Over the past few years, the United States has seen major changes in marijuana laws.
The majority of states currently allow medical marijuana under certain conditions. Some states, like Alabama and Mississippi, permit it under specific circumstances, like severe epileptic conditions. Other states, like Louisiana and West Virginia, allow only for infused products, such as pills or oils.
A number of states have decriminalized the possession of small amounts of marijuana.
And in the District of Columbia and eight states (Alaska, Colorado, California, Washington, Oregon, Nevada, and most recently Maine and Massachusetts) marijuana is legalized for recreational use.
In 2018, at least 12 states plan to consider the legalization of marijuana, with more possibly joining. With over 60% of Americans now supporting the full legalization of marijuana for adults, public opinion has certainly shifted.
But marijuana has long been called a “gateway drug,” so what will be the impact of its legalization? Does legalization of marijuana lead to other drug use? Let’s take a look.
Is Marijuana a Gateway Drug?
This is actually a complicated question, with no clear “yes” or “no” answer.
First, there’s the question of correlation vs. causation. As the National Institute on Drug Abuse (NIDA) points out, research suggests that marijuana use is “likely to precede use of other licit and illicit substances and the development of addiction to other substances.”
Additionally, research with rodents suggests that early use of marijuana—while the brain is still developing—decreases the reactivity of the dopamine reward center in the brain. It also “primes” the brain for enhanced responses to other drugs.
So there is a correlation between marijuana use and later use of other drugs. But is marijuana use causing people to use harder drugs?
In a report commissioned by Congress to examine the potential dangers of medical marijuana, the Institute of Medicine of the National Academy of Sciences wrote, “Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana — usually before they are of legal age.”
The report goes on to conclude, “There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs.”
In fact, NIDA clarifies that the majority of people who use marijuana don’t progress to harder drugs. Other substances, like alcohol and nicotine, also prime the brain for future drug use, and they also typically precede use of other substances.
NIDA offers another possible reason for the correlation between the use of marijuana and other drugs: Perhaps people who are more vulnerable to taking drugs are just more likely to start with substances that are more readily available, such as alcohol, nicotine, and marijuana.
This drug use exposes them to people who use harder drugs, increasing their chances of trying other drugs later.
The Impact of Legal Marijuana (So Far)
A new paper by researchers from the Consumer Financial Protection Bureau, Harvard University and Western Carolina University has studied the impact of recent developments in marijuana laws.
According to the paper, looser marijuana laws don’t appear to have a major impact (positive or negative) on other drug use thus far.
Researchers did find some effects, however. It appears that the use of heroin and cocaine among teenagers has decreased where marijuana laws are looser, and attempting to obtain harder drugs seems more risky in the face of marijuana legalization.
On the negative side, the study found that easing up on marijuana laws also made it easier to obtain psychedelic drugs, amphetamines, and barbiturates.
A 2014 study published by JAMA Internal Medicine found that in states with any kind of medical marijuana law, the mortality rate from opioid overdoses was 25% lower. This effect also increased over time.
Can Marijuana Treat Opioid Addiction?
As mentioned above, it appears that legalization of marijuana may help curb opioid addiction. According to a report in Drug and Alcohol Dependence, hospitalization rates for opioid painkiller dependence and abuse dropped an average of 23% in states legalizing medical marijuana. Hospitalization rates for opioid overdoses dropped an average of 13%. Meanwhile, no evidence was found of cannabis overdose deaths.
And Dr. Marcus Bachhuber, a professor at the Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, states that some of his patients have used marijuana to taper off highly addictive opioids.
Other doctors have used this same approach, and “a small but growing number” of pain doctors and addiction specialists are advocating marijuana as a substitute for more dangerous drugs.
At High Sobriety, a rehab center in West Los Angeles, clients receive “cannabis inclusive treatment,” using marijuana to detox from drugs and alcohol and also to help maintain sobriety.
Founder Joe Schrank, who started one of New York’s first sober-living homes, says that marijuana won’t kill patients like opiates do. Instead, it will help them sleep, relax, develop an appetite, and gain a sense of emotional control. The “bedrock 12-step program” that requires total abstinence leads many people to fail and sometimes succumb to drug or alcohol overdose.
Schrank’s methods have plenty of opponents, however. According to Thomas McLellan, founder of the Treatment Research Institute, “Marijuana has exactly no role in the treatment of any mental illness, especially substance-use disorders.”
U.S. Attorney General Jeff Sessions says, “I’m astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana, so people can trade one life-wrecking dependency for another.”
The jury is still out on exactly how the legalization of marijuana will impact the use of other drugs.
Thus far, there’s been no major impact. While lax marijuana laws may make it easier to acquire other drugs, it also makes attempting to obtain these drugs appear riskier. And it’s clear that opiate overdoses and hospitalizations are declining in states that allow medical marijuana.
While some doctors and addiction specialists are even advocating the use of marijuana to treat addiction to more dangerous substances, other specialists argue that total abstinence is key for recovering addicts. More research is needed on this alternative treatment.
Over time, a clearer picture will emerge of just how the legalization of marijuana will influence the use of other drugs.