Coffee the Gateway Drug

Some in the vaping community, (certainly if online comments are anything to go by), were alarmed by press attention to an elaborate thesis recently published that suggested nicotine was a 'gateway drug', that could cause people to go on to become cocaine users.

Anti-vapers seized on the story, and now responses challenging the idea have started to be drafted and published.

But, a lot of what the thesis (published in New England Journal of Medicine and a press release can be found here) is about, is studies in rodents, and uses a lot of different lines of loosely connected reasoning to accuse nicotine of causing other drug use. It wouldn't have been a direct matter of concern for us anyway, as we only hope to see nicotine sources like vaping used instead of smoking, but the thesis specifically accused e-cigarettes, and presumed once again that commonly made and very weak argument, that e-cigs may create new tobacco smokers (rebutted here by Dr Joel Nitzkin), rather than the other way around. As such e-cigarettes were put in the spotlight in this paper, and the incredible accusation was made that vaping would increase progression to tobacco smoking and even hard drugs like crystal meth and cocaine!

Much of the data used to create this thesis was purely rodent research and looked at the molecular biochemistry and neurochemistry of addiction, with, predictably, an examination of the dopamine system and the related 'reward centres'. This is somewhat misleading, because literally any stimulant, or anything that makes you feel good, is going to have partly, as the basis of that experience and effect, an influence on these systems. All behavioral choices requires changing activity in these systems. So I went and googled to see if caffeine was found to do this. Sure enough, you can read the paper here;

Caffeine choice prospectively predicts positive subjective effects of caffeine and d-amphetamine

Moreover, unlike the nicotine research, this was research on human subjects, and adolescents at that (the target concern of the anti-vapers at present).

So, if it's a stimulant, and nicotine isn't a particularly powerful one, you can expect this effect by influencing dopamine. Saying that in people nicotine makes people into heavy cocaine users is a bit like presuming that running, sex, and drinking coffee can do this. What seems to be more likely, is that if you took these relatively weak stimulants like caffeine and nicotine away, people would become MORE, not less likely to seek other stimulants to get through. And heavy caffeine ingestion appears to have overall health benefits. The evidence isn't yet so strong for nicotine, but it is certainly plausible. Would banning these stimulants be good, or bad for our economy and public health, particularly if we can make the product as free from harmful contaminants as possible?

And even then, the thesis missed something. If nearly all vapers are ex-smokers, with an equivalent amount of nicotine absorption, their risk of going on to harder drugs would seem to be reduced by e-cigarettes, since the authors Denise and Eric Kandel, should have examined the effect of MAO inhibitors specific to tobacco smoking on addiction (the available evidence says they do have a significant or strong effect on this), when they specifically compared e-cigarettes and tobacco.