Since the war on drugs began, we have been fed information regarding cannabis, often incorrect information. We were bombarded by media images of “reefer madness” and stories telling us all what fate lay ahead of us if we dared to consume cannabis. Since then, due to the mounting scientific evidence most of these “facts” have been disproven, yet they continue to be repeated by many today. In this series of articles, we aim to examine the many myths that have been repeated and relied upon over the decades of cannabis prohibition.
For decades we have been told that cannabis consumers are more likely to use other drugs, and for decades this was believed by many. As a result, government and public health policies have prioritized preventing cannabis use via the criminalisation of consumers. According to the gateway theory consuming cannabis increases the chances of using and misusing other drugs such as opioids or stimulants such as cocaine. So, what is the truth?
The evidence
A paper published in 2020 which examined cannabis as a gateway drug for opioids examined decades of data regarding cannabis as a gateway drug. Although much of the research it listed did discover a correlation, they frequently also had significant methodological flaws. For instance, one study discovered that youths who use cannabis have a 104-fold increased risk of using cocaine. Nonetheless, there were notable distinctions between the two groups that existed prior to their cannabis use. This implies that additional contextual variations, personality variations, or additional risk factors may explain the usage of both medicines. Further studies in 2021 again examined the concept of the gateway theory, both studies found a correlation between cannabis consumption and opioid use. One study noted the low quality of evidence and found it was not possible to conclude that cannabis use caused misuse of other drugs. Researchers of the second study were cautious that the data was subject to hidden bias, suggesting their data does not provide evidence of cannabis as a gateway drug. While these studies mainly focused on opioid use, a further study conducted in 2021 found that chronic pain patients who are receiving medicinal cannabis reduced their opioid consumption, with some studies finding a 64% reduction, suggesting that cannabis can play a role in harm reduction and improving the quality of life of patients.
Correlation vs Causation: Ice cream is responsible for shark attacks.
The above studies have found a correlation between cannabis consumption and the risk of using and misusing other drugs, but the correlation is not causation. Because two things correlate does not necessarily mean one causes the other.
For example, ice cream sales tend to increase in the summertime, but so do drowning and shark attacks. This does not mean ice cream causes shark attacks, it is simply a correlation due to environmental factors. Do we now ban ice cream? Or just ban ice cream at the beach where sharks may be present? Do we criminalise, convict and jail people for making ice cream at home, or buying ice cream in a shop? Do we ban ice cream consumers from travelling to other countries? No that would be silly right?
Cannabis is the most widely used drug globally and Ireland is no different in that regard. It is estimated that anywhere between 13-20% of people in Ireland have consumed cannabis either in the most recent past or in their lifetime. If there was any truth to the gateway theory, then surely, we would see the same figures if not more for the consumption of other drugs, but this is not the case. We have seen many of our politicians, worldwide celebrities and past US presidents admit to cannabis consumption, which evidently did not lead to the use or misuse of other drugs.
The gateway theory focuses on biological and pharmacological reasoning for drug use. We know we cannot view drug use in isolation, people’s choices and especially drug choices are influenced by a range of environmental factors such as socioeconomic circumstances, poverty, family and home life, peer groups, trauma, and culture. People’s choice to consume cannabis will be influenced by individual circumstances and unique reasoning, whether it is medicinal or adult use, each person will have their own individual reason for consumption.
For research to capture the whole picture of drug use, it should aim to address the impact and implications of environmental factors on drug consumption. Separating a single substance from the overall conversation on drug use is counterproductive, it achieves nothing more than reiterating decades-old myths that have already resulted in detrimental impacts for cannabis consumers. The key to finding an answer to this question is the ability to bypass an approach based on correlation in favour of one based on causation. Our drug policy is currently based on the pretence that cannabis use leads to the use and misuse of other drugs, cannabis consumers are viewed as “addicts” as people who consume other “harder” drugs. This is where caution is needed. We must be careful not to exchange the label of a criminal with one of an addict in need of help or categorised as a patient in the future of cannabis reform. What policy advisors need to be aware of is that non-problematic cannabis consumption is the norm, not the exception.