Breaking Bad in Bourbon Country: Does Alcohol Prohibition Encourage Methamphetamine Production?
Jose Fernandez, Stephan Gohmann & Joshua Pinkston
Southern Economic Journal, forthcoming
This article examines the influence of local alcohol prohibition on the prevalence of methamphetamine labs. Using multiple sources of data for counties in Kentucky, we compare various measures of meth manufacturing in wet, moist, and dry counties. Our preferred estimates address the endogeneity of local alcohol policies by exploiting differences in counties' religious compositions between the 1930s, when most local‐option votes took place, and recent years. Even controlling for current religious affiliations, religious composition following the end of national Prohibition strongly predicts current alcohol restrictions. We carefully examine the validity of our identifying assumptions, and consider identification under alternative assumptions. Our results suggest that the number of meth lab seizures in Kentucky would decrease by 35% if all counties became wet.
Crime and the legalization of recreational marijuana
Davide Dragone et al.
Journal of Economic Behavior & Organization, forthcoming
First-pass evidence is provided that the legalization of the cannabis market across US states is inducing a crime drop. We exploit the staggered legalization of recreational marijuana enacted by the adjacent states of Washington (end of 2012) and Oregon (end of 2014). Combining county-level difference-in-differences and spatial regression discontinuity designs, we find that the policy caused a significant reduction in rapes and property crimes on the Washington side of the border in 2013-2014 relative to the Oregon side and relative to the pre-legalization years 2010-2012. The legalization also increased consumption of marijuana and reduced consumption of other drugs and both ordinary and binge alcohol. Four possible mechanisms are discussed: the direct psychotropic effects of cannabis; substitution away from violence-inducing substances; reallocation of police effort; reduced role of criminals in the marijuana business.
Early Evidence on Recreational Marijuana Legalization and Traffic Fatalities
Benjamin Hansen, Keaton Miller & Caroline Weber
NBER Working Paper, March 2018
Over the last few years, marijuana has become legally available for recreational use to roughly a quarter of Americans. Policy makers have long expressed concerns about the substantial external costs of alcohol, and similar costs could come with the liberalization of marijuana policy. Indeed, the fraction of fatal accidents in which at least one driver tested positive for THC has increased nationwide by an average of 10 percent from 2013 to 2016. For Colorado and Washington, both of which legalized marijuana in 2014, these increases were 92 percent and 28 percent, respectively. However, identifying a causal effect is difficult due to the presence of significant confounding factors. We test for a causal effect of marijuana legalization on traffic fatalities in Colorado and Washington with a synthetic control approach using records on fatal traffic accidents from 2000-2016. We find the synthetic control groups saw similar changes in marijuana-related, alcohol-related and overall traffic fatality rates despite not legalizing recreational marijuana.
The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime
Jennifer Doleac & Anita Mukherjee
University of Virginia Working Paper, March 2018
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality. These effects are driven by urban areas and vary by region. We find the most detrimental effects in the Midwest, including a 14% increase in opioid-related mortality in that region. We also find suggestive evidence that broadening Naloxone access increased the use of fentanyl, a particularly potent opioid. While Naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to Naloxone encourages riskier behaviors with respect to opioid abuse.
U.S. Employment and Opioids: Is There a Connection?
Janet Currie, Jonas Jin & Molly Schnell
NBER Working Paper, March 2018
This paper uses quarterly county-level data to examine the relationship between opioid prescription rates and employment-to-population ratios from 2006–2014. We first estimate models of the effect of opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We also estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, but there is no relationship for men. These findings suggest that although they are addictive and dangerous, opioids may allow some women to work who would otherwise leave the labor force. When we examine the effect of employment-to-population ratios on opioid prescriptions, our results are more ambiguous. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely to curb the opioid epidemic.
Factors Associated With County-Level Differences in U.S. Drug-Related Mortality Rates
American Journal of Preventive Medicine, forthcoming
Methods: Using data from the U.S. Centers for Disease Control and Prevention Multiple-Cause of Death Files (2006–2015, analyzed in 2017); U.S. Census Bureau; U.S. Department of Agriculture Economic Research Service; Agency for Healthcare Research and Quality; and Northeast Regional Center for Rural Development, this paper modeled associations between county-level drug-related mortality rates and economic, social, and healthcare environments. Spatial autoregressive models controlled for state fixed effects and county demographic characteristics.
Results: The average county-level age-adjusted drug-related mortality rate was 16.6 deaths per 100,000 population (2006–2015), but there were substantial geographic disparities in rates. Controlling for county demographic characteristics, average mortality rates were significantly higher in counties with greater economic and family distress and in counties economically dependent on mining. Average mortality rates were significantly lower in counties with a larger presence of religious establishments, a greater percentage of recent in-migrants, and counties with economies reliant on public (government) sector employment. Healthcare supply factors did not contribute to between-county disparities in mortality rates.
Recent rapid decrease in adolescents’ perception that marijuana is harmful, but no concurrent increase in use
Aaron Sarvet et al.
