In Reply

Letters to the Editor regarding the article Cannabis Use in Germany Frequency, Routes of Administration, and Co-use of Inhaled Nicotine or Tobacco Products by Prof. Dr. Daniel Kotz, PhD MSc MPH, PD Dr. rer. nat. Sabrina Kastaun, Dr. rer. nat. Jakob Manthey, PD Dr. rer. nat. Eva Hoch, and Dr. PH Stephanie Klosterhalfen in issue 2/2024

Olderbak et al. underline once more the differences we reported and discussed in the 12-month prevalence of cannabis consumption between our German Study on Tobacco Use (DEBRA) and the Epidemiological Survey on Substance Abuse in Germany (ESA) as well as the Alcohol Survey. Additionally, we wish to emphasize in this context that the survey method can have an important effect on response behaviors. In the DEBRA study, people are interviewed in person/orally at their front door, whereas the ESA and Alcohol Survey use written, web-based, or telephone questionnaires. In the context of a sensitive topic such as cannabis consumption, an in-person interview may result to a greater degree in socially desirable or even untruthful response behaviors. This effect may possibly lessen as a result of the cannabis legislation in force since 1 April 2024, at least in adults. An in-person/oral interview does, however, have many advantages. Interviewers can, for example, by means of personal contact improve motivation to participate, explain questions, and provide assistance in responding.

Our study’s focus was on investigating which administration routes cannabis users currently prefer (1) and which inhaled nicotine and tobacco products they co-use—an important aspect on the background of the high prevalence of the consumption of such products and decline in smoking cessation attempts in Germany (2, 3). The new cannabis legislation aims—among others—to improve protection for young people and health (4) and should therefore absolutely be seen as an inducement for improving tobacco control in Germany.

The different surveys regarding cannabis in Germany have their own priorities as well as methodological strengths and limitations. The different methodological approaches provide valuable information for creating a comprehensive overall picture, which helps better to understand the effects of cannabis consumption on health and society better.

DOI: 10.3238/arztebl.m2024.0093

On behalf of the authors

Prof. Dr. Daniel Kotz, PhD MSc MPH

Institut für Allgemeinmedizin (ifam)

Schwerpunkt Suchtforschung und klinische Epidemiologie

Centre for Health and Society (chs)

Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf

Düsseldorf

Conflict of interest statement

The authors of all contributions declare that no conflict of interest exists.

References

1. Kotz D, Kastaun S, Manthey J, Hoch E, Klosterhalfen S: Cannabis use in Germany: Frequency, routes of administration, and co-use of inhaled nicotine or tobacco products. Dtsch Arztebl Int 2024; 121: 52–7

2. Kotz D, Batra A, Kastaun S: Smoking cessation attempts and common strategies employed—a Germany-wide representative survey conducted in 19 waves from 2016 to 2019 (The DEBRA Study) and analyzed by socioeconomic status. Dtsch Arztebl Int 2020; 117: 7–13

3. Borchardt B, Kastaun S, Pashutina Y, Viechtbauer W, Kotz D: Motivation to stop smoking in the German population between 2016–2021 and associated factors: results from a repeated cross-sectional representative population survey (German Study on Tobacco Use, DEBRA study). BMJ Open 2023; 13: e068198

4. Bundesministerium für Gesundheit: Eckpunktepapier der Bundesregierung zur Einführung einer kontrollierten Abgabe von Cannabis an Erwachsene zu Genusszwecken 2022; www.bundesgesundheitsministerium.de/ministerium/meldungen/kontrollierte-abgabe-von-cannabis-eckpunktepapier-der-bundesregierung-liegt-vor.html (last accessed on 18 April 2024).