Cannabis smoking has become more common than cigarette smoking among American adults, according to a new Gallup poll, with usage more than doubling since 2013. This milestone reflects a dramatic shift in how Americans consume substances and raises important questions about health, regulation, and the future of cannabis policy in the United States.

What's Driving the Surge in Cannabis Use?

The increase in cannabis smoking reflects broader changes in American attitudes toward marijuana, driven by decades of legalization efforts across states and evolving perceptions about the drug's safety compared to tobacco. As more states have legalized medical and recreational cannabis, access has expanded significantly. The shift also coincides with declining cigarette use, which has hit an all-time low, suggesting some adults may be switching from traditional tobacco to cannabis products.

This trend comes as federal regulators continue to grapple with how to oversee cannabis products. The Congressional Research Service recently called out the Food and Drug Administration (FDA) for being more than six months late in publishing lists of hemp-derived cannabinoids and issuing guidance on how to define product serving sizes for THC products. These regulatory delays highlight the challenge of keeping pace with a rapidly evolving market.

How Are Regulators Responding to Cannabis Growth?

State and federal officials are taking varied approaches to cannabis regulation. California lawmakers sent Governor Gavin Newsom a bill to more clearly define marijuana packaging and labeling rules that appeal to children, reflecting concerns about youth exposure. Meanwhile, some states are moving in the opposite direction. An Oregon senator announced a renewed push to ban marijuana edibles containing more than 10 milligrams of THC for 2027 after her bill fell short of passage this year.

The regulatory landscape remains fragmented, with different states adopting different standards for product potency, labeling, and safety testing. This patchwork approach creates challenges for both consumers and businesses trying to navigate compliance requirements across multiple jurisdictions.

What Does the Evidence Say About Medical Cannabis?

While recreational use is climbing, medical cannabis research continues to evolve. Recent studies have found promising results for specific conditions. A study found that "marijuana can be helpful for symptom control, reducing reliance on opioid pharmaceuticals, and may improve quality of life in patients with" inflammatory bowel disease. However, the evidence for cannabis varies significantly depending on the specific condition, cannabinoid type, and formulation used.

For patients with epilepsy or seizure disorders, the picture is more nuanced. The clearest evidence supports purified cannabidiol (CBD), not whole cannabis flower or THC-dominant products. The FDA has approved Epidiolex, a purified CBD oral solution, specifically for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex in patients one year of age and older. A 2025 systematic review of seven randomized trials found that 10 and 20 milligrams per kilogram of body weight per day of cannabidiol probably increased the proportion of people who achieved at least a 50 percent reduction in monthly seizures.

However, the same review found that serious adverse events were probably increased at the higher 20 milligram per kilogram dose, and the certainty for several other cannabinoid comparisons was low or very low. This underscores an important distinction: purified, FDA-approved CBD has stronger evidence than retail CBD products or cannabis flower.

Steps to Take If Considering Medical Cannabis for Seizure Disorders

• Confirm Your Diagnosis: Work with your neurologist to establish the exact epilepsy syndrome or seizure disorder, since evidence for purified CBD applies only to specific conditions like Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex.
• Review All Medications: Discuss potential interactions with your current antiseizure medicines, particularly clobazam and valproate, which carry special risks when combined with CBD due to liver and sedation concerns.
• Establish Baseline Measurements: Record seizure type, frequency, duration, rescue medication use, and any injuries before starting treatment so you can accurately measure whether the cannabis product is helping.
• Plan for Monitoring: Arrange for baseline and follow-up liver tests if appropriate, and set a review date with your healthcare team to assess whether the treatment is working and whether any dose adjustments are needed.
• Never Stop Existing Treatment Abruptly: Do not stop or reduce an established antiseizure medicine simply because CBD or low-THC cannabis is added, as abrupt withdrawal can increase seizure frequency and the risk of status epilepticus, a life-threatening condition.

The National Center for Complementary and Integrative Health warns that CBD can cause reduced alertness, mood changes, decreased appetite, diarrhea, and liver injury, and can interact with other medicines. Additionally, nonprescription CBD products may contain different amounts of CBD than their labels claim, which is especially problematic when treatment requires a stable blood level.

Why CBD and THC Are Not Interchangeable

A critical distinction in cannabis medicine is that CBD and THC are different cannabinoids with different effects. The trials supporting purified CBD do not establish that a THC-dominant product prevents seizures. THC can impair attention, coordination, judgment, and short-term memory. For some patients, intoxication, missed doses, sleep disruption, vomiting, or an inconsistent product could complicate seizure management even if the product is legally available.

This distinction matters because some states allow physicians to prescribe low-THC cannabis for seizure disorders beyond the FDA-approved indications. However, the evidence for one diagnosis, dose, and pharmaceutical product should not be generalized to a different seizure type or formulation. A dispensary formulation may differ significantly from prescription cannabidiol in CBD concentration, THC exposure, other cannabinoids, ingredients, and route of administration.

What About the Broader Cannabis Regulation Debate?

Beyond medical applications, cannabis regulation has become increasingly politicized. Texas Democrats are calling out Republican officials for allegedly working to restrict hemp THC products in order to benefit alcohol companies, which are among their campaign contributors. During the last legislative session, Texas Lieutenant Governor Dan Patrick championed legislation to recriminalize many hemp products, though the bill was ultimately vetoed by Governor Greg Abbott.

According to campaign finance records, Patrick's campaign committee received $275,000 from Silver Eagle Distributors, an alcohol distributor company. Democratic candidates are using this issue to argue that cannabis restrictions benefit industries with financial interests in keeping cannabis products off the market. The Bexar County Democratic Party noted that hemp represents a "multi-billion dollar industry with over 14,000 small business owners and more than 50,000 employees," and questioned whether the restrictions were designed to protect alcohol industry profits.

The political debate highlights a tension between public health concerns, economic interests, and personal freedom. As cannabis use continues to rise and surpass cigarette smoking, policymakers will face increasing pressure to develop coherent, evidence-based regulations that balance safety, access, and industry concerns.