Mariah Sanderson: Evidence points to marijuana as gateway drug

Editor’s note: This commentary is by Mariah Sanderson, of Essex Junction, who is the director of the Burlington Partnership for a Healthy Community, a substance abuse prevention coalition in Burlington, and a Steering Committee member of Smart Approaches to Marijuana Vermont. She is the mother of two.

Proponents of marijuana legalization have a history of trying to normalize marijuana use and distract voters from its harmful effects by touting its supposed benefits. Remember how medical marijuana was supposed to cure cancer, along with most other known diseases?

Now we’re being told that marijuana will end the opiate crisis. Unfortunately, the evidence this time is just as slim as it was before.

There is a well-known link between marijuana and opiates – and also tobacco, alcohol and other addictive substances. Survey after survey, for year after year, has shown that people who use one of these drugs are more likely to use at least one of the other drugs.

The effect is also dose-dependent: heavy users of one drug are more likely to be heavy users of one or more other drugs. Infrequent users are less likely to be co-users.

These data give rise to the chicken-and-egg question of which drug came first, and this leads to the next question: Is one of these drugs a more powerful inducement to co-use than any other drug? Is there a gateway drug?

There is some evidence from studies with humans that marijuana use is more likely to lead the use of other drugs. A Canadian study found that more young people tried marijuana first, and that almost 50 percent of the co-users started with marijuana – but most young people who have used a substance try marijuana, alcohol and tobacco around the same time, so more research is needed. It is also consistent with animal experiments showing THC’s ability to “prime” the brain for enhanced responses to other drugs.

Rat research has shown that marijuana and opiates use some of the same brain pathways involved in addiction, and that marijuana use sensitizes this pathway in a way that makes individuals who try opiates after marijuana more likely to want more, and that this craving passes from parent to child.

Another rat study indicated that this sensitization is transmitted from grandparent to grandchild, even if the middle-generation parents never used marijuana or opiates. If these results hold true in further research, we’ve found an epigenetic effect, which is truly scary.

Will addicts easily give up one of these drugs for another that’s less deadly?


Another indirect indicator that marijuana might have some level of gateway effect can be found in the Colorado results of the National Survey of Drug Use and Health. Looking at the use rate rankings for Past Year Nonmedical Use of Painkillers in the 12+ age range (i.e, everyone), and comparing 2013 to 2014, we see that Colorado jumped from 12th highest in the nation to second highest in the nation. At the same time, Colorado’s marijuana use rate rose from second highest to number one.

These findings are consistent with the idea of marijuana as a “gateway drug.” However, cross-sensitization is not unique to marijuana. Alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like marijuana, also generally used before a person advances to other, more immediately harmful substances. So we can say that starting to use one drug makes you more likely to start using another drug, but more research is definitely needed.

In terms of the opiate crisis, a more important question would be: Will addicts easily give up one of these drugs for another that’s less deadly? The word “easily” is key. The fact that so many heavy users are co-users of several drugs illustrates how tightly these drug addiction systems are intertwined.

There is plenty of anecdotal evidence that opiate users will use marijuana to try to stave off withdrawal symptoms and cravings. For some, marijuana merely helps them sustain their addiction. Relapse rates for both drugs are tragically high.

There is no question that opiates kill more of their users than marijuana does, but marijuana does kill, through traffic accidents, suicides and accidental deaths. A U.S. study released just this month strongly supports an earlier French study indicating that marijuana use is also involved in strokes and cardiovascular deaths.

For some, marijuana use has led to psychosis, including schizophrenia, and worsens other mental health problems, all at a much greater rate than opiates.

So the question becomes do we want to make it easier for addicts to get a substance that could provide temporary relief but help maintain their addiction, while still putting them at some risk for death and greater risk for mental health and heart problems? Or instead, would our state be better served to put more money and effort into improving and expanding our addiction and substance abuse treatment systems and into prevention efforts that recognize that marijuana and other substance use has ill effects on health and should be discouraged.

Because the fact is, they’re all gateway drugs.

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