Malcolm Gladwell Is Wrong. Marijuana Is Not a Gateway Drug.

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Almost immediately after Malcolm Gladwell’s latest piece, “Is Marijuana As Safe As We Think?,” went up on The New Yorker earlier this week, the backlash was, shall we say, lit.

It wasn’t entirely surprising. Gladwell had chosen the ultimate bellwether to deconstruct, analyze, and thinkpiece: marijuana and its supposed threat to American culture.

What researchers and experts both found odd was Gladwell’s reliance on journalist Alex Berenson’s newly released, controversial book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence to build his case that marijuana was potentially dangerous.

“This book is really poorly researched and it cherry-picks and misrepresents data,” Jolene Forman, a senior staff attorney at the Drug Policy Alliance, told the Daily Beast.

Here’s how critics broke down Gladwell’s argument on marijuana.

Claim 1: Marijuana can cause mental illness and psychosis.

At the beginning of his article, Gladwell cites a report from the National Academy panel in 2017: “Cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.”

But the reasoning goes a dangerous step forward: “Is this the reason, Berenson wonders, for the rising incidence of schizophrenia in the developed world, where cannabis use has also increased?”

That’s a perilous jump in logic, using correlation to imply a causation.

“It is irresponsible to say that marijuana causes mental illness,” Forman told the Daily Beast. “The symptoms of psychosis—environmental factors, social determinants, and genetic predispositions—are all present and emerge long before anybody uses cannabis. It really takes a huge logical leap to say that someone uses marijuana and that it’s responsible for mental illness.”

Diana Martinez, a professor of psychiatry at Columbia University who studies the neurochemistry of addiction, said that scientific circles hadn't established a connection between marijuana and mental illness.

“One cannot say that cannabis causes mental illness,” she told The Daily Beast via email. “Nor can we even say, at this point, that cannabis definitely eases mental illness. There is data showing that heavy high potency cannabis use in adolescents is associated with a diagnosis of schizophrenia. But one cannot infer causality from this data.”

Claim 2: Marijuana can make people violent.

Gladwell builds on his mental illness-marijuana hypothesis by citing a story of the inspiration behind Berenson’s book. Berenson's wife, a psychiatrist of mentally ill criminals, told Berenson a horrific story about “someone who’d cut up his grandmother or set fire to his apartment.” Berenson’s wife’s automatic response? “Of course, he was high, been smoking pot his whole life.”

This story was one of the most head-scratching, confusing ones to researchers interviewed by The Daily Beast.

“I don't think it's known,” Martinez said of the link between marijuana and violence. She pointed to some research done on Mexican drug trafficking organizations but added that “none of this data shows that cannabis instigates violent behavior in humans.”

Susan Weiss, a senior adviser at the National Institute on Drug Abuse, said the tie, if any, between marijuana and violence is one “we know even less about” than marijuana’s tie to mental illness. “There are many confounding factors that make it difficult to understand the link between cannabis and violent behavior,” she said: how a person grew up, who their peers are, and their genetic predisposition, among other things. But, Weiss said, “it doesn’t seem like when people are high on cannabis they are more likely to commit acts of violence.”

Chronic misuse could potentially cause periods of paranoia, Weiss said, that could lead to a greater likelihood of committing some violent act.

But to test that is a different matter. “To show that cannabis incites violence, we'd have to expose humans to cannabis and see if there [are] changes in aggression,” Martinez said. “In studies that have exposed adults to cannabis that I have seen, there haven't been reports of increased violence.”

Claim 3: Marijuana can be a gateway drug.

Of the claims that Berenson-via-Gladwell made in the New Yorker piece, it was the gateway theory that invited the most scorn.

“Berenson, in his role as devil’s advocate, emphasizes the research that sees cannabis as opening the door to opioid use,” wrote Gladwell. “Seventy-two thousand Americans died in 2017 of drug overdoses. Should you embark on a pro-cannabis crusade without knowing whether it will add to or subtract from that number?”

