In questi giorni è uscito il lavoro di Eric Kandel, il Premio Nobel per la medicina, che con l’Università di Cagliari avrebbe esposto in uno studio che la cannabis è una sostanza di accesso per altre sostanze più pesanti, riportando di attualità il mito della “Gateway hypothesis”, la teoria del passaggio secondo la quale la cannabis sarebbe (o meglio potrebbe essere) la porta di accesso ad altre sostanze.
Lo studio sicuramente è valido, seppur come sempre si evita di sottolineare nei titoloni (speriamo solo che i media non inizino a cavalcare questo studio per sostenere la proibizione della cannabis), che solo un elevato uso in età adolescenziale potrebbe portare ad eventuali desideri di altre sostanze in futuro, alzando appunto la soglia di sensibilità alle sostanze.
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Inoltre, se il Premio Nobel per la medicina ci permette una piccola osservazione che riteniamo però importante, questa tipologia di studi non andrebbe fatta con analoghi sintetici dei cannabinoidi ma, se possibile, direttamente con i cannabinoidi naturali, per i quali il corpo umano è predisposto naturalmente ad interagire tramite il sistema endocannabinoide presente in ognuno di noi.
Ma esistono diversi studi precedenti, altrettanto validi, che analizzano i vari aspetti di questa situazione particolare.
Andiamo a vederli insieme.
Gli esperti, finora, concordano sul fatto che l’uso della cannabis non sia collegato all’uso di altre sostanze illecite:
- “Esistono prove convincenti e durature del fatto che la cannabis non è una sostanza di base, … Eppure, i fattori politici non basati sulle prove sia a sinistra che a destra rimangono la ragione della persistenza del mito del gateway”.
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- “[] l’uso di cannabis non ha un’influenza casuale sull’iniziazione delle sostanze forti”.
- “La cannabis non è la causa di altri usi di sostanze: in questo senso, rifiutiamo la teoria del gateway”.
- “Non ci sono prove conclusive che gli effetti dell’uso di cannabis siano causalmente legati all’uso successivo di altri farmaci”.
Sequenzialmente, la maggior parte dei consumatori di sostanze illecite ha prima sperimentato alcol o tabacco
- “L’alcol è la sostanza più comunemente usata e la maggior parte dei polisostanze che utilizzavano gli intervistati consumava alcol prima dell’avvio di tabacco o marijuana.Gli intervistati che iniziarono l’uso di alcool in sesta hanno riferito un consumo di sostanze illecite di durata significativamente superiore e uso di sostanze illecite più frequente di quelli che iniziano l’uso di alcolici nel nono grado o dopo … I nostri risultati … affermano che il primo avvia l’uso di alcol, maggiore è la probabilità che si dedicheranno all’uso futuro di sostanze illecite. ”
- RISORSE: Relazione tra sequenza di iniziazione della sostanza e ulteriore uso di sostanze: uno studio prospettico nazionale francese , Comportamenti di dipendenza, 2016
- Analisi delle coorti di nascita del fumo di sigarette adolescenti e successivo consumo di marijuana e cocaina , American Journal of Public Health, 2016
Statisticamente, la stragrande maggioranza delle persone che cercano di provare la cannabis non usano altre droghe illecite e, in genere, cessano di usare la cannabis dopo i 45 anni.
- “[T] la maggior parte delle persone che usano la marijuana non usa altre sostanze” più difficili “.”
- “L’uso di sostanze tende a calare verso la fine della giovane età adulta, questo declino è vero sia per l’alcol che per l’uso di droghe illecite … Per la marijuana … l’uso di punta si è verificato intorno ai 19 anni, è rimasto stabile per i prossimi quattro anni cinque anni, e poi rifiutato. ”
Nelle giurisdizioni in cui la cannabis è legalmente accessibile, gli adulti segnalano in genere la riduzione del loro uso di altre sostanze controllate. In questo senso, la marijuana sembra agire più come un potenziale “farmaco d’uscita” piuttosto che come un presunto “gateway”
- “[F] indizi sull’effetto di sostituzione della cannabis e sui meccanismi biologici alla base di esso suggeriscono fortemente che la cannabis potrebbe svolgere un ruolo nel ridurre l’impatto sulla salute pubblica degli oppioidi soggetti a prescrizione e non-prescrizione … Il crescente corpo di ricerca a sostegno dell’uso medico di la cannabis come sostituto o sostituto degli oppioidi crea una giustificazione basata sull’evidenza per governi, operatori sanitari e ricercatori accademici per considerare l’implementazione e la valutazione degli interventi basati sulla cannabis nella crisi da oppioidi. ”
- “Tra gli intervistati che usavano regolarmente gli oppioidi, oltre i tre quarti (76,7%) indicavano che riducevano il loro uso da quando avevano iniziato la cannabis medica: questo era significativamente (p <0,0001) maggiore rispetto ai pazienti che riducevano il loro uso di antidepressivi (37,6%) o alcol (42,0%). Circa i due terzi dei pazienti hanno ridotto l’uso di farmaci anti-ansia (71,8%), emicranici (66,7%) e sonno (65,2%) a seguito di cannabis medica “.
- “I risultati includono un alto consumo di cannabis auto-segnalato come sostituto dei farmaci prescritti (63%), in particolare oppiacei farmaceutici (30%), benzodiazepine (16%) e antidepressivi (12%). I pazienti hanno anche riferito di sostituire la cannabis con alcool ( 25%), sigarette / tabacco (12%) e droghe illecite (3%). ”
- “Questi risultati riferiti dai pazienti supportano la ricerca precedente secondo cui gli individui utilizzano la cannabis come sostituto di farmaci soggetti a prescrizione, in particolare narcotici / oppioidi e indipendentemente dal fatto che si identificano come utenti medici o non medici, soprattutto se soffrono di dolore, ansia e depressione. ”
- “La sostituzione della cannabis per uno o più alcolici, droghe illecite o farmaci soggetti a prescrizione medica è stata segnalata dall’87% degli intervistati, con una percentuale di sostituzione dell’80,3% per i farmaci prescritti, del 51,7% per l’alcol e del 32,6% per sostanze illecite. la cannabis è stata sostituita da tutte e tre le classi di sostanze e suggerisce che l’uso medico della cannabis possa svolgere un ruolo di riduzione del danno nel contesto dell’uso di queste sostanze e possa avere implicazioni per approcci terapeutici basati sull’astinenza. ”
In ambito clinico, l’uso di cannabis è associato a desiderio ridotto di cocaina e oppiacei
- “In questo studio longitudinale, abbiamo osservato che un periodo di uso intenzionale della cannabis riferita da se stessi … era associato a periodi successivi di uso ridotto del crack [cocaina]. … Considerato il notevole carico globale di morbilità e mortalità imputabile a crack i disturbi dell’uso di cocaina oltre a una mancanza di efficaci terapie farmacologiche, echeggiano richieste di ricerca sperimentale rigorosa sui cannabinoidi come potenziale trattamento per i disturbi da consumo di cocaina crack “.
- “I partecipanti che hanno scelto di fumare marijuana durante il processo avevano maggiori probabilità di completare il trattamento indipendentemente dall’assegnazione al gruppo di trattamento”.
- “L’abuso o la dipendenza dalla cannabis ha previsto un minor consumo di eroina e cocaina durante il trattamento stesso”.
- “La maggior parte dei soggetti nel nostro studio ha smesso di usare cocaina crack e ha riferito che l’uso della cannabis aveva ridotto il loro desiderio e prodotto cambiamenti soggettivi e concreti nel loro comportamento aiutandoli a superare la dipendenza”.
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