‘Gateway drug’ is a term used to describe a habit-forming substance which compels a user to turn towards more addictive drugs. Examples of popular gateway drugs in today’s context include tobacco, alcohol and marijuana. According to the gateway drug theory, chronic and early use of these so-called gateway drugs increases the likelihood of using other, more potent and addictive drugs such as heroin. We can’t help but question if the latest trend among youths, vaping, could indeed be the new age gateway drug? Let’s find out.
How does gateway drug theory work?
The gateway drug theory was made popular in the 1970s and 1980s. Back then, it was used by politicians to bring attention to the ‘War on Drugs’ and clamp down on specific narcotics such as cocaine and even marijuana. Despite the recent legalisation of cannabis products for medicinal and recreational purposes in a number of states in the United States, there is good science behind the gateway drug theory.
The biological findings to support this claim comes from studies on both humans and animals. The underlying process involved here is the alteration of neurological pathways in the brain following juvenile use of supposed gateway drugs. Addiction research in animals have indicated that early-age-use of certain types of substances increases probability to develop addiction towards other substances.
Postmortem findings indicate that the mesolimbic dopamine pathway area (the so-called reward system in the brain) of these animals have been altered due to the use of substance, as opposed to the pathway area of animals outside the study. This corroborates the hypothesis that early use of certain drugs does indeed increase one’s chances of being wooed by other drugs.
So, is vape a gateway drug?
Fortunately, there are a number of studies that can help us answer this question. By definition, the gateway hypothesis for e-cigarettes/vape suggests that many of the youth who are now tobacco addicts (and users of other substances), would not have been addicted in the first place if it weren’t for a previous history of vaping.
Here’s how it is a gateway drug:
- Nicotine normalisation – A number of vape/e-cigarette companies have produced formulations that can deliver higher nicotine concentrations than some traditional combustible cigarettes. According to a study on the public health consequences of e-cigarettes, there is evidence to suggest that higher nicotine concentrations may heighten the risk of transitioning from e-cigarette use back to combustible cigarettes. This is worrying since more and more youths are now taking up vaping. According to the U.S. General Surgeon Report in 2015, vaping among high school students had increased by 900 percent, 40 percent of which have never smoked traditional combustible tobacco prior.
- Renormalisation of the smoking culture – There is a growing concern that an increase in e-cigarette use may renormalise a smoking culture among young people, subverting decades of anti-smoking efforts. According to a study, 60% of vapers in the United States admitted to vaping in public areas where combustible cigarette smoking was disallowed.
- Association with cannabis use – The relationship between tobacco use and the initiation and escalation of cannabis use is pretty well-established. Based on recent research, vaping may carry a similar risk. According to studies, vaping at the tender age of 14 was associated with almost a fourfold increase in the odds of initiating and consistently using cannabis two years later. The exposure to high levels of nicotine in adolescence is thought to prime the brain’s reward system to increase the pleasure that it experiences from using cannabis, setting up potential for a more rapid progression of use. Not only that, following the recent mass hospitalisation of young vapers in the U.S., it was found that the majority of vape juices used contained tetrahydrocannabinol (THC) from cannabis. The provision of an additional method of inhaling cannabinoids or other psychoactive drugs solidifies the ‘gateway drug’ notion associated with vape.
Here’s how it is not a gateway drug:
- Diversion hypothesis – Despite plenty of strong evidence pointing towards the validity of the new gateway drug argument, time-trend analyses have demonstrated a significant decline in smoking prevalence among U.S. youth and young adults over the past 30 days – in tandem with the rising popularity of vaping. These findings support the diversion hypothesis, which suggests that at population level, e-cigarette use partially replaces and/or substitutes cigarette smoking completely.
- Too soon to say – Proponents of the diversion hypothesis have suggested that the concern surrounding a gateway hypothesis may be premature, because many of these studies include smoking a single cigarette as the primary outcome, while e-cigarette users may be only temporarily experimenting with cigarettes and are unlikely to progress to more frequent smoking. Those in support of this hypothesis have suggested that e-cigarettes have not been available and popular for a long enough time to determine whether they lead to long-term cigarette use.
The counter argument directed towards the gateway drug hypothesis failed to address the association of vaping with cannabis and other psychoactive drugs. Effectively, the opinion in favour of the gateway hypothesis stands firm due to the robust observable biological alterations. Furthermore, the recent deaths and mass hospitalisations associated with vaping further solidifies the warning to stay clear from such devices as it may increase your mortality and morbidity risk significantly. If you are transitioning from smoking to vaping, the best option is to seek medical help from doctors or resort to healthier alternatives as opposed to inhaling a cocktail of chemicals into your lungs. To help Malaysian smokers give up the habit of smoking successfully, the government has increased the availability and the accessibility of the mQuit service.
To quit right now, visit http://jomquit.moh.gov.my/.
Hello Health Group does not provide medical advice, diagnosis or treatment.
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