Online Program

Examining the stepping-off hypothesis among young adult marijuana users in Los Angeles

Tuesday, November 3, 2015

Ekaterina Fedorova, M.S., Department of Community Health and Prevention, Drexel University, School of Public Health, Philadelphia, PA
Sheree M. Schrager, PhD, MS, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Carolyn F. Wong, PhD, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles/USC, Los Angeles, CA
Ellen Iverson, MPH, Division of Adolescent Medicine, Children's Hospital Los Angeles, Los Angeles, CA
Stephen Lankenau, PhD, Dornsife School of Public Health, Drexel University, Philadelphia, PA

The “stepping-off hypothesis,” in contrast to the conventional “gateway hypothesis,” suggests that marijuana use might be associated with reduced or lower illicit drug use in some cases. We evaluated the stepping-off hypothesis among a sample of marijuana users (aged 18-26 years) by examining whether patient status (medical marijuana patients (MMP) vs. non-patient marijuana users (NPU) and self-reported medical purpose of marijuana use (for medical reasons at least on half occasions in the past 90 days) predicted 90-day illicit drug use.


187 MMP and 114 NPU were recruited in Los Angeles during 2014-15. Study participants were surveyed about reasons for and rates of marijuana use, illicit drug use, and health outcomes. Logistic regression analysis investigated effects of patient status, marijuana use for medical purposes, and other covariates on 90-day illicit drug use.


61% of the sample were MMP, and 59% reported using marijuana for medical purposes at least on half or more occasions in the past 90 days. 75% reported lifetime and 31% reported 90-day illicit drug use, such as cocaine, MDMA and mushrooms.  No differences in 90-day illicit drug use were found between MMP and NPU.  However, participants who reported using marijuana for medical purposes on half or more occasions were significantly less likely to use illicit drugs (OR=0.58, P<0.05), more likely to use marijuana with higher frequency (175 vs 118 days in the past 90 days, P<0.001), and scored higher on anxiety (P<0.05) and somatization (P<0.01) subscales.


In this sample of marijuana-using young adults, results provide preliminary support for the stepping-off hypothesis: marijuana use for medical purposes (but not medical marijuana patient status) was associated with lower rates of illicit drug use.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines
Social and behavioral sciences

Learning Objectives:
Evaluate the stepping-off hypothesis (discontinuation of illicit drug use) among young adults who use marijuana for medical purposes

Keyword(s): Drug Abuse, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a research associate and coordinator of multiple NIH funded grants focusing on the epidemiology of HIV and drug use. For more than 10 years I had been involved in the research related to HIV epidemiology and prevention among injection drug users. Over the last couple of years my research focus shifted towards epidemiology of medical marijuana and illicit drug use.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.