The singer lit a hand-rolled cigarette as she accepted her best video award for Wrecking Ball at the Ziggo Dome in Amsterdam - where smoking marijuana is tolerated.
The drug is not legal in the Netherlands, but smokers are not prosecuted for possession of small amounts and it is sold openly in cafes known as "coffee shops".
The 20-year-old, who is managed by Larry Rudolph - who also represents Britney Spears - had already caused a stir by arriving at the event in a revealing mini-dress emblazoned with images of murdered rappers The Notorious B.I.G and Tupac Shakur along with the words "please stop violence".
Rapper Eminem - real name is Marshall Bruce Mathers - emerged the biggest winner at the awards.
The 41-year-old had more cause to celebrate after scoring his seventh consecutive number one UK album with The Marshall Mathers LP 2 and took to the stage to perform Berzerk and Rap God - two tracks from his new works.
"This is crazy. I want to say thank you to everybody over the years," he said.
Claiming her prize, the US singer gave a dramatic performance of her song Unconditionally, suspended like a sequin-covered glitter ball nine metres (30 feet) above the set.
Thirty Seconds To Mars frontman Jared Leto reacted to his band's win in the best alternative category by calling for a minute of silence for those affected by Typhoon Haiyan in the Philippines.
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