Gateway Drug Concept: Fact or Fiction

Gateway Drug Concept: Fact or Fiction

Does the illusive “gateway” drug exist? Moreover, is there a single drug, which opens a portal into the bowels of addiction? These, and many more questions must be addressed if one is to understand the gravity of this “gateway” drug hypothesis. Through an in-depth exploration into the “gateway” drug concept, the research will demonstrate, conclusively, that there is no precedent for a nefarious cascading of drugs- and there is no single drug that has the power to alter benign, recreational use, into full-blown addiction.

It should be established, at the commencement, that the etymology of the term “gateway” drug remains uncredited at the time of this writing. In other words, in the history of drug use, the aforementioned term has never been attributed to an individual as the creator. Use of the term, by Robert Dupont, is the most credited, since his use was documented as early as 1985, while he acted as director of the National Institute on Drug Abuse. Prior to Dupont’s use of the term, “gateway,” there existed two alternative and interchangeable terms: The Gateway Hypothesis and the much older term, the Stepping-Stone Theory (Kandel, 2002). The Gateway Hypothesis was extremely magniloquent and fundamentally flawed, as its position postulated that marijuana eventually lead to the use of narcotics. Kandel’s analyses of said models are most comprehensively expressed in a single sentence, stating, “the investigators concluded that all those who used marijuana would eventually also use heroin” (Kandel, 2002). The application of the debunking motif to this extremely flawed theory is very simple. It began and ended by questioning heroin addicts and discovered that the majority of heroin users had used marijuana, prior to their heroin use. Thus the Stepping-Stone Theory was developed. One cannot presume to build a lasting theory, based entirely on one drug as the cornerstone. Such research could be considered threadbare and speculative.

The key argument over the concept of the “gateway” drug is that it is inherently flawed. By stating that one drug is the causative precursor of induction into illicit drug use, overlooks a multitude of factors. One of the more recent flawed theories came about in the 1970s. The Gateway Hypothesis was based upon the concept of “sequencing.” Sequencing, in short, was the gradual climb from a substance with low potential for addiction, to one with high potential for addiction. As illustrated in the above paragraph, the foundation of this theory was that use of marijuana would lead to narcotic use. While this may be nothing new, it is relevant to illustrate the commonalities and extreme inaccuracies shared between the Stepping-Stone Theory and The Gateway Hypothesis. According to Kandel, “Because of the theoretical and policy implications of the Gateway Hypothesis for understanding adolescent development and the formulation of prevention and intervention programs, a critical examination of the hypothesis is warranted” (Kandel, 2002).

Alcohol and cigarettes were possibly the first drugs to earn the scarlet letter and be associated with the concept of the “gateway” drug. Insidious as they may be, they are merely scapegoats and overly demonized in the United States- any drug can be the primary drug of abuse and need not have any legalized and or illicit predecessor. Applying a superior perspective to alcohol as a “gateway” drug, alcohol is only as dangerous as the amount ingested. It is curious that alcohol is one of the few drugs to be outlawed, during “prohibition,” only to be reintroduced into society. There is no comparison to the “Not Even Once” maxim, which serves as the tenet for the Montana Meth Project. Whereas alcohol may be consumed occasionally, recreationally and in moderation, methamphetamine has the capacity to cause addiction on first use, according to research presented by Thomas M. Siebe’s philanthropic Meth Project initiative (“What Is Meth, Effects of Meth & Facts About Methamphetamine – Meth Project,” 2014). In order to demonstrate the significance of alcohol, it is necessary to compare it to a drug so destructive as methamphetamine. Methamphetamine has no cultural significance, nor it is used in ceremonial rituals or communal experiences. So, this drug is not cross-cultural, but alcohol is. “Both research and common sense tell us that the young people least likely to drink disruptively are those who were introduced to alcohol by moderate-drinking parents, rather than being initiated into drinking by their peers” (Peele & Brodsky, 2007). Peele and Brodsky defend key concepts that differ from other drugs, and annul alcohol as having any “gateway” properties. The authors challenge that,

Looking from the other direction, adolescents and young adults who have had some experience with tobacco, alcohol, and marijuana are somewhat more likely to try “hard” drugs as well. But these generalizations do not mean that “soft” drug use causes, or even predisposes, a young person to use “hard” drugs. (Peele & Brodsky, 2007)

Two prominent psychologists, Jonathan Shedler and Jack discovered that adolescents, who tried illicit drugs and or alcohol, became more resilient and able to regulate use, than frequent drug and alcohol users and those who abstained completely. However, the medical institution is far from innocent and plays a major role in the gateway to medically-induced addiction.

