Link Between Marijuana, Opioid Use Exists, But Is Pot a Gateway Drug?
“It started for me with pot, and just progressed to hell.”
“Weed didn’t do it for me. But, definitely, weed started it all for me.”
— Chasing the Dragon
For decades, health officials and politicians have debated whether or not marijuana is a gateway to more powerful drugs, such as opioids.
For many of those who are living the nightmare of opioid addiction, there is no doubt. Take, for instance, a recent DEA education film, Chasing the Dragon, which featured the stories of seven high school opioid addicts. For five of the seven, it all started with pot. (See sidebar for their drug bios.)
But statistics indicate that the causal link between cannabis usage as the gateway to harder drugs is a bit more murky.
According to the National Institute on Drug Abuse, people who use marijuana are more likely to eventually try opioids than people who don’t. But does marijuana use actually CAUSE opioid use? If so, in what sense?
It is not true that marijuana use inevitably leads to opioid use. The most recent statistics indicate that about 41 million Americans used marijuana in 2017, while less than 12 million used opioids. It is true, however, that people who use hard drugs such as heroin and other opioids generally have used marijuana first.
For instance, a 2017 study of more than 34,000 marijuana users, published in the American Journal of Psychiatry, concluded:
“Cannabis use appears to increase rather than decrease the risk of developing non-medical prescription opioid use and opioid use disorder.”
And a 2013 analysis of data from the National Survey on Drug Use and Health found that young men and women who had used marijuana were two-and-a-half times more likely to report illegal use of prescription opioids.
But while the correlation between marijuana and opioid use is clear, its meaning is not. Does the experience of using marijuana make people more likely to try other illegal drugs? Or are people who use marijuana different from those who don’t in a way that also makes them more likely to use opioids?
A 2002 study conducted by the Drug Policy Research Center concluded that, while marijuana gateway effects may exist, a simple alternative explanation is “drug use propensity.”
But there are many factors to consider when attempting to determine a person’s propensity toward drug usage. A big one is personality type. For instance, a 2019 UK study concluded:
“There is a significant difference in the psychological profiles of drug users and non-users. Hence, a psychological predisposition to drug addiction exists.” [Emphasis added.]
Does Legalization Make It Better or Worse?
Ironically, the gateway theory has been used to support both sides of the legalization debate. The anti-legalization lobby argues that using marijuana exposes people to the experience of scoring, possessing and consuming an illegal drug.
Meanwhile, the pro-legalization lobby argues that, if marijuana users could purchase the drug through legal channels and not be exposed to harder drugs, cannabis would no longer be a gateway.
The Only Gateway?
But marijuana isn’t the only drug with gateway potential.
According to the National Institute on Drug Abuse, like pot, alcohol and nicotine also prime the brain for a heightened response to other drugs. And also like pot, alcohol and nicotine are typically used before a person progresses to more harmful substances.
A 2016 study of 2,800 high school seniors, published in the Journal of School Health, determined that the teenagers’ first drug of choice was overwhelmingly alcohol. In addition, of the three main substances — alcohol, tobacco and marijuana — they were the least likely to start using pot before the others.
It would appear that, if there is a true gateway drug, it may be alcohol.
Does Anybody Really Know?
So is marijuana a gateway drug or not?
Yes and no. The most reasonable answer is that, if there is a causal link, it works both ways: marijuana users are more likely to try other drugs, and people inclined to try other drugs are also predisposed to experiment first with marijuana.
Clear as mud.