THURSDAY, March 23 (HealthDay News) -- Teenagers who have used herbal supplements in the past are more likely to have also used tobacco, alcohol and illegal drugs, a new study shows.

High school students in upstate New York who said they'd tried herbals were twice as likely to have reported using tobacco, more than three times as likely to have drank alcohol, and between 4 and 14 times as likely to have taken illegal drugs (such as cocaine and steroids) than teens who had never used herbal supplements. The researchers were quick to note that the study is preliminary and can't answer questions of cause and effect. "Though we found that adolescents in this sample who said they'd tried herbal products were more likely to try drugs, we're not saying that one causes the other. It's an association," said researcher Dr. Susan Yussman, an assistant professor of pediatrics in the division of adolescent medicine at the University of Rochester, Rochester, N.Y. Her team published the findings in the March 23 issue of the Journal of Adolescent Health. Yussman's group examined a 1999 survey of more than 2,000 high school students from Monroe County, N.Y. The survey asked, "During your life, how many times have you taken herbal or other natural products, either to make you feel better, or to help you perform better at sports or school?" Herbal remedies, therefore, could include everything from dietary supplements such as vitamins or St. John's Wort, to natural performance enhancers such as creatine. Just over 25 percent of the students reported using these herbal products. Usage increased with age and varied by ethnicity, but not by gender. The study also found a strong association between herbal product use and every substance examined. For example, teens who used herbal products were 4.4 times more likely to have used LSD, PCP, ecstasy, and "magic" mushrooms, almost six times more likely to have tried cocaine, almost seven times more likely to have used methamphetamines, almost nine times more likely to have done heroin, and 14.5 times more likely to have used steroids, compared with teens who had never used herbal products. The heaviest herbal product users were more likely to have used illicit drugs, the researchers noted. "It may be that teens using certain products are more open to using other products, whether they're legal or illegal," said Yussman. "Also, the way the question was worded in the survey may have affected how adolescents interpreted it and why the strongest association was found between herbal product and steroid use." Other study limitations, noted Yussman, include that its results may not be generalizable, it excluded students who don't regularly attend school, and it didn't include data on the specific herbal products teens were using or why they were taking them. Dr. Adam Bisaga, a research psychiatrist at the New York State Psychiatric Institute, New York City, added that this makes it impossible to know whether herbal product use leads to drug use or vice-versa, or if something else, such as curiosity, was responsible for the association. Despite these limitations, Dr. Thomas Kosten, a professor of psychiatry at Yale University School of Medicine, said the study suggests experts need to look at herbal use more carefully as a potential gateway to other drug use, just as past research has looked at tobacco, alcohol and marijuana as possible gateway drugs. The other question is what is in these herbals, including drugs that may have toxic or addictive potential, Kosten said. That issue is largely unanswered and certainly deserves attention, he added. Until these questions are answered, Yussman recommended that health care providers give information on the proper use of all medications, whether they're a prescription, over-the-counter or herbal product. Health care providers and parents should also ask if adolescents are using herbal products -- and probe deeper if they are. Bisaga added that bringing up herbal products first may make it easier to ask about other products they've considered using. "When seen for a health assessment, adolescents may be more likely to reveal the use of herbal products, which are less stigmatizing, than the use of psychoactive substances," he said. "But, based on this study, I would not go as far as to suggest that kids who use herbal products should be suspected of drug use. Behavioral changes are much more likely to suggest drug abuse." More information For more on the safety and effectiveness of herbal products, visit the U.S. National Center for Complementary and Alternative Medicine.

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