Iatrogenic addiction, or hospital-induced drug addiction is becoming an alarming trend. The genesis of the addiction may begin with a simple surgical procedure, or a visit to the emergency room. Upon discharge, the patient is prescribed something like hydrocodone, a schedule III narcotic analgesic. While many may be deterred by the side effects, or feel no pain relief, others reach a minor euphoric sensation. When the prescription is depleted, the patient may present to their primary care physician, a friend, or to an emergency room. This time, they want something stronger, and may have performed some research to assure that they get a schedule II, like oxycodone. As the former builds a tolerance, they will search for morphine, and then hydromorphone- a drug that is seven milligrams of morphine to every one milligram of hydromorphone (“Dilaudid (Hydromorphone Hydrochloride) Drug Information: Description, User Reviews, Drug Side Effects, Interactions – Prescribing Information at RxList,” n.d.). However, as the supporting literature outlines, oxycodone hydrochloride extended-release tablets, better known as OxyContin, are the most highly prescribed and sought-after of the narcotics. They range from ten milligrams to eighty milligrams, and are generally prescribed for chronic pain where surgery may not be an option. Sadly, this hospital-induced addiction can be thwarted by prescribing nonsteroidal anti-inflammatory drugs, or NSAIDs. While physicians may believe they are alleviating pain, they are producing addicts in a mechanized corruption line (Webster, 2012). The below chart illustrates the mortality rate and the link from opioid use to heroin use- this occurs without any “gateway” drug, least of all marijuana.

“Fewer than one in five non-medical users of OxyContin in our sample reported that pain relief was the reason for initiating non-medical OxyContin use” (Grau et al., 2007).

It is essential to note that marijuana may not prove to be a “gateway” drug, but it is far from harmless. The misinformation over the legalization of marijuana debate is immeasurable, as is the equally rivaled medical information. To begin with, the legalization of marijuana in the Netherlands, Switzerland, and Canada, was reversed after the innocuous drug showed deleterious results after a three-fold spike in use following said legalization. Of the many myths, surrounding marijuana use, the most disturbing is the wanton misconception that it has use in medicine. To date, the only FDA approved form of marijuana is Marinol, which are essentially the anti-emetic properties of the drug without the “high.” Marinol produces an effect known as drug-induced hyperphagia- colloquially known as “the munchies.” This synthetic form of THC, marijuana’s active constituent, is administered in a capsule, and passes through the gastrointestinal tract where it is readily absorbed. Marinol is mainly prescribed to cancer patients undergoing chemotherapy, and AIDS patients to prevent a condition known as “wasting,” due large in part to their lack of appetite (Tandy, 2005). What causes the drug to be insalubrious is that long-term use has shown impairment of memory recall and slowed reaction time. Moreover, the advocates of medical marijuana fail to comprehend key concepts regarding human anatomy and physiology. Human lungs are designed to inhale oxygen, through delicate membranes within the bronchial passages, leading to small capillary beds. This is how red blood cells become oxygenated. Now, consider replacing oxygen with smoke- a thick substance that coats the passages of the bronchi and the microscopic capillary beds. Simply stated, human lungs were not designed for smoke inhalation (Martini, Nath, Bartholomew, & Welch, 2009).

Whether it is for some unforeseen political agenda, or a blind quest to reveal the root of addiction, the “gateway” concept has more oppositional literature than the concept’s advocates are able to produce. From alcohol to methamphetamine, narcotics and marijuana to heroin, there is no compelling evidence to reinforce the argument that any of the aforementioned drugs hold gateway properties- save narcotics of lesser abuse potential to narcotics of greater abuse potential.

References

Dilaudid (Hydromorphone Hydrochloride) Drug Information: Description, User Reviews, Drug Side Effects, Interactions – Prescribing Information at RxList. (n.d.). Retrieved June 18, 2014, from http://www.rxlist.com/dilaudid-drug.htm

Golub, A., Johnson, B. D., & Dunlap, E. (2005). Subcultural evolution and illicit drug use*. Addiction Research & Theory, 13(3), 217-229. doi: 10.1080/16066350500053497

Grau, L. E., Dasgupta, N., Grau, L. E., Dasgupta, N., Harvey, A. P., Grau, L. E., … Heimer, R. (2007). Illicit Use of Opioids: Is OxyContin® a “Gateway Drug”? American Journal on Addictions, 16(3), 166-173. doi: 10.1080/10550490701375293

Hall, W., & Lynskey, M. (2005). Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug and Alcohol Review, 24(1), 39-48. doi: 10.1080/09595230500126698

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