Is Marijuana a Gateway to Opioids?

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Is Marijuana a Gateway to Opioids?

“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.



600px US DrugEnforcementAdministration Seal.svg Sarah – Began using marijuana at age 13 and became addicted to opiates after being prescribed oxycodone for injuries related to an automobile accident.

Matt – Began using marijuana at age 11 and became addicted to opiates at age 15.

Julia – Involved in many school activities and was an honor roll student. She began using marijuana at age 11 and eventually used other drugs. She overdosed on opiates four times.

Cory – Enjoyed outdoor activities and was an Eagle Scout. He first used marijuana and eventually tried other drugs. He was addicted to opiates by age 17.

Melissa – Began using marijuana at age 13 and got hooked on oxycodone after a pregnancy. She was arrested on eight occasions for drug abuse and suffered numerous health issues due to multiple overdoses.

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 Dragonwhich 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.

Chicken-and-Egg Dilemma

The trend toward pot legalization across the U.S. has coincided with a surge in opioid-related deaths. Is that just a coincidence?

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.

Muddy Waters

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?

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.]

Medical Cannabis

Studies have found that patients who use medical marijuana tend to reduce their use of prescription opioids.

Here’s how the Canadian medical marijuana producer Canntrust grows and processes its product:



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.


Centers for Disease Control

American Journal of Psychiatry

National Institute on Drug Abuse

Neuroscience News

The Washington Post

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