The most popular consumption method for cannabis across the globe is inhalation, especially through combustion and often by mixing cannabis flowers or resin with tobacco. But how healthy is this? In this article we explain everything you need to know about this practice.
According to some statistics, mixing cannabis and tobacco is common among Europeans  . About 77-90% of the users in Europe combine the two, as compared to 5-8% in the United States, 7% in Mexico and Brazil, 16% in Canada, 20% in New Zealand, and 51% in Australia.
Interestingly, tobacco is native to South America and its use was not known in Europe until it was first imported in the 16th century and the habit of smoking began. Perhaps because it was something new, tobacco smoking expanded in Europe more than in the countries it originated from. The same consumption method was also used for cannabis and eventually lead to the habit of mixing the two plants.
The most frequent way of consuming cannabis mixed with tobacco is in a rolled joint, which is also the most usual way these two substances are smoked separately. It is also typical to mix them in classic pipes made of different materials (mainly wood or glass), or in more cannabis-specific pipes, like water pipes or bongs.
However, mixing tobacco with cannabis is not essential to use these devices. Depending on their capacity and the chosen material, pipes can also be a convenient tool to smoke cannabis on its own.
There are different reasons why users choose to mix cannabis with tobacco:
– It is popularly believed that the interaction of cannabis with nicotine produces a stronger effect.
– It may also be a strategy to consume a smaller amount of cannabis and thereby lessen its effect.
– For financial reasons: cannabis is usually more expensive than tobacco, so when you mix them together you don’t have to use as much, which works out cheaper.
– For cigarette smokers, it can be a strategy to enjoy the consumption of both substances at the same time.
– Many cannabis users prefer using tobacco for organoleptic reasons, especially when consuming extracts such as hash, bubble hash, or rosin.
According to the Spanish Committee for the Prevention of Smoking (CNPT), mixing cannabis with tobacco can be more harmful to health than when these are consumed separately. In addition, it can increase the risk of dependence and can make it difficult to reduce or stop the use of both substances.
For this reason, the EVICT project was launched in 2015. This is a working group for the approach and study of policies for the control of polydrug use involving cannabis and tobacco. 
Smoking cannabis and tobacco together can lead to several health risks:
– Tobacco contains nicotine, which stimulates the dopaminergic system, influencing the pleasure circuits in the brain. This means that it leads to a certain degree of physical and especially psychological dependence, in addition to causing hormonal and cardiovascular disorders.
– Tobacco contains thousands of chemicals, many of which are recognised as toxic and carcinogenic. For this reason, smoking is associated with a high mortality rate.
– The combustion produced by smoking is a very harmful process for human health as it creates free radicals, which are compounds that promote cellular aging, increase the risk of cancer, and lead to cardiovascular problems such as high blood pressure, strokes, and heart disease.
– The process of smoking directly affects the respiratory system, which can cause problems and diseases of the upper airways (e.g. mouth and throat disorders, tracheitis) and of the lower airways (e.g. bronchitis, emphysema), increasing the risk of cancer throughout the respiratory tract. This risk is reduced by using cannabis on its own without mixing it with tobacco. 
– Chronic cannabis use during adolescence (15-20 years) can affect the brain circuits related to mood, the reward and pleasure mechanisms, as well as some cognitive functions such as memory and attention. In addition to affecting some brain areas related to emotions, the use of tobacco promotes chronic cannabis use during adolescence, which can lead to emotional and cognitive problems in adulthood.   
– Exposure to passive inhalation, mainly in closed environments, carries the same risks that have been previously mentioned, thereby affecting non-smokers as well, although to a lesser extent.
Despite all these risks, there are also several scientific studies that point to some interesting effects on the practice of mixing tobacco and cannabis. For instance, a 2009 study measured the concentration of cannabinoids in the smoke produced by the combustion of cannabis in its pure form and when mixed with tobacco . To the researchers’ surprise, the findings showed that tobacco could increase cannabinoid availability by up to 45%, thus confirming the hypothesis that the mixture of the two substances favours a more powerful psychoactive effect.
Another study conducted in 2017 found no evidence on the levels of psychoactivity . However, this research did determine that tobacco could help reduce the harmful effects of cannabis on cognitive functions such as memory, thanks to the stimulating activity of nicotine on heart rate and blood pressure.
This beneficial effect on memory had already been studied in previous research , which revealed that users of cannabis that was mixed with tobacco showed a greater reduction in the brain structures responsible for memory processes (such as the hippocampus) when compared to users of cannabis without tobacco.
To be able to use cannabis more safely, there are a number of different tools and alternative options that can help reduce or eliminate the risks associated with cigarette smoking and combustion:
Tobacco quality: Certain tobacco brands that have been organically grown, without any additives, can help reduce some of the risks.
Types of filters: There are many alternatives to the traditionally used hollow filters, such as active carbon filters and plastic filters with sponges of different densities, which can trap some of the harmful substances produced by combustion.
Use of other plants: Tobacco is not the only plant that can be mixed and smoked with cannabis. There are others like the gordolobo leaves; the white horehound or chamomile flowers (which are also beneficial for the lungs); raspberry leaves (which help with nicotine detox); damiana (which is considered an aphrodisiac); rosemary (which enhances the anti-inflammatory effects of cannabis); artemis and lavender; or mint and melissa (which showcase relaxing properties among other benefits).
Vaporisation: This method makes it possible to use cannabis through inhalation whilst avoiding the risks associated with tobacco use and combustion. The most recommended vaporisers are those that can be used with flowers and extracts. Electronic cigarettes, on the contrary, contain cutting liquids (such as glycerine, propylene glycol, C8-MCT oil, etc.), which can lead to some health risks, especially pulmonary.
Alternatives to inhalation: Good alternatives to inhalation for the consumption of cannabis include sublingual use and ingestion. Sublingual use produces a much longer lasting effect, so it is important to dose more carefully. In addition, there are certain micro dosing techniques that you can use to help you quit smoking.
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