The gateway debate over marijuana

CHRIS LOWE, A 41-year-old carpenter on Martha’s Vineyard, has smoked pot since his early 20s, both legally and illegally. When he lived in Montana, he had a certificate to grow, sell, and use medical marijuana until the state changed its laws. He says he qualifies for medical marijuana in Massachusetts, but doesn’t bother because the bureaucracy is too consuming.

Despite his prolonged daily use, Lowe says marijuana hasn’t led him down the path of addiction or caused him to use other drugs on anything more than a recreational basis.

“I don’t need it, I can go without it,” he says. “At this point, it’s a lifestyle choice.”

While he started using pot daily to deal with chronic pain in his foot, Lowe says marijuana is now the equivalent of an after-work beer, calming his mind and easing his aches and pains.

“It just chills me,” says the father of two teens. “My mind races. I’ll party on occasion [with other substances], but not regularly. Is it a gateway? No way. It just seems so ridiculous. You’re only addicted if you have an addictive personality.”

While Lowe’s view is one of a marijuana user, it’s also a position increasingly taken by researchers who say access to marijuana and use as a youngster is not necessarily the path to use and abuse of harder drugs such as opioids, cocaine, and methamphetamine.

“Correlation does not mean causation,” says Miriam Boeri, a sociology professor at Bentley University who has studied addicts and addiction for more than 16 years. “Most of the gateway theories are used to scare parents. The real gateway is having it illegal. It forces people to go into an illegal environment to purchase it and exposes them to the people and the drugs involved in that environment.”

With the question of legalizing the commercial sale and recreational use of marijuana in Massachusetts heading to the ballot, it’s a debate that will increase in volume as November nears because both sides have studies to buttress their argument. Leading elected officials such as Gov. Charlie Baker, Boston Mayor Marty Walsh, and Attorney General Maura Healey insist the scourge of addiction starts with the first puff.

“Decades of research have now debunked the myth that marijuana is harmless,” the trio wrote in an oped in the Boston Globe. “The science also shows that regular marijuana users — especially those who start at a young age — are more likely to try more dangerous drugs.”

But science doesn’t necessarily bolster their argument, though anecdotal research does lend support. Opponents of legal marijuana point to a study by Colorado law enforcement, which was the first state to begin the legal sale of recreational marijuana, that shows marijuana use among adolescents increased after the law passed. With the ongoing opioid crisis grabbing attention, it’s an argument that could resonate with voters who have children.

“Not everybody that smokes marijuana is going to go on to become a narcotics user,” says Charles Faris, president and CEO of Worcester-based Spectrum Health Systems, which operates addiction treatment services around the state. “But every narcotics user we see in our program has started with marijuana. Who is to say who will go on to be a narcotics user? We’re losing four to five people a day across the state to opioid overdoses. Why do we want to introduce another readily available intoxicating substance?”

Faris, who has been in the addiction treatment field for 45 years, says it’s easy for either side to “cherry pick” research to buttress their case but his experience tells him something different. He dismisses the argument, as some proponents of legal marijuana say, that if you have an addictive personality, even candy is a gateway drug.

“I’ve heard people say those who use [harder] drugs probably started with milk, too,” says Faris, a member of the group opposing legalization “If you have a beer while watching a game or wine with dinner, your intent is not to get drunk, at least I hope it’s not. If you’re going out and you’re smoking a joint, your intent is to get a buzz. I think the comparisons to candy, milk, are silly.”

Since decriminalization of marijuana in Massachusetts in 2008, Faris says he has seen an increase in use among the 13 to 16 year olds who receive services through his organization.

But that view is not necessarily backed by research. A report in Pediatrics, the medical journal of the American Academy of Pediatrics, looked at states that decriminalized marijuana or legalized medical marijuana and found that, while several states experienced an increase in marijuana usage, there was little overall change in the number of youths who use pot.

“Since legislation allowing medical marijuana took effect across a number of states, there have been no significant increases or decreases in youth-use rates, with the exceptions of Alaska and New Mexico,” says the report. “Additionally, two recently published studies have similarly found no significant differences in current use rates after legislation or only differences in two states (Montana decreased, Delaware increased) that can be explained equally by chance.”

Part of the reason the Pediatrics study showed little overall change in the number of youths who use pot is the fact that it’s so easy to get marijuana now, often easier than getting alcohol.

“For sure, pot is easier” to get, says Tom, an 18-year-old high school senior in central Massachusetts. “It’s not that hard to find. It’s just more available, more [young] people want it. Not everyone has a friend who’s 21.”

Tom, who says he smokes to ease his anxieties and depression, says his parents smoked pot when they were younger but don’t want him to use it because of where it could lead him.

“They said that they tried and they used to do it every now and then to have fun,” says Tom, who doesn’t let his parents know he smokes regularly. “They’re afraid I’m going to get into trouble. They always talk about how worried they are it’s a gateway drug. I’ve never done any other kinds of drugs; that’s the way I intend to keep it.”

Several studies, including one in 2003 by the RAND Corporation’s Drug Policy Research Center, have attempted to debunk the theory that smoking marijuana will lead to harder drug use. The RAND study says other factors such as predisposition to addiction, poverty, and race are just as likely to trigger harder drug use as access to marijuana.

“The people who are predisposed to use drugs and have the opportunity to use drugs are more likely than others to use both marijuana and harder drugs,” the study says. “Marijuana typically comes first because it is more available. Once we incorporated these facts into our mathematical model of adolescent drug use, we could explain all of the drug use associations that have been cited as evidence of marijuana’s gateway effect.”

The Rand study’s conclusion, though, is not the consensus position. A later study done by the British journal Addiction says the gateway effect of marijuana cannot be easily dismissed but added a caveat that the path from marijuana to heroin and other narcotics is narrower as the user gets older.

“Regular or heavy cannabis use was associated with an increased risk of using other illicit drugs, abusing or becoming dependent upon other illicit drugs, and using a wider variety of other illicit drugs,” the study concluded. “The risks of use, abuse/dependence, and use of a diversity of other drugs declined with increasing age. The findings may support a general causal model such as the cannabis gateway hypothesis, but the actual causal mechanisms underlying such a gateway, and the extent to which these causal mechanisms are direct or indirect, remain unclear.”

Boeri, the Bentley professor, says addiction often has societal causes. She says incarceration, which can introduce young people to harder criminals and drug users, and lack of economic opportunity are more likely to lead to addiction than marijuana. She also says she has seen marijuana be an effective treatment for opioid addiction, which is often treated by administering another legal narcotic, methadone, that continues the cycle of addiction. She points to a study by the National Bureau of Economic Research that she says concludes legalizing marijuana could help reduce the problem people are so worried about.

“In every state that legalized marijuana, there were fewer opioid deaths the closer you are to a marijuana dispensary,” she says of the study’s conclusions. “It’s not the best solution and it’s not agreeable to everybody, but we are in the throes of a heroin and opioid epidemic crisis right now. Marijuana is useful for getting off other drugs. It’s safer than other substitutes like methadone. Doesn’t it make sense to include this as one of the treatments?”

Most of the studies, regardless of conclusions, acknowledge the effects that marijuana can have on developing brains and urge regulations to prohibit marketing to young people similar to what alcohol and tobacco have done over the years.

Lowe, the Martha’ Vineyard carpenter, says his kids know about his marijuana use and he talks to them about it regularly. That, he says, is a better solution than prohibition.

“My boys grew up with it, they look at it as a vegetable,” says Lowe. “But I wouldn’t want them to make adult decisions like that [about smoking now.] I would want them to be a little older. It’s more about public perception than anything. I do want to protect my children as long as possible, protect their innocence.”