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Various modes of cannabis use may influence pharmacokinetics, usage patterns, and harm, affecting CUD risk. We measured associations between modes of cannabis use, including multi\u2010modal patterns, and CUD prevalence and severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting<\/jats:title>\n                    <jats:p>This cross\u2010sectional study analyzed data from a nationally representative sample of US adults using the 2022\u20132023 National Survey on Drug Use and Health (NSDUH) data. Multivariable logistic regression analyses were employed to estimate the association between modes of cannabis use and past\u2010year CUD, adjusting for potential confounders and covariates. Analyses were stratified by sex, age, and cannabis use frequency. Among multi\u2010modal users, common combinations and their associations with CUD were further examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants\/Cases<\/jats:title>\n                    <jats:p>Respondents 18\u2009years or older who reported past\u2010year cannabis use (unweighted n\u2009=\u200925\u2009549; weighted N\u2009=\u200958\u2009850\u2009309).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Exposure of interest was the mode of cannabis use, primarily categorized as smoke\u2010only, vape\u2010only, oral\/mucosal\u2010only, dab\u2010only, topicals\u2010only, and multi\u2010modal (\u2265 two modes). The outcome variable was CUD in the past year, and CUD severity, based on\n                      <jats:italic>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM\u20105)<\/jats:italic>\n                      criteria. Covariates included age, sex, race\/ethnicity, income, education, state cannabis law status, age of cannabis initiation, cannabis use motive, frequency of use, perceived risk of smoking cannabis, illicit drug use, past year mental illness, nicotine dependence, and alcohol use disorder.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Of the total past\u2010year cannabis users, 53.9% reported multi\u2010modal cannabis use. Overall, CUD prevalence was 30.3%, ranging from 4.4% among oral\/mucosal\u2010only to 40.5% among multi\u2010modal, and 28.9% among dab\u2010only users (p\u2009&lt;\u20090.0001). Moderate\u2010to\u2010severe CUD affected 13.2% of all users and was concentrated among multi\u2010modal and dab\u2010only users. In multivariable regression, multi\u2010modal users had fourfold higher odds of CUD (adjusted odds ratio [AOR]\u2009=\u20094.14; 95% confidence interval [CI]: 2.91\u20135.90). Elevated odds were also observed among smoke\u2010only (AOR\u2009=\u20092.98; 95% CI: 2.02\u20134.39) and vape\/dab\u2010only users (AOR\u2009=\u20091.89; 95% CI: 1.09\u20133.29), compared with oral\/mucosal\u2010only users. Analyses of multi\u2010modal combinations showed the highest CUD odds among those using smoke + vape + oral\/mucosal + dab (AOR\u2009=\u200919.74; 95% CI: 9.11\u201342.75), compared with oral\/mucosal + topicals users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the United States, modes of cannabis use appear to be statistically significantly associated with prevalence and severity of cannabis use disorder, with multi\u2010modal and inhaled routes conferring the greatest risk. Findings underscore the importance of considering mode of use alongside frequency and potency in clinical assessment, prevention, and policy strategies aimed at reducing cannabis\u2010related harms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70474","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T08:26:47Z","timestamp":1779784007000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations between modes of cannabis use and cannabis use disorder: Evidence from the 2022 to 2023 United States National Survey on Drug Use and Health"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-9665","authenticated-orcid":false,"given":"Amrit","family":"Baral","sequence":"first","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6465-8686","authenticated-orcid":false,"given":"Cerina","family":"Dubois","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janardan","family":"Devkota","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-6928","authenticated-orcid":false,"given":"Denise C.","family":"Vidot","sequence":"additional","affiliation":[{"name":"Global Cannabis and Psychedelics Research Collaboratory, School of Nursing and Health Studies University of Miami  Coral Gables FL USA"},{"name":"Department of Public Health Sciences University of Miami Miller School of Medicine  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Vandrey","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8929-9579","authenticated-orcid":false,"given":"Johannes","family":"Thrul","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"},{"name":"Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University  Baltimore MD USA"},{"name":"Centre for Alcohol Policy Research La Trobe University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-021-00247-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2019.1669626"},{"key":"#cr-split#-e_1_2_10_4_1.1","unstructured":"ChapekisA ShahS.Most Americans now live in a legal marijuana state-and most have at least one dispensary in their county Pew Research Center: Pew Research Center;2024[updated 2024 February 29"},{"key":"#cr-split#-e_1_2_10_4_1.2","unstructured":"cited 2025 September 10]. 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