Drug and Alcohol Dependence, May 2018, Pages 68-74
Methods: Two repeated cross-sectional U.S. nationally-representative surveys of 8th, 10th, and 12th-graders: Monitoring the Future (MTF) (1991-2015; N = 1,181,692) and National Survey on Drug Use and Health (NSDUH) (2002–2014; N = 113,317). We examined trends in the year-to-year prevalence of perceiving no risk of harm in using marijuana regularly, and prevalence of regular marijuana use within the previous month. A piecewise linear regression model tested for a change in the relationship between trends. Similar analyses examined any past-month use and controlled for demographic characteristics.
Results: Among MTF 12th-graders, the prevalence of regular marijuana use and risk perceptions changed similarly between 1991 and 2006 but diverged sharply afterward. The prevalence of regular marijuana use increased by ∼1 percentage point to 6.03% by 2015. In contrast, the proportion of 12th-graders that perceived marijuana as posing no risk increased over 11 percentage points to 21.39%. A similar divergence was found among NSDUH 12th-graders and other grades, for any past month marijuana use, and when controlling demographic characteristics.
Unique treatment potential of cannabidiol for the prevention of relapse to drug use: Preclinical proof of principle
Gustavo Gonzalez-Cuevas et al.
Cannabidiol (CBD), the major non-psychoactive constituent of Cannabis sativa, has received attention for therapeutic potential in treating neurologic and psychiatric disorders. Recently, CBD has also been explored for potential in treating drug addiction. Substance use disorders are chronically relapsing conditions and relapse risk persists for multiple reasons including craving induced by drug contexts, susceptibility to stress, elevated anxiety, and impaired impulse control. Here, we evaluated the “anti-relapse” potential of a transdermal CBD preparation in animal models of drug seeking, anxiety and impulsivity. Rats with alcohol or cocaine self-administration histories received transdermal CBD at 24 h intervals for 7 days and were tested for context and stress-induced reinstatement, as well as experimental anxiety on the elevated plus maze. Effects on impulsive behavior were established using a delay-discounting task following recovery from a 7-day dependence-inducing alcohol intoxication regimen. CBD attenuated context-induced and stress-induced drug seeking without tolerance, sedative effects, or interference with normal motivated behavior. Following treatment termination, reinstatement remained attenuated up to ≈5 months although plasma and brain CBD levels remained detectable only for 3 days. CBD also reduced experimental anxiety and prevented the development of high impulsivity in rats with an alcohol dependence history. The results provide proof of principle supporting potential of CBD in relapse prevention along two dimensions CBD: beneficial actions across several vulnerability states, and long-lasting effects with only brief treatment. The findings also inform the ongoing medical marijuana debate concerning medical benefits of non-psychoactive cannabinoids and their promise for development and use as therapeutics.
Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain
Corey Hayes et al.
Health Services Research, forthcoming
Objective: Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP).
Data Sources: Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files.
Study Design: Using a retrospective cohort study design, the Mental Health Component (MCS12) and Physical Health Component (PCS12) scores of the Short Form-12 Version 2 were assessed to measure mental and physical HRQoL.
Data Collection: Chronic, noncancer pain participants were classified as chronic, nonchronic, and nonopioid users. One-to-one propensity score matching was employed to match chronic opioid users to nonchronic opioid users plus nonchronic opioid users and chronic opioid users to nonopioid users.
Principal Findings: A total of 5,876 participants were identified. After matching, PCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = −0.98, 95% CI: −2.07, 0.10), chronic versus nonopioid users (LSM Diff = −2.24, 95% CI: −4.58, 0.10), or chronic versus nonchronic opioid users (LSM Diff = −2.23, 95% CI: −4.53, 0.05). Similarly, MCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = 0.76, 95% CI: −0.46, 1.98), chronic versus nonopioid users (LSM Diff = 1.08, 95% CI: −1.26, 3.42), or chronic versus nonchronic opioid users (LSM Diff = −0.57, 95% CI: −2.90, 1.77).
Trends in Medical Use of Opioids in the U.S., 2006–2016
Brian Piper et al.
American Journal of Preventive Medicine, forthcoming
Methods: Data were obtained from the U.S. Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System for 2006–2016. Analyses include quantities of ten opioids legally dispensed nationwide by weight and converted to Morphine Milligram Equivalents. Geospatial and state-level analyses were also completed in 2017.
Results: The total for ten opioids peaked in 2011 (389.5 metric tons Morphine Milligram Equivalents) relative to both 2006 (286.1) and 2016 (364.6). Changes in the volume of opioids by weight over the decade were agent specific. Since 2011, there were decreases in hydrocodone (–28.4%); oxymorphone (–28.0%); fentanyl (–21.4%); morphine (–18.9%); oxycodone (–13.8%); and meperidine (–58.0%) and an increase in buprenorphine (75.2%) in 2016. There were substantial inter-state variations in rates with a fivefold difference between the highest Morphine Milligram Equivalents in 2016 (Rhode Island=2,623.7 mg/person) relative to the lowest (North Dakota=484.7 mg/person). An association was identified between state median age and per capita Morphine Milligram Equivalents (r =0.49, p<0.0005).
Substance Use Behaviors and the Timing of Family Formation During Young Adulthood
Bohyun Joy Jang, Megan Patrick & Megan Schuler
Journal of Family Issues, April 2018, Pages 1396-1418
The impact of substance use on the life course of young adults can be substantial, yet few studies have examined to what extent early adult substance use behaviors are related to the timing of family formation, independent of confounding factors from adolescence. Using panel data from the Monitoring the Future study (N~20,000), the current study examined the associations between three substance use behaviors (i.e., cigarette use, binge drinking, and marijuana use) and the timing of family formation events in young adulthood. Survival analysis and propensity score weighting addressed preexisting differences between substance users and nonusers in the estimation of the timing of union formation (i.e., marriage, cohabitation) and parenthood. Results for young adult substance users showed general patterns of reduced rates of marriage and parenthood and increased cohabitation during young adulthood. Variations were evident by substance and sex.
Smokin` hot: Adolescent smoking and the risk of psychosis
Antti Mustonen et al.
Acta Psychiatrica Scandinavica, forthcoming
Objective: Daily smoking has been associated with a greater risk of psychosis. However, we are still lacking studies to adjust for baseline psychotic experiences and other substance use. We examined associations between daily smoking and psychosis risk in a 15-year follow-up while accounting for these covariates in a prospective sample (N = 6081) from the Northern Finland Birth Cohort 1986.
Methods: Self-report questionnaires on psychotic experiences (PROD-screen), tobacco smoking and other substance use were completed when the cohort members were 15–16 years old. Tobacco smoking was categorized into three groups (non-smokers, 1–9 cigarettes and ≥10 cigarettes/day). Psychosis diagnoses were obtained from national registers until the age of 30 years.
Results: Subjects in heaviest smoking category were at increased risk of subsequent psychosis (unadjusted HR = 3.15; 95% CI 1.94–5.13). When adjusted for baseline psychotic experiences the association persisted (HR = 2.87; 1.76–4.68) and remained significant even after adjustments for multiple known risk factors such as cannabis use, frequent alcohol use, other illicit substance use, parental substance abuse, and psychosis. Furthermore, number of smoked cigarettes increased psychosis risk in a dose–response manner (adjusted OR = 1.05; 1.01–1.08).
Decreasing Campus Smoking with Punishments and Social Pressures
Kaytlynn Clemons et al.
Contemporary Economic Policy, forthcoming
This paper reports the effectiveness of a Midwest state university's “100% tobacco-free” policy. The policy used social pressures and punishments to incentivize tobacco users to no longer consume tobacco on campus. The policy had three distinct periods (Pre-Promotion, Post-Promotion, and Post-Policy). Social pressures and punishments were introduced during the Post-Promotion and Post-Policy periods, respectively. Changes in cigarette consumption were inferred by counting the number of cigarette butts found at various locations on campus. A statistically significant decrease in the number of cigarette butts was observed during the Post-Promotion period. After the initial drop, tobacco use remained constant for the remainder of the period. An additional decrease was observed once punishments were introduced in the third period. However, the number of cigarette butts observed on campus remained significantly above zero. Further research is needed to understand how smokers substitute across time, location, and tobacco products after the implementation of similar policies.
Electronic Cigarette Use and Progression From Experimentation to Established Smoking
Benjamin Chaffee, Shannon Lea Watkins & Stanton Glantz
Pediatrics, April 2018
Methods: Among participants (age 12–17 years) in the nationally representative Population Assessment of Tobacco and Health survey who had smoked a cigarette (≥1 puff) but not yet smoked 100 cigarettes (N = 1295), we examined 3 outcomes at 1-year follow-up as a function of baseline e-cigarette use: (1) having smoked ≥100 cigarettes (established smoking), (2) smoking during the past 30 days, and (3) both having smoked ≥100 cigarettes and past 30-day smoking (current established smoking). Survey-weighted multivariable logistic regression models were fitted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for smoking risk factors.
Results: Versus e-cigarette never use, having ever used e-cigarettes was positively associated with progression to established cigarette smoking (19.3% vs 9.7%), past 30-day smoking (38.8% vs 26.6%), and current established smoking (15.6% vs 7.1%). In adjusted models, e-cigarette ever use positively predicted current established smoking (OR: 1.80; 95% CI: 1.04–3.12) but did not reach statistical significance (α = .05) for established smoking (OR: 1.57; 95% CI: 0.99–2.49) and past 30-day smoking (OR: 1.32; 95% CI: 0.99–1.76).
Conclusions: Among adolescent cigarette experimenters, using e-cigarettes was positively and independently associated with progression to current established smoking, suggesting that e-cigarettes do not divert from, and may encourage, cigarette smoking in this population.