not shown a clear effect on either tobacco or cannabis cessation and reduction among co-users. However, dual substance interventions targeting tobacco and cannabis appear feasible.
KW - Cannabis
KW - cannabis use disorder
KW - co-use
KW - smoking cessation
KW - tobacco
KW - tobacco use disorder
UR - http://www.scopus.com/inward/record.url?scp=85080918442&partnerID=8YFLogxK
U2 - 10.1111/add.14993
DO - 10.1111/add.14993
M3 - Review article
SN - 0965-2140
VL - 115
SP - 1800
EP - 1814
JO - Addiction
JF - Addiction
IS - 10
ER -
