A New Survey Analysis Examines the Idea of Cannabis as a “Gateway Drug” for Young Adults

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A reportedly first-of-its-kind study tested the idea that cannabis use leads to other substance use in young adults.

A study recently published in the journal Drug and Alcohol Dependence analyzed surveys from over 8000 young adults to test the hypothesis of cannabis being a “gateway drug” to other substances such as alcohol and tobacco (1). The authors noted that young adults in the US (ages 18-25) have the highest reported past-year and past-30 days cannabis use compared to other age groups, and that cannabis use continues to rise in this age group (1).

“Young adults report high rates of current cannabis use,” the introduction stated (1). “The proliferation of legalized cannabis in the US has led to greater access and availability, causing cannabis to become the new ‘gateway’ drug. This study examined the prevalence of trying cannabis before alcohol or tobacco and the association of initiation with cannabis first with single and poly-substance use in young adults.”


The authors looked at data from the Population Assessment of Tobacco and Health (PATH) study (1). According to their website, the PATH study started in 2013 and is a collaboration between the National Institutes on Health (NIH) and the Food and Drug Administration (FDA) to study tobacco use across the nation and its effects on health (2).

“Initiating cannabis before alcohol and tobacco (6%) was rare,” read the Results section of the abstract (1). “In adjusted regression models, initiating cannabis before alcohol and tobacco was associated with increased odds of past 30-day cannabis use, past 30-day tobacco use, and past 30-day polysubstance use and decreased odds of past 30-day alcohol use. Initiating cannabis at the same age as either alcohol or tobacco, or trying cannabis after these substances was associated with increased odds of all substance use outcomes.”

“Alcohol is overwhelmingly tried before either tobacco or cannabis,” the authors concluded (1). “Cannabis initiation at an earlier age than alcohol and tobacco is uncommon. Those who initiated cannabis before alcohol and tobacco appeared less likely to have a wide constellation of substance use and mental health vulnerabilities compared to those who tried cannabis at the same age as they tried at least one other substance.”


  1. Cohn, A. M.; Elmasry, H. First Use of Cannabis Compared to First Use of Alcohol and Tobacco: Associations with Single and Poly-Substance Use Behavior. Drug and Alcohol Dependence 2023, 248, 109904.
  2. Path (population assessment of tobacco and Health) Study - Home (accessed Jul 5, 2023).