An additional form of co-administration occurs in the form of blunt smoking (83;84). Blunts are prepared by removing a majority of the tobacco from a cigar paper and rolling cannabis in it and can contain more cannabis and tobacco than other tobacco-containing cannabis preparations (85). This is consistent with the epidemiological observation of elevated rates of cannabis use disorders in blunt versus joint smokers (86). While there is a distinct ethnic sub-culture surrounding blunt usage in the U.S, Cooper and Haney (87) find that blunts produced greater increases in carbon monoxide levels and, in women, joints increased plasma tetrahydrocannabinol levels. Thus, blunt smokers may be at greater risk for the hemodynamic consequences of carbon monoxide, particularly because the relatively reduced plasma levels of tetrahydrocannabinol may delay intoxication and, consequently, prolonged blunt smoking. However, joint smokers consistently reported greater subjective liking than blunt smokers. Thus, the link between cannabis preparation and development of cannabis use disorders remains unclear.
