Reassessing the marijuana gateway effect.

AIMS Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths' risk of initiating hard drugs (the 'marijuana gateway' effect). This report examines whether these associations could instead be explained as the result of a common factor-drug use propensity-influencing the probability of both marijuana and other drug use. DESIGN A model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from US household surveys of drug use conducted between 1982 and 1994. Model assumptions include: (1) individuals have a non-specific random propensity to use drugs that is normally distributed in the population; (2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity, and (3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity. FINDINGS Each of the phenomena used to support claims of a 'marijuana gateway effect' are reproduced by the model, even though marijuana use has no causal influence over hard drug initiation in the model. CONCLUSIONS Marijuana gateway effects may exist. However, our results demonstrate that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common-factor model. No gateway effect is required to explain them. The common-factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model.