Grow, Gift, Repair

Vancouver-based study finds that cannabis can be a “reverse gateway drug”

A study published this week in PLOS One, a peer-reviewed scientific and medical journal, found that for some street youth in Vancouver, cannabis is a “reverse gateway drug.”

The study was conducted over two years, from 2017 to 2019, and focused on 56 “street-involved youth” in Vancouver. Researchers also interviewed youth-focused care providers. 

The study found that young people “may use cannabis to reduce the harms caused by other forms of substance use and in order to transition away from more harmful forms of substance use.”

Researchers sought to examine “how young people understood, experienced and engaged with cannabis in the context of drug scene entrenchment and drug use trajectories that included the use of other substances, such as alcohol, fentanyl, heroin and meth.”

The majority of study participants, who had a median age of 21, said they consumed cannabis daily, usually while cycling on or off other drugs, primarily alcohol, opioids and meth.

During periods where the individuals were consuming cannabis, but no other substances, participants referred to themselves as being “sober” and “drug-free,” with all participants describing their cannabis use as a form of mental health and substance use treatment, rather than recreational. 

Cannabis was frequently described as a treatment for depression, anxiety, attention deficit hyperactivity disorder and chronic pain, as well as a means to reduce the use of other drugs. “Many young people described cannabis as a means of intermittently reducing their use of or eliminating these more problematic forms of substance use,” the study notes.

“Weed is very medicinal — it’s the best medication there is. It cures my hyperactivity. I also have scoliosis, and my back pain stops, too, when I use it,” said 21-year-old Blake, who was a daily meth user at the time of his interview. 

Another participant, 19-year-old Jeremiah, described his cannabis consumption as a way to combat the daily stress he faces as he navigates periods of unstable housing and homelessness.

“I’ve been sleeping on the beach for three months. I smoke a lot of weed. And then I don’t have sadness. My environment is still sad, but smoking weed helps me a lot. That’s very, like, therapeutic for me. And it just lets me, like, keep going,” he said. 

For others, their cannabis consumption was seen in a less positive light. A few of the youth reported that using weed could sometimes trigger cravings for harder substances, while others, like 24-year-old Mason, said they were ridiculed when they tried to enter treatment programs for cannabis consumption. 

“People treated me like total crap when I was [in residential treatment] for pot,” he said. “I mean, like, total shit. It was like, ‘Oh, well, that’s not a drug. You don’t need to be in treatment.’ And when I went there for morphine and shit, they were just kind of like, ‘Whoa [i.e., that’s a “real” addiction].’”

The study notes that the care providers interviewed acknowledged both the benefits and harms of cannabis consumption among “youth experiencing street entrenchment,” and emphasized the importance of remaining unbiased in conversations about cannabis consumption among youth. 

“I think it’s important to have an open conversation with people about what pot means to them, and I think all service providers need to be having these conversations,” said one counsellor. “We need to be looking at the pros and cons and asking young people, ‘How is it for you? You’re smoking pot, are you okay with that, or do you want to make some changes?’c

The counsellor added that ceasing cannabis consumption, especially when used as a form of self-medication, can also trigger other issues. “How is that gonna affect you and how can we work with that? Because there are going to be consequences to not using anymore, especially if you’ve been using to self-medicate,“ the counsellor said. “But if they say, ‘Hey, pot is what keeps me sane’ it’s like, okay, then let’s work on other stuff.”

The study concludes by noting that the majority of participants viewed cannabis as a tool that allowed them to transition away from what they viewed as more problematic substances and to relieve mental and physical health issues. This needs to be acknowledged when working with youth who are facing similar circumstances, study authors write. 

“It is imperative that future policy and programming interventions, and provider education and training, be responsive to the ways in which youth in our setting are actively using cannabis to navigate their everyday lives and healthcare needs,” the study concludes.