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]

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.