New CDC: Drug overdose rates in the era of legalized marijuana.

“An aficionado I see.”

I am a legal medical marijuana patient in the state of Florida. What you call “getting high” I call medicating. For me, cannabis is medicine.

Been using cannabis daily since Feb 2015. I went from a non-functioning lump of depression & anxiety to a functional human working 2 jobs after being unemployable for over a decade.

“For me, cannabis is medicine.”

Yeah. I was there at the beginning when this ruse was hatched.

“I went from a non-functioning lump of depression & anxiety to a functional human working 2 jobs after being unemployable for over a decade.”

Good for you.

It’s funny how pot does the opposite to a lot of people.

You’re probably stoned, so it’s understandable, but the quote you provide does not say what you state above.

Please point out my misunderstanding of the quote I provided, shown below.

It did not find, however, that marijuana is a "gateway drug."

"Little evidence supports the hypothesis that initiation of marijuana use leads to an abuse disorder with other illicit substances," the report said.

“I was there at the beginning when this ruse was hatched.”

For you it’s a ruse. For me it’s been LIFESAVING. Nothing you will ever say or do will change that fact.

“It’s funny how pot does the opposite to a lot of people.”

If it’s ‘funny’ to you, what does that say about you exactly?

https://www.youtube.com/watch?v=NcRJxu7EXMU&t=627s

This is the quote I referred to.

“the DEA said in 2016 that pot is not a gateway drug.”

Very different than “It did not find, however, that marijuana is a “gateway drug.”

I’m not sure where this latter quote came from or why you bring it up as I did not comment on it.

I’m curious, how would you design a study to address and answer the hypothesis that initiation of marijuana use leads to an abuse disorder with other illicit substances?

You didn't read the report, did you?

From: Denial of Petition To Initiate Proceedings To Reschedule Marijuana

Marijuana as a “Gateway Drug”

Kandel (1975) proposed nearly 40 years ago the hypothesis that marijuana is a “gateway drug” that leads to the use or abuse of other illicit drugs. Since that time, epidemiological research explored this premise. Overall, research does not support a direct causal relationship between regular marijuana use and other illicit drug use. The studies examining the gateway hypothesis are limited. First, in general, studies recruit individuals influenced by a myriad of social, biological, and economic factors that contribute to extensive drug abuse (Hall & Lynskey, 2005). Second, most studies that test the hypothesis that marijuana use causes abuse of illicit drugs use the determinative measure any use of an illicit drug, rather than DSM-5 criteria for drug abuse or dependence on an illicit drug (DSM-5, 2013). Consequently, although an individual who used marijuana may try other illicit drugs, the individual may not regularly use drugs, or have a diagnosis of drug abuse or dependence.

Little evidence supports the hypothesis that initiation of marijuana use leads to an abuse disorder with other illicit substances. For example, one longitudinal study of 708 adolescents demonstrated that early onset marijuana use did not lead to problematic drug use (Kandel & Chen, 2000). Similarly, Nace et al. (1975) examined Vietnam-era soldiers who extensively abused marijuana and heroin while they were in the military, and found a lack of correlation of a causal relationship demonstrating marijuana use leading to heroin addiction. Additionally, in another longitudinal study of 2,446 adolescents, marijuana dependence was uncommon but when it did occur, the common predictors of marijuana dependence were the following: parental death, deprived socio-economic status, and baseline illicit drug use other than marijuana (von Sydow et al., 2002).

When examining the association between marijuana and illicit drugs, focusing on drug use versus abuse or dependence, different patterns emerge. For example, a study examining the possible causal relationship of the gateway hypothesis found a correlation between marijuana use in adolescents and other illicit drug use in early adulthood and, adjusting for age-linked experiences, did not effect this correlation (Van Gundy and Rebellon, 2010). However, when examining the association in terms of development of drug abuse; age-linked stressors and social roles moderated the correlation between marijuana use in adolescents and other illicit drug abuse. Similarly, Degenhardt et al. (2009) examined the development of drug dependence and found an association that did not support the gateway hypothesis. Specifically, drug dependence was significantly associated with the use of other illicit drugs prior to marijuana use.

Interestingly, the order of initiation of drug use seems to depend on the prevalence of use of each drug, which varies by country. Based on the World Health Organization (WHO) World Mental Health Survey that includes data from 17 different countries, the order of drug use initiation varies by country and relates to prevalence of drug use in each country (Degenhardt et al., 2010). Specifically, in the countries with the lowest prevalence of marijuana use, use of other illicit drugs before marijuana was common. This sequence of initiation is less common in countries with higher prevalence of marijuana use. A study of 9,282·households in the United States found that marijuana use often preceded the use of other illicit drugs; however, prior non-marijuana drug dependence was also frequently correlated with higher levels of illicit drug abuse (Degenhardt et al., 2009). Additionally, in a large 25-year longitudinal study of 1,256 New Zealand children, the author concluded that marijuana use correlated to an increased risk of abuse of other drugs, including cocaine and heroin (Fergusson et al., 2005).

