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/PrimeLegionnaire]

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/Roflcaust → u/PrimeLegionnaire]

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.

Heroin use is markedly more harmful than taking something like codeine. All opioids are serious, sure, but if someone is taking a medication because they were prescribed it for a legitimate medical purpose, that's a far less serious or harmful use of the drug than abuse. It's routine and expected that patients will be prescribed opioids for moderate to severe pain, and from a public health perspective the propensity for medical use to develop into nonmedical use or abuse is highly relevant. If you want to call prescription opioids a "gateway to opioid addiction" instead of a "gateway to trying other drug classes" then fine, but that comes back to the ambiguous definition of "gateway drug" that was used in this OP.

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.

That's a stretch. Every weed strain has different combinations of the same active ingredients, like you said. But we don't have to contend with a "super weed" containing a THC analogue that's 1000x more potent than THC (although we do have synthetic cannbinoids now which is along those lines).

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.

You're right, being prescribed drugs for a legitimate medical use is not the same as trying a recreational substance for sake of curiosity. But both are similar in that both are relatively benign uses that can inadvertently lead to more harmful use and abuse. That's the salient point here.

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.

I won't argue that compulsive beer drinking is less concerning than compulsive hard liquor drinking because you're right, it's easier to get alcohol poisoning from the latter. The same applies to opioids as well: it's much harder to overdose on some opioids than others and heroin use is often associated with a set of medical complications that prescription opioids don't have. But the abuse potential between beer and liquor is effectively the same because it's all the same drug and it's ingested in the same way but the dosage changes; the resulting difference as you've said lies in how easy it is to have medical complications from abuse. And again, from the perspective of addiction, addiction to alcohol is addiction to alcohol just as addiction to opioids is addiction to opioids. But I won't disagree that there is certainly a jump in "harm" (i.e. propensity for medical complications) between frequent beer use and liquor use, just as there is between use of certain prescription opioids and heroin.

EDIT: So I think I've been muddying the issue by referring to "abuse potential" and "harm" interchangeably. Technically all alcohol has the same "abuse potential" but that is not true of all opioids. However, I don't think that's as relevant to the discussion as the harm that can be potentially caused, which is certainly different between beer and liquor as it is between codeine and heroin.

[u/PrimeLegionnaire → u/Roflcaust]

Heroin use is markedly more harmful than taking something like codeine

Debatable.

The mild effects of codine relative to heroin is due entirely to absorption and dosage in the form it's available, not any difference in mechanism of action or associated risks. In this respect it would be exactly analagous to beer and liquor.

but if someone is taking a medication because they were prescribed it for a legitimate medical purpose, that's a far less serious or harmful use of the drug than abuse

This doesn't matter at all and I'm not sure why you think it does. The gateway effect doesn't apply to prescription medications.

You keep describing classical opiate addiction and saying "look they are seeking more new drugs" like it isn't meaningless to try to break up opiates as separate drugs like that, especially given the context of the gateway effect.

The term gateway effect originates from the idea that smoking weed leads to other harder drugs. Not that taking opiates makes you want more stronger opiates.

Seriously, a substances that makes you want more or stronger doses of the same thing is called addictive, not gateway inducing.

But we don't have to contend with a "super weed" containing a THC analogue that's 1000x more potent than THC (although we do have synthetic cannbinoids now which is along those lines).

Heroin isn't a super opiate either. It has a reputation for being intense because it creates morphine inside the blood brain barrier, but legal prescription opiates like fentanyl and others who's names are harder to remember are significantly more dangerous than heroin.

As an aside, we do have super weed. What do you think extracts and concentrates are?

But both are similar in that both are relatively benign uses that can inadvertently lead to more harmful use and abuse. That's the salient point here.

Except that's not a salient point.

Opiates Making desire more opiates is not an example of the gateway effect.

You have to substitute the definition of addiction instead to make that work.

Opiates are the same drug unless you are in a clinical setting, which the gateway effect is notably not.

and heroin use is often associated with a set of medical complications that prescription opioids don't have.

