E-cigarettes: A ‘Gateway’ to Harder Drugs?

by Dr Antonio Howell, MD

in quit smoking

Dr. Howell

Electronic cigarettes are currently marketed as alternative to traditional cigarettes and as a great means to ward off smoking. But alarming research from Columbia University suggests that electronic cigarettes may function as a “gateway drug” that can prime the brain to be more receptive to harder drugs.



E-cig And Flavor BottlesThe findings, published in the New England Journal of Medicine, add to the debate about the risks and benefits of electronic cigarettes, the increasingly popular devices that deliver nicotine directly without burning tobacco.

In laboratory studies, the researchers showed that “once mice and rats are on nicotine, they are more addicted to cocaine” after being introduced to that drug, said Dr. Aruni Bhatnagar of the University of Louisville, who was not involved in the study but chaired a 10-member American Heart Association panel on the impact of e-cigarettes.

The findings by Kandel and his wife, Columbia University researcher Denise Kandel, expand on her earlier work on nicotine as a “gateway drug,” a theory she first reported on in 1975.

“E-cigarettes have the same physiological effects on the brain and may pose the same risk of addiction to other drugs as regular cigarettes, especially in adolescence during a critical period of brain development,” they wrote.

“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,” they wrote.


In a 2004 study which involved a large, longitudinal sample, Denise Kandel found that the rate of cocaine dependence was highest among users who started using cocaine after having smoked cigarettes.

Dr. Shanta Rishi Dube of the Georgia State University School of Public Health, who was not involved in the research, said the results “appear valid based on prior studies that have looked at nicotine as a potential gateway (drug).”

Bhatnagar said the findings strengthen the case for regulation of e-cigarettes by the U.S. Food and Drug Administration.

“If we don’t have strict laws on youth access and marketing for e-cigarettes, we may fuel an entire new generation of people on nicotine, and that will be a gateway drug for the use of other drugs,” Bhatnagar said.


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