Although many individuals with a drug abuse disorder may have used marijuana as one of their first illicit drugs, this fact does not correctly lead to the reverse inference that most individuals who used marijuana will inherently go on to try or become regular users of other illicit drugs. Specifically, data from the 2011 NSDUH survey illustrates this issue (SAMHSA, 2012). NSDUH data estimates 107.8 million individuals have a lifetime history of marijuana use, which indicates use on at least one occasion, compared to approximately 36 million individuals having a lifetime history of cocaine use and approximately 4 million individuals having a lifetime history of heroin use. NSDUH data do not provide information about each individual's specific drug history. However, even if one posits that every cocaine and heroin user previously used marijuana, the NSDUH data show that marijuana use at least once in a lifetime does not predict that an individual will also use another illicit drug at least once.

Finally, a review of the gateway hypothesis by Vanyukov et al. (2012) notes that because the gateway hypothesis only addresses the order of drug use initiation, the gateway hypothesis does not specify any mechanistic connections between drug “stages” following exposure to marijuana and does not extend to the risks for addiction. This concept contrasts with the concept of a common liability to addiction that involves mechanisms and biobehavioral characteristics pertaining to the entire course of drug abuse risk and disorders.

Pot is a 1000% more potent than it was back in the day (60’s-80’s).

I wouldn’t think there would be much desire for something stronger unless the person is simply a full blown druggie (waste of space) and not a recreational user.

Never liked it myself. Alcohol was my drug of choice. Quit that years ago.

I’m not sure where this latter quote came from or why you bring it up as I did not comment on it.

You quoted both me, the former quote, and a quote I found in the article, the latter quote.

Did you even read the article?

>> Irrelevant ad hominem; the report (https://www.federalregister.gov/documents/2016/08/12/2016-17960/denial-of-petition-to-initiate-proceedings-to-reschedule-marijuana) cites plenty of scientific evidence for that statement. <<

Nonsense. That report admits the existence of several studies showing that marijuana use was a strong indicator of the future use of other, harder addictive drugs... but dismisses them all in total on the argument that they only tested for whether people who used marijuana regularly were more likely to USE other drugs, not necessarily more likely to become dependent on them once they did use them. What it refutes is that something inherent about the nature of marijuana makes them more likely to become addicted to other drugs than other people who try those other drugs.

But that’s not the point! The point is that marijuana makes people more likely to try other drugs, giving them the opportunity to become addicted to them, which is clearly demonstrated by numerous studies! What the DEA refuted is not what people mean by “gateway drugs” Here are some definitions (emphasis and parenthetical statements are mine in all):

Wikipedia: Gateway drug effect ... is a comprehensive catchphrase for the often observed effect that the use of a psychoactive drug is coupled to an increased probability of the USE of further drugs.

Dictionary.com: any mood-altering drug, as a stimulant or tranquilizer, that does not cause physical dependence but may LEAD TO THE USE of addictive drugs

Collins: A gateway drug is a drug such as marijuana that is believed by some people to LEAD TO THE USE of more harmful drugs such as heroin or cocaine.

Center for Disease Control: a drug that is thought to LEAD TO THE USE of more dangerous drugs (such as cocaine or heroin).

National Institute on Drug Abuse: Some research suggests that marijuana use is LIKELY TO PRECEED USE of other licit and illicit substances46 and the development of addiction to other substances. For instance, a study using longitudinal data from the National Epidemiological Study of Alcohol Use and Related Disorders found that adults who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within 3 years; people who used marijuana and already had an alcohol use disorder at the outset were at greater risk of their alcohol use disorder worsening

National Institutes on Health: The gateway drug hypothesis refers to the pattern of substance use during adolescence whereby legal substances, such as nicotine and alcohol, PRECEDE THE PROGRESSIVE USE of illicit substances like cocaine and heroin.

Meth is the worst. Eventually you lose all your teeth, and still want more.

This gives a longer term picture. Note that Mass was already among the worst states in 2016, the year it voted to legalize. Also note that CA had one of the lowest rates of OD deaths, as well as one of the lowest increases between 2010 and 2016.

And finally, CO, OR, AK and WA ranked among the lowest. While you can't say legal pot is responsible for the lower death rates, it is a real stretch to argue legal pot is responsible for higher death rates.

+1000

This number six says exactly what I said. Some studies say one thing others say another. They also are very narrow differentiating use vs abuse etc...so they are often apples to oranges.

