International Journal of Preventive Medicine

: 2015  |  Volume : 6  |  Issue : 1  |  Page : 127-

Is the use of nutritional supplements in dosage forms a "gateway" to oral substance abuse?

Mahbubeh Ebrahimnegad Shirvani1, Ata Pourabbasi2,  
1 Vice Deputy of Health, Tehran University of Medical Sciences, Tehran, Iran
2 Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

Correspondence Address:
Ata Pourabbasi
Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Shari«SQ»ati Hospital, North Kargar Street, Tehran

How to cite this article:
Shirvani ME, Pourabbasi A. Is the use of nutritional supplements in dosage forms a "gateway" to oral substance abuse?.Int J Prev Med 2015;6:127-127

How to cite this URL:
Shirvani ME, Pourabbasi A. Is the use of nutritional supplements in dosage forms a "gateway" to oral substance abuse?. Int J Prev Med [serial online] 2015 [cited 2020 Jun 3 ];6:127-127
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Full Text

Dear Editor,

Dietary supplements have become increasingly popular among children and adolescents in the recent years and their use is increasing. The results of several studies in different countries demonstrate significant increase in the consumption of different dietary supplements in all age groups. [1] In certain population such as athletes and students, the increasing oral use of dietary supplements has become a serious concern for stakeholders. [2]

Meeting the daily dietary demand of trace elements and vitamins is the main justification of consumption of the dietary supplements. In other words, although prescription of nutritional supplements in children and adolescents is a therapeutic approach for the treatment of certain nutritional disorders, consumption of these products in different forms such as tablets, capsules, powders, and ampoules may contribute to an increase in frequency and amount of their intake. This can contribute to formation of a behavior of drug-form supplement intake regardless of their content which may itself, in turn, lead to an increase in their consumption among children and adolescents.

It can be argued that this new behavioral pattern may lead to an alarming tendency for repetition of taking drug forms with other contents which maybe ilicid or dangerous for adolescents.

Many believe that today, we are witnessing a change of pattern from traditional to industrial substance abuse and oral agents are replacing the traditional smoked substances. [3]

This transformation, as well as normalization of consumption of oral dietary supplements, can be considered as an important contributing factor for involvement of individuals in a drug-abuse culture. Interestingly, it seems that this pattern is in line with the "gateway hypothesis." [4]

According to the gateway hypothesis, the misuse of licit substances such as alcohol or tobacco can facilitate the use of light illicit drugs such as marijuana; and this, in turn, in a gradual process, leads to the use of more addictive illicit substances such as heroin and cocaine. Thus, marijuana serves as a gateway for heavy-drug abuse. Based on this hypothesis, several countries have passed legislations and implemented strict policies against abuse of light illicit drugs.

Therefore, it can be suggested that normalization and internalization of regular use of a medication with health benefits such as nutritional supplements maybe a gateway toward abuse of oral drugs in different forms such as tablets, capsules, powders, etc., This argument can be supported by the demonstrated pattern that using licit sports supplements can lead to the use of anabolic hormones and illicit doping agents. [5] Of course, it should be noted that the role of other reinforces such as social determinants and peer pressures should not be ignored in this regard.

However, further studies are warranted to shine more light on this issue and its validity. If proven true, more awareness-raising activities need to be carried out on the issue so that parents can effectively prevent the adverse effects of the excessive use of drug-form dietary supplements by their children.

Several different alternative strategies can be adapted for the provision of dietary supplements in vulnerable groups such as fortification of milk and bread instead of drug forms of nutritional needs. This may effectively prevent from normalization and internalization of oral supplement intake behavior which may lead to the aforementioned abuse patterns and its consequences.


1Farina EK, Austin KG, Lieberman HR. Concomitant dietary supplement and prescription medication use is prevalent among US adults with doctor-informed medical conditions. J Acad Nutr Diet 2014;114:1784-90.e2.
2Dodge TL, Jaccard JJ. The effect of high school sports participation on the use of performance-enhancing substances in young adulthood. J Adolesc Health 2006;39:367-73.
3Commonly Abused Drugs Charts: National Institute of Health 2015. Available from: [Last cited on 2015 Sep 17].
4Vanyukov MM, Tarter RE, Kirillova GP, Kirisci L, Reynolds MD, Kreek MJ, et al. Common liability to addiction and "gateway hypothesis": Theoretical, empirical and evolutionary perspective. Drug Alcohol Depend 2012;123 Suppl 1:S3-17.
5Hildebrandt T, Harty S, Langenbucher JW. Fitness supplements as a gateway substance for anabolic-androgenic steroid use. Psychol Addict Behav 2012;26:955-62.