3. The Cannabis And Tobacco Cessation Advice (CATCA) project: A mixed method study exploring UK stop smoking practitioners’ knowledge, attitudes and practices around co-use

Cannabis use is associated with poorer tobacco smoking cessation outcomes yet both substances are rarely formally co-treated. This study aims to identify knowledge, attitudes and practices of stop smoking practitioners when supporting tobacco cessation among smokers who also use cannabis (co-users).

An online survey was sent to UK stop smoking practitioners via the National Centre for Smoking Cessation and Training followed by a sub-sample of online qualitative interviews. Questions included practitioners’ knowledge, confidence and training needs and whether they ask, advise and refer to specialist cannabis services. Logistic regression was conducted to estimate odds ratios (ORs) of intervening. Interviews explored barriers and facilitators of engagement with cousers and were transcribed and analysed using the Framework approach.

693 practitioners completed the questionnaire and 20 were interviewed. Practitioners acknowledged the importance of asking about co-use and offering cessation support. 27% always/often asked clients about cannabis use, 22% advised and 34% referred to cannabis service. Practitioners’ confidence increased likelihood of asking (OR (95%CI)=2.1 (1.65-2.7)), advising (OR(95%CI)=1.46 (1.06-2.00)) and referring (OR(95%CI)=3.70 (2.85-4.78)). Having recording systems in place for cannabis use increased the likelihood of asking (OR(95%CI)=1.61 (1.15-2.24)). Interview themes highlighted the importance of a comprehensive approach. Lack of training, concerns about privacy and impact on therapeutic relationships were identified as potential barriers.

The rate of asking, advising and referring is low. Practitioners report limited knowledge to support co-users. Training and adequate recording systems within smoking cessation treatment settings might facilitate the provision of such support.