Are e-cigarettes a gateway to regular cigarettes and/or drugs?

Nicotine clearly acts as a gateway drug on the brain, and this effect is likely to occur whether the exposure comes from smoking cigarettes, passive tobacco smoke, or e-cigarettes. – Dr. Denise Kandel

Married couple Drs. Denise & Eric Kandel have recently produced compelling evidence that nicotine makes users prone to other forms of addiction by altering the structure of the brain. They tested this using lab mice, nicotine, and cocaine, and showed that nicotine-addicted mice were more likely to also become addicted to the illicit drug as a result. But are e-cigarettes really a gateway to harder drugs, or to regular cigarettes for that matter?

Gateway to heaven

The ‘gateway drug’ hypothesis is one which was posed by the very same Dr. Denise Kandel in 1975, and one that is not without its critics. Yes, many hard drug users are smokers, but that doesn’t necessarily mean they are hard drug users because they are smokers; Correlation does not establish causality, as scientists like to remind us.

Others have argued that drugs such as cannabis act as a gateway to other illicit drugs not by changing the brain’s chemistry, but because people who buy cannabis are exposed to dealers who can provide other drugs. They also say that if you’re the type of person who is open to experimenting with cannabis, you may well be open to experimenting with other substances. 

Still, whether physiological or sociological, the gateway drug theory is one that has a great deal of weight behind it, and one that has helped inform much of drug policy (not to mention the War on Drugs) for the past 40 years.

E-cigs and cigarettes

To return to smoking, the numbers argue that e-cigarette uptake by “never-smokers” is extremely rare, and that the most common reason for using them is to quit smoking regular cigarettes. In the US, less than 1% of adolescents who had never smoked had tried e-cigarettes, while in England the number of 16+ year old never-smokers who now regularly vape is at about 0.2%. More numbers

However, the concern is that largely unregulated e-cigarette marketing could lead on to more and more young people being attracted to vaping, and ultimately on to using nicotine products.

The long and short of it

There is no definitive evidence that shows, as of yet, that there is a causal link between vaping and moving on to smoke cigarettes. There is some research showing that young people who smoke e-cigarettes are more likely to also smoke regular cigarettes, but it is unclear whether they are starting with one or the other.

What we should be most concerned about is that e-cigarettes are currently marketed in a way that has been banned for regular cigarettes since the 1960s, including on TV and radio. This is worrying since studies have long shown that young people who are exposed to tobacco adverts are more likely to begin smoking.

We should also be concerned that e-cigarettes come in flavours such as chocolate, strawberry, and even ‘maple pancake’, which are the kind of flavours banned in regular cigarettes precisely because they appeal to young people.

So whether or not e-cigarettes are a gateway to more harmful addictions remains to be seen. But for the time being, heavily regulated marketing should be at the top of the agenda.

 

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A Consultation on Electronic Cigarettes and Strengthening Tobacco Control in Scotland, closing date Jan 2, 2015

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