E-Cigarettes, Heroin, And The Gateway Theory

From: Forbes/Op-Ed

Jacob Sullum, Contributor

Judging from the comments on my recent post about a fear-mongering WNBC story warning that e-cigarettes encourage drug use by teenagers,  I should have more clearly stated what I thought was obvious: I do not agree that “e-cigarettes lead to heroin” (as I sarcastically summarized the story’s message), and WNBC presents no evidence to back up that claim. Instead the station quotes two sources, Nassau County Police Lt. Kevin Smith and Assemblywoman Linda Rosenthal (D-Manhattan), who offer variations on what is known as the “gateway” or “stepping stone” theory of drug use. “For young people, marijuana is a gateway,” says Smith, decrying the use of e-cigarettes to consume marijuana extracts. “The next thing you know they’re doing acid, molly, even heroin.” Rosenthal says it starts with nicotine rather than marijuana: “Once you try electronic cigarettes, you can become hooked to them, move on to cigarettes and then move on to other drugs.”

Let’s start with Rosenthal’s claim. Is there any evidence that vaping leads to smoking? WNBC cites survey data indicating that “the percentage of middle and high school students who smoke e-cigarettes with nicotine and other additives in them more than doubled from 2011 to 2012.” But that increase was in past-month use, which may indicate nothing more than experimentation. Furthermore, as Boston University public health professor Michael Siegel has pointed out, nine out of 10 teenagers who reported using e-cigarettes in the previous month were already smokers. That means the trend viewed with alarm by WNBC may actually be a sign of successful harm reduction. In any case, these data  provide no support for Rosenthal’s claim that people “move on to cigarettes,” let alone “other drugs,” after trying e-cigarettes.

What about Smith’s warning that after “young people” smoke (or vape) marijuana, “the next thing you know they’re doing acid, molly [MDMA], even heroin”? Data from the most recent National Household Survey on Drug Use and Health indicate that 42 percent of Americans 12 and older have tried marijuana, compared to 9 percent who have tried LSD, 6 percent who have tried MDMA, and 1.6 percent who have tried heroin. In other words, less than 4 percent of the people who have tried pot also have tried heroin. The percentage is even smaller for past-year use: Less than 2 percent of the people who report consuming marijuana in the last year also report consuming heroin. Evidently the link between marijuana and heroin is not as strong as Smith implies.

Even if cannabis consumers rarely try heroin, it remains  true that people who use marijuana are more likely to try heroin than people who never smoke pot. The question is how to interpret that association: Does smoking pot make people more likely to try heroin, or is it just that the sort of people who are apt to try marijuana are also more likely to be attracted to heroin? If the former, is the process pharmacological or social? To what extent is it a product of laws that assign the two drugs to the same category? I discuss these and related issues in a 2003 Reason essay that clarifies the questions raised by claims like Smith’s and places them in historical context.

Since some readers seemed to think I had joined the campaign against vaping, I should add that even if e-cigarettes do make it easier for teenagers to consume marijuana (as WNBC suggests), that would be no reason to stand in the way of adults who want to use them.

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