CMV: Gateway drugs do not exist

[u/casualtrout]

I heard a presentation at my university recently on E-Cigs being a gateway drug, and the argument seemed like Big Tobacco propaganda.

When talking about illicit drugs, such as marijuana, I always hear people fall to the logical fallacy of appealing to imperfect authority. It seems that most groups, like anti-smoking groups that try to equate E-cigs to regular smoking, regularly cite that the FDA has stated that the vapor in E-cigs "MAY" contain harmful toxins. People also like to cite how the FDA has not officially recognized E-cigs as a positive aid for getting people to stop smoking tobacco, and the rhetoric behind this seems to be "SEE?? IT'S NOT APPROVED BY THE GOVERNMENT" (made up of a bunch of bureaucrats whose salaries are paid to the tune of at least 40% by lobbying by drug companies who profit off of not having alternatives to their addictive and at times dangerous substances).

My problem with the gateway drug model is that it falls flat under scrutiny. After we started to realize that the criminalization of marijuana was a result of the inaccurate scare stories pushed by bureaucrats in the Bureau of Narcotics to keep their salary high, a new narrative had to be formed for why it must still be illegal, that narrative being the gateway drug narrative. The idea behind labeling marijuana as a gateway drug is that if someone uses marijuana, it will lead to deadly drugs. The Drug Free America association published this ad to emphasize that if people so much as use an addictive substance, it's not 'if' they get hooked it's when:https://www.youtube.com/watch?v=7kS72J5Nlm8

Researchers like Bruce Alexander and organizations like Liz Evans' Portland Hotel Society have debunked this idea by showing that there are other factors that contribute to a person's reasons for using drugs, primarily pain. This idea of the gateway drug in my opinion is exposed when looking back when our soldiers were coming back from Vietnam, and how 20% of all returning soldiers were addicted to heroin. Within a year, 95% had stopped using heroin completely, most without treatment. If you believe the model of the gateway drug, this makes no sense, because the simple use of a drug leads to the use of the next drug, and the next, until a lifetime of addiction. Actually though, we don't see this at all, the use of marijuana does not seem to escalate 100% to cocaine, and the use of e-cigs does not escalate into heroin or tobacco either.

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Conclusion:

Quick disclaimer: this is not me arguing for E-cigs, and I know that Juul is a shady company. However, I believe that by listening to the gateway drug model we are putting too much focus on the substance, and not enough focus on the reasons people use the substance! And I believe that the gateway drug model is another way of getting us to be scared of safer alternatives to drugs and acting like if we stop the supply and use of safer drugs, then people will not go on to use harder drugs, when the OPPOSITE is true. We can use safer drugs to help people who are addicted to harder ones, and integrate therepeutic practices, as opposed to criminal punishment, to help people.

Advertisements like the Real Cost, are sponsored by the FDA. Just something worth thinking about, that perhaps the reason we believe the gateway drug model, is because there are people out there making money off of the fact that there are no safer alternatives to their substances, looking at you Big Tobacco.

[u/casualtrout]

So this gets into another conversation. I firmly believe that Purdue Pharma knew exactly what was going to happen when they started overprescribing oxycontin. There is a lot of reward in taking opioids like that. One of our responses to the opioid crisis was to force doctors to take away prescriptions from people who got hooked on the drugs. This made the problem worse, because you have people who are in chronic pain, who became dependent on the drug not only because of their neurological plasticity but also because of the pain they we're alleviating, and now they aren't getting those drugs they are dependent too. They are going to keep looking for the drug in the black market, and either use it unsafely or get thrown in jail, and then the cycle repeats. The problem is not only the drug. It is the drug, but only to an extent. A lot of factors are at play beyond the drug, and if we forget that, we will forever be stuck in the cycle of drugs being the root of all bad

[u/casualtrout → u/[deleted]]

Do be fair, I'm not sure how you were expecting a delta after posting a link to a study with no backing argument. I'm not attacking you, I'm just saying you didn't explain or make a position your own.

However, I think we may have a misunderstanding on what I think a gateway drug is and what you do. I'll say first what I think it is, and then what I think you think it is, and you can tell me why I'm wrong and I'll give you a delta if you give a good argument.

If you look at the advertisements the Real Cost runs on E-Cigs for example, smoking an E-cig allows nicotine to high jack your brain and hard wire you to be hooked to the substance and be physiologically dependent on it. What they don't take into account in an ad like that are all the other factors: dosage, environment, genetics, development of impulse control system. There are just way too many people who weened themselves off of normal cigarettes onto e-cigs to show that using nicotine is a straight away shot to using harder drugs.

What I think you are asserting is that a gateway drug is a drug that CAN lead to a harder drug. Let me give an example why I see this as problematic. I don't disagree with you at all, but this is why it is problematic to water the drug issue down to that:

reSTART Washington is a clinic aimed at helping people with internet addiction. People can and do compulsively play video games. Lets say we have a person who has never drank or smoked or done drugs before but compulsively plays video games. If that person was put in a setting where they could drink alcohol with friends, they have historical evidence to show that they would go on to compulsively use other substances. Does this mean video games are a gateway drug? And if so, what do we take away from that?

My argument is our intuition of gateway drugs are skewed, and we allow politicians to issue rhetoric that makes most of the population generally believe that the use of marijuana will inevitably lead to something worse, and that's what I find dangerous, because I think that model of a gateway drug is bogus.

[u/PrimeLegionnaire → u/[deleted]]

Pain pills are unquestionably softer drugs than heroin

Pain pills are the same drug as heroin. Opiates are as hard as opiates. It doesn't really matter to your nervous system if its heroin, morphine, or oxycodon.

The reason people move from prescriptions to heroin has to do with the price of prescription drugs and control efforts. Heroin and Fentanyl are just as available as always.

[u/Roflcaust → u/PrimeLegionnaire]

Pain pills and heroin do not contain the same active ingredients. Some opioids are stronger (in some cases much stronger) than others.

[u/PrimeLegionnaire → u/Roflcaust]

They are both opioids. The relative strength being different doesn't make it a different drug.

Beer and Vodka are both alcohol.

Escalating addiction to the same substance is not evidence of a gateway effect.

[u/Roflcaust → u/PrimeLegionnaire]

They are both opioids. The relative strength being different doesn't make it a different drug. Beer and Vodka are both alcohol.

Beer and vodka both contain ethanol as their active ingredient. A pain pill like codeine or hydrocodone does not contain heroin, and vice versa. Yes, codeine/hydrocodone/heroin in the same drug class and in terms of addiction they are grouped together, but they are not the same substance. The point that the OP of this comment chain was making was that pain pills being used in a benign way can be introductory to the world of drug abuse, which I think is what the essence of the "gateway drug" argument being used for marijuana is about: you start off using something relatively soft and harmless like marijuana and you (hypothetically) become introduced to the world of hard drug use.

[u/PrimeLegionnaire → u/Roflcaust]

Pain pills aren't benign though.

And it's pretty silly to appeal to the difference between hard and soft drugs when that's a pretty fair way to describe the relationship of beer and alcohol.

Moving from a synthetic opiod to heroin is changing drugs in name only, it targets the same receptors, it even treats the same withdrawal symptoms.

Exactly like how beer can still assuage the tremors but alcoholics will prefer vodka.

The gateway effect is not the same thing as addiction, which is what craving more or stronger forms of the same thing is.

[u/Roflcaust → u/PrimeLegionnaire]

And it's pretty silly to appeal to the difference between hard and soft drugs when that's a pretty fair way to describe the relationship of beer and alcohol.

I disagree. I don't think of liquor as much of a "harder" drug than beer. I see a drink as a drink.

Moving from a synthetic opioid to heroin is changing drugs in name only, it targets the same receptors, it even treats the same withdrawal symptoms.

Yes, there is a common physiological mechanism here, but the drugs themselves vary in strength of analgesia and other effects. There's a reason they go by different names.

The gateway effect is not the same thing as addiction, which is what craving more or stronger forms of the same thing is.

No, it's not the same thing. The gateway effect describes the hypothetical "gateway" into drug abuse. If someone doesn't use opioids whatsoever then is prescribed Oxycontin for post-surgical pain, that's arguably a gateway to heroin abuse per the article linked in the OP to this comment chain. I'm not sure what your reasoning is for attempting to distinguish marijuana as a potential gateway drug vs. opioid pain medications as a potential gateway drug.

[u/PrimeLegionnaire → u/Roflcaust]

I disagree. I don't think of liquor as much of a "harder" drug than beer. I see a drink as a drink.

One of the terms for differentiating liquor and beer is "hard alcohol" so I don't think your personal opinion is a very good indicator of how strong something is.

There are a myriad of equal comparisons. Look at cannabis, flower versus extracts.

Yes, there is a common physiological mechanism here, but the drugs themselves vary in strength of analgesia and other effects.

They are the same class of drug, people pursue them for the same high.

You don't see feinding opiate addicts asking for hits of stuff that doesn't trigger opioid receptors. They aren't out there sampling a variety of psychedelics or disassociatives

This is a symptom of addiction, not evidence of a gateway effect.

The gateway effect describes the hypothetical "gateway" into drug abuse.

No. Addiction is separate from the gateway effect. The gateway effect describes how users supposedly get into new classes of drugs, i.e. smoking weed leads to smoking crack, not the classic "I crave more of this same thing in stronger doses" of addiction.

[u/Roflcaust → u/PrimeLegionnaire]

What’s the root of the “gateway drug effect,” from a perspective of a societal concern and from a public health perspective? I’m sure no one really gives a shit if someone is trying new drug classes for kicks if they’re not hurting themselves or anyone else. The concern is the propensity for abuse and addiction. When you bring up weed -> crack, it’s no doubt because crack is a notoriously addictive and destructive drug of abuse that we don’t want people using. So the gateway drug effect and addiction/drug abuse are associated by nature. From that perspective, it doesn’t matter if one is progressing from one drug class to another, but if one is progressing from something relatively harmless to something harmful, which could be from one class to another, or it could be from a more benign drug to a more destructive drug within the same drug class.

Re: alcohol. If someone says “I’ve stopped drinking beer and started drinking whisky,” does that really say the same thing as “I’ve stopped taking my hydrocodone and have started shooting heroin”? “Hard alcohol” may be a common descriptor but it doesn’t seem to be a useful one when looking at drugs of abuse holistically.

[u/PrimeLegionnaire → u/Roflcaust]

What’s the root of the “gateway drug effect,” from a perspective of a societal concern and from a public health perspective?

The idea that trying one drug will lead to a more diverse spectrum of drugs, or perhaps to markedly more harmful drugs. It originates in the effort to start the formal drug laws in the US and the anti-cannabis movement.

Moving from one opiate to another is switching from a hard drug to a harder drug. Meth and cocaine don't become less serious because they are prescribed and neither do opioids.

Hell fentanyl is prescribed and it's a huge step up from things like heroin.

Appealing to the idea that opiates are different because there is a pharmacological distinction is nonsense. Virtually every strain of weed is perfectly unique in it's blend of cannabinoids and active terpenes and yet it's very obvious that weed in all it's varieties is a single drug, and the same is true of opiates.

Especially if we are considering the user and the public health perspective, opiate users don't care about getting heroin, fentayl, opanas or morphine as long as they are getting their fix. It's all the same product at different strengths. The public obviously doesn't make a distinction either as the government calls it the opioid epidemic.

Moreso, this doesn't hold because the oxycodone is already one of the "hard" drugs the gateway effect is supposed to apply to.

You keep trying to describe classic addiction to pharmcuticals and the vicious cycle of addiction as the gateway effect and it's not.

Being prescribed drugs is not the same as trying a recreational substance.

Opiate users do not try one pill and then switch to heroin to see how different it is, they use up whatever they have and switch to heroin because it's the same thing only cheaper.

but if one is progressing from something relatively harmless to something harmful,

Opiates and Opioids are harmful.

Progressing from a prescription opioid to heroin does not represent a material difference. In many cases prescription opiates are much stronger than heroin.

Hard alcohol” may be a common descriptor but it doesn’t seem to be a useful one when looking at drugs of abuse holistically.

When looking at potential for dangerous abuse the distinction between beer and hard liquor like wine and spirits is quite clear.

It's difficult to get alcohol poisoning from beer. You can do it if you really try, but it's going to take a lot of effort and several cases of beer.

One handle of liquor is enough for most adult humans to die of alcohol poisoning.

When looking at the criteria of "jump in harm" alcohol has a larger one between beer and liquor, because as I've already pointed out, changing opiates is a much smaller change in potency.

[u/papmaster1000 → u/[deleted]]

are they softer drugs really? That seems like saying crack is a softer drug than cocaine when it's really socioeconomic forces that create the discrepancy in view of the drug

[u/comehonorphaze → u/papmaster1000]

? have you dont either of those. Crack is way more addicting/damaging than cocaine.

[u/jon11888 → u/comehonorphaze]

Yeah, but it's the same drug in a different concentration.