Medical Marijuana is a Gateway to Relief for the Sick and Suffering

On June 20th the state legislature passed the Compassionate Care Act making New York the 23rd state to make medical marijuana available to a group of seriously ill people (New York State Reaches Multiple Last-Minute Deals, Erica Orden, June 20, 2014, Wall Street Journal). A week before the bill’s passage, Erica Orden reported in the Wall Street Journal (Medical Marijuana Bill Advances in New York, June 12, 2014), that Governor Cuomo raised doubts about whether he would sign the bill. He cited his concern that “marijuana a gateway drug for other illegal substances”. Despite these concerns, the Governor decided that, along with tight regulations laid out in the bill, the potential benefits of medical marijuana outweigh this risk and agreed to sign the bill.

I would like to applaud the Governor for his wisdom in making this decision and reassure him and others who share his “gateway” concern. As an addiction psychologist with 35 years helping people address serious problems with marijuana and other drugs, my experience has shown me that, while it is certainly true that some people who use marijuana go on to use other drugs, including heroin, it is simply not true that marijuana is “gateway drug.”

Research does not support the “gateway theory” – the notion that marijuana use, especially among youth, leads to the use of other substances. Because marijuana is the mostly widely used illicit substance, were the gateway theory true, we would expect to see many more users of other illicit substances than we do. But the vast majority of people who use marijuana do not go on to use other illicit drugs. One the key flaws in the “gateway theory” is that it equates the correlation between marijuana use and the use of other drugs with causation. By the same logic, we could argue that milk is a gateway to illicit drug use since most people who use illicit drugs also drank milk as young people. People who use other illicit substances and develop significant problematic relationships with them do so for complex mix of psychological, biological and social reasons that could be the focus of another essay but certainly not because they used marijuana previously.

In fact, a strong body of research from states with medical marijuana programs have found that youth rates of marijuana use drop or remain stable after a state passes a medical marijuana law. For instance, a recent study in the Journal of Adolescent Health, using data from nine states over twenty years, found no increases in adolescent marijuana use following the enactment of medical marijuana laws. An American Journal of Public Health article from 2013, using data from 4 states over 9 years, concluded: “Our results suggest that, in the states assessed here, MMLs [medical marijuana laws] have not measurably affected adolescent marijuana use in the first few years after their enactment.” A prior 2012 study looking at a 17 year period reached a similar conclusion: “We are confident that marijuana use by teenagers does not increase when a state legalizes medical marijuana.” And a 1999 Institute of Medicine report found that: “There is broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern.”

Certainly, some people have problems with marijuana, and some marijuana users will go on to use other drugs, including heroin. But denying those with debilitating medical conditions access to medical marijuana is not a meaningful or winning prevention strategy; it does nothing to prevent the misuse of drugs and only harms our sickest and most vulnerable citizens. Rather, we need honest, reality-based drug prevention and treatment programs to reduce the problematic use of marijuana by children and adults alike. The worst dangers associated with medical marijuana come from forcing patients to seek medical marijuana on the illicit market.

So what message will passing the Compassionate Care Act send to young people? It would send the message that New York cares about sick and suffering patients enough to provide them access to a medicine that can help alleviate their anguish. Let’s stop trotting out tired scare tactics about medical marijuana as a gateway to heroin. Let’s show some common sense and compassion and recognize medical marijuana as a gateway to relief for thousands of New Yorkers living with cancer, multiple sclerosis, epilepsy and other debilitating conditions.


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