I’ll ask you the same question. How would you design a study to answer this “gateway drug” hypothesis?

This number six says exactly what I said. Some studies say one thing others say another. They also are very narrow differentiating use vs abuse etc...so they are often apples to oranges.

Your original contention with me was that I misquoted the article.

What it refutes is that something inherent about the nature of marijuana makes them more likely to become addicted to other drugs than other people who try those other drugs.

No, more likely than non-marijuana users.

But that’s not the point! The point is that marijuana makes people more likely to try other drugs,

No causal link has been established - just a correlation.

giving them the opportunity to become addicted to them

Which is why we care about an alleged "gateway" - making the DEA's approach a reasonable one.

Research shows that the correlation between earlier marijuana use and later use of other drugs can be explained by a "common-factor" model, that is, a third factor that causes both results, such as individuals' opportunities and unique propensities to use drugs, or more broadly a social or psychological predisposition towards anti-social behaviour. (http://www.rand.org/pubs/research_briefs/RB6010/index1.html, http://rds.homeoffice.gov.uk/rds/pdfs2/hors253.pdf)

This number six says exactly what I said. Some studies say one thing others say another.

Only if you ignore this paragraph from the report:

Although many individuals with a drug abuse disorder may have used marijuana as one of their first illicit drugs, this fact does not correctly lead to the reverse inference that most individuals who used marijuana will inherently go on to try or become regular users of other illicit drugs. Specifically, data from the 2011 NSDUH survey illustrates this issue (SAMHSA, 2012). NSDUH data estimates 107.8 million individuals have a lifetime history of marijuana use, which indicates use on at least one occasion, compared to approximately 36 million individuals having a lifetime history of cocaine use and approximately 4 million individuals having a lifetime history of heroin use. NSDUH data do not provide information about each individual's specific drug history. However, even if one posits that every cocaine and heroin user previously used marijuana, the NSDUH data show that marijuana use at least once in a lifetime does not predict that an individual will also use another illicit drug at least once.

I’ll ask you the same question. How would you design a study to answer this “gateway drug” hypothesis?

The first thing I'd do is make sure no one who currently believes in the gateway drug hypothesis takes part in the study because this makes them inherently biased as to the outcome of the study.

California’s legalized marijuana law went into effect in 2018.

I will say that Oregon’s and Washington’s abilities to stay near the bottom are data points against prohibition, but, and Colorado’s death rate is still one of the lower ones, but let’s look at states which changed their marijuana laws between 2010 and 2016:

Alaska HAD one of the lowest overdose rates in 2010... Now, it’s one of the highest.

New Hampshire, passed an absurdly broad “medical *wink* *wink* “ marijuana law in 2014... and had the largest increase in death rates in the nation.

Right behind NH, DC’s death rate also EXPLODED; It signed a recreational-marijuana law in 2015.

Also, LOOK OUT, MAINE!!!

Connecticut, Delaware, Maryland, Ohio and Massachusetts decriminalized between 2011 and 2015. All showed amazingly large increases in overdose death rates.

In fact, these “liberalizing” states represent #2, #3, #4, #7, #8, #9, #10, #11 # and 12 on the highest overdose death rates chart you provided; #1, #5 and #6 — the only ones of the top 12 not among these liberalizers — were all part of the Allegheny Opiate Explosion.

>> “Little evidence supports the hypothesis that initiation of marijuana use leads to an abuse disorder with other illicit substances,” the report said. <<

What the DEA is saying is that marijuana doesn’t make you more susceptible to addiction than anyone else who uses those hard drugs. But that’s not the concept of the Gateway Drug hypothesis, which is that using marijuana makes you more likely to use those hard drugs. That’s a deliberate and political straw man fallacy, which is why I pointed out that the DEA was a toady for James Comey and Barack Obama.

>> NSDUH data estimates 107.8 million individuals have a lifetime history of marijuana use, which indicates use on at least one occasion, compared to approximately 36 million individuals having a lifetime history of cocaine use and approximately 4 million individuals having a lifetime history of heroin use.>>

This is perhaps the most ridiculous straw man I’ve ever read. That’s supposing that the Gateway Drug hypothesis is that if you ever, even once, use marijuana, you will certainly use harder drugs. The Gateway Drug hypothesis, rather, is that if you habitually use marijuana, you will eventually become more likely to try harder drugs.

From the National Institutes of Health:

Of those with a dependence on cocaine, 59% to 89% use marijuana regularly.

That’s not the end of the issue, since that could show that cocaine use causes marijuana use, not the other way around. But in my younger days, I met a LOT of cocaine users and heard their testimonies about how they got hooked into drugs, and I can’t imagine ONE of them started with cocaine BEFORE trying marijuana.