Cannabis a 'gateway' drug? The head of the Ontario Medical Association thinks so

Dr. Nadia Alam, president of the Ontario Medical Association, told CBC's London Morning Thursday that she worries smoking pot can act as a 'gateway' to harder drug use, like crack cocaine. But two London doctors have other opinions on the risks associated with cannabis.

Dr. Nadia Alam says physicians have already seen a spike in pot-related visits to ER

Recreational marijuana will become legal Oct. 17. (Robert F. Bukaty/Associated Press)

Following the interview on London Morning on Thursday, Dr. Nadia Alam contacted the CBC on Saturday to say that she had "missspoke" when it came to her comments about marijuana being a gateway drug.

Smoking a joint can act as a "gateway" to using harder drugs down the road, according to the president of the Ontario Medical Association.

Dr. Nadia Alam toured southwestern Ontario this week to speak with fellow doctors. She also appeared on CBC Radio's London Morning Thursday to discuss her concerns with recreational cannabis, which becomes legal across the country on Oct. 17.

"[Recreational cannabis] can cause anxiety, it can cause withdrawal symptoms for people who become addicted to it," said  Dr. Alam said. "It can lead to the use of other, more serious drugs like crack cocaine."

Dr. Alam said that increased pot use has already added strain to emergency rooms — and she expects to only get worse as users take cannabis legalization as a license to smoke up with impunity.

But Dr. Andrea Sereda, a physician at the London InterCommunity Health Centre, isn't so sure. She said that people tend to start using hard drugs because of "gateway experiences," like poverty or trauma, rather than gateway drugs.

Dr. Andrea Sereda of the London InterCommunity Health Centre says "gateway experiences" like poverty and trauma are more likely to cause people to use hard drugs. (Craig Chivers/CBC)

"People with these experiences are much more likely to use harmful drugs like crystal meth, or crack or opiates," said Dr. Sereda.

Dr. Michael Hart, founder of London's Ready to Go medical clinic, also disagreed with Dr. Alam, and said the idea of marijuana being a gateway drug has been disproven 'over and over.'

"When people use cannabis they don't necessarily tend to use other drugs after," he said. "They tend to use more drugs after they use alcohol."

Plenty of problems aside from 'gateway' question, docs say

Dr. Alam pointed out that smoking pot can harm developing brains, something Dr. Sereda is also concerned about. (Robert F. Bukaty/Associated Press)

But that's not to say that recreational pot use is risk-free, the doctors agreed.

Dr. Alam pointed out that symptoms like stomach pain and vomiting can equally point to life-threatening conditions, or to simple over-use of cannabis, and that it can take a lot of testing to tease out the difference. 

"People don't realize that," said Dr. Alam. "They don't realize they could've saved themselves that entire heartache, that anxiety, that discomfort, that pain, if they only knew that smoking cannabis could've made the difference."

She added that cannabis can also:

  • Cause anxiety.
  • Expose users to carcinogens.
  • Lead to withdrawal symptoms in those who develop addiction.
  • Cause stomach problems including nausea, vomiting and weight loss.
  • Lead to mental health problems and lower intelligence, especially when used by those under 25 whose brains are still developing. 

Dr. Sereda said she 'completely agrees' with Dr. Alam's concerns regarding the impact of cannabis on developing brains.

"They have very real effects on their cognition skills, their memory and their concentration and their moods," said Dr. Sereda, adding that she also agrees with Dr. Alam's concerns regarding the risk of drug-induced psychosis.

"This happens in around 1 per cent of marijuana users, and as marijuana use maybe becomes more frequent with legalization, it's pretty reasonable to expect psychosis will be more common as well as a side effect."

Dr. Hart also agreed that cannabis can cause addiction, and that strains high in THC can carry an elevated risk of anxiety and psychosis. But he added that not all pot should be painted with the same brush, and that many kids and teens can stand to benefit from medicinal cannabis.

"I have many patients who are in their teens, I have pediatric patients with autism, I have teens with really severe depression and anxiety and they don't use high THC, they use high CBD. And they do extremely well with it," he said.