It goes without saying that spreading reform and adult-use legalization over the past decade is transforming the way we look at cannabis and increasing its accessibility. Throughout this new journey, the opposition has regularly brought up concerns around increased underage access. While many studies have already worked to debunk that more legal cannabis innately means higher use among minors and young adults, a new study looks a bit broader.

Researchers with the University of Oklahoma tracked substance use patterns in a cohort of more than 8,000 young adults (aged 18 to 24 years old) over six years to track what kind of substances young people typically turn to first. Ultimately, the research shows young people typically try alcohol and/or tobacco before they experiment with cannabis.

Study Explores Substance Use Initiation in a New Cannabis Landscape

The study, titled “First use of cannabis compared to first use of alcohol and tobacco: Associations with single and poly-substance use behavior,” was published in the journal Drug and Alcohol Dependence.

Study authors note that nearly 145 million Americans lived in a state with some form of legalized recreational or medical cannabis use in 2022, accounting for 45% of the U.S. population. They also noted that legal cannabis markets may be “particularly relevant” to young adults (18-24) since they have the highest proportion of past-year and past 30-day cannabis use (23.2%) compared to youth (6.3%) and adults over the age of 25 (10.4%).

They note that previous research examining the sequencing of alcohol, tobacco and cannabis initiation in young adults regularly identified alcohol as a catalyst to later substance use. It begs the question, has legal cannabis use changed the pattern?

“No studies to our knowledge have examined whether using cannabis before alcohol and tobacco compared to using cannabis at the same age as alcohol or tobacco confers greater risk of reporting current poly-substance use and other drug use,” authors state.

Researchers used data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study restricted use files, ranging from September 2013 through November 2019. 

Alcohol, Tobacco Use Still Precedes Cannabis Use For Most Young Adults

The results found that few young people (6%) initiated their substance use with cannabis, and those who did were less likely in life to consume alcohol or to report either substance abuse or mental health issues. Among those with exclusive cannabis initiation, the majority were male (62.3%), more than one-third were non-Hispanic white (38.3%) and the majority had at most a high school diploma or GED (65%), while 34.9% had at least some college experience.

They also found that those who initiated cannabis use at the same time they began consuming alcohol and tobacco (22%) were more likely to report use of multiple drugs later in life. 

The study suggests that alcohol is still the most popular substance initiation, with 52% of respondents consuming alcohol before any other controlled substance.

“Alcohol is overwhelmingly tried before either tobacco or cannabis,” authors concluded.

“Cannabis initiation at an earlier age than alcohol and tobacco is uncommon. Those who initiated cannabis before alcohol and tobacco appeared less likely to have a wide constellation of substance use and mental health vulnerabilities compared to those who tried cannabis at the same age as they tried at least one other substance.”

They added, “Finally, the odds of reporting current substance use and poly-substance use were greatest among young adults who initiated cannabis at the same age as alcohol or tobacco.”

Supporting Past Findings and Fighting Against the “Gateway Drug” Stereotype

As researchers noted, the results are consistent with previous studies—it’s simply the most recent, better reflecting the current reality of the expanding cannabis market.

One 2016 study similarly found that alcohol is the first substance consumed by individuals who report polydrug use later in life. Researchers evaluated drug use patterns from a nationally representative sample of 2,835 high school seniors. Not only was alcohol the most common first substance, but researchers said that the earlier one initiates alcohol use, the more likely it is they will engage in future illicit substance use.

A number of other studies have attempted to look into the longstanding assertion that cannabis is a “gateway drug,” leading to further substance use, though studies have repeatedly found the claim holds little weight. 

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According to a new study, it would appear that alcohol and tobacco are the real gateway drugs.
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