Much of the thinking behind this stems from what's been referred to as the gateway hypothesis that suggested that marijuana use led to a chase for a higher high into harder drugs. Research from the '70s (which many experts credit for kicking off the War on Drugs), however, found that young people rarely start with marijuana when they began experimenting with drugs—and that cigarettes and alcohol were often what kick-started harder drug experimentation.

That's led to a lot of debate about whether the gateway drug hypothesis actually exists or not. Weiss noted that the hypothesis has traditionally been tested using animals, where the only variable being studied is the exposure of that animal to a drug. But animals don’t have socioeconomic statuses, differences in education, or peer pressure—all elements that can affect a person’s use of marijuana and other drugs.

Michael Vanyukov, a professor of pharmaceutical sciences at the University of Pittsburgh who has studied the roots of substance abuse, thinks the problem is in the terminology itself. “‘Gateway drug’ as a term is basically a false concept,” he said. “There are no gateway drugs because any drug can be a gateway inasmuch as you can start your drug career with any drug.”

Vanyukov said marijuana is wrongly thought of as a gateway drug because it is commonly available and used among experimenting teens in the United States. But blaming marijuana as a potential source of the opioid crisis in America doesn’t make sense to Vanyukov, who pointed to Japan, where cannabis is seldom used first towards illicit drug use (and therefore not a “gateway”).

Previous research on marijuana has shown some surprising correlations. Cocaine use has high instances of use along with opioid abuse, suggesting that that drug could be more of a predictor of opioid abuse than marijuana for some populations. And while a large number of opioid users have used marijuana prior to using opioids, research has shown that nearly all had dabbled in tobacco and alcohol.

Martinez said that opioid abuse should be looked at in the same light as mental illness. “It's going to include a lot of factors; family history, genetics, environment, and other drug (or alcohol) use,” she said. “Few patients with a opioid use disorder started with opioids as the first drug they ever took. Most will have used cannabis before they've tried opioids, but I suspect they've also tried tobacco and alcohol, and likely other drugs as well.”

Vanyukov agreed: “It’s an opportunistic phenomenon. There is gateway behavior, not a gateway drug.”

The idea of gateway behavior rather than gateway drugs has picked up steam in recent years as more is being understood about the neurological mechanisms of addiction and genetics. What we now know that we might not have understood nearly half a century ago as we explored what caused some people to fall into drug abuse is that genes make some people more susceptible to use and abuse drugs, making the choice of first drug—marijuana or otherwise—less important than once believed.

“If you remove marijuana from circulation, you will obviously not stop drug use and addiction,” Vanyukov said, referring to opioids. “It’s no gateway from that standpoint.”

The real problem: We barely know anything about marijuana.

With harder drugs like LSD or psilocybin, clinical researchers can request permission from the Drug Enforcement Agency.

That’s not the case with marijuana. The Controlled Substances Act of 1970 effectively banned marijuana research in the United States by labeling it a Schedule 1 drug, which meant that the government found marijuana not only lacks any medical potential but also is a highly addictive substance. As Popular Science has detailed, getting marijuana research approved requires a DEA license along with approval of the study by the FDA. Even after that, though, “research-grade marijuana” can only be obtained from the National Institute on Drug Abuse.

Gladwell references those issues in his piece: “We need proper studies, the panel concluded, on the health effects of cannabis on children and teen-agers and pregnant women and breast-feeding mothers and ‘older populations’ and ‘heavy cannabis user’; in other words on everyone except the college student who smokes a joint once a month.” But Gladwell goes on to repeatedly cite Berenson’s conclusion that marijuana is unsafe.

“No psychoactive compound is entirely neutral—that’s why they are psychoactive,” Vanyukov said. “If there is a disposition to psychosis, it may be triggered by a psychoactive compound.” But to point to marijuana as the source of mental illness? Forman said that such a leap in logic was “irresponsible.”

“We don’t think marijuana is not harmful,” Forman said. “But we need to know how to reduce those harms. The state has no way to test [for adulterated marijuana], consumers have no way of knowing about the safety and component and packaging of their marijuana. And states can dramatically limit marketing and advertising for public safety and barring kids. It doesn’t have to be the next big tobacco or big alcohol.”