Associations between the order of drug use initiation and the development of opioid dependence among egyptian adults: Cannabis as a gateway and culture-specific drug

Aim: The primary aim of this study was to study, for the first time to our knowledge in Egypt, the relationship of initial use of cannabis as a gateway drug to later dependency on opioid among Egyptian adults. Methods: Forty-eight patients were recruited from outpatient psychiatric attendees at a psychiatric hospital, Cairo, Egypt. A semistructured interview was conducted to assess the relationship of initiating cannabis abuse to later opioid dependence, and its relationship to demographic and clinical variables. Results: The most frequent age group at the time of presentation of the sample was 15 to 25 years (47.9%). The mean age of starting abuse of drugs was 15.8 years (SD=2.6; 11 to 25 y): 42 individuals (87.5%) started with cannabis and 4 (8.3%) started with alcohol. The entire group was dependent on opioid and 46 (95.5%) were dependent on cannabis at the same time; 19 (39.6%) were dependent on alcohol. The significant predictors of being dependent on opioid were being single (r²=0.650, P=0.001), having a Vocational Education and Training qualification (r ²=0.329, P=0.02), an early age of onset of use (r²=0.327, P= 0.02), cannabis as the initial drug used (r²=0.487, P=0.001), and the use of cough medicine (r²= 0.516, P=0.001) or tramadol (r ²=0.363, P=0.01) currently. Conclusions: The results of this study indicate that the typical pattern of drug abuse among Egyptians starts with cannabis but not alcohol, as alcohol is completely forbidden in Islam, which is not the case with cannabis.