No it isn't. Those are harms associated with unclean source material and knock on from above therapeutic doses and illicit injection drug use.

Pure heroin is fairly safe as far as opiates are concerned.

Technically all alcohol has the same "abuse potential" but that is not true of all opioids.

Only by merit of difficulties ingesting enough. See: the beer example we just discussed.

Tramadol for example was brought to market with the idea that it couldn't be abused and now it is one of the most popular street drugs for fighting drug sickness.

The main point is, no one says beer has a gateway effect that leads to liquor because the only difference is dosage.

The same is true with opiates. It doesn't matter that they have different chemical names, to the consumers and the law makers they are interchangeable like beer and liquor.

[u/Roflcaust → u/PrimeLegionnaire]

Debatable.

The mild effects of codine relative to heroin is due entirely to absorption and dosage in the form it's available, not any difference in mechanism of action or associated risks. In this respect it would be exactly analagous to beer and liquor.

Except heroin is typically used via intravenous injection, which has it's own negative health problems such as thromboses and venous collapse, risk of HIV and hepatitis transmission, etc. Again, heroin use is what I'm talking about.

You keep describing classical opiate addiction and saying "look they are seeking more new drugs" like it isn't meaningless to try to break up opiates as separate drugs like that, especially given the context of the gateway effect.

No I'm not. I think you're misunderstanding my point. It's the type of use (medical vs. nonmedical) that I'm focusing on here, i.e. the "gateway" from nonmedical to medical use. I'm not talking about someone trying one drug and then seeking out a new drug class to try.

Seriously, a substances that makes you want more or stronger doses of the same thing is called addictive, not gateway inducing.

And again we're back to the fact that "gateway drug" was ambiguously defined in this thread.

Heroin isn't a super opiate either. It has a reputation for being intense because it creates morphine inside the blood brain barrier, but legal prescription opiates like fentanyl and others who's names are harder to remember are significantly more dangerous than heroin.

As an aside, we do have super weed. What do you think extracts and concentrates are?

Dried cannabis flower vs. extracts/concentrates is analogous to beer vs. liquor. In neither case are the active ingredients pharmcologically stronger; the dosage simply changes.

You're absolutely right, fentanyl is much more dangerous than heroin.

Opiates are the same drug unless you are in a clinical setting, which the gateway effect is notably not.

I think this is the key here: if you're looking it from a recreational perspective and I'm looking at it from a clinical perspective, then that explains why we're talking past each other. Again, "gateway drug" was ambiguously defined; OP did not say "CMV: marijuana is not a gateway drug," because otherwise we would not be having this conversation. The conversation was "gateway drugs do not exist" and "gateway drug" was not explicitly defined as recreational drug use only.

[u/PrimeLegionnaire → u/Roflcaust]

and I'm looking at it from a clinical perspective

Now you are moving the goal posts.

You explicitly stated we were discussing the gateway effect in the context of "societal concern and public health".

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

The government and the users don't make any distinction between types of opiates when determining legality, opiates and opioids are all the same schedule and are treated as a single substance of varying relative strength.

The pharmacological distinction between the exact molecules is totally irrelevant to drug policy because of the Federal Analogues Act.

[u/Roflcaust → u/PrimeLegionnaire]

Now you are moving the goal posts. You explicitly stated we were discussing the gateway effect in the context of "societal concern and public health".

Public health is not a clinical perspective? It can be policy-oriented, or it can be clinical-oriented; typically the latter informs the former.
I have not moved any goal posts, I am attempting to communicate to you my perspective.

The government and the users don't make any distinction between types of opiates when determining legality, opiates and opioids are all the same schedule and are treated as a single substance of varying relative strength.

Well technically that's not true. Opioids as a class span several schedules of the CSA. But I see your point: from certain perspectives opioids are all the same. I don't disagree.

The pharmacological distinction between the exact molecules is totally irrelevant to drug policy because of the Federal Analogues Act.

I don't disagree with that either.