A Yale study published Tuesday in the Journal of Adolescent Health found that people who used alcohol or tobacco in their youth are almost twice as likely to abuse prescription opiate drugs than those who only used marijuana.

Researchers were careful to specify that any youth substance abuse, including just marijuana use, makes people more than twice as likely to abuse prescription opiate drugs in young adulthood. However, the study’s authors noted that clinical data from the National Survey on Drug Use and Health revealed that of the 12 percent of young adults who said they’d abused prescription opiates, “prevalence of previous substance use was 57% for alcohol, 56% for cigarettes, and 34% for marijuana.”

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The Centers for Disease Control said in January that prescription opiate overdoses kill more Americans every year than cocaine and heroin overdoses combined.

Interestingly, the Yale study also found a bit of a gender skew that may indicate boys are naturally more inclined than girls to engage in risk-taking behaviors. “We found that among young boys, all previous substance use (alcohol, cigarettes, and marijuana), but only previous marijuana use in young girls, was associated with an increased likelihood of subsequent abuse of prescription opioids during young adulthood,” researchers wrote.

The findings seem to confirm a study published last month in The Journal of School Health, which fleshed out several misconceptions about the so-called “gateway drug” theory and pinpointed alcohol, instead of marijuana, as the most commonly abused substance for first-time drug users.

Researchers used the University of Michigan’s Monitoring the Future survey to prove that marijuana use is not the primary indicator of whether an individual will abuse other more dangerous substances. In doing so, the School Health study proved that there is data which correlates to a so-called “gateway effect,” showing that the largest gateway is actually alcohol.

“If you take [our findings] and apply them to a school health setting, we believe that you are going to get the best bang for your buck by focusing on alcohol,” study co-author Adam E. Barry told Raw Story. Public health officials have been making similar efforts with tobacco, saying they’re encouraged by the success of educational ad campaigns that show the true health effects experienced by many life-long smokers.

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Yale researchers reached a similar conclusion, saying: “Prevention efforts targeting early substance abuse may help to curb the abuse of prescription opioids.”

A study published in 2010 in the medical journal Lancet ranked alcohol as the most harmful drug known to man, with more than double the potential harms of heroin use.

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