{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:08:41Z","timestamp":1773004121045,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["24CA2012"],"award-info":[{"award-number":["24CA2012"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropsychopharm Rep"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Cannabis has historically been used for medicinal and industrial purposes, but is strictly regulated worldwide due to the psychoactive effects of THC. In Japan, cannabis is frequently labeled a \u201cgateway drug,\u201d yet strong causal evidence for progression to other substances is limited. This study investigates whether cannabis acts as a gateway drug among Japanese users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymous online survey was conducted in January 2021 with 3900 individuals reporting lifetime cannabis use in Japan. Participants were recruited via social media. The survey gathered data on demographics, cannabis and other substance use history, order of substance initiation, psychiatric background, and criminal records. A Sankey diagram visualized substance use progression, and odds ratios were calculated to assess the likelihood of using other substances following cannabis use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all respondents, 81.5% were male, with the largest age group being 20\u201324. Tobacco and alcohol were the most common initial substances, while cannabis was typically the third. Odds for subsequent use of alcohol, tobacco, methamphetamine, and other illicit drugs after cannabis use were 1.25, 0.77, 0.08, and 0.78, respectively, suggesting low probabilities of progression. Nearly half of those who reported cannabis as their third drug did not use other substances afterward.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cannabis use in Japan typically follows alcohol and tobacco, and rarely leads to further drug use. These findings challenge the gateway hypothesis in the Japanese context. Shared vulnerabilities and strict drug policies may shape these patterns. Further research is warranted to explore the impact of legal changes on drug use behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registry and Registration Number of the Study\/Trial<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/npr2.70033","type":"journal-article","created":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T12:58:49Z","timestamp":1752411529000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Revisiting the Gateway Drug Hypothesis for Cannabis: A Secondary Analysis of a Nationwide Survey Among Community Users in Japan"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1831-1512","authenticated-orcid":false,"given":"Yuji","family":"Masataka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery St. Marianna University School of Medicine  Kawasaki Japan"},{"name":"General Incorporated Association Green Zone Japan  Saitama Japan"},{"name":"Department of Neurology Kumamoto Seijo Hospital  Kumamoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5614-0000","authenticated-orcid":false,"given":"Munenori","family":"Katayama","sequence":"additional","affiliation":[{"name":"Department of Drug Dependence Research National Institute of Mental Health, National Center of Neurology and Psychiatry  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Futaba","family":"Umemura","sequence":"additional","affiliation":[{"name":"Graduate School of Medical and Dental Sciences, Niigata University  Niigata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"General Incorporated Association Green Zone Japan  Saitama 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Key Findings and Literature Review.\u201dhttps:\/\/www.ojp.gov\/pdffiles1\/nij\/252950.pdf."},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1402309"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.npp.1301127"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2013.16"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.3.311"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2012.06.020"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/00221320109597489"},{"key":"e_1_2_12_22_1","unstructured":"Ministry of Health Labour and Welfare of Japan \u201cRegarding the Enactment of the Act to Partially Amend the Cannabis Control Act and the Narcotics and Psychotropics Control Act \u201d(2024) https:\/\/www.mhlw.go.jp\/content\/11121000\/001206962.pdf."},{"key":"e_1_2_12_23_1","unstructured":"Ministry of Health Labour and Welfare of Japan \u201cMaterials From the 2nd Meeting of the Expert Committee on Cannabis and Other Drug Policy \u201d(2021) https:\/\/www.mhlw.go.jp\/stf\/shingi2\/0000158516_00002.html."},{"key":"e_1_2_12_24_1","unstructured":"Ministry of Justice of Japan \u201cWhite Paper on Crime Part VII: Drug Crime \u201d(2020) https:\/\/www.moj.go.jp\/content\/001338450.pdf."},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2021.12.017"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004444"},{"issue":"2","key":"e_1_2_12_27_1","first-page":"258","article-title":"Analysis and Visualization of Confounders and Treatment Pathways Leading to Amputation and Non\u2010Amputation in Peripheral Artery Disease Patients Using Sankey Diagrams: Enhancing Explainability","volume":"13","author":"Korutla R.","year":"2025","journal-title":"Biomedicine"},{"key":"e_1_2_12_28_1","unstructured":"Japanese Police Agency \u201cChapter\u00a02: Combatting Stimulant Drugs \u2013 National Police Agency White Paper (Japanese) \u201d(1880) https:\/\/www.npa.go.jp\/hakusyo\/s55\/s550200.html."},{"key":"e_1_2_12_29_1","unstructured":"T.Shimane D.Qiu andK.Wada \u201cNationwide Survey on Drug Use in Japan \u201d (2017) https:\/\/www.ncnp.go.jp\/nimh\/yakubutsu\/report\/pdf\/J_NGPS_2017.pdf."},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-024-01034-6"},{"key":"e_1_2_12_31_1","volume-title":"Drug Use for Grown\u2010Ups: Chasing Liberty in the Land of Fear","author":"Hart C. 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