A new study performed by researchers at Georgia State suggests that e-cigarettes are potentially a “gateway drug” for using cannabis, although this is significantly affected by an individual’s mental health status.
E-cigarettes can contain nicotine, a highly addictive substance included in traditional cigarettes. Now, Georgia state research has identified that using e-cigarettes may lead to the subsequent use of cannabis, making them somewhat of a gateway drug. However, the study did find that a person’s risk for cannabis use greatly depends on their mental health status and the type of mental disorder they experience.
Jidong Huang, associate professor of health management and policy in the School of Public Health and the study’s corresponding author, commented: “We know from existing literature that e-cigarette use is associated with subsequent cannabis use, particularly in youth and young adults. We also know that some population subgroups, such as certain minority populations and those with mental health problems, are more likely to use tobacco products. What we need to better understand is the link between e-cigarette use and subsequent cannabis use among those subgroups.”
The study is published in the American Journal of Preventive Medicine.
Is vaping a gateway drug to cannabis?
For their study, the team utilised four years of data between 2013 and 2018 from the Population Assessment of Tobacco and Health (PATH) study, research performed in the US about how tobacco use affects health. The study sample included youths aged from 12 to 17 who reported never using cannabis at the study’s inception.
The researchers controlled for factors such as age, race, ethnicity, parental education, and state recreational cannabis laws, discovering that cannabis use was more prevalent in individuals who use e-cigarettes than those who did not.
Cannabis use was 13.8% at year two of the PATH study for those who vaped, 9.7% at year three, and 26.3% at year four. In contrast, for those who did not use e-cigarettes, the prevalence of using cannabis was 2.2% at year two, 2.4% at year three and 2.9% at year four. Additionally, the researchers found that cannabis use was more frequent in individuals who reported high severity of mental health issues.
How do mental health problems impact cannabis use?
Next, they analysed the data based on the participants’ types of mental health problems. They discovered that the association between cannabis use and vaping depended on whether their mental health problems were externalising (oppositional, impulsive, or risk-taking behaviour) or internalising (anxiety or depression).
Individuals with externalising mental health problems (EMH) who use e-cigarettes are much more likely to start using cannabis than those without EMH. Interestingly, the opposite was true for people with internalising mental health problems (IMH).
Huang said: “Mental health problems are generally associated with higher levels of tobacco use and cannabis use, so our hypothesis was that e-cigarette users with mental health problems are going to be more likely to initiate cannabis use compared with e-cigarette users without mental health problems. But what we found was that there is a great deal of nuance based on the type of mental health problems that e-cigarette users are facing.”
The experts theorised that this might be due to multiple reasons, one being that people with IMH may feel isolated and therefore have fewer opportunities to attain cannabis or socialise with those who are using it compared to people without IMH. Additionally, due to e-cigarettes being widely available, they may be an easy option to self-medicate.
“If they find e-cigarettes are sufficient for dealing with stress or anxiety, they may be less likely to engage in other substance use,” said Huang.
Huang stated that it is essential to continue research into e-cigarettes potentially being a gateway drug to cannabis use and that more studies are needed to understand the mechanisms behind this transition in young adults with mental health problems. He also highlighted the importance of finding out the motivations to start using e-cigarettes or cannabis in the first place.
He concluded: “The reasons to use cannabis or e-cigarettes may be very different depending on the type of mental health problems that people are experiencing. People with internalising mental health problems may be using substances on a more regular basis or using them alone because that’s their coping mechanism. But those with externalising mental health problems might only use substances on occasions when they’re with their peers because it’s a way